Résumé
Ecological studies suggested a link between air pollution and severe COVID-19 outcomes, while studies accounting for individual-level characteristics are limited. In the present study, we aimed to investigate the impact of short-term ambient air pollution exposure on disease severity among a cohort of 569 laboratory confirmed COVID-19 patients admitted to designated hospitals in Zhejiang province, China, from January 17 to March 3, 2020, and elucidate the possible biological processes involved using transcriptomics. Compared with mild cases, severe cases had higher proportion of medical conditions as well as unfavorable results in most of the laboratory tests, and manifested higher air pollution exposure levels. Higher exposure to air pollutants was associated with increased risk of severe COVID-19 with odds ratio (OR) of 1.89 (95% confidence interval (CI): 1.01, 3.53), 2.35 (95% CI: 1.20, 4.61), 2.87 (95% CI: 1.68, 4.91), and 2.01 (95% CI: 1.10, 3.69) for PM2.5, PM10, NO2 and CO, respectively. OR for NO2 remained significant in two-pollutant models after adjusting for other pollutants. Transcriptional analysis showed 884 differentially expressed genes which mainly were enriched in virus clearance related biological processes between patients with high and low NO2 exposure levels, indicating that compromised immune response might be a potential underlying mechanistic pathway. These findings highlight the impact of short-term air pollution exposure, particularly for NO2, on COVID-19 severity, and emphasize the significance in mitigating the COVID-19 burden of commitments to improve air quality. © 2022
Résumé
INTRODUCTION: New Medicare Benefits Schedule (MBS) telehealth item codes were added in 2020 to allow Australians to gain access to medical services during COVID-19 lockdown restrictions. Previous studies have been conducted on the utilisation of specific MBS item codes however none have been conducted on all medical practitioner telehealth item codes. OBJECTIVE: This retrospective epidemiological analysis aims to determine the utilisation rate of newly introduced medical practitioner telehealth MBS item codes and compare them with the usage of existing in-person item codes METHODS: The utilisation of 319 MBS item codes were extracted from the Medicare Statistics Database between March 2020 to March 2021. Using count and population statistics a population adjusted rate was generated and a linear regression analysis undertaken. RESULTS: A total of 199,059,309 in-person and telehealth services (Male, n=84,007,935;42.2%, Female, n=115,051,374;57.8%) were utilised during the study period. 147,697,104 were in-person compared to 51,191,898 telehealth services. In-person usage decreased by 27.5% while telehealth increased by 358.8%. In-person utilisation increased by 32.4% as the year continued while the telehealth utilisation decreased by 40.7%. There was a non-significant increase in total in-person item code utilisation (p=0.76) and a non-significant decrease (p=0.32) in the total telehealth item codes used CONCLUSION: There was initially increased usage of telehealth especially during lockdown restrictions. However, when lockdowns eased, usage of telehealth decreased while in-person increased. Regardless, telehealth item codes continued to be used despite changes to eligibility criteria and lockdown restrictions easing. Hence, it appears that patients are accepting of telehealth as a healthcare delivery method.
