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Background As the most basic unit of infectious disease prevention and control，community health service institutions are the frontline and important gateway for the prevention and control of infectious disease. Primary care physicians are responsible for epidemic surveillance，vaccination，health promotion and assistance to centers for disease control in investigating and disposing outbreaks and public health emergencies in their districts，and play an active role in disease prevention and control by groups，susceptible population protection，infectious source control and health education，as well as the effective prevention and control of infectious diseases. Objective To understand the ability of primary care physicians to diagnose and treat infectious diseases in the community，analyse their existing problems and shortcomings，design and conduct a series of intensive training related to infectious diseases for improving the capacity of infectious disease prevention and control at the primary level；To evaluate the effectiveness of online continuing medical education，so as to provide a reference for better continuing medical education on infectious diseases in the community. Methods All participants of the National Community Infectious Diseases Continuing Education Conference held by the Department of Family Medicine of the University of Hong Kong-Shenzhen Hospital in November 2021 were selected as research subjects from November 2021 to March 2022. The questionnaires were distributed to all registered attendees before and after the conference through the QR code of the questionnaire star，and the content of pre-conference questionnaire included demographic characteristics of the participants，participation in infectious disease training in the community since started working，diagnosis and treatment of infectious diseases in the community，subjective attitudes towards the prevention and control of infectious diseases in the community（willingness to manage infectious diseases in the community，satisfaction with their own infectious disease management skills），expertise in infectious disease prevention and control and knowledge related to conference content，attitude towards hepatitis B. The content of the post-conference questionnaire mainly included knowledge about the content of conference，attitude towards hepatitis B and satisfaction survey of this online conference. A total of 301 primary care physicians completed the questionnaire before and after the conference，and a total of 194 completed the questionnaire before and after the conference. Results Among all participants，166 （55.1%） had attended infectious disease training in the community，of whom 49（29.5%） were satisfied with their infectious disease diagnosis and treatment ability；135（44.8%） had not attended the training，of whom 22（16.3%） were satisfied with their infectious disease diagnosis and treatment ability. 143（86.1 %） of 166 participants who had attended infectious disease training in the community indicated their willingness to manage community infectious diseases，99（73.3%） of 135 participants who had not attended infectious disease training in the community indicated their willingness to manage community infectious diseases. 66（27.3%） of participants who were satisfied with their infectious disease diagnosis and treatment ability indicated their willingness to manage community infectious diseases. The top three infectious disease tests conducted by the institutions were hepatitis B，AIDS，and hepatitis C；the top three infectious diseases treated in the past six months were hepatitis B，influenza，hand，foot and mouth disease. Different self-evaluation and willingness to train may affect the willingness to manage community infectious diseases（P<0.05）. Among the participants who completed the questionnaire both before and after the conference，the highest correct answer rate for compulsory management of statutory infectious diseases before the conference was 89.7%，the owest accuracy rate for the type of disinfection of the COVID-19 infection was only 17.0%，the correct rates of other questions ranged from 34.0% to 40.7%. The correct rates of the questions after the conference were higher than those before the conference，and the correct rates ranged from 48.9% to 52.6%. The score of attitude towards hepatitis B after the conference was higher than that before the conference （P<0.05）. In terms of feedback after conference，254（98.1%） expressed satisfaction in the total of 259 questionnaires. In terms of suggestions for online conference，179（69.1%） and 174（67.2%） participants believed that online fluency and online interaction need to be improved. Conclusion The primary care physicians receive relatively less infectious diseases training in the community，inadequate infectious diseases training in the community can improve the confidence of self-competence，attitude of active management of infectious diseases and diagnosis and treatment ability in the primary care physicians. The future direction of continuing medical education should focus on the training of emerging infectious diseases and novel medical concepts，relevant experts should be invited to comment on the necessity and effectiveness of training in the community. © 2023 Chinese General Practice. All rights reserved.
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Exercise at home has already been a common behavior in the current world, especially in the post-COVID-19 era, even some athletes need to do physical fitness at home to keep their state due to the quarantine. So, the importance of online physical training and evaluation is highly increasing. In this work, we build an online 8-form Tai Chi Chuan (TCC) training and evaluation system, which provides a platform for coaches and users to conduct TCC training and evaluation online. Coaches formulate an evaluation rule and upload coaching videos to the platform, then users watch videos online and submit their own recordings, finally, users will get a score of their recordings. To complete this task, we propose a video capture method to record users' sports exercise videos from different perspectives, construct a 3D pose estimation model to identify human pose from captured video, and propose an evaluation model which can judge users' performance and assign a score to each video. To test our proposed models, we make a dataset consisting of key pose frames of TCC, and the key pose frames are extracted from users' TCC exercise videos. We use the dataset to train our models and assign scores to key poses, then compare the results with scores given by professional TCC players. In addition, we add all key pose scores from every single user together and obtain the whole score of an exercise video. The experiment results show that the error between scores assigned by our models and scores given by professional players does not exceed 1.6 in most scoring of a whole exercise video, and Root Mean Square Error (RMSE) is about 0.75 in the scoring of each key pose. © 2022 IEEE.
