Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 111
Filter
1.
J Orthop Res ; 40(1): 43-54, 2022 01.
Article in English | MEDLINE | ID: covidwho-1787691

ABSTRACT

Anterior cruciate ligament (ACL) injuries are one of the most common and severe knee injuries across sports. As such, ACL injury prevention has been a focus of research and sports medicine practice for the past three-plus decades. Examining the current research and identifying both clinical strategies and research gaps, the aim of this review is to empower clinicians and researchers with knowledge of where the ACL injury prevention literature is currently and where it is going in the future. This paper examines the mechanism of ACL injury prevention, screening, implementation, compliance, adherence, coronavirus, and areas of future research. Clinical significance: The time lag between research and practical implementation in general healthcare settings can be as long as 17 years; however, athletes playing sports today are unable to wait that long. With effective programs already established, implementation and adherence to these programs is essential. Strategies such as coaching education, increasing awareness of free programs, identifying barriers, and overcoming implementation obstacles through creative collaboration are just a few ways that could help improve both ACL injury prevention implementation and adherence.


Subject(s)
Anterior Cruciate Ligament Injuries/prevention & control , Athletic Injuries/prevention & control , Knee Injuries/prevention & control , Athletes , Humans , Sports
2.
Pak J Med Sci ; 36(COVID19-S4): S17-S21, 2020 May.
Article in English | MEDLINE | ID: covidwho-1726829

ABSTRACT

OBJECTIVES: To evaluate basic knowledge of Health Care Professionals (HCPs) of Pakistan in managing COVID 19 patients. It includes information regarding infection control measures, administrative and professional support. This was followed by evaluation of psychological factor that can act as a barrier in effective management of these patients. METHODS: The survey was conducted on line using Google Form. After approval from hospital ethical committee survey link was disseminated to HCPs using social media. RESULTS: Four hundred fifteen HCPs were participated. Most of them were younger than 30 years and majority of them were postgraduate trainees. Results showed gaps in the knowledge about basic infection control measure like donning/doffing and understanding about high-risk procedures. On job training, professional and administrative support is compromising. Many of HCPs are anxious nowadays, having symptoms related to burn out with logical reasons behind. Even with all those hurdles they are committed and ready to volunteer themselves. CONCLUSION: The HCPs of Pakistan needs urgent attention for providing them Formal training regarding infection control measure. Administrative and professional support is required from institutions and scientific societies. Online teaching modules and webinar is a suitable option. The symptoms of burn out are significant and would increase with passage of time. This needs to be supported by occupational health committees.

3.
Infect Control Hosp Epidemiol ; 42(11): 1340-1344, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574695

ABSTRACT

BACKGROUND: Widespread testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) is necessary to curb the spread of coronavirus disease 2019 (COVID-19), but testing is undermined when the only option is a nasopharyngeal swab. Self-collected swab techniques can overcome many of the disadvantages of a nasopharyngeal swab, but they require evaluation. METHODS: Three self-collected non-nasopharyngeal swab techniques (saline gargle, oral swab and combined oral-anterior nasal swab) were compared to a nasopharyngeal swab for SARS-CoV-2 detection at multiple COVID-19 assessment centers in Toronto, Canada. The performance characteristics of each test were assessed. RESULTS: The adjusted sensitivity of the saline gargle was 0.90 (95% CI 0.86-0.94), the oral swab was 0.82 (95% CI, 0.72-0.89) and the combined oral-anterior nasal swab was 0.87 (95% CI, 0.77-0.93) compared to a nasopharyngeal swab, which demonstrated a sensitivity of ˜90% when all positive tests were the reference standard. The median cycle threshold values for the SARS-CoV-2 E-gene for concordant and discordant saline gargle specimens were 17 and 31 (P < .001), for the oral swabs these values were 17 and 28 (P < .001), and for oral-anterior nasal swabs these values were 18 and 31 (P = .007). CONCLUSIONS: Self-collected saline gargle and an oral-anterior nasal swab have a similar sensitivity to a nasopharyngeal swab for the detection of SARS-CoV-2. These alternative collection techniques are cheap and can eliminate barriers to testing, particularly in underserved populations.


