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BackgroundInflammatory rheumatic and musculoskeletal diseases (iRMDs), including rheumatoid arthritis (RA) and juveneille inflammatory arthritsi (JIA), are common and cause a high disease burden globally. Early diagnosis of iRMDs and subsequent timely access to disease modifying therapies is associated with improved health and socio-economic outcomes. However, the COVID-19 pandemic meant that the way healthcare was delivered changed abruptly as all consultations were ‘remote by default' was widely implemented, replacing traditional ‘face-to-face' healthcare.ObjectivesTo describe the impact of the COVID-19 pandemic upon referral patterns and incident diagnosis of iRMDs.MethodsData from the Clinical Practice Research Datalink Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal (MSK) conditions, in a primary care setting, for pre-COVID-19 (01/04/2017–31/03/2020), early-COVID-19 (01/04/2020–31/07/2021), and late-COVID-19 pandemic (01/08/2020–31/10/2021) periods. Prevalent and incident MSK consultations were determined. Referrals were matched to these consultations. Trends in referrals to MSK services and further incident diagnoses of iRMDs were described using Joinpoint regression and comparisons made between time-periods. Negative binomial regression was used to compare incident rates between time-periods: first MSK consultation to RA/JIA/iRMD diagnosis;first MSK consultation to first referral;first referral to RA/JIA/iRMD diagnosis. The number of consultations between first MSK consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation.ResultsThe incidence of RA and JIA reduced by -13.3% (from 32.0 to 17.2 per 100,000) and -17.4% (from 1.8 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, and then increased by 1.9% (from 17.2 to 25.2 per 100,000) and 3.7% (from 0.97 to 1.3 per 1,000,000) per month respectively between April 2020 and October 2021. The incidence of all diagnosed iRMDs was stable until October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% (from 4.8 to 2.4 per 100) per month in patients presenting with a MSK condition. After May 2020, referrals increased significantly (16.8% per month from 2.4 to 4.5 per 100) to July 2020. Time from first MSK consultation to RA diagnosis, and referral to RA diagnosis increased in the early-pandemic period (rate ratio (RR) 1.11, 95% confidence interval (CI) 1.07-1.15;RR 1.23, 95%CI 1.17-1.30) and remained consistently higher in the late-pandemic (RR 1.13, 95%CI 1.11-1.16;RR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period.ConclusionPatients with underlying RA/JIA that developed during the pandemic may be yet to present, or in the process of being referred and/or diagnosed. Primary care clinicians should remain alert to this possibility and consider the use of fast-track referral pathways where indicated. It is apparent that patients developing incident episodes of inflammatory arthropathies may display a prodrome of other MSK symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.References[1]Jordan KP, Kadam UT, Hayward R, et al. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskeletal Disorders 2010;11:144.[2]NHS England and NHS Improvement. Important and urgent - Next steps on NHS response to COVID-19 2020. Available at: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0098-total-triage-blueprint-september-2020-v3.pdf Accessed Oct 2, 2021.AcknowledgementsWe wish to acknowledge: members of our PPIE group who helped to formulate the research question and provide insight into the implications of our results;and to Prof Edward Roddy, Prof Sa antha Hider and Dr Lorna Clarson for their insights as consultant rheumatologists and commissioners of healthcare services.Disclosure of InterestsNone Declared.