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STATEMENT OF PROBLEM/QUESTION: Will a telehealth initiative improve poorly controlled type 2 diabetes mellitus (DM) and unmet social determinants of health (SDOH) needs exacerbated by the COVID-19 pandemic? DESCRIPTION OF PROGRAM/INTERVENTION: Due to COVID-19, many patients with DM faced challenges accessing healthcare, as well as exacerbations of socioeconomic disparities regarding access to food, affordable housing, and safe places to exercise. To address these challenges, we adapted an existing student-faculty collaborative practice at Beth Israel Deaconess Medical Center, Boston, MA, to a telehealth platform to provide targeted DM management, and referrals to dietitians and community resource specialists. MEASURES OF SUCCESS: We assessed clinical outcomes, such as changes in hemoglobin A1c (HbA1c), LDL, and number of medication adjustments. Measured quality indicators included frequency of HbA1c, LDL, and microalbuminuria measurements, as well as prescription of cardiovascular/diabetic medications such as ACE inhibitors, statins, and aspirin within the year prior to enrollment and within 6 months after the final visit. To measure the role and intervenability of SDOH needs, we tracked the results of SDOH screens to identify key needs, as well as the number of dietitian and community resource specialist (CRS) referrals placed. FINDINGS TO DATE: Of 998 patients with non-insulin-dependent type 2 DM, 60 were enrolled in the program, of whom 42% were white and had a median BMI of 32.0 kg/m2 (IQR 28.3-36.1). Patients endorsed high motivation (8/10) and confidence (7/10) in managing their diabetes, but reported inadequate nutrition education (56.7% of cohort), as well as difficulty maintaining a healthy diet (76.7%) and exercising (78.3%). Analysis of baseline data and for those who completed the program thus far (n = 22, >6 months since last clinic visit), showed a significant decrease in mean HbA1c (mean ±SEM) from 8.72±0.15 to 8.09±0.22 (p = 0.03). LDL levels were not significantly different before and after the program, 90.3±5.4 vs 100.9±10.6 (p = 0.42). Lab draw frequency (HbA1c, LDL) and medication prescription (ACE inhibitors, statin, aspirin) and were not significantly different. Of patients who completed the program, 8 (36.4%) had their diabetes medications adjusted. 2 (9.1%) were referred to a CRS, and 2 (9.1%) were referred to a dietitian. KEY LESSONS FOR DISSEMINATION: Our ongoing study showed that the implementation of a telehealth diabetes program with SDOH screening can be an effective way to assist patients with uncontrolled diabetes. We identified significant patient needs for additional support and clinical care. Assessing socioeconomic burdens faced by patients and understanding the impact and key features of such a collaborative telehealth program can pave the way for the implementation of a similar model of care for other chronic conditions.
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Pedestrian infrastructures in Hong Kong enable multilevel city life in a vertical metropolis plagued by land scarcity. Public spaces integrated into pedestrian networks play an indispensable role in neighbourhood accessibility. We visualize the impact of the Covid-19 vaccine passport (VP) restrictions on the use of public space on pedestrian accessibility to all 97 metro stations in Hong Kong. Pedestrians without a vaccine passport (PwoVP) need to walk significantly longer alternative routes. Specifically, VP-related access restrictions to indoor walkways have doubled the shortest travel time for PwoVP and a 50% reduction in accessibility of two-thirds of stations.
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Currently the whole world is going through an epidemiological crisis due to Covid-19, a virus which has a greater impact on people who are overweight or obese. Obesity represents a risk factor for serious illness and death from COVID-19. There is an enzyme that converts angiotesin-2, which is an enzyme that SARS-CoV-2 uses for entry at the cellular level, it is found in higher amounts in people with obesity. Among the group of people who can suffer from obesity are adolescents, who do not always maintain healthy eating habits or perform physical activities. In this research, a mobile application is presented to control and monitor the patient's body mass index according to their weight and height, making it known if they have obesity or any variant. In addition, it allows the patient to know the appropriate portions of daily food and to keep an own control of their physical activities and a history of their meals. That is why the objective of this research is to determine the impact that a mobile application can have on the obesity prevention process in adolescents. This study was carried out in Lima in 56 adolescents from 10 to 19 years old, in which 44.6% managed to improve their condition and 26.7% managed to stay in a normal condition.
