Implications from COVID-19 for future pandemic global health governance

BACKGROUND

Limitations of current global health governance revealed during the COVID-19 pandemic can inform the ongoing deliberations of an international treaty on pandemics.

OBJECTIVES

To report on WHO definitions for governance and the enforcement of treaties in the context of a proposed international treaty on pandemics.

SOURCES

This narrative review was based on keyword searches related to public health, global health governance, and enforcement in PubMed/Medline and Google Scholar. Snowballing for additional articles followed the keyword search review.

CONTENT

WHO lacks a consistent definition of global health governance. Moreover, in its current state, the proposed international treaty on pandemics lacks articulated compliance, accountability, or enforcement mechanisms. Findings reveal that humanitarian treaties often fail to achieve their aims absent clear enforcement mechanisms. The proposed international treaty on public health is garnering a range of perspectives. Decision-makers should evaluate whether a globally aligned definition of global health governance is needed. Decision-makers should also consider whether the proposed international treaty on pandemics should be opposed if it lacks sufficiently clear compliance, accountability, and enforcement mechanisms.

IMPLICATIONS

To our knowledge, this narrative review is believed to be the first of its kind to search scientific-oriented databases regarding governance and international pandemic treaties. The review includes several findings that advance the literature. These findings, in turn, reveal two key implications for decision-makers. First, whether an aligned definition for governance addressing compliance, accountability, and enforcement mechanisms is needed. Second, whether a draft treaty lacking enforcement mechanisms should be approved.

Breast and cervical cancer programs' success in maintaining screening during periods of high COVID-19: A qualitative multi-case study analysis

Objective

During the first year of the COVID-19 pandemic, most of the Centers for Disease Control and Prevention (CDC)'s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) funded programs (recipients) experienced significant declines in breast and cervical cancer screening volume. However, 6 recipients maintained breast and/or cervical cancer screening volume during July-December 2020 despite their states' high COVID-19 test percent positivity. We led a qualitative multi-case study to explore these recipients' actions that may have contributed to screening volume maintenance.

Methods

We conducted 22 key informant interviews with recipients, screening provider sites, and partner organizations. Interviews explored organizational and operational changes; screening barriers; actions taken to help maintain screening volume; and support for provider sites to continue screening. We documented contextual factors that may have influenced these actions, including program structures; clinic capacity; and state COVID-19 policies.

Results

Thematic analysis revealed crosscutting themes at the recipient, provider site, and partner levels. Recipients made changes to administrative processes to reduce burden on provider sites and delivered tailored technical assistance to support safe screening. Provider sites modified clinic protocols to increase patient safety, enhanced patient reminders for upcoming appointments, and increased patient education on the importance of timely screening during the pandemic. Partners worked with provider sites to identify and reduce patients' structural barriers to screening.

Conclusion

Study findings provide lessons learned to inform emergency preparedness-focused planning and operations, as well as routine operations for NBCCEDP recipient programs, other cancer screening initiatives, primary care clinics, and chronic disease prevention programs.

Changes in food sufficiency among Korean adults in urban and rural areas during the COVID-19 pandemic: an analysis of the 7th and 8th Korea National Health and Nutrition Examination Survey

Objectives

Understanding changes in food sufficiency within various demographic groups during emergency situations, such as the global coronavirus disease 2019 (COVID-19) pandemic, is crucial in formulating public health policies for future preparedness. This study investigated potential differences between urban and rural residents in food sufficiency trends during the COVID-19 pandemic and examined how these changes varied according to sociodemographic factors.

Methods

This cross-sectional study analyzed data from 19,724 adults aged 20 years and older, utilizing information from the 7th-8th Korea National Health and Nutrition Examination Survey (2018-2021).

Results

In urban areas, across all subpopulations, food sufficiency improved significantly during the COVID-19 period relative to pre-pandemic levels (p<0.001). However, in rural regions, a significant increase in food sufficiency during the COVID-19 era was observed only among women, with an odds ratio of 1.42 (confidence interval, 1.06 to 1.89). Nevertheless, no significant interaction terms were found between region and various sociodemographic factors regarding changes in food sufficiency during the COVID-19 period.

Conclusion

During the COVID-19 pandemic, food sufficiency among urban residents improved compared to the pre-pandemic era, whereas their rural counterparts saw no such improvement. Additionally, no significant interaction was detected between urban versus rural areas and changes in food sufficiency during the COVID-19 period. These findings indicate the need for targeted food policies to prepare for potential future pandemics, particularly in rural areas, where food sufficiency did not improve.

Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review

BACKGROUND

The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning.

AIM

The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic.

METHODS

This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google.

RESULTS

Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication.

DISCUSSION

Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment.

CONCLUSION

There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.

Emergency department responses to nursing shortages

BACKGROUND

The COVID-19 pandemic exacerbated the nursing shortage, which is predicted to continue to worsen with significant numbers of nurses planning to retire within the next 5 years. There remains a lack of published information regarding recommended interventions for emergency departments (EDs) facing a sudden nursing shortage.

METHODS

We queried emergency department leaders from the American College of Emergency Physicians to examine the impact of nursing shortages on EDs and to gather real-world interventions employed to mitigate the effects of the shortage.

RESULTS

Most respondents (98.5%) reported nursing shortages, with 83.3% describing prolonged shortages lasting more than 12 months, with negative impacts such as misses/near-misses (93.9%) and increasing left without being seen rates (90.9%). ED leaders reported a range of interventions, including operational flow changes, utilizing alternative staff to fill nurse roles, recruitment of new nurses, and retention strategies for existing nurses. They employed temporary and permanent pay increases as well as efforts to improve the ED work environment and techniques to hire new nurses from atypical pipelines.

CONCLUSION

We report a patchwork of solutions ED leaders utilized which may have variable efficacy among different EDs; personalization is essential when selecting interventions during a sudden nursing shortage.

Strengthening global health security through health early warning systems: A literature review and case study

Disease transmission is dependent on a variety of factors, including the characteristics of an event, such as crowding and shared accommodations, the potential of participants having prolonged exposure and close contact with infectious individuals, the type of activities, and the characteristics of the participants, such as their age and immunity to infectious agents [1-3]. Effective control of outbreaks of infectious diseases requires rapid diagnosis and intervention in high-risk settings. As a result, syndromic and event-based surveillance may be used to enhance the responsiveness of the surveillance system [1]. In public health, surveillance is collecting, analyzing, and interpreting data across time to inform decision-making and aid policy implementation [1]. In this review article we aimed to provide an overview of the principles, types, uses, advantages, and limitations of surveillance systems and to highlight the importance of early warning systems in response to the information received by disease surveillance. The study conducted a comprehensive literature search using several databases, selecting, and reviewing 78 articles that covered different types of surveillance systems, their applications, and their impact on controlling infectious diseases. The article also presents a case study from the Hajj gathering, which highlighted the development, evaluation, and impact of early warning systems on response to the information received by disease surveillance. The study concludes that ongoing disease surveillance should be accompanied by well-designed early warning and response systems, and continuous efforts should be invested in evaluating and validating these systems to minimize the risk of reporting delays and reducing the risk of outbreaks.

Monthly Analysis of Infant Mortality Rate in Portugal during the COVID-19 Pandemic: Insights from Continuous Monitoring

INTRODUCTION

The COVID-19 pandemic significantly impacted global public health. Infant mortality rate (IMR), a vital statistic and key indicator of a population's overall health, is essential for developing effective health prevention programs. Existing evidence primarily indicates a decrease in IMR during the COVID-19 pandemic. We conducted a national-level analysis to calculate IMR and describe its course over the years (from 2016 until 2022), using a month-by-month analysis.

METHODS

Data on the number of deaths under one year of age was collected from the Portuguese E-Death Certification System (SICO), and data on the number of monthly live births was obtained from Statistics Portugal. The IMR was calculated per month, considering the previous 12 months' cumulative number of deaths under one year of age and the number of live births.