Subject(s)
COVID-19 , Outpatients , Humans , Nasopharynx , SARS-CoV-2 , Saliva , Specimen Handling
4.
Am Soc Clin Oncol Educ Book ; 41: e295-e303, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1416833

ABSTRACT

A diagnosis of melanoma requires multidisciplinary specialized care across all stages of disease. Although many important advances have been made for the treatment of melanoma for local and advanced disease, barriers to optimal care remain for many patients who live in areas without ready access to the expertise of a specialized melanoma center. In this article, we review some of the recent advances in the treatment of melanoma and the persistent challenges around the world that prevent the delivery of the best standard of care to patients living in the community. With the therapeutic landscape continuing to evolve and newer more complex drug therapies soon to be approved, it is important to recognize the many challenges that patients face and attempt to identify tools and policies that will help to improve treatment outcomes for their melanoma.


Subject(s)
Melanoma , Humans , Melanoma/diagnosis , Melanoma/epidemiology , Melanoma/therapy , Treatment Outcome
5.
Vet Res ; 52(1): 77, 2021 Jun 02.
Article in English | MEDLINE | ID: covidwho-1257965

ABSTRACT

The number and severity of diseases affecting lung development and adult respiratory function have stimulated great interest in developing new in vitro models to study lung in different species. Recent breakthroughs in 3-dimensional (3D) organoid cultures have led to new physiological in vitro models that better mimic the lung than conventional 2D cultures. Lung organoids simulate multiple aspects of the real organ, making them promising and useful models for studying organ development, function and disease (infection, cancer, genetic disease). Due to their dynamics in culture, they can serve as a sustainable source of functional cells (biobanking) and be manipulated genetically. Given the differences between species regarding developmental kinetics, the maturation of the lung at birth, the distribution of the different cell populations along the respiratory tract and species barriers for infectious diseases, there is a need for species-specific lung models capable of mimicking mammal lungs as they are of great interest for animal health and production, following the One Health approach. This paper reviews the latest developments in the growing field of lung organoids.


Subject(s)
Lung , Mammals , Organoids , Tissue Culture Techniques/methods , Animals , Lung/growth & development , Lung/pathology , Lung/physiopathology , Organoids/growth & development , Organoids/pathology , Organoids/physiopathology
6.
AIDS Res Hum Retroviruses ; 37(8): 585-588, 2021 08.
Article in English | MEDLINE | ID: covidwho-1272954

ABSTRACT

In 2016, the World Health Organization developed a plan for viral hepatitis elimination by 2030. Globally, control of hepatitis B virus (HBV) and hepatitis C virus (HCV) are the most challenging aspects of viral hepatitis elimination. In many developed countries elimination of HBV could be targeted to special populations mostly immigrants from low resource settings. Elimination of HCV, however, remains a challenge globally. Barriers to HCV elimination include high cost of medications and the ability to engage specific at-risk populations as well as individuals who are out of medical care. In the context of the coronavirus disease 2019 (COVID-19) pandemic, treatment access and screening have been further negatively impacted by social distancing rules and COVID-19-related anxieties. This threatens to throw most countries off course in their elimination efforts. Before the pandemic, some states in the United States had scaled up their elimination efforts with plans to ramp up testing and treatment using Netflix-like payment models for HCV direct acting antiviral drugs. Most of these efforts have stalled on account of the health system's focus on COVID-19 control. To prevent further delays in achieving elimination targets, programs would need to explore new models of care that address COVID-19-related access hurdles. Systems that leverage technologies such as telemedicine and self-testing could help maintain treatment levels. Mathematical models estimate that COVID-19-related delays in 2020 could lead to 44,800 hepatocellular cancers and 72,300 liver-related deaths for the next decade.