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The COVID-19 pandemic has placed an unprecedented burden on the healthcare system, disrupting routine care including breast cancer screening. We used data from 2392 women without a history of breast cancer enrolled in the Boston Mammography Cohort Study (BMCS) to investigate whether subgroups defined by age, race, or family history of breast cancer: 1) experienced greater declines in screening or diagnostic imaging during the lockdown;or 2) had slower rebound during reopening. In this interrupted time series analysis, we used Poisson regression with robust standard errors to model expected monthly rates of breast cancer screening and diagnostic imaging from January 2019 through December 2020. We defined the pre-COVID-19 period as January 1, 2019, to February 29, 2020;the lockdown period as March 1 to May 30, 2020;and the reopening period as June 1 to December 31, 2020. We examined changes in trends overall and tested for the difference in trends by age (<50 vs ≤50), race (white vs non-white), and first-degree family history of breast cancer (yes or no). The mean monthly rate of breast cancer screening in the BMCS cohort was 45 per 1000 people during the pre-COVID-19 period, 7 per 1000 people during the lockdown period, and 50 per 1000 people during the reopening period. The mean monthly rate of breast cancer diagnostic imaging was 6 per 1000 people during the pre-COVID-19 period, 3 per 1000 people during the lockdown period, and 6 per 1000 people during the reopening period. During the pre-COVID-19 period, those who are age 50 or older had 5.3% higher monthly trend in breast cancer screening rates (p=0.005) and 9.8% higher monthly trend in diagnostic imaging rates (p=0.0389). During the lockdown period, those who were age 50 or older had a lower monthly trend in breast cancer screening rates compared to those who were younger than 50 (p<0.0001), while those who were white and those with family history have higher monthly trends of breast cancer screening rates compared to their respective counterparts (p<0.0001). During the reopening phase, those who are age 50 or older have 18.5% lower monthly trend in breast cancer screening rates in comparison to those who are younger than 50 (p=0.0008) and those who were white have 36.2% higher monthly trend in breast cancer diagnostic procedure rates in comparison to those who are non-white (p=0.018). Overall, we observed a significant decline in breast cancer screening rates with the advent of the COVID-19 pandemic. For the most part, screening and diagnostic imaging rates during the reopening phase equaled or exceeded those of the pre-COVID-19 period. However, the rate of return to screening was lower in women age 50 or older and the rebound in diagnostic imaging was lower in nonwhite women. Careful attention must be paid as the COVID-19 recovery continues to ensure equitable resumption of care. Future work will examine other factors including insurance status, breast cancer risk scores, and geographic location.
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Ever since the COVID-19 pandemic started in Wuhan, China, much research work has been focusing on the clinical aspect of SARS-CoV-2. Researchers have been leveraging on various Artificial Intelligence techniques as an alternative to medical approach in understanding the virus. Limited studies have, however, reported on COVID-19 transmission pattern analysis, and using geography features for prediction of potential outbreak sites. Predicting the next most probable outbreak site is crucial, particularly for optimizing the planning of medical personnel and supply resources. To tackle the challenge, this work proposed distance-based similarity measures to predict the next most probable outbreak site together with its magnitude, when would the outbreak likely to happen and the duration of the outbreak. The work began with preprocessing of 1365 patient records from six districts in the most populated state named Selangor in Malaysia. The dataset was then aggregated with population density information and human elicited geography features that might promote the transmission of COVID-19. Empirical findings indicated that the proposed unified decision-making approach outperformed individual distance metric in predicting the total cases, next outbreak location, and the time interval between start dates of two similar sites. Such findings provided valuable insights for policymakers to perform Active Case Detection. © 2021 Tech Science Press. All rights reserved.
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Introduction and Objectives Descriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- A nd outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic. Methods A retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust. Results Overall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall postdischarge. Conclusions Whilst clinical features, course of illness and inhospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients' delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.