RESULTS

In Portugal, the IMR decreased before and during the COVID-19 pandemic. The lowest values were observed in September and October 2021 (2.15 and 2.14 per 1000 live births, respectively). The IMR remained below the threshold of three deaths per 1000 live births during the pandemic's critical period.

CONCLUSION

Portugal has achieved remarkable progress in reducing its IMR over the last 60 years. The country recorded its lowest-ever IMR values during the COVID-19 pandemic. Further studies are needed to fully understand the observed trends.

Which roads lead to access? A global landscape of six COVID-19 vaccine innovation models

BACKGROUND

Unequal and inequitable access to Covid-19 vaccines in low- and middle-income countries (L&MICs) was a major political, ethical and public health failure in the pandemic. However, vaccine developers' practices were not monolithic, but rather, took diverse approaches to supplying different countries, with important implications for global access.

RESULTS

Using data on R&D investments, regulatory approvals, manufacturing and purchase agreements, and vaccine deliveries, we identified six distinct innovation models that apply across the 14 COVID-19 vaccines with more international presence from 2020-2022. "Western Early Arrivers" Pfizer/BioNTech and Moderna supplied the largest volumes quickly and prioritized high-income countries (HICs) from registration to vaccine delivery. "Western Latecomers" Janssen and Novavax supplied intermediate volumes later, also prioritizing HICs but with a greater proportion to L&MICs. "Major Chinese Developers" Sinopharm and Sinovac supplied intermediate volumes early, primarily to middle-income countries (MICs). "Russian Developer" Gamaleya completed development early but ultimately supplied small volumes, primarily to middle-income countries (MICs). "Cosmopolitan Developer" Oxford/AstraZeneca supplied large volumes early to HICs and MICs at the lowest prices. Finally, "Small MIC Developers" CanSino, Bharat Biotech, Medigen, Finlay Institute and the Center for Genetic Engineering and Biotechnology (CGEB), exported relatively small volumes to a few MICs. Low-income countries (LICs) were not targeted by any developer, and received far fewer doses, later, than any other income group. Almost all developers received public funding and other forms of support, but we found little evidence that such support was leveraged to expand global access.

CONCLUSIONS

Each of the six innovation models has different implications for which countries get access to which vaccines, how quickly, and at which prices. Each offers different strengths and weaknesses for achieving equitable access. Our findings also suggest that Western firms had the greatest capacity to develop and deliver vaccines quickly during the pandemic, but such capacity is rapidly becoming more globally distributed with MICs playing a significant role, especially in supplying other MICs. Given the critical role of public support in enabling pandemic vaccine development and supply, governments have both the capacity and responsibility to craft international rules that will make responses to future pandemics more equitable and effective.

Health of singleton neonates in Switzerland through time and crises: a cross-sectional study at the population level, 2007-2022

BACKGROUND

Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic.

METHODS

Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy.

RESULTS

Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret.

CONCLUSION

Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.

Validation of the Pandemic Grief Risk Factors and Its Relationship With Work-Related Stress and Grief Reaction Among Healthcare Workers Who Witnessed Patient Deaths

BACKGROUND

The Pandemic Grief Risk Factors (PGRFs) was developed as a self-report tool to compile a comprehensive list of unique risk factors related to grief when experiencing a coronavirus disease 2019 (COVID-19) loss. We explored the reliability and validity of the PGRF among healthcare workers who witnessed their patients' deaths during the COVID-19 pandemic. Further, we examined whether the general severity of PGRF may have been associated with work-related stress and pandemic grief reactions.

METHODS

An online survey was conducted among tertiary hospital healthcare workers (doctors and nursing professionals) who had witnessed the deaths of patients they cared for. Pandemic Grief Scale for healthcare workers, the Stress and Anxiety to Viral Epidemics-3 items, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 responses were collected.

RESULTS

In total, 267 responses were analyzed. The single-factor structure of the Korean version of the PGRF showed a good fit for the model. The scale demonstrated good internal consistency and convergent validity with other depression and anxiety rating scales. The mediation analysis revealed that work-related stress directly influenced pandemic grief reactions positively, and depression, anxiety, and general severity of grief risk factors partially mediated the association positively.

CONCLUSION

Among healthcare workers who witnessed the deaths of their patients due to COVID-19, the Korean version of the PGRF was valid and reliable for measuring the overall severity of PGRF. The PGRF can be used to identify individuals at risk for dysfunctional grief.

Progress with the Learning Health System 2.0: a rapid review of Learning Health Systems' responses to pandemics and climate change

BACKGROUND

Pandemics and climate change each challenge health systems through increasing numbers and new types of patients. To adapt to these challenges, leading health systems have embraced a Learning Health System (LHS) approach, aiming to increase the efficiency with which data is translated into actionable knowledge. This rapid review sought to determine how these health systems have used LHS frameworks to both address the challenges posed by the COVID-19 pandemic and climate change, and to prepare for future disturbances, and thus transition towards the LHS2.0.

METHODS

Three databases (Embase, Scopus, and PubMed) were searched for peer-reviewed literature published in English in the five years to March 2023. Publications were included if they described a real-world LHS's response to one or more of the following: the COVID-19 pandemic, future pandemics, current climate events, future climate change events. Data were extracted and thematically analyzed using the five dimensions of the Institute of Medicine/Zurynski-Braithwaite's LHS framework: Science and Informatics, Patient-Clinician Partnerships, Continuous Learning Culture, Incentives, and Structure and Governance.

RESULTS

The search yielded 182 unique publications, four of which reported on LHSs and climate change. Backward citation tracking yielded 13 additional pandemic-related publications. None of the climate change-related papers met the inclusion criteria. Thirty-two publications were included after full-text review. Most were case studies (n = 12, 38%), narrative descriptions (n = 9, 28%) or empirical studies (n = 9, 28%). Science and Informatics (n = 31, 97%), Continuous Learning Culture (n = 26, 81%), Structure and Governance (n = 23, 72%) were the most frequently discussed LHS dimensions. Incentives (n = 21, 66%) and Patient-Clinician Partnerships (n = 18, 56%) received less attention. Twenty-nine papers (91%) discussed benefits or opportunities created by pandemics to furthering the development of an LHS, compared to 22 papers (69%) that discussed challenges.

CONCLUSIONS

An LHS 2.0 approach appears well-suited to responding to the rapidly changing and uncertain conditions of a pandemic, and, by extension, to preparing health systems for the effects of climate change. LHSs that embrace a continuous learning culture can inform patient care, public policy, and public messaging, and those that wisely use IT systems for decision-making can more readily enact surveillance systems for future pandemics and climate change-related events.

TRIAL REGISTRATION

PROSPERO pre-registration: CRD42023408896.

Pandemic Effects on Stability of End-of-Life Preferences and Patient-Surrogate Dyad Congruence

CONTEXT

Whether a largescale disaster alters people's previous decisions about their end-of-life care is unknown.

OBJECTIVES

We examined the effects of a disaster, the COVID-19 pandemic, on stability of end-of-life care preferences among dialysis patients and on patient-surrogate goals-of-care congruence.

METHODS

We used a natural experimental design to examine goals-of-care preferences pre- and postexposure to the pandemic during a pragmatic trial testing SPIRIT (sharing patient's illness representations to increase trust), an evidence-based advance care planning (ACP) intervention. There were 151 patient-surrogate dyads who prior to the pandemic lockdown had completed baseline (T1) and postintervention assessments (T2) regarding their goals-of-care preferences in two end-of-life scenarios. Of those 151 dyads, 59 intervention, and 51 usual care dyads consented to be in the present study and completed the goals-of-care tool two additional times, at enrollment (T3) and six months later (T4), along with the COVID stress scale (CSS). Dyad congruence was ascertained by comparing patient and surrogate responses to the goals-of-care tool.

RESULTS

There were no changes over time in the proportions of patients who chose comfort-care-only in the goals-of-care tool. The proportion of patients who chose comfort-care-only and dyad congruence were higher in SPIRIT compared to usual care, but there was no interaction between that treatment effect and exposure to the pandemic. CSS was associated with neither patients' preferences nor dyad congruence.