Subject(s)
COVID-19/epidemiology , Disease Eradication/statistics & numerical data , Hepatitis, Viral, Human/epidemiology , Antiviral Agents/therapeutic use , Goals , Hepatitis C/diagnosis , Hepatitis C/drug therapy , Hepatitis C/epidemiology , Hepatitis, Viral, Human/diagnosis , Hepatitis, Viral, Human/drug therapy , Humans , Pandemics , SARS-CoV-2 , Time Factors
7.
J Alzheimers Dis Rep ; 5(1): 143-152, 2021 Feb 24.
Article in English | MEDLINE | ID: covidwho-1256347

ABSTRACT

Memory interventions for older adults with cognitive concerns result in improved memory performance and maintenance of cognitive health. These programs are typically delivered face-to-face, which is resource intensive and creates access barriers, particularly for those with reduced mobility, limited transportation, and living in rural or remote areas. The COVID-19 pandemic has created an additional access barrier, given the increased risk this disease poses to older adults. Internet-based interventions seek to overcome these barriers. This paper describes the protocol of a pilot study that aims to evaluate the feasibility, acceptability, and efficacy of one such internet-based intervention: the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program. OPTIMiSE focuses on improving knowledge regarding memory and providing training in effective memory strategies for everyday life. The pilot study described in this protocol will be a single-arm pre-post study of 8 weeks duration, with a single maintenance session 3 months post-intervention. Participants will be Australian adults aged ≥60 years reporting cognitive changes compared with 10 years ago. Primary outcome measures will address feasibility, acceptability, and efficacy. Secondary outcome measures assessing sense of community and self-efficacy will be administered at the 8-week and 3-month timepoints. Data collection will conclude mid-2021, and results will be presented in a subsequent publication. Translation of memory interventions to internet-based delivery has the potential to remove many access barriers for older adults; however, the acceptability and feasibility of this modality needs investigation. OPTIMiSE is the initial step in what could be an important program enabling access to an evidence-based memory intervention for older adults worldwide. Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12620000979954.

8.
Aust J Gen Pract ; 50(6): 388-393, 2021 06.
Article in English | MEDLINE | ID: covidwho-1249757

ABSTRACT

BACKGROUND AND OBJECTIVES: Immunisation uptake in Australian older adults is suboptimal. General practice registrars are responsible for a significant proportion of immunisations in this age group and are also in the process of developing patterns of practice. Despite their role, little is known about general practice registrars' attitudes towards immunisation of older adults, the barriers faced, and the role supervisors play in developing adult immunisation skills. METHOD: This was a qualitative study involving semi-structured interviews with general practice registrars and supervisors purposively sampled from around Australia. Data were analysed using thematic analysis. RESULTS: The five key themes were grouped in terms of perceptions of registrars' role in immunisation of older adults, consultation barriers, health system barriers, managing vaccine hesitancy, and a team approach to vaccination. DISCUSSION: Vaccine positivity is an important attitude to cultivate within the general practice environment as it has an impact on registrar behaviour. Immunisation-skilled nurses could play a role in training general practice registrars in immunisation. Findings from the present study may be useful in improving vaccine uptake in the elderly in the context of the COVID-19 vaccine rollout.


Subject(s)
Attitude of Health Personnel , COVID-19 Vaccines , COVID-19/prevention & control , General Practitioners/psychology , Physician's Role , Aged , Australia/epidemiology , Clinical Competence , Communication Barriers , Female , Health Surveys , Humans , Male , Nurse's Role , Patient Acceptance of Health Care , Patient Care Team , Physician-Patient Relations , Qualitative Research , SARS-CoV-2
9.
Bioconjug Chem ; 32(6): 1067-1077, 2021 06 16.
Article in English | MEDLINE | ID: covidwho-1241779