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Background/Aims The COVID-19 pandemic abruptly changed healthcare delivery. This study describes the impact the pandemic had on time to referral and diagnosis of inflammatory arthropathies (IA), including rheumatoid arthritis (RA) and juvenile inflammatory arthritis (JIA), in patients presenting in primary care with musculoskeletal problems. Methods Data from the Clinical Practice Research Datalink (CPRD) Aurum were analysed from 01/04/17 to 01/10/2021 to describe episodes of care for patients with musculoskeletal conditions for pre-COVID-19 (01/04/ 2017-31/03/2020), peri-COVID-19 (01/04/2020-31/07/2021), and post- COVID-19 lockdown (01/08/2020-31/10/2021) periods. Prevalent and incident musculoskeletal consultations were determined. Referrals were matched to these consultations. Trends in referrals to musculoskeletal services and further incident diagnoses of IA were described using Joinpoint Regression and comparisons made between timeperiods. Negative binomial regression was used to compare incident rates between time-periods of: RA/JIA/IA diagnosis and referral from first musculoskeletal consultation;and RA/JIA/IA diagnosis from first referral. The number of consultations between first musculoskeletal consultation and referral/diagnosis were described. Results were adjusted for age and sex and further stratified by geographical region and deprivation. Results The incidence rate of RA and JIA reduced by average -13.32% (from 31.98 per 1,000,000 to 17.15 per 1,000,000) and -17.43% (from 1.77 per 1,000,000 to 0.97 per 1,000,000) per month respectively between January 2020 and April 2020, then increased by 1.9% (from 17.15 per 1,000,000 to 25.22 per 1,000,000) and 3.7% (from 0.97 per 1,000,000 to 1.28 per 1,000,000) per month respectively between April 2020 and October 2021. Referral incidence decreased between February 2020 and May 2020 by -16.8% per month in patients presenting with a musculoskeletal condition. After May 2020, referrals increased significantly (16.8% per month) July 2020. Time from first musculoskeletal consultation to RA diagnosis, and referral to RA diagnosis increased in the peri-COVID-19 period (IRR 1.11, 95%CI 1.07-1.15;IRR 1.23, 95%CI 1.17-1.30) and remained consistent in the post- COVID-19 (IRR 1.13, 95%CI 1.11-1.16;IRR 1.27, 95%CI 1.23-1.32) periods respectively, compared to the pre-COVID-19 period. Similarly, number of consultations between first musculoskeletal consultation and referral/RA diagnosis reduced significantly in the peri-COVID-19 (IRR 0.92, 95%CI 0.88-0.96) and post-COVID-19 (IRR 0.92, 95%CI 0.90-0.95) periods. No change was observed between first musculoskeletal consultation and first referral. Similar results were observed for IA but not for JIA. Conclusion Patients with RA/JIA onset during the pandemic may be yet to present or are currently transitioning through referral and diagnosis. Primary care clinicians should remain alert to possible IA diagnosis and consider fast-track referral pathways where indicated. Patients developing incident episodes of IA may display a prodrome of other musculoskeletal symptoms and conditions, which alone may not warrant referral but in combination require further investigation. Commissioners should be alert to these findings to allow for the appropriate planning and commissioning of services.
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Approximately 1/3 of adult women have experienced intimate partner violence (IPV), and the prevalence, severity, and frequency of IPV has been exacerbated during COVID-19 and the related lockdowns. Among the many challenges faced by IPV survivors, the physical assaults result in brain injury in the large majority of IPV survivors. Yet the nature of this brain damage and how it contributes to function has been remarkably understudied. Mild traumatic brain injury (mTBI) is common in the general population and repetitive mTBI is gaining specific recognition. Survivors of IPV typically do not seek medical attention and may suffer subsequent mTBIs in the midst of recovery. It cannot be assumed that mTBI from IPV is equivocal to those that have been studied in athletics and the military in terms of debilitating and persisting neurological issues. Unique aspects of mTBI in IPV survivors include being highly repetitive and often coupled with other injuries, involving strangulationrelated trauma and elevated risk during pregnancy, and critically, typically remaining untreated in the acute setting. The poor understanding of the consequences and burden of brain injury in IPV is amajor knowledge gap that is imperative to address if we are to improve the care and outcomes for IPV survivors. The proposed symposium, which consists of a diverse and balanced group of junior and senior scientists, will feature recent findings from clinical and preclinical studies that provide insight into the epidemiology, functional and pathological consequences, biomarkers, and treatments of IPV-related brain injury.
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The Covid-19 pandemic has been, so far, the longest and more intense crisis in the history of commercial aviation. We contribute to the academic discussion by providing an assessment of the impacts of COVID-19 on this industry by exploring supply and demand datasets, as well as fleet status changes. Results show a more intense impact on international markets, although the domestic ones have not fully recovered. Also, the crisis seems to have a strong demand-shock component as consumers have not reacted to additional supply levels during the recovery months. The road to recovery will require a better understanding of passenger demand and fundamental changes in the economic, environmental and managerial resilience of airlines. © John R. Bryson, Lauren Andres, Aksel Ersoy and Louise Reardon 2021.
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Care homes for older people may become places of deprivation of liberty due to their residents' lack of capacity to consent to their stay. The Optional Protocol to the Convention Against Torture requires States Parties to establish National Preventive Mechanisms to undertake visits to all places of deprivation of liberty to prevent torture and other ill treatment. This paper discusses the ways in which National Preventive Mechanisms report on human rights concerns in older people's care homes across 26 Council of Europe states. A framework established by the European Committee for the Prevention of Torture provides a starting point for this analysis. Common themes around restraint, ill treatment, safeguards for involuntary placements, and resourcing issues emerge. Against a backdrop of concerns heightened by the Covid-19 pandemic, the paper concludes that a narrow focus on individual human rights needs to be supplemented by addressing the structural issues on which the more broadly conceived rights of residents of care homes for older people depend.