CONCLUSIONS

The pandemic alone did not appear to influence patients' goals-of-care preferences or dyad congruence. This finding supports the stability of value-based end-of-life preferences in general, even during a disaster.

Increasing evolution, prevalence, and outbreaks for rift valley fever virus in the process of breaking geographical barriers

BACKGROUND

Rift valley fever (RVF) is listed as one of prioritized diseases by WHO. This study aims to describe RVF virus' landscape distribution globally, and to insight dynamics change of its evolution, prevalence, and outbreaks in the process of breaking geographical barriers.

METHODS

A systematic literature review and meta-analyses was conducted to estimate RVF prevalence by hosts using a random-effect model. Molecular clock-based phylogenetic analyses were performed to estimate RVF virus nucleotide substitution rates using nucleotide sequences in NCBI database. RVF virus prevalence, nucleotide substitution rates, and outbreaks were compared before and after breaking geographical barriers twice, respectively.

RESULTS

RVF virus was reported from 26 kinds of hosts covering 48 countries from 1930 to 2022. Since RVF broke geographical barriers, (1) nucleotide substitution rates significantly increased after firstly spreading out of Africa in 2000, (2) prevalence in humans significantly increased from 1.92 % (95 % CI: 0.86-3.25 %) to 3.03 % (95 % CI: 2.09-4.12 %) after it broke Sahara Desert geographical barriers in 1977, and to 5.24 % (95 % CI: 3.81-6.82 %) after 2000, (3) RVF outbreaks in humans and the number of wildlife hosts presented increasing trends. RVF virus spillover may exist between bats and humans, and accelerate viral substitution rates in humans. During outbreaks, the RVF virus substitution rates accelerated in humans. 60.00 % RVF outbreaks occurred 0-2 months after floods and (or) heavy rainfall.

CONCLUSION

RVF has the increasing risk to cause pandemics, and global collaboration on "One Health" is needed to prevent potential pandemics.

Holistic One Health Surveillance Framework: Synergizing Environmental, Animal, and Human Determinants for Enhanced Infectious Disease Management

Recent pandemics, including the COVID-19 outbreak, have brought up growing concerns about transmission of zoonotic diseases from animals to humans. This highlights the requirement for a novel approach to discern and address the escalating health threats. The One Health paradigm has been developed as a responsive strategy to confront forthcoming outbreaks through early warning, highlighting the interconnectedness of humans, animals, and their environment. The system employs several innovative methods such as the use of advanced technology, global collaboration, and data-driven decision-making to come up with an extraordinary solution for improving worldwide disease responses. This Review deliberates environmental, animal, and human factors that influence disease risk, analyzes the challenges and advantages inherent in using the One Health surveillance system, and demonstrates how these can be empowered by Big Data and Artificial Intelligence. The Holistic One Health Surveillance Framework presented herein holds the potential to revolutionize our capacity to monitor, understand, and mitigate the impact of infectious diseases on global populations.

The impact of COVID-19 on adult burns: A statewide review of epidemiology and clinical outcomes

INTRODUCTION

The COVID-19 pandemic has significantly impacted the clinical presentations of burns and the provision of services. This study aims to describe and analyse patterns and trends in adult burns across New South Wales (NSW) and the Australian Capital Territory.

METHODS

A NSW statewide retrospective review was conducted from 2017 to 2022 for adult patients with burns. A comparative analysis was performed for the COVID-19 group (2020-2022) and control group between 2017 and 2019.

RESULTS

We found a total of 11,433 patients (7102 non-COVID vs 4331 COVID-19). The average age in the COVID-19 group was 1.4 years older than counterparts (40.6 vs 42.0, p < 0.001). The 18 - 25 and 36 - 45 age groups experienced significantly lower proportions of presentations, whereas, the 76-85 years experienced significantly higher proportions. There was a significantly higher proportion of pressure injuries (0.1% vs 0.4%, p < 0.001) and contact burns (17.2% vs 18.7%), but lower explosions (1.3% vs 0.2%) for the COVID-19 group compared to their counterparts. The mean TBSA% was 0.4% greater in the COVID-19 group compared to their counterparts (2.4 vs 2.8, p < 0.001). There were significantly more operating sessions (0.2 vs 0.3, p < 0.001). The mean length of stay was significantly greater by 0.8 days for the COVID-19 group compared to their counterparts (1.5 vs 2.3, p < 0.001).

CONCLUSIONS

Epidemiological changes were not greatly different to previous years from the impact of COVID-19. The shift in elderly presentations and operative interventions reflects the holistic care of burns units working in a new landscape with an invigorated focus on telehealth and outpatient care.

The COVID-19 pandemic and changes in spatio-temporal patterns of suicide: monthly variations among localities in Argentina

The aim of this study was to assess space-time clustering of suicide in Argentina between 2017 and 2020. A spatio-temporal scan statistic using a space-time permutation model was employed to retrospectively detect clusters of total suicides by sex and by age group. From 2017 to 2020, six statistically significant spatio-temporal clusters were identified in Argentina with either more or less suicides than expected. Two clusters extended from May 2019 to July and September 2020, while the remaining four clusters were detected only during 2020. The start of the COVID-19 pandemic seems to have changed the spatio-temporal patterns of suicide in Argentina. Despite the national decrease in the number of suicides during 2020 compared to previous years, the spatio-temporal analysis revealed both areas with decreases and increases in suicide. This heterogeneous scenario highlights the need for the study of local effects behind the emergence of these spatio-temporal suicide clusters.

[Feasibility of clinical examination scenarios under pandemic conditions]

BACKGROUND

Due to the COVID-19 pandemic, contact restrictions occurred worldwide, which affected medical schools as well. It was not possible to hold classroom lectures. Teaching contents had to be converted to a digital curriculum within a very short time. Conditions for assessments posed an even greater challenge. For example, solutions had to be found for objective structured clinical examinations (OSCE), which were explicitly forbidden in some German states. The aim of this study was to evaluate the feasibility of an OSCE under pandemic conditions.

MATERIALS AND METHODS

At the end of the 2020 summer semester, 170 students completed a combined otolaryngology and ophthalmology OSCE. Examinations were held in small groups over the course of 5 days and complied with strict hygiene regulations. The ophthalmology exam was conducted face to face, and the ENT OSCE virtually. Students were asked to rate the OSCE afterwards.

RESULTS

Between 106 and 118 of the students answered the questions. Comparing the face-to-face OSCE with the virtual OSCE, about 49% preferred the face-to-face OSCE and 17% preferred the virtual OSCE; 34% found both variants equally good. Overall, the combination of an ENT and ophthalmology OSCE was rated as positive.

CONCLUSION

It is possible to hold an OSCE even under pandemic conditions. For optimal preparation of the students, among other things, it is necessary to transform teaching contents to a digital curriculum. The combination of an ENT and ophthalmology OSCE was positively evaluated by the students, although the face-to-face OSCE was preferred. The overall high satisfaction of the students confirms the feasibility of a virtual examination with detailed and well-planned preparation.

Differences between the true reproduction number and the apparent reproduction number of an epidemic time series

The time-varying reproduction number R(t) measures the number of new infections per infectious individual and is closely correlated with the time series of infection incidence by definition. The timings of actual infections are rarely known, and analysis of epidemics usually relies on time series data for other outcomes such as symptom onset. A common implicit assumption, when estimating R(t) from an epidemic time series, is that R(t) has the same relationship with these downstream outcomes as it does with the time series of incidence. However, this assumption is unlikely to be valid given that most epidemic time series are not perfect proxies of incidence. Rather they represent convolutions of incidence with uncertain delay distributions. Here we define the apparent time-varying reproduction number, RA(t), the reproduction number calculated from a downstream epidemic time series and demonstrate how differences between RA(t) and R(t) depend on the convolution function. The mean of the convolution function sets a time offset between the two signals, whilst the variance of the convolution function introduces a relative distortion between them. We present the convolution functions of epidemic time series that were available during the SARS-CoV-2 pandemic. Infection prevalence, measured by random sampling studies, presents fewer biases than other epidemic time series. Here we show that additionally the mean and variance of its convolution function were similar to that obtained from traditional surveillance based on mass-testing and could be reduced using more frequent testing, or by using stricter thresholds for positivity. Infection prevalence studies continue to be a versatile tool for tracking the temporal trends of R(t), and with additional refinements to their study protocol, will be of even greater utility during any future epidemics or pandemics.