ABSTRACT

Passing through the blood-brain barrier (BBB) to treat neurological conditions is one of the main hurdles in modern medicine. Many drugs with promising in vitro profiles become ineffective in vivo due to BBB restrictive permeability. In particular, this includes drugs such as antiviral porphyrins, with the ability to fight brain-resident viruses causing diseases such as HIV-associated neurocognitive disorders (HAND). In the last two decades, BBB shuttles, particularly peptide-based ones, have shown promise in carrying various payloads across the BBB. Thus, peptide-drug conjugates (PDCs) formed by covalent attachment of a BBB peptide shuttle and an antiviral drug may become key therapeutic tools in treating neurological disorders of viral origin. In this study, we have used various approaches (guanidinium, phosphonium, and carbodiimide-based couplings) for on-resin synthesis of new peptide-porphyrin conjugates (PPCs) with BBB-crossing and potential antiviral activity. After careful fine-tuning of the synthetic chemistry, DIC/oxyma has emerged as a preferred method, by which 14 different PPCs have been made and satisfactorily characterized. The PPCs are prepared by coupling a porphyrin carboxyl group to an amino group (either N-terminal or a Lys side chain) of the peptide shuttle and show effective in vitro BBB translocation ability, low cytotoxicity toward mouse brain endothelial cells, and low hemolytic activity. Three of the PPCs, MP-P5, P4-MP, and P4-L-MP, effectively inhibiting HIV infectivity in vitro, stand out as most promising. Their efficacy against other brain-targeting viruses (Dengue, Zika, and SARS-CoV-2) is currently under evaluation, with preliminary results confirming that PPCs are a promising strategy to treat viral brain infections.


Subject(s)
Anti-HIV Agents/pharmacokinetics , Blood-Brain Barrier/metabolism , Peptides/pharmacokinetics , Porphyrins/pharmacokinetics , Animals , Anti-HIV Agents/chemistry , Anti-HIV Agents/pharmacology , Biological Transport , Cell Line , Drug Discovery , HEK293 Cells , HIV/drug effects , HIV Infections/drug therapy , Humans , Mice , Peptides/chemistry , Peptides/pharmacology , Porphyrins/chemistry , Porphyrins/pharmacology
11.
Hum Resour Health ; 19(1): 64, 2021 05 12.
Article in English | MEDLINE | ID: covidwho-1225777

ABSTRACT

BACKGROUND: The COVID-19 pandemic posed a huge challenge to the education systems worldwide, forcing many countries to provisionally close educational institutions and deliver courses fully online. The aim of this study was to explore the quality of the online education in China for international medical and nursing students from low- and middle-income countries (LMICs) as well as the factors that influenced their satisfaction with online education during the COVID-19 pandemic. METHODS: Questionnaires were developed and administered to 316 international medical and nursing students and 120 teachers at a university in China. The Chi-square test was used to detect the influence of participants' personal characteristics on their satisfaction with online education. The Kruskal-Wallis rank-sum test was employed to identify the negative and positive factors influencing the online education satisfaction. A binary logistic regression model was performed for multiple-factor analysis to determine the association of the different categories of influential factors-crisis-, learner-, instructor-, and course-related categories, with the online education satisfaction. RESULTS: Overall, 230 students (response rate 72.8%) and 95 teachers (response rate 79.2%) completed the survey. It was found that 36.5% of students and 61.1% of teachers were satisfied with the online education. Teachers' professional title, students' year of study, continent of origin and location of current residence significantly influenced the online education satisfaction. The most influential barrier for students was the severity of the COVID-19 situation and for teachers it was the sense of distance. The most influential facilitating factor for students was a well-accomplished course assignment and for teachers it was the successful administration of the online courses. CONCLUSIONS: Several key factors have been identified that affected the attitudes of international health science students from LMICs and their teachers towards online education in China during the COVID-19 pandemic. To improve the online education outcome, medical schools are advised to promote the facilitating factors and cope with the barriers, by providing support for students and teaching faculties to deal with the anxiety caused by the pandemic, caring for the state of mind of in-China students away from home, maintaining the engagement of out-China students studying from afar and enhancing collaborations with overseas institutions to create practice opportunities at students' local places.