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Purpose of Study The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has a predilection for severe outcomes in adults. Immunocompromised adults are at higher risk of severe disease. The pediatric population has experienced lower rates of morbidity and mortality. However, recent data shows that pediatric patients with cancer may also be at higher risk of severe disease, as seen in the adult population. This descriptive study will help assess the effect of SARS-CoV-2 infection on pediatric patients with oncologic disorders. Methods Used This IRB-approved retrospective study was conducted between March 2020 to August 2021. Patients between the ages of 0-21 years with an oncologic disorder who tested positive for SARS-CoV-2 were included. Laboratory evaluation was included if within 2 weeks of initial infection with 3 patients being excluded due to no labs available but still included in the clinical analysis. Summary of Results Thirty-one oncology patients with SARSCoV- 2 infection were identified. Median age of 9 years (range 1-20). Fifteen females and 16 males. Diagnoses included were acute leukemia (15), lymphoma (4), CNS tumor (8), and solid tumor (4). Fifty-five percent of patients were asymptomatic and had been tested due to a scheduled hospital admission, procedure requiring sedation, or known exposure to SARSCoV- 2. Forty-eight percent of patients were obese or overweight. Most common symptoms included fever (26%), congestion (19%), and cough (26%). Only 6% of patients complained of loss of taste. No patients complained of loss of smell. Twenty-nine percent of patients had moderate SARS-CoV- 2 disease severity, requiring inpatient management for symptoms without ICU-level care. Three patients developed pneumonia, 2 requiring supplemental oxygen, but none needed ICU-level care. Of the four patients who had completed therapy, one was asymptomatic and the other 3 had mild disease, requiring symptomatic care at home. One patient had been fully vaccinated against SARS-CoV-2 with a mild infection occurring 2 months after the second vaccine. Median laboratory values for patients who had SARSCoV- 2 mild/moderate disease compared to asymptomatic patients included hemoglobin 10.4 g/dL and 11.5 g/dL, platelet 185,000and 198,000, absolute lymphocyte count 820 and 1465, absolute neutrophil count 1145 and 1780, respectively. No statistically significant difference was found. Conclusions Pediatric oncology patients at our institution had a more benign course with SARS-CoV-2 when compared to national and international reports. Although almost half of our patients were obese or overweight, none had severe disease. Loss of taste and/or smell was uncommon in our patients. As data is rapidly growing, it is important to evaluate risk factors, outcomes, and natural history in this vulnerable population in order to develop management guidelines.
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Public Significance Statement The current study explored the ways that housing and employment instability brought on by the COVID-19 pandemic contributed to heightened psychological distress among a sample of transgender and gender diverse (TGD) individuals collected using an online survey platform. Our findings indicate that TGD individuals experienced heightened levels of psychological distress directly related to employment and housing instability which is a crucial and timely concern given that TGD individuals experienced greater psychological distress, unemployment, and housing instability relative to the general population prior to the pandemic. Receiving a COVID-19 diagnosis or experiencing symptoms associated with COVID-19 also predicted heightened levels of psychological distress. It is recommended that additional TGD-specific protections be implemented and expanded upon in order to meet the current and impending needs of TGD individuals. Transgender and gender diverse (TGD) individuals are faced with various societal factors that contribute to health disparities. As COVID-19 spreads, health disparities that existed prior to the pandemic have become exacerbated. The current study aims to address factors that may be negatively impacting TGD individuals during the COVID-19 pandemic by exploring their experiences related to symptoms of depression, symptoms of anxiety, employment, and housing. TGD participants (N = 342) were recruited from an online participant recruitment platform and answered questions related to their psychological well-being and changes in employment and housing since the start of the pandemic. Adverse changes in employment since the start of the pandemic were reported by almost 1/3 of participants and were associated with higher depression and anxiety. Changes in housing were reported by almost 1/4 of participants and were associated with higher anxiety. Experiencing COVID-19 symptoms or receiving a COVID-19 diagnosis were also associated with higher anxiety. Findings indicate TGD individuals who experienced changes in employment and housing since the start of the COVID-19 pandemic experience greater levels of psychological distress. Findings may inform mental health providers and policymakers on the repercussions the pandemic has had on TGD individuals.