Trends in emergency department visits for emergency care-sensitive conditions before and during the COVID-19 pandemic: a nationwide study in Korea, 2019-2021

OBJECTIVE

Emergency care systems worldwide have been significantly affected by the COVID-19 pandemic. This study investigated the trend of emergency department (ED) visits for emergency care-sensitive conditions (ECSCs) in Korea before and during the pandemic.

METHODS

We performed a longitudinal study using the national ED database in Korea from January 2019 to December 2021. We calculated the number and incidence rate of visits for ECSCs per 100,000 ED visits, and the incidence rate ratio of 2021 relative to the value in 2019. The selected ECSCs were intracranial injury, ischemic heart disease, stroke, and cardiac arrest.

RESULTS

The number of ED visits for all causes decreased by about 23% during the pandemic. The number of ED visits for intracranial injuries decreased from 166,695 in 2019 to 133,226 in 2020 and then increased to 145,165 in 2021. The number of ED visits for ischemic heart disease and stroke decreased in 2020 but increased to 2019 levels in 2021. In contrast, the number of ED visits for cardiac arrest increased from 23,903 in 2019 to 24,344 in 2020 and to 27,027 in 2021. The incidence rate and incidence rate ratio of these four ECSCs increased from 2019 to 2021, suggesting increasing relative proportions of ECSCs in total ED visits.

CONCLUSION

During the COVID-19 pandemic, the number of cardiac arrests seen in the EDs increased, but that of other ECSCs decreased. The decrease in ED visits for ECSCs was not as pronounced as the decrease in ED visits for all causes during the pandemic. Further studies are needed to determine clinical outcomes in patients with ECSC during the pandemic.

Are thoughts and behaviours of individuals with schizophrenia more susceptible to being influenced during pandemic situations? A glimpse provided by the COVID-19 pandemic

Individuals with psychotic disorders such as schizophrenia may be more vulnerable during pandemics, but research on this topic is limited. This study examined COVID-19 impact on a population affected by schizophrenia during the COVID-19 pandemic. Levels of psychological distress and COVID-19-related behaviours, from the COVID-related Thoughts and Behavioral Symptoms (Cov-Tabs) Scale, were compared between 107 patients with schizophrenia and 70 control participants. Participants with schizophrenia had significantly higher Cov-Tabs scores than non-clinical participants. These results suggest a higher vulnerability in this population, emphasising the need for targeted support and further assessment.

Barriers to accessing post-pregnancy contraception in Brazil: The impact of COVID-19

The aim of our article is to discuss barriers associated with post-pregnancy contraception in Brazil during the SARS-CoV-2 (COVID-19) pandemic. Socioeconomic differences in gaining access to long-acting reversible contraceptive (LARC) methods became greater during the COVID-19 pandemic. The inadequate distribution of existing resources and the reduced capacity for elective care meant that healthcare providers in family planning had to be reallocated to respond to COVID-19 emergencies. In Brazil, 74% of the population depends on the national health service (Sistema Unico de Saúde) including for the provision of free contraception. However, the only LARC method available at the public service is the copper-intrauterine device (IUD); implants and hormonal-IUDs are not available, except at some teaching hospitals. Contraceptive sales remained unmodified during the pandemic, which shows that the majority of the population used less effective or no contraceptive methods during this time. However, sales of implants and the hormonal-IUD increased significantly, indicating the inequity of the low-income portion of the society as only the wealthy can afford these. On the other hand, there was an increase in sales of emergency contraception. The uptake of postpartum IUDs and contraceptive implants at the selected teaching hospitals in which they were available was high during the COVID-19 pandemic as they were the only methods immediately available. In conclusion, the COVID-19 pandemic increased both inequality and social differences in gaining access to contraceptives. Postpartum and immediate post abortion methods were also good strategies during the pandemic and were well accepted by the population. However, they were not offered by most services.

The effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer

The COVID-19 pandemic placed a significant burden on healthcare resources, limiting care to emergent and essential services only. The objective of this study was to describe the effect of the COVID-19 pandemic on the diagnosis and progression of oral cancer lesions in Montreal, Canada. A retrospective analysis of health records was performed. Patients presenting for a new oncology consultation for an oral lesion suspicious for cancer between March 2018 and March 2022, within the Department of Oral and Maxillofacial Surgery of the McGill University Health Center, were included. Data was collected on sociodemographic characteristics, oral cancer risk behaviors of study participants, oral cancer delays, tumor characteristics, and clinical management. A total of 190 patients were included, 91 patients from the pre-pandemic period and 99 from the pandemic period. The demographic characteristics of the patients in the two periods were comparable. There was no significant difference in the patient, professional, or treatment delay between the two periods. There was a non-significant increase in pathologic tumor size during the pandemic, but the pathologic staging and postoperative outcomes were comparable to those of the pre-pandemic cohort. The results indicate that emergent care pathways for oral cancer treatment were efficiently maintained despite the pandemic shutdown of services.

Social Distance Warriors Should Not Be Regarded as Moral Exemplars in a Pandemic Nor as Paragons of Politeness: A Response to Shaw

In a recent article, Shaw contrasts his own supposed good behaviour, as that of a self-proclaimed "social distance warrior" with the alleged rude behaviour of one of his relatives, Jack, at social events in the former's house in Scotland in the early stages of the COVID-19 pandemic. He does so to illustrate and support his claims that it was wrong and rude to fail to comply with the governmental advice regarding social distancing because we had a responsibility "to minimize risk" and not wrong nor rude to challenge and cajole those people who failed to do so. This article shows that his claims are contestable. It suggests that his own behaviour was no better than Jack's.

Nurses' perceptions of desired support from their employer during the COVID-19 pandemic: a qualitative survey study

BACKGROUND

Nurses play a crucial role in getting through the COVID-19 pandemic. However, the burden of the COVID-19 pandemic for nurses has been recognized, and thus, support for nurses is urgently needed. Support with various methods should help nurses' welfare and their ability to cope at work. Moreover, with appropriate support, it is possible to avoid anxiety, insomnia, or uncertainty caused by work. The aim of this study was to describe nurses' perceptions of desirable support from their employer during the COVID-19 pandemic.

METHODS

This qualitative survey study is a part of a follow-up study for the entire personnel of Helsinki University Hospital. This study focuses on one open-ended question answered by nurses (n = 579) at baseline of a follow-up study. Answers were analysed using qualitative content analysis with an inductive approach.

RESULTS

The findings reveal that various types of support desired from an employer. Qualitative content analysis raised six main categories, 39 categories, 167 sub-categories and 1235 codes from the original text. Main categories were as follows: Awarding personnel, Offering safety in working conditions, Showing appreciation to personnel, Offering a variety of support methods, Providing proper flow of information and Ensuring proper management in exceptional situations.

CONCLUSIONS

This study provides a better understanding of nurses´ perspectives on support from their employer during the COVID-19 pandemic. Results of this study suggest that employers, for example, should award personnel, ensure that working conditions are safe, show more appreciation to personnel. Employers should also pay attention to offer a variety method of support and make sure that the information is provided with a proper flow. In exceptional situations is important to ensure proper management too. With appropriate support methods, employers can avoid a shortage of nurses and maintain nursing as an attractive profession in the future.