Subject(s)
Attitude , COVID-19 , Education, Distance , Education, Medical/methods , Education, Nursing/methods , Faculty , Students , Adolescent , Adult , Attitude of Health Personnel , Developing Countries , Faculty, Medical , Faculty, Nursing , Female , Humans , Internet , Male , Nurses , Pandemics , Physicians , SARS-CoV-2 , Students, Medical , Students, Nursing , Young Adult
12.
PLoS One ; 16(5): e0250833, 2021.
Article in English | MEDLINE | ID: covidwho-1223798

ABSTRACT

Despite the availability of highly effective and well-tolerated direct-acting antivirals, not all patients with chronic hepatitis C virus infection receive treatment. This retrospective, multi-centre, noninterventional, case-control study identified patients with chronic hepatitis C virus infection initiating (control) or not initiating (case) treatment at 43 sites in Germany from September 2017 to June 2018. It aimed to compare characteristics of the two patient populations and to identify factors involved in patient/physician decision to initiate/not initiate chronic hepatitis C virus treatment, with a particular focus on historical barriers. Overall, 793 patients were identified: 573 (72%) who received treatment and 220 (28%) who did not. In 42% of patients, the reason for not initiating treatment was patient wish, particularly due to fear of treatment (17%) or adverse events (13%). Other frequently observed reasons for not initiating treatment were in accordance with known historical barriers for physicians to initiate therapy, including perceived or expected lack of compliance (14.5%), high patient age (10.9%), comorbidities (15.0%), alcohol abuse (9.1%), hard drug use (7.7%), and opioid substitution therapy (4.5%). Patient wish against therapy was also a frequently reported reason for not initiating treatment in the postponed (35.2%) and not planned (47.0%) subgroups; of note, known historical factors were also common reasons for postponing treatment. Real-world and clinical trial evidence is accumulating, which suggests that such historical barriers do not negatively impact treatment effectiveness. Improved education is key to facilitate progress towards the World Health Organization target of eliminating viral hepatitis as a major public health threat by 2030.


Subject(s)
Antiviral Agents/therapeutic use , Hepacivirus/isolation & purification , Hepatitis C/drug therapy , Hepatitis C/psychology , Patient Compliance/psychology , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Drug Therapy, Combination , Female , Germany/epidemiology , Hepatitis C/epidemiology , Hepatitis C/virology , Humans , Male , Middle Aged , Retrospective Studies , Sustained Virologic Response , Young Adult
13.
Public Health Rep ; 136(3): 327-337, 2021 05.
Article in English | MEDLINE | ID: covidwho-1223668

ABSTRACT

INTRODUCTION: Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia. METHODS: A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution. RESULTS: Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups. PRACTICAL IMPLICATIONS: This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.


Subject(s)
COVID-19/epidemiology , Data Collection/methods , Internet-Based Intervention , Public Health Surveillance/methods , Self Report , Symptom Assessment , Adolescent , Adult , Aged , Appalachian Region/epidemiology , Female , Humans , Male , Middle Aged , Patient Participation , SARS-CoV-2 , Young Adult
14.
J Food Biochem ; 45(6): e13750, 2021 06.
Article in English | MEDLINE | ID: covidwho-1218148