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During the outbreak of COVID-19, this paper aimed to discuss its potential risks on reproductive health, which was underpinned by the virus, drugs, disinfectants and psychological problems. The literatures review on previous and latest studies showed that COVID-19 may have potential effects on both men's and women's reproductive systems;that contraception should be recommended during antiviral treatment and for at least eight months after the end of antiviral treatment, but there is no evidence to support the termination of pregnancy without medical indicators during early pregnancy;and that chlorine disinfectants are not recommended for assisted reproduction laboratories. Medical professionals should make a comprehensive assessment according to the patient's fertility needs, disease status and psychological level, in order to provide reasonable fertility guidance and counselling. © 2020 Chinese Medical Association
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Introduction and ObjectivesDescriptions of clinical characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19), their clinical course and short-term in- and outpatient outcomes in deprived urban populations in the United Kingdom is still relatively sparse. We describe the epidemiology, clinical course, experience of non-invasive ventilation and intensive care, mortality and short-term sequalae of patients admitted to two large District General Hospitals across a large East London NHS Trust during the first wave of the pandemic.MethodsA retrospective analysis was carried out on a cohort of 1,946 patients admitted to two hospital sites during the first UK wave of the pandemic, including descriptive statistics and survival analysis. A more detailed analysis was undertaken of a subset of patients admitted across three Respiratory Units in the trust.ResultsOverall survival and rates of transfer to critical care are comparable to data from other urban centers. Increasing age, male sex and Asian ethnicity were associated with worse outcomes. Increasing severity of chest X-ray abnormalities trended with mortality. Radiological changes persisted in over 50% of cases at early follow up (6 weeks). Ongoing symptoms including hair loss, memory impairment, breathlessness, cough and fatigue were reported in 67% of survivors, with 42% of patients unable to return to work due to ongoing symptoms. At 12-week follow up, 5 patients out of 109 followed up required treatment for pneumonitis with 2 requiring re-admission. Associated complications such as MI, PE and CVA were seen in less than 2% overall post-discharge.ConclusionsWhilst clinical features, course of illness and in-hospital outcomes are broadly in line with published literature, our initial follow up data suggest there are ongoing sequalae of COVID-19 including, persistent symptoms and radiological abnormalities. These data highlight the ongoing need for localized pathways to provide physical, emotional and psychological support these patients. There are also potential economic ramifications from these patients’ delayed return to work. Further data, including longer term follow up data, are necessary to improve our understanding of this novel pathogen and associated disease.
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Background: Numerous descriptive studies of COVID-19 have been undertaken in countries around the world describing local experiences including China, Italy and America. Aims: To better understand the impact of the first UK peak of the COVID-19 pandemic on the local population, and whether findings of international data were applicable to the population served by a large London NHS Trust. Methods: We performed a retrospective cohort study from 10/03/20-26/04/20 of 215 adult patients with confirmed/clinically suspected COVID-19 admitted to 3 acute respiratory wards, collecting patient demographics, laboratory and imaging findings, progress during admission and outcome including discharge or death. Results: 209 patients were included in the final analysis. Most patients were male (66.0%). Median age was 66 years and increasing age decreased survival probability (p<0.001). Median length of stay was 9 days (IQR 5-15). Most patients were of white ethnicity (57%);36% (n=75) were from BAME groups and 8% from other (n=16). The severity of bilateral opacification of chest X ray on admission trended with mortality (p = 0.0248). 64 (33%) had diabetes, 30 (15%) were obese and 36% (n=70) had underlying lung disease. A high number of patients had a clinical frailty score >5 (64.6%). 29% (n=44) of patients required non-invasive ventilation, of which 45% required transfer to ITU. Conclusion: Our cohort of patients with severe disease mirrors existing data that older, more comorbid, male patients were more likely to be affected. Severity of radiological findings correlated with mortality. The higher proportion of patients of white ethnicity highlights the need for ongoing study into local variation of disease.
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Background: There is a growing body of literature on COVID-19 suggesting decreased survival with increasing age, in black and minority ethnic patients (BAME), and with comorbidities such as diabetes mellitus and obesity. Aims: To evaluate whether these risk factors were relevant in a cohort of COVID-19 patients admitted to a large North East London NHS trust serving 3 boroughs with a highly diverse population. Method: Data was collected for 215 patients from 10/03/2020-26/04/2020 for retrospective analysis. 209 patients with confirmed or clinically suspected COVID-19 admitted to 3 respiratory wards were included in the final analysis. Results: Most patients were male (66.0%). 77 patients died during the data collection period (32%). 32.4% of patients had pre-existing diabetes, and 14.4% had pre-existing obesity. 118 patients were of White ethnicity (56.5%), 43 Asian (20.6%), 28 Black (13.4%), 4 Mixed (1.9%) and 16 Other (7.7%). In a Cox proportional hazards model, there was a significant difference in survival for patients >65 years old (HR 6.12, 2.20-17.1, p < 0.001). There was a no significant difference in survival for patients based on sex, pre-existing diabetes, obesity or ethnicity. Conclusion: In contrast to international data and despite serving a population with rich ethnic diversity, COVID-19 infection in our cohort was most prevalent in white patients. The unchanged survival between white and BAME groups may reflect the high measures of deprivation in the local population. To better understand these findings continued investigation into the local demographics and variations are critical to stratify risk and to help plan for further peaks in the pandemic.
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Coronavirus disease 2019 (COVID-19) has been a pandemic worldwide. The data about COVID-19 in renal transplant recipient is deficiency. Herein we report two COVID-19 cases in renal transplant recipients. Both cases were discharged following a treatment regimen including discontinued immunosuppressant and low-dose methylprednisolone-based therapy. There were no signs of rejection during the treatment. These successfully treated cases can provide helpful information about the management of COVID-19 in renal transplant recipients.