Impact of COVID-19 pandemic on marriage, divorce, birth, and death in Kerman province, the ninth most populous province of Iran

This study examined the impact of the COVID-19 pandemic on marriage, divorce, birth, and death rates using the Poisson regression model and an interrupted time-series Poisson regression model. Before the pandemic, marriage and birth rates were decreasing, while divorce and death rates were increasing, with only the trend in birth rates being statistically significant. The immediate effect of the pandemic was a significant decrease in the divorce rate, but there were non-significant effects on birth and marriage rates. However, in the months following the onset of the pandemic, there was a statistically significant sustained effect on increasing death and divorce rates. Forecasts based on pre-pandemic data showed that by the end of 2020, marriage, divorce, death, and birth rates were higher compared to pre-pandemic levels. In conclusion, the pandemic has greatly impacted society, particularly in terms of death and divorce rates. Birth rates were not immediately affected to the time lag between decisions and actual births. Fear of COVID-19 may have increased death rates as people avoided seeking medical help. Vaccination and effective treatment strategies are vital in reducing the pandemic's impact on mortality. Supporting families financially is important due to the role of economic issues in couples' decisions.

The global economic burden of COVID-19 disease: a comprehensive systematic review and meta-analysis

BACKGROUND

The COVID-19 pandemic has caused a considerable threat to the economics of patients, health systems, and society.

OBJECTIVES

This meta-analysis aims to quantitatively assess the global economic burden of COVID-19.

METHODS

A comprehensive search was performed in the PubMed, Scopus, and Web of Science databases to identify studies examining the economic impact of COVID-19. The selected studies were classified into two categories based on the cost-of-illness (COI) study approach: top-down and bottom-up studies. The results of top-down COI studies were presented by calculating the average costs as a percentage of gross domestic product (GDP) and health expenditures. Conversely, the findings of bottom-up studies were analyzed through meta-analysis using the standardized mean difference.

RESULTS

The implemented search strategy yielded 3271 records, of which 27 studies met the inclusion criteria, consisting of 7 top-down and 20 bottom-up studies. The included studies were conducted in various countries, including the USA (5), China (5), Spain (2), Brazil (2), South Korea (2), India (2), and one study each in Italy, South Africa, the Philippines, Greece, Iran, Kenya, Nigeria, and the Kingdom of Saudi Arabia. The results of the top-down studies indicated that indirect costs represent 10.53% of GDP, while the total estimated cost accounts for 85.91% of healthcare expenditures and 9.13% of GDP. In contrast, the bottom-up studies revealed that the average direct medical costs ranged from US $1264 to US $79,315. The meta-analysis demonstrated that the medical costs for COVID-19 patients in the intensive care unit (ICU) were approximately twice as high as those for patients in general wards, with a range from 0.05 to 3.48 times higher.

CONCLUSIONS

Our study indicates that the COVID-19 pandemic has imposed a significant economic burden worldwide, with varying degrees of impact across countries. The findings of our study, along with those of other research, underscore the vital role of economic consequences in the post-COVID-19 era for communities and families. Therefore, policymakers and health administrators should prioritize economic programs and accord them heightened attention.

Community Resilience and Cultural Responses in Crisis: Lessons Learned from Pacific Islander Responses to the COVID-19 Pandemic in the USA

Pacific Islander communities in the USA experienced some of the most severe effects of the COVID-19 pandemic. This qualitative synthesis examines the literature on Pacific Islander community responses and lessons learned from COVID-19, using a systematic search that identified 28 articles with this focus. Thematic analysis was subsequently used to classify both documented efforts by Pacific Islander communities to respond to the pandemic, as well as lessons learned and best practices from research in this area. Results revealed multiple efforts to address the pandemic, including Pacific Islander grassroots approaches, government responses, inter-sector collaboration, and research. Results further emphasized the importance of culturally and linguistically responsive outreach and messaging; partnership, engagement, and capacity building; and changes in research and policy approaches to promote health equity. Future efforts to address public health crises should make the most of Pacific Islander cultural approaches to disaster response. To achieve this, government and other organizations that work with PI communities need to support the development of the PI leadership, healthcare and research workforces, and work with Pacific Islander communities to build long-term, sustainable, and trustworthy partnerships.

Coping with the hospital environment during the COVID-19 pandemic: A qualitative study of the survivors' perspective during their stay at the ICU and inpatient ward

The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings.

Economic hardship and perpetration of intimate partner violence by young men in South Africa during the COVID-19 pandemic (2021-2022): a cross-sectional study

BACKGROUND

Economic hardship is a potential trigger for intimate partner violence (IPV) perpetration. While higher IPV rates have been reported in low-income regions, few African studies have focused on IPV being triggered by economic hardship among young men during the COVID-19 pandemic. We therefore estimated economic hardship's effect on IPV perpetration by young men in eThekwini District, South Africa, during the COVID-19 pandemic.

METHODS

A cross-sectional survey of COVID-19 pandemic experiences was conducted among youth aged 16-24 years through an anonymous self-administered questionnaire, including questions about economic hardship (increased difficulty accessing food or decreased income) and IPV perpetration. A prespecified statistical analysis plan with a directed acyclic graph of assumed exposure, outcome, and confounder relationships guided our analyses. We measured association of economic hardship and IPV perpetration through odds ratios (ORs) computed from a multivariable logistic regressions adjusted for measured confounders. Secondary outcomes of physical and sexual IPV perpetration were analyzed separately using the same specifications. Propensity score matching weights (PS-MW) were used in sensitivity analyses. Analysis code repository: https://github.com/CAndrewBasham/Economic_Hardship_IPV_perpetration/ RESULTS: Among 592 participants, 12.5% reported perpetrating IPV, 67.6% of whom reported economic hardship, compared with 45.6% of those not reporting IPV perpetration (crude OR = 2.49). Median age was 22 years (interquartile range 20-24). Most (80%) were in a relationship and living together. Three quarters identified as Black, 92.1% were heterosexual, and half had monthly household income < R1600. We estimated an effect of economic hardship on the odds of perpetrating IPV as OR = 1.83 (CI 0.98-3.47) for IPV perpetration overall, OR = 6.99 (CI 1.85-36.59) for sexual IPV perpetration, and OR = 1.34 (CI 0.69-2.63) for physical IPV perpetration. PS-MW-weighted ORs for IPV perpetration by economic hardship were 1.57 (overall), 4.45 (sexual), and 1.26 (physical).

CONCLUSION

We estimated 83% higher odds of self-reported IPV perpetration by self-reported economic hardship among young South African men during the COVID-19 pandemic. The odds of sexual IPV perpetration were The seven-times higher by economic hardship, although with limited precision. Among young men in South Africa, economic hardship during COVID-19 was associated with IPV perpetration by men. Our findings warrant culturally relevant and youth-oriented interventions among young men to reduce the likelihood of IPV perpetration should they experience economic hardship. Further research into possible causal mechanisms between economic hardship and IPV perpetration could inform public health measures in future pandemic emergencies.

Factors associated with the use of medicines and self-medication during the COVID-19 pandemic in 12 Latin American countries

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has triggered a rise in the global phenomenon of self-medication. The use of medicines with unsubstantiated claims of benefit for the prevention and/or treatment of infected people has been widely adopted.

Objective

To determine the factors associated with the use of medicines and self-medication by Latin American populations during the COVID-19 pandemic.

Methods

This analytical cross-sectional study was conducted via an analysis of secondary data collected from 8777 responses from 12 Latin American countries obtained from a survey on the use of medicines and self-medication during the pandemic.

Results

Respondents who reported using Paracetamol, Ibuprofen, or antibiotics (ABx) disclosed this as self-medication in 26.9%, 16.6%, and 9.7% of cases respectively. In our multivariate analysis, significant associations were found between: self-medication by individual choice and the use of Hydroxychloroquine, ABx, or non-steroidal anti-inflammatory drugs (NSAIDs) (p = 0.026, = 0.003, and <0.001 respectively); self-medication on the recommendation of a family member, with ABx, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, and <0.001 respectively); and self-medication on the recommendation of another person, with Chloroquine, Hydroxychloroquine, Azithromycin, Penicillin, other ABx, Warfarin, Ivermectin, Paracetamol, Ibuprofen, or other NSAIDs (p <0.001, <0.001, <0.001, = 0.001, <0.001, <0.001, = 0.004, <0.001, <0.001, and <0.001 respectively).

Conclusion

There was a significantly high prevalence of self-medication in our Latin American study population, including the use of medicines not recommended for COVID-19 treatment and/or prevention. The implementation of public health measures aimed at combating the worrying COVID-19 infodemic is essential to prevent this ongoing issue and its associated negative impacts on both current public health and future medication efficacy. This is especially important in the case of ABx due to the threat of a future antimicrobial resistance pandemic.