ABSTRACT

Nutraceuticals need special attention as preventive molecules to create a natural barrier against various dreadful diseases like cancer and to regulate metabolism. In the present study, two spices, Trachyspermum ammi and Cinnamomum verum, been identified as excellent Protein Tyrosine Phosphatases (PTPases) sources that play significant role in the regulation of cell signal transduction and developmental processes in plants as well as animals, being lucrative and potential targets for pharmacological modulation. PTPases from both cases were partially purified into 0%-40% and 40%-80% fractions based on ammonium sulfate saturation levels. Fraction (40%-80%) exhibited a purification level of 4.44-fold and 2.86-fold with specific activity of 44.06 and 23.33 U/mg for PTPases from T. ammi and C. verum, respectively. PTPases being found to be thermally stable up to 70°C imply their industrial significance. Kinetic studies showed Km values to be 7.14 and 8.33 mM, whereas the activation energy (Ea ) values were 25.89 and 29.13 kJ/mol, respectively. Divalent cations: Cu2+ , Zn2+ , and Mn2+ acted as inhibitors of PTPases, from both sources. The Ki values of inhibitors varied from 0.014-0.125 mM in the descending order Cu2+  > Zn2+  > Mn2+ and Mn2+  > Cu2+  > Zn2+ for PTPases from T. ammi and C. verum, respectively. The inhibitory effect of sodium metavanadate aligns with prominent PTPase characteristics. In addition to these properties, the thermostability of PTPases from two spices enhances their significance in industries with therapeutically vital products. Although the source of PTPases is culinary spices, further studies are required to establish the utilization of PTPases as nutraceuticals and in therapeutic formulations. PRACTICAL APPLICATIONS: For a healthy lifestyle, awareness needs to be created by humankind towards food habits to minimize illnesses. Numerous studies have explored the consumption of nutraceutical products acts as a natural barrier and immune booster for various human ailments including SARS-COV-2. PTPases play important roles in regulating intracellular signaling and, ultimately, biological function along with their structural features. The importance of PTPases and their inhibitors has been implicated in various diseases like cancer, diabetes, and obesity. Further investigations need to be undertaken to explore the therapeutic properties of PTPases in both in vivo and in vitro for their clinical significance.


Subject(s)
Ammi , COVID-19 , Ammi/metabolism , Animals , Cinnamomum zeylanicum/metabolism , Dietary Supplements , Humans , Kinetics , Protein Tyrosine Phosphatases/metabolism , SARS-CoV-2 , Spices
15.
Contraception ; 104(1): 111-116, 2021 07.
Article in English | MEDLINE | ID: covidwho-1209123

ABSTRACT

OBJECTIVES: We aimed to characterize the combined impact of federal, state, and institutional policies on barriers to expanding medication and telemedicine abortion care delivery during the COVID-19 pandemic in the abortion-restrictive states of Ohio, Kentucky, and West Virginia. STUDY DESIGN: We analyzed 4 state policies, 2 COVID-related state executive orders, and clinic-level survey data on medication abortion provision from fourteen abortion facilities in Ohio, Kentucky, and West Virginia from December 2019 to December 2020. We calculated the percent of medication abortions provided at these facilities during the study period by state, to assess changes in medication abortion use during the pandemic. RESULTS: We ascertained that COVID-19-executive orders in Ohio and West Virginia that limited procedural abortion in Spring 2020 coincided with an increase in the overall number and proportion of medication abortions in this region, peaking at 1613 medication abortions (70%) in April 2020. Ohio and West Virginia, which had executive orders limiting procedural abortion, saw relatively greater increases in April compared to Kentucky. Despite temporary lifting of the mifepristone REMS, prepandemic regulations banning telemedicine abortion in Kentucky and West Virginia and requiring in-person clinic visits for medication abortion distribution in Ohio limited clinics' ability to adapt to offer medication abortion by mail. CONCLUSIONS: Our findings illustrate how restrictive medication and telemedicine abortion policies in Ohio, Kentucky, and West Virginia created additional obstacles for patients seeking medication abortion during the pandemic. Permanently lifting federal regulations on in-clinic distribution of mifepristone would only advantage abortion seekers in states without restrictive telehealth and medication abortion policies. State policies that limit access to comprehensive abortion services should be central in larger efforts toward dismantling barriers that impinge upon reproductive autonomy. IMPLICATION STATEMENT: We find that abolishing the REMS on mifepristone would not be enough to expand access to patients in abortion-restrictive states with telemedicine and medication abortion laws. While the REMS is a barrier, it represents one of several hindrances to the expansion of telemedicine abortion distribution across the United States.