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Introduction: Teledentistry has allowed for the provision of dental care remotely. It has benefitted people living in regional, rural and remote communities. The use of teledentistry rapidly increased during the COVID-19 pandemic to minimise transmission risk while still allowing for the provision of care, especially during mandated lockdowns. Aim: This study aims to pilot and assess the validity of a questionnaire developed to understand early career dental practitioners’ opinions regarding teledentistry in Australia. Method: Registered early career dental practitioners currently working in Australia were invited to participate. Participants were asked to respond to a series of questions regarding teledentistry on themes containing diagnosis, accessibility, patient care, technology and finances. In addition, participants were asked for feedback upon the conclusion of the questionnaire. Results: A total of 23 dental practitioners (60% female, age range 20–34) participated in this study. Work experiences ranged from 0–10 years. A total of 18 participants worked in metropolitan areas, while five worked in regional areas. All participants used teledentistry for approximately 1–9 hours per week. Over 82% of participants believed that telehealth was effective for consultations, and over 90% believed it was more convenient than face-to-face consultations. However, over 78% believed teledentistry was ineffective for diagnosing complex dental cases. Over 95% of participants believed that teledentistry improved patient healthcare access and was beneficial during the coronavirus (COVID-19) pandemic. All participants believed that teledentistry was a useful tool for post-operative care, and over 86% of participants felt that patients accepted teledentistry. Conclusion: This questionnaire effectively determines the utilisation of teledentistry during a global pandemic from the perspective of early career dental practitioners. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
Résumé
Ecological studies suggested a link between air pollution and severe COVID-19 outcomes, while studies accounting for individual-level characteristics are limited. In the present study, we aimed to investigate the impact of short-term ambient air pollution exposure on disease severity among a cohort of 569 laboratory confirmed COVID-19 patients admitted to designated hospitals in Zhejiang province, China, from January 17 to March 3, 2020, and elucidate the possible biological processes involved using transcriptomics. Compared with mild cases, severe cases had higher proportion of medical conditions as well as unfavorable results in most of the laboratory tests, and manifested higher air pollution exposure levels. Higher exposure to air pollutants was associated with increased risk of severe COVID-19 with odds ratio (OR) of 1.89 (95% confidence interval (CI): 1.01, 3.53), 2.35 (95% CI: 1.20, 4.61), 2.87 (95% CI: 1.68, 4.91), and 2.01 (95% CI: 1.10, 3.69) for PM2.5, PM10, NO2 and CO, respectively. OR for NO2 remained significant in two-pollutant models after adjusting for other pollutants. Transcriptional analysis showed 884 differentially expressed genes which mainly were enriched in virus clearance related biological processes between patients with high and low NO2 exposure levels, indicating that compromised immune response might be a potential underlying mechanistic pathway. These findings highlight the impact of short-term air pollution exposure, particularly for NO2, on COVID-19 severity, and emphasize the significance in mitigating the COVID-19 burden of commitments to improve air quality.
Résumé
Introduction: Telehealth usage increased especially in the coronavirus pandemic. Objective: To determine whether oral and maxillofacial surgeons (OMS) believe that telehealth is an adequate substitute for in-person consultations. Methods: OMS were interviewed. These were transcribed and themes and subthemes coded. Quotes were selected to create narratives about themes and subthemes and a frequency table generated. Results: 20 OMS were interviewed. There were 200 positive, 215 negative, 9 neutral and 256 unstated comments. Major themes were diagnosis, accessibility, patient-centred care, technology and finances. 34 sub-themes were identified. OMS were most satisfied with accessibility and most dissatisfied with diagnosis. Conclusion: OMS had mixed opinions regarding telehealth. While it can improve access, the technology, interventional capacity and diagnostic ability are limited. Face-to-face was preferred. Further studies are required to improve telehealth.
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Understanding the transmission mechanism of SARS-CoV-2 is a prerequisite to effective control measures. To investigate the potential modes of SARS-CoV-2 transmission, 21 COVID-19 patients from 12-47 days after symptom onset were recruited. We monitored the release of SARS-CoV-2 from the patients' exhaled breath and systematically investigated environmental contamination of air, public surfaces, personal necessities, and the drainage system. SARS-CoV-2 RNA was detected in 0 of 9 exhaled breath samples, 2 of 8 exhaled breath condensate samples, 1 of 12 bedside air samples, 4 of 132 samples from private surfaces, 0 of 70 samples from frequently touched public surfaces in isolation rooms, and 7 of 23 feces-related air/surface/water samples. The maximum viral RNA concentrations were 1857 copies/m3 in the air, 38 copies/cm2 in sampled surfaces and 3092 copies/mL in sewage/wastewater samples. Our results suggest that nosocomial transmission of SARS-CoV-2 can occur via multiple routes. However, the low detection frequency and limited quantity of viral RNA from the breath and environmental specimens may be related to the reduced viral load of the COVID-19 patients on later days after symptom onset. These findings suggest that the transmission dynamics of SARS-CoV-2 differ from those of SARS-CoV in healthcare settings.
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Previous studies on the pneumonia outbreak caused by the 2019 novel coronavirus disease (COVID-19) were mainly based on information from adult populations. Limited data are available for children with COVID-19, especially for infected infants. We report a 55-day-old case with COVID-19 confirmed in China and describe the identification, diagnosis, clinical course, and treatment of the patient, including the disease progression from day 7 to day 11 of illness. This case highlights that children with COVID-19 can also present with multiple organ damage and rapid disease changes. When managing such patients, frequent and careful clinical monitoring is essential.