Increased Organizational Stress in Primary Care: Understanding the Impact of the COVID-19 Pandemic, Medicaid Expansion, and Practice Ownership

BACKGROUND

Primary care is the foundation of health care, resulting in longer lives and improved equity. Primary care was the frontline of the COVID-19 pandemic public response and essential for access to care. Yet primary care faces substantial structural and systemic challenges. As part of a longitudinal analysis to track the capacity and health of primary care, we surveyed every primary care practice in Virginia in 2018 and again in 2022.

METHODS

Surveys were emailed or mailed up to 6 times and nonresponders received a phone call. Questions assessed organizational characteristics, scope of care, capacity, and organizational stress in the prior year. From respondents, 39 clinicians, nurses, staff, administrators, and practice managers were interviewed.

RESULTS

526 out of 2296 primary care practices (23% response rate) completed the survey, with broad representation across geography, ownership, and payer mix. Compared with 2018, in 2022 there were increases in practices owned by health systems (25% vs 43%, P < .0001) and average percent of patients with Medicaid per practice (12% vs 22%, P < .0001). The percent of practices reporting any major stressor increased from 34% to 53% (P < .0001). The main increased stress was losing a clinician, with 13% of practices in 2018 versus 42% in 2022 reporting losing a clinician (P < .0001).

CONCLUSIONS

Primary care practices are resilient and continue to serve their communities, including a broad scope of services and care for underserved people. However, the COVID-19 pandemic caused significant stress. With an increase in clinicians leaving clinical practice, we anticipate worsening access to primary care.

Integrated Behavioral Health Adaptations During the COVID-19 Pandemic

INTRODUCTION

COVID-19 pandemic lockdowns threatened standard components of integrated behavioral health (IBH) such as in-person communication across care teams, screening, and assessment. Restrictions also exacerbated pre-existing challenges to behavioral health (BH) access.

METHODS

Semistructured interviews were completed with clinicians from family medicine residency programs on the impact of the pandemic on IBH care delivery along with adaptations employed by care teams to ameliorate disruption.

RESULTS

Participants (n = 41) from 14 family medicine residency programs described the rapid shift to virtual care, creating challenges for IBH delivery and increased demand for BH services. With patients and care team members at home, virtual warm handoffs and increased attention to communication were necessary. Screening and measurement were more difficult, and referrals to appropriate services were challenging due to higher demand. Tele-BH facilitated continued access to BH services but was associated with logistic challenges. Participants described adaptations to stay connected with patients and care teams and discussed the need to increase capacity for both in-person and virtual care.

DISCUSSION

Most practices modified their workflows to use tele-BH as COVID-19 cases increased. Participants shared key learnings for successful implementation of tele-BH that could be applied in future health care crises.

CONCLUSION

Practices adapted readily to challenges posed by pandemic restrictions and their ability to sustain key elements of IBH during the COVID-19 pandemic demonstrates innovation in maintaining access when in-person care is not possible, informing strategies applicable to other scenarios.

Impact of COVID-19 on American Family Physicians' Intent to Retreat from Clinical Care

PURPOSE

This survey evaluated whether the COVID-19 pandemic was a traumatic stress event for family physicians associated with burnout, changes in life priorities, and intentions to retreat from clinical practice.

METHODS

We report on 683 clinically active family physicians surveyed through the Council of Academic Family Medicine's Educational Research Alliance (CERA) in the fall of 2021.

RESULTS

Overall, 35.2% of family physicians experienced the pandemic as a traumatic stress like event. This was associated with changing life priorities (OR 2.6, CI 1.8-3.9), burnout (OR 1.6, CI 1.1 to 2.4), and withdrawal from clinical practice in various ways. Those who changed their priorities in life were more likely to restrict scope of practice (OR 3.9, CI 2.6-5.9), reduce clinical work effort (OR 3.4, 2.3 to 5.1), relocate (OR 3.1, CI 2.0 to 4.8), retire (OR 2.7, CI 1.4-4.9), reroute their career away from patient care (OR 2.1, CI 1.4-3.1) and less likely to avoid redesigning the practice to improve well-being (OR 0.3, CI 0.2-0.7). Those who experienced burnout were more likely to retire (OR 5.5, CI 2.8 to 10.5), reduce clinical work effort (OR 4.2, CI 2.9-6.1), reroute their career away from patient care (OR 3.9, CI 2.6-5.8), relocate (OR 3.8, CI 2.4 to 5.9), and restrict scope of practice (OR 3.3, CI 2.3 to 4.9). Overall, 48.5% of family physicians expressed some intention to retreat from clinical practice.

CONCLUSION

The COVID-19 pandemic impacted family physician's career plans. Remedying burnout is a high-yield opportunity for retaining clinically active family physicians. Physicians retreating from clinical medicine related to changing life's priorities needs further exploration.

Health Care Costs Following COVID-19 Hospitalization Prior to Vaccine Availability

BACKGROUND

Postacute sequelae of coronavirus (PASC) disease of 2019 (COVID-19) include morbidity and mortality, but little is known of the impact on medical expenditures. This study measures patients' health care costs after COVID hospitalization before vaccinations.

METHODS

The Merative MarketScan database is used to track trends in medical expenditures for commercially insured patients hospitalized for COVID-19 (case subjects) compared with COVID-19 patients not hospitalized (control subjects) using a propensity score matching model. Medical expenditures were estimated from 30-, 60-, and 120-day clean periods after an initial COVID-19 encounter through the end of 2020.

RESULTS

Average total medical expenditures were 96% higher for individuals hospitalized for COVID-19 starting 30 days after initial COVID-19 encounter and almost 70% higher 120 days after based on the propensity score matching. The average spending differential was $11,242 30 days after and $4959 120 days after. This effect is highest for inpatient admissions and services 60 days after at $56,862 and lowest among pharmaceuticals 120 days after at $329. The magnitude of the difference is greater for those with hypertension or diabetes where total expenditures is $14,958 30 days after, and $5962 120 days after compared with those without these chronic conditions.

DISCUSSION

The results suggest both health and economic implications for COVID-19 hospitalization and supports the use of vaccinations to help mitigate these implications. PASC includes increased health care costs for hospitalized patients, particularly for those with chronic conditions. Preventing COVID-19 hospitalization has economic value in terms of reduced medical spending in addition to health benefits associated with reduced morbidity and mortality.

Care Delivery in Community Health Centers Before, During, and After the COVID-19 Pandemic (2019-2022)

INTRODUCTION

Health centers provide primary and behavioral health care to the nation's safety net population. Many health centers served on the frontlines of the COVID-19 pandemic, which brought major changes to health center care delivery.

OBJECTIVE

To elucidate primary care and behavioral health service delivery patterns in health centers before and during the COVID-19 public health emergency (PHE).

METHODS

We compared annual and monthly patients from 2019 to 2022 for new and established patients by visit type (primary care, behavioral health) and encounter visits by modality (in-person, telehealth) across 218 health centers in 13 states.

RESULTS

There were 1581,744 unique patients in the sample, most from health disparate populations. Review of primary care data over 4 years show that health centers served fewer pediatric patients over time, while retaining the capacity to provide to patients 65+. Monthly data on encounters highlights that the initial shift in March/April 2020 to telehealth was not sustained and that in-person visits rose steadily after November/December 2020 to return as the predominant care delivery mode. With regards to behavioral health, health centers continued to provide care to established patients throughout the PHE, while serving fewer new patients over time. In contrast to primary care, after initial uptake of telehealth in March/April 2020, telehealth encounters remained the predominant care delivery mode through 2022.

CONCLUSION

Four years of data demonstrate how COVID-19 impacted delivery of primary care and behavioral health care for patients, highlighting gaps in pediatric care delivery and trends in telehealth over time.