Subject(s)
Abortifacient Agents/therapeutic use , Abortion, Induced/legislation & jurisprudence , COVID-19 , Postal Service , Telemedicine/legislation & jurisprudence , Abortion, Induced/methods , Drug and Narcotic Control , Elective Surgical Procedures , Federal Government , Health Services Accessibility , Humans , Kentucky , Ohio , Public Policy , Risk Evaluation and Mitigation , SARS-CoV-2 , State Government , Telemedicine/organization & administration , West Virginia
16.
Indian J Ophthalmol ; 69(5): 1264-1270, 2021 May.
Article in English | MEDLINE | ID: covidwho-1207844

ABSTRACT

PURPOSE: COVID-19 pandemic has affected the healthcare system worldwide hindering the continuum of treatment of chronic disease patients. The objective of the study is to analyze the barriers encountered by the glaucoma patients for the follow-up visit and medication adherence during the pandemic. METHODS: This cross-sectional study included glaucoma patients who did not attend the scheduled appointment from April 1, 2020 to July 31, 2020 in a tertiary eye care center (88.21%). Eligible patients of age >18 years and advised antiglaucoma medication in Madurai Zone were interviewed with validated questionnaire through telephonic call. RESULTS: 363 patients answered the questionnaire through telephonic interview. 57.3% of the patients were found to be non-adherent to medication. The main barriers for glaucoma follow-up visit during the pandemic were lockdown restriction, transport problem, and financial difficulties. The top barriers for medication adherence were non availability of medication (54.81%), financial difficulties (30.29%), did not feel much improvement with eye drops (20.19%). On multiple regression analysis, longer distance to hospital, low socioeconomic status, more than one antiglaucoma medication use, lack of awareness of glaucoma, non-complaint before COVID-19 and stress due to the pandemic were found to be significant factors for medication non adherence. CONCLUSION: COVID-19 pandemic has emphasized the need for reformation in health care system for accessibility of medical care to patients in rural areas. Decentralization of health system to primary care level and utilization of teleophthalmology should be considered by health care planners in future.


Subject(s)
COVID-19 , Glaucoma , Ophthalmology , Telemedicine , Adolescent , Communicable Disease Control , Cross-Sectional Studies , Follow-Up Studies , Glaucoma/drug therapy , Glaucoma/epidemiology , Humans , India/epidemiology , Medication Adherence , Pandemics , SARS-CoV-2
17.
Health Syst Reform ; 7(1): e1897323, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1207212

ABSTRACT

As countries all over the world grapple with containing the COVID-19 outbreak, Low- and Middle-Income Countries (LMICs) are particularly hard-pressed because on the one hand, the pandemic has created unforeseen high demand for health services which requires increased spending. On the other hand, the contagion and the public health measures taken to curb it have disrupted economies whilst creating additional spending pressures as well. This constrains the policy options available for LMICs to ensure an adequate and sustainable financing for the health sector's COVID-19 response whilst maintaining routine supply of essential health services. Despite this, as demonstrated by India, many LMICs are undertaking many reform efforts to address both the health and economic hardships caused by the pandemic. In this commentary, we describe the policy tools that one such LMIC, India, has used to enable financing for the outbreak.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Family Characteristics , Health Expenditures/statistics & numerical data , Developing Countries , Female , Humans , India/epidemiology , Male , Pandemics , SARS-CoV-2
18.
Int J Med Inform ; 151: 104467, 2021 07.
Article in English | MEDLINE | ID: covidwho-1202311

ABSTRACT

BACKGROUND: Telemedicine has been a useful healthcare alternative in the fight to contain the recent Covid-19 global pandemic. Yet the extent of its application and efficacy as an alternative route for healthcare provision remains a major concern for clinicians and patients. OBJECTIVE: This study sought to identify barriers to the successful implementation of telemedicine in Sub-Saharan African (SSA) countries. METHOD: A systematic review of the literature was conducted by applying the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for identifying, selecting, evaluating and interpreting findings. RESULTS: Our results from 66 empirical studies revealed a wide usage of telemedicine technology across SSA countries but also showed insufficient evidence of usage for fighting Covid-19 infection. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the successful implementation of telemedicine in SSA. A list of recommendations was produced for each telemedicine barrier. CONCLUSION: Our review shows current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. This review offers a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.