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This research examined the effects of the COVID-19 pandemic on social media marketing in India. There is little research on the impact of a pandemic on consumer behaviors. To address this gap, this exploratory study surveyed Indian consumers’ social media behaviors. Observations from 313 Indian consumers were collected to compare how their social media behaviors for consumer decision-making have changed since the COVID-19 pandemic started. A Wilcoxon signed-rank test was used to test mean differences in social media behaviors prior to and after the COVID-19 pandemic began. The findings demonstrated increased usage of social media as a tool for consumer decision-making. With the global reach of the COVID-19 pandemic, the implications of a growing prominence of social media in consumer-decision making are likely relevant to most nations. Recommendations for the use of social media as a marketing tool are provided. © 2021 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
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COVID-19 , Psoriasis , Estudios Transversales , Humanos , Pandemias , Psoriasis/epidemiología , SARS-CoV-2RESUMEN
Psoriasis is a common immune-mediated inflammatory skin disease with frequent multimorbidity, and immunosuppressants are the mainstay of treatment in moderate-to-severe disease. An understanding of the impact of COVID-19 on individuals with psoriasis and the effect of psoriasis therapies on the course of COVID-19 is urgently required to inform clinical decision-making. This study sought to characterize the clinical course of COVID-19 in patients with psoriasis and to identify factors associated with hospitalization. Clinicianreported cases of confirmed or suspected COVID-19 in psoriasis were collected via an international online registry. Multivariable-adjusted logistic regression identified factors associated with hospitalization. Patient risk-mitigating behaviours were characterized using an independent global selfreport registry. In total, 334 clinician-reported cases (median age 50 years, 62% male, median body mass index 28 kg m-2, 85% white) from 22 countries [most frequently, the U.K. (35%), Italy (22%) and Spain (16%)] were available between 27 March and 20 June 2020. Altogether, 245 (73.3%) patients were receiving a biologic, 54 (16.2%) a nonbiologic and 31 (9.3%) no systemic treatment. Overall, 311 (93.1%) achieved a full recovery, 71 (21.2%) were hospitalized and nine (2.7%) died. Risk factors associated with hospitalization were older age [adjusted odds ratio (aOR) 1.71, 95% confidence interval (CI) 1.26-2.32], male sex (aOR 2.37, 95% CI 1.11-5.04) and nonwhite ethnicity (aOR 3.40, 95% CI 1.27-9.11), in addition to chronic lung disease (aOR 4.37, 95% CI 1.62-11.74) and hypertension (aOR 2.23, 95% CI 1.05-4.74). Reduced risk of hospitalization was associated with use of a biologic (aOR 0.42, 95% CI 0.18-0.98) vs. nonbiological systemic therapy. There was no difference in risk of hospitalization between classes of biologics. An independent selfreport psoriasis registry (1167 patients from 39 countries) suggested increased social isolation (76% vs. 66%;P < 0.05) but similar nonadherence to medication (18% vs 22%) in patients receiving biologics vs. nonbiological systemic treatments. In this international moderate-to-severe psoriasis case series, most patients fully recovered from COVID-19;older age, being male and being of nonwhite ethnicity increased risk of hospitalization. Use of biologics, when compared with nonbiological systemic therapies, was associated with reduced risk of hospitalization;however, this requires further study owing to potential selection bias and unmeasured confounding such as a difference in risk-mitigating behaviours.
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This exploratory research examines how the COVID-19 pandemic led to increases in consumers’ social media marketing behaviors in the United States (U.S.). Previous research on the impact of a pandemic has focused on behavior for preventive health, however, little attention has been given to the impact of a pandemic on consumer behaviors. To bridge this gap, the Consumer Decision-Making Model was used as a framework to investigate changes in consumers’ social media behaviors as they preform various consumer decision-making processes. More specifically, a questionnaire was used to collect survey data from 327 U.S. consumers. Analysis of Variance tests were performed to examine mean differences in consumers’ use of social media as a consumer decision-making tool. The findings showed that consumers have increased their utilization of social media as a tool for identifying products, collecting information on products, evaluating products, and making product purchases. Thus, the findings demonstrate the growing importance of social media marketing since the COVID-19 pandemic began. Given that the COVID-19 pandemic is a global phenomenon, the findings likely can be extrapolated across many nations. Suggestions are provided to help businesses adopt to changes in consumers’ social media behaviors as they relate to the consumer decision-making processes. © 2021 The Author(s). This open access article is distributed under a Creative Commons Attribution (CC-BY) 4.0 license.
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BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.