Experiences and challenges with the new European Clinical Trials Regulation

BACKGROUND

The new European Medicines Agency (EMA) Clinical Trials Information System (CTIS), based on the Clinical Trials Regulation (CTR EU 536/2014), came into full effect on 31 January 2022 and was intended to provide an easier, more streamlined approach to the registration of clinical trials taking place in Europe. Using the experience gained on the new regulatory framework from three multi-national European clinical research studies of outbreak-prone infectious diseases, this article describes the advantages and shortcomings of the new clinical trial submission procedure.

METHODS

We report the time to approval, size of the application dossier, and number of requests for information (RFIs) for each study. We also explore the experience of each study within the regulatory framework and its use of CTIS to document the real-world, practical consequences of the system on individual studies. The study assesses the experience of three multi-country studies conducted in Europe working within the EU and non-EU regulatory environments.

RESULTS

While the time to regulatory and ethical approval has improved since the implementation of the new regulation, the timelines for approvals are still unacceptably slow, particularly for studies being conducted in the context of an evolving outbreak. Within the new regulatory approval procedure, there is evidence of conflicting application requirements, increased document burden, barriers to submitting important modifications, and debilitating technical hurdles.

CONCLUSIONS

CTIS promised to lower the administrative bar, but unfortunately this has not been achieved. There are challenges that need to be urgently confronted and addressed for international research collaborators to effectively manage health crises in the future. While the value of multi-national outbreak research is clear, the limitations and delays imposed by the system, which raise challenging ethical questions about the regulation, are prejudicial to all clinical research, especially publicly funded academic studies. This report is relevant to both regulators and clinical researchers. It is hoped that these findings can help improve pan-European clinical trials, especially for the purpose of epidemic preparedness and response.

TRIAL REGISTRATION

This paper references experiences gained during management of three pan-European trials: EU-SolidAct's Bari-SolidAct (CT No. 2022-500385-99-00 - 15 March 2022) and AXL-SolidAct (CT No. 2022-500363-12-00 - 19 April 2022), and MOSAIC (CT No. 2022-501132-42-00 - 22 June 2022).

Socioeconomic mortality differences during the Great Influenza in Spain

Despite being one of the deadliest viruses in history, there is limited information on the socioeconomic factors that affected mortality rates during the Great Influenza Pandemic. In this study, we use occupation-province level data to investigate the relationship between influenza excess mortality rates and occupation-related status in Spain. We obtain three main results. Firstly, individuals in low-income occupations experienced the highest excess mortality, pointing to a notable income gradient. Secondly, professions that involved more social interaction were associated with a higher excess of mortality, regardless of income. Finally, we observe a substantial rural mortality penalty, even after controlling for income-related occupational groups. Based on this evidence, it seems that the high number of deaths was caused by not self-isolating. Some individuals did not quarantine themselves because they could not afford to miss work. In rural areas, home confinement was likely more limited because their inhabitants did not have immediate access to information about the pandemic or fully understand its impact due to their limited experience handling influenza outbreaks.

[Quality of life of people with Parkinson's disease during confinement due to the covid-19 pandemic]

INTRODUCTION

The study was aimed to explore the quality of life of people with Parkinson's disease during confinement due to the coronavirus infectious disease 2019 (covid-19) pandemic.

MATERIAL AND METHODS

The study was quantitative, descriptive and correlational. The sample was 51 people with Parkinson's disease, from the region of Magallanes and Chilean Antarctica, and whose information was collected from the database of the Rehabilitation Corporation Club de Leones Cruz del Sur, to which they belong.

RESULTS

The main results show that 51.6% of people with Parkinson's disease report a «good and very good» quality of life and that the main domains of the Parkinson's Disease Questionnaire (PDQ-39) affected are: body discomfort, mobility and emotional well-being. According to the analysis of the qualitative ranges of the PDQ-39, the dimensions that were most compromised during the confinement by the covid-19 pandemic were: communication, stigma and emotional well-being. In addition, women had a poorer quality of life than men. Finally, it was shown that the progression of symptoms affects the quality of life of people with Parkinson's disease.

CONCLUSIONS

In conclusion, during the confinement due to the covid-19 pandemic people with Parkinson's disease increased symptoms and presented a lower quality of life, especially women.

Effect of COVID-19 lockdown on health of women in Pakistan - Socioeconomic perspective

Objectives

This study investigates the dimensions of women's experiences during the COVID-19 lockdown in Pakistan, considering their historical vulnerability to natural disasters.

Methods

A cross-sectional study was conducted in Pakistan from May to September 2020 at Services institute of medical Sciences, Lahore. An online survey collected socio-demographic data, household responsibilities, and access to medical services using a self-designed questionnaire. Women aged 18 years and above (n=1307) were included through convenience sampling. Data analysis utilized SPSS 20.0.

Results

Of the surveyed women, 10 (14.9%) experienced improved health outcomes, while 39 (58.27%) faced poor health outcomes. Proper access to medical services was reported by 29 (43.3%) participants, while 38 (57.1%) had no access. Two women (3.0%) conceived during the lockdown. 45 (67.2%) women lived in nuclear families, and 21 (31.3%) in joint family systems. Additionally, 46 (68.7%) women were significantly burdened with household chores, while 21 (31.3%) had a normal routine. Among COVID-19-positive respondents, 70% reported weight gain from increased screen time and sedentary lifestyle. Difficulties in managing children's online classes were reported by 34.6% of participants. Moreover, 84% had a monthly income below one hundred thousand PKR. Among women aged 23-28 years, 30.9% had adverse effect on their husband's income, and 4.7% experienced unemployment. Unfortunately, 16% of respondents lost a relative due to COVID-19. Even with access to health facilities.

Conclusion

The COVID-19 lockdown in Pakistan led to adverse socioeconomic and health outcomes for women. These findings highlight the measures needed to address women's challenges amid pandemic impact.

Lessons from COVID-19 Pandemic: A Successful Policy and Practice by Pasteur Institute of Iran

The present study aims to provide an insight to the comprehensive efforts of Pasteur Institute of Iran (PII) regarding COVID-19 management, research, achievements, and vaccine production, though there are many challenges. The relevant literature review was investigated through national and international database and also reports from the related research departments. Six strategies were taken by PII to manage the pandemic of COVID-19. While this pandemic has been hopefully controlled, SARS-CoV-2 could still be a potential threat. Therefore, COVID-19 data management and updated studies, as well as long-term safety and efficacy of the SARS-CoV-2 vaccines are still on the agenda.

Health Literacy Among University Students in the COVID-19 Pandemic: A Systematic Review

BACKGROUND

The purpose of this systematic review was to assess different studies that worked on university students' health literacy during covid19 pandemic and to make an overview of this issue to recognize possible determinants associated with health literacy.

METHODS

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Four databases (Google Scholar, Web of Science, Pubmed, and Scopus) were used for searching cross-sectional works that assessed the health literacy of university students. We searched papers from December 1st, 2019 up to June 10th, 2022. English language articles were used. Studies were done in countries including; Iran, Pakistan, the USA, Vietnam, China, Colombia, Germany, and Indonesia.

RESULTS

The systematic review contains 12 research studies involving 17773 students. There was a relationship between health literacy and some determinants. Positive determinants included age, female gender, Urban background, cognitive maturity, Higher educational qualification, information source (Health workers), number of semesters, and parental education. Some negative determinants were male gender, Rural background, smoking, drinking, being able to pay for medication, lower conspiracy beliefs, and higher fear of COVID-19.

CONCLUSION

University students around the world should have courses about health literacy according to university disciplines. These courses should be available for students of different fields to enhance their effectiveness, and training should be associated with students' needs and their subgroup traits.

Protocol for a systematic review to understand the long-term mental-health effects of influenza pandemics in the pre-COVID-19 era

AIMS

This protocol describes a forthcoming systematic review of the question: 'What are the long-term effects of historical influenza pandemics on mental health, resulting either from illness itself or the social or economic effects of pandemics and public health responses?'