Subject(s)
COVID-19 , Telemedicine , Africa South of the Sahara , Humans , Policy , SARS-CoV-2
19.
World J Psychiatry ; 11(4): 94-108, 2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1200304

ABSTRACT

The coronavirus disease 2019 pandemic affects psychiatric patients disproportionately compared to the general population. In this narrative review, we examine the impact of the pandemic on significant global health disparities affecting vulnerable populations of psychiatric patients: People of diverse ethnic background and color, children with disabilities, sexual and gender minorities, pregnant women, mature adults, and those patients living in urban and rural communities. The identified disparities cause worsened mental health outcomes placing psychiatric patients at higher risk for depression, anxiety and posttraumatic stress disorder symptoms. Those psychiatric patients who are ethnic minorities display barriers to care, including collective trauma and structural racism. Sexual and gender minorities with mental illness face discrimination and limited access to treatment. Pregnant women with psychiatric diagnoses show higher exposure to domestic violence. Children with disabilities face a higher risk of worsening behavior. Mature adults with psychiatric problems show depression due to social isolation. Psychiatric patients who live in urban communities face pollutants and overcrowding compared to those living in rural communities, which face limited access to telehealth services. We suggest that social programs that decrease discrimination, enhance communal resilience, and help overcome systemic barriers of care should be developed to decrease global health disparities in vulnerable population.

20.
J Manag Care Spec Pharm ; 26(11): 1468-1474, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1200401

ABSTRACT

The COVID-19 pandemic and the social unrest pervading U.S. cities in response to the killings of George Floyd and other Black citizens at the hands of police are historically significant. These events exemplify dismaying truths about race and equality in the United States. Racial health disparities are an inexcusable lesion on the U.S. health care system. Many health disparities involve medications, including antidepressants, anticoagulants, diabetes medications, drugs for dementia, and statins, to name a few. Managed care pharmacy has a role in perpetuating racial disparities in medication use. For example, pharmacy benefit designs are increasingly shifting costs of expensive medications to patients, creating affordability crises for lower income workers, who are disproportionally persons of color. In addition, the quest to maximize rebates serves to inflate list prices paid by the uninsured, among which Black and Hispanic people are overrepresented. While medication cost is a foremost barrier for many patients, other factors also propagate racial disparities in medication use. Even when cost sharing is minimal or zero, medication adherence rates have been documented to be lower among Blacks as compared with Whites. Deeper understandings are needed about how racial disparities in medication use are influenced by factors such as culture, provider bias, and patient trust in medical advice. Managed care pharmacy can address racial disparities in medication use in several ways. First, it should be acknowledged that racial disparities in medication use are pervasive and must be resolved urgently. We must not believe that entrenched health system, societal, and political structures are impermeable to change. Second, the voices of community members and their advocates must be amplified. Coverage policies, program designs, and quality initiatives should be developed in consultation with those directly affected by racial disparities. Third, the industry should commit to dramatically reducing patient cost sharing for essential medication therapies. Federal and state efforts to limit annual out-of-pocket pharmacy spending should be supported, even though increased premiums may be an undesirable (yet more equitable) consequence. Finally, information about race should be incorporated into all internal and external reporting and quality improvement activities. DISCLOSURES: No funding was received for the development of this manuscript. Kogut is partially supported by Institutional Development Award Numbers U54GM115677 and P20GM125507 from the National Institute of General Medical Sciences of the National Institutes of Health, which funds Advance Clinical and Translational Research (Advance-CTR), and the RI Lifespan Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose, respectively. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health.


Subject(s)
Coronavirus Infections/epidemiology , Health Status Disparities , Managed Care Programs/organization & administration , Pharmaceutical Services/organization & administration , Pneumonia, Viral/epidemiology , Racial Groups/statistics & numerical data , Betacoronavirus , COVID-19 , Cost Sharing , Drug Industry , Fees, Pharmaceutical , Female , Health Expenditures/statistics & numerical data , Health Services Accessibility , Hispanic or Latino , Humans , Male , Managed Care Programs/economics , Medication Adherence , Pandemics , Pharmaceutical Services/economics , Retrospective Studies , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology
SELECTION OF CITATIONS
SEARCH DETAIL