METHODS

We will review studies that investigate associations between influenza pandemics and long-term mental-health impacts. Following the PICO framework, populations (P) may include those with and without pre-existing mental-health symptoms or conditions. Intervention (I) is exposure to an influenza pandemic during the study period encompassing five pandemics (1889-2009). Comparators or controls (C) are not applicable. The review will address outcomes (O) of mental-health morbidity from direct infection and/or related circumstances, including, for example, receiving a disability pension, institutionalisation and/or death.

RESULTS

Due to societal disruptions, illness and bereavement during pandemics, many people are likely to be affected in myriad ways. Therefore, investigation into mental-health consequences should not be restricted by risk group or diagnosis. To our knowledge, this protocol and forthcoming systematic review are the first to include studies for broad populations and multiple measures of mental-health morbidity. The historical perspective and comparison of pandemics with varying severity but assumed similar causative pathogens also enable insights into the consistency of long-term consequences across pandemics.

CONCLUSIONS

Pandemics likely produce long-term mental-health impacts with relevance for social, health and economic planning. The systematic review based on this protocol will complement other evidence on pandemic impacts and help policymakers incorporate relevant interventions.

Routine pediatric vaccinations during the COVID-19 pandemic: A review of the global impact

The coronavirus disease 2019 (COVID-19) pandemic has put standard, routine childhood vaccinations at risk worldwide. The disruption in vaccine coverage has resulted in a negative impact on the health of children, with some races, ethnicities, age groups, areas of settlement, and parts of the world affected more than others. This literature review studied and examined the impact of COVID-19 on infant, child, and adolescent vaccinations. Retrospectively, the analysis showed a decline, delays, or interruptions in the coverage of vaccines during the pan-demic and a decline in some countries' pre-pandemic and post-pandemic eras. Necessary attempts and efforts should be made for these delayed and missed vaccinations, as failure to do so could put children's health at risk. Thus, priority should be directed at instituting catch-up programs to support vaccine uptake and decrease the probability of acquiring vaccine-preventable diseases.

Burnout syndrome and anxiety among healthcare workers during global pandemics: An umbrella review

BACKGROUND

Burnout syndrome and anxiety are two mental health symptoms experienced by healthcare workers (HCWs) that can be exacerbated during pandemics due to increased job demands and the global health workforce crisis.

AIM

To provide a comprehensive review and summary of evidence on burnout and anxiety in HCWs during previous global pandemics.

METHODS

A systematic search on electronic databases such as PubMed Central and MEDLINE was conducted to identify high-quality systematic review studies that reported on the prevalence of burnout and/or anxiety in HCWs during any previous global pandemic.

RESULTS

Twenty-four high quality systematic review articles were found to be suitable for inclusion. Twenty articles focused merely on Coronavirus disease 2019, while four articles examined multiple pandemics. Burnout was examined in nine articles, while anxiety was examined in the remaining 21 articles. Female HCWs and nurses were identified to be at a higher risk of developing burnout and anxiety during pandemic. We also observed a variation in the prevalence of burnouts and anxiety across different studies due to different mental health instruments were used in different studies.

CONCLUSION

Nurses and females HCWs had a high prevalence of burnout syndrome and anxiety during pandemic. More emphasis and attention should be paid to safeguarding the psychological well-being of these at-risk populations in the future pandemics.

Shifts in Mental Health Needs in Portugal during the COVID-19 Pandemic: What Do Mental Health Warrants Tell Us?

N/a.

Nationwide Trends in Non-COVID-19 Infectious Disease Laboratory Tests in the Era of the COVID-19 Pandemic in Korea

The coronavirus disease 2019 pandemic has brought significant changes to infectious disease management globally. This study explored changes in clinical microbiological testing trends and their implications for infectious disease incidence and medical utilization during the pandemic. We collected nationwide claims for monthly clinical microbiology tests from January 2018 to March 2022 using the National Health Insurance Service database. Seasonal autoregressive integrated moving average models were employed to make predictions for each disease based on the baseline period (January 2018 to January 2020). The results showed a significant decrease in general bacterial and fungal cultures, respiratory infectious disease-related, and inflammatory markers, while the representatives of tests for vector-borne diseases, healthcare-associated infections, and chronic viral infections remained stable. The study highlights the potential of clinical microbiological testing trends as an additional surveillance tool and offers implications for future infectious disease management and surveillance strategies in pandemic settings.

Assessment of the Implementation of the International Health Regulations during the COVID-19 Pandemic: Portugal as a Case Study

INTRODUCTION

The International Health Regulations (IHR) were developed to prepare countries to deal with public health emergencies. The spread of SARS-CoV-2 underlined the need for international coordination, although few attempts were made to evaluate the integrated implementation of the IHR's core capacities in response to the COVID-19 pandemic. The aim of this study was to evaluate whether IHR shortcomings stem from non-compliance or regulatory issues, using Portugal as a European case study due to its size, organization, and previous discrepancies between self-reporting and peer assessment of the IHR's core capacities.

METHODS

Fifteen public health medical residents involved in contact tracing in mainland Portugal interpreted the effectiveness of the IHR's core capabilities by reviewing the publicly available evidence and reflecting on their own field experience, then grading each core capability according to the IHR Monitoring Framework. The assessment of IHR enforcement considered efforts made before and after the onset of the pandemic, covering the period up to July 2021.

RESULTS

Four out of nine core IHR capacities (surveillance; response; risk communication; and human resource capacity) were classified as level 1, the lowest. Only two were graded level 3 (preparedness; and laboratory), the highest. The remaining three) (national legislation, policy & financing; coordination and national focal point communication; and points of entry) were classified as level 2.

CONCLUSION

Portugal exemplifies the extent to which implementation of the IHR was not fully achieved, which has resulted in the underperformance of several core capacities. There is a need to improve preparedness and international cooperation in order to harmonize and strengthen the global response to public health emergencies, with better political, institutional, and financial support.

The effectiveness of vaccination, testing, and lockdown strategies against COVID-19

The ability of various policy activities to reduce the reproduction rate of the COVID-19 disease is widely discussed. Using a stringency index that comprises a variety of lockdown levels, such as school and workplace closures, we analyze the effectiveness of government restrictions. At the same time, we investigate the capacity of a range of lockdown measures to lower the reproduction rate by considering vaccination rates and testing strategies. By including all three components in an SIR (Susceptible, Infected, Recovery) model, we show that a general and comprehensive test strategy is instrumental in reducing the spread of COVID-19. The empirical study demonstrates that testing and isolation represent a highly effective and preferable approach towards overcoming the pandemic, in particular until vaccination rates have risen to the point of herd immunity.

Evaluation of falls in older persons in the emergency department during the early Coronavirus-2019 pandemic and pre-pandemic periods

PURPOSE

This study aimed to investigate the clinical characteristics, outcomes and healthcare costs of older patients presented to the emergency department (ED) with falls in the periods before and during the Coronavirus disease-2019 (COVID-19) pandemic.

METHODS

Hospital records one year before and after the onset of the COVID-19 pandemic were retrospectively analyzed through "International Statistical Classification of Diseases-10th Revision" codes. Age, gender, falls, triage classification, length of stay (LOS) in the hospital and the ED, COVID-19 status, Glasgow Coma scale, consultations-comorbidities, injury status, outcomes in the ED, and costs were recorded.

RESULTS

The study comprised of 3187 patients aged ≥ 65 years admitted to the ED of a university hospital between March 2019 and 2021. In terms of pre-pandemic and pandemic periods; older patients presenting with falls to the ED, consultations, Charlson Comorbidity Index, and LOS in the ED were lower in the pandemic period, but costs were higher (p = 0.03, p = 0.01, p = 0.01, p = 0.01 and p = 0.02, respectively). Hospitalization/mortality rates were higher in COVID-19 positive patients (77.2%) than in COVID-19 negative patients (4.6%) within the pandemic period and the patients in the pre-pandemic period (22.8%), and the costs, as well (both p = 0.01).

CONCLUSION

Though the number of fall-related presentations of older persons to the ED, comorbidity burden, consultations, and the LOS in the ED was lower, direct costs were higher during the pandemic period, particularly for COVID-19 positive older patients admitted to ED with falls than the pre-pandemic period, and those patients were with poorer outcomes.