Impact of the COVID-19 Pandemic on the Treatment of Cancer Patients at a Hospital in Peru.

BACKGROUND: The appearance of the new coronavirus, SARS-CoV-2, in Wuhan - China, in 2019 led to the declaration of a COVID-19 pandemic by the World Health Organization. Peru confirmed its first case on March 6, 2020, prompting a significant change in medical care. PURPOSE: Our objective was to determine the impact of the COVID-19 pandemic on cancer treatment in Peru. METHODS: A retrospective analysis of hospital data from the National Institute of Neoplastic Diseases revealed substantial decreases in oncological treatments in 2020 compared to 2019. RESULTS: Oncological treatments involving bone marrow transplantation had a greater impact between the months of April and September, at -100% (p=0.003). However, treatments involving surgery in April (-95% [p≤0.001]), radiotherapy in May (-76% [p=0.002]) and chemotherapy in June (-71% [p≤0.001]) also showed significant impacts. Comparative analysis with international data revealed similar trends in cancer care interruptions in different countries. However, variations in the magnitude of the impact were observed, influenced by regional health policies and the severity of the pandemic. CONCLUSIONS: The findings underscore the challenges cancer care providers face during public health crises, requiring adaptive strategies to ensure continued access to essential treatments. Addressing these challenges requires comprehensive public health responses to mitigate the impact of future crises on cancer care systems.

A Case Report Highlighting the Significance of COVID-19 Unveiling Megaloblastic Anemia and Worsening Dementia in the Elderly.

The COVID-19 pandemic has resulted in substantial lifestyle changes with significant implications for nutritional health. Factors such as movement restrictions and disruptions in food supply chains led to the restricted availability of primary sources of essential micronutrients. To highlight this, we present the case of an elderly woman with an underlying subclinical cobalamin deficiency who developed symptomatic megaloblastic anemia, requiring hospital admission under lockdown conditions. This exemplifies how changes in diet during the COVID-19 lockdown have hastened the onset of B12 deficiency symptoms. Adverse outcomes can be avoided by identifying people at high risk of poor nutritional status and implementing policy initiatives that enhance their nutritional condition. This case report showed how important the B12 shortage was during the COVID-19 lockdown, especially for older people. They are more likely to be malnourished during COVID-19 for several reasons.

The collateral effects of COVID-19 on marine pollution.

The COVID-19 pandemic has gained significant attention to the intersection of public health crises and environmental challenges, particularly in the context of marine pollution. This paper examines the various impacts of the pandemic on marine environments, focusing on the pollution attributed to single-use plastics (SUPs) and personal protective equipment (PPE). Drawing on a comprehensive analysis of literature and case studies, the paper highlights the detrimental effects of increased plastic waste on marine ecosystems, biodiversity, and human health. Statistical data and graphical representations reveal the scale of plastic pollution during the pandemic, emphasizing the urgent need for mitigation strategies. The study evaluates innovative monitoring techniques and future recommendations, emphasizing stakeholder collaboration in sustainable waste management. By broadening geographic examples and comparative analyses, it provides a global perspective on the pandemic's impact, highlighting the importance of international cooperation for safeguarding marine ecosystems.

Antimicrobial resistance patterns among critical priority pathogens in an intensive care unit at a tertiary hospital in Egypt: a descriptive analysis comparing pre- and COVID-19 eras.

Background. The intensified global challenge of antimicrobial resistance, set against the backdrop of the COVID-19 pandemic, is a cause for major concern. Within healthcare settings, intensive care units are recognized as focal points for Gram-negative infections. The study pursued to assess the prevalence and antimicrobial resistance patterns of critical priority pathogens (Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, comprising Klebsiella pneumoniae and Escherichia coli) during both pre- and COVID-19 periods.Gap Statement. The decision to explore this topic stemmed from the urgent need to understand how the exceptional healthcare crisis of COVID-19 affected AMR patterns.Methods. This was an observational retrospective analysis of 1056 clinical specimens obtained from 950 patients who were admitted to the Medical Intensive Care Unit at Kasr Al-Aini Hospital, Cairo University, Egypt.Results. In the period before COVID-19, 342 pathogenic isolates (135 K. pneumoniae, 83 P. aeruginosa, 76 A. baumannii and 48 E. coli) were obtained from samples collected from 450 patients. Conversely, during the COVID-19 period, 714 isolates (237 K. pneumoniae, 205 A. baumannii, 199 P. aeruginosa and 73 E. coli) were collected from the same number of patients. In the course of the pandemic, there is a slight increase in A. baumannii and P. aeruginosa infections, whereas E. coli and K. pneumoniae exhibit a distinct trend with a noticeable reduction in infection rates during COVID-19. During the COVID-19 period, a noticeable rise in resistance rates was observed for all antibiotics utilized. The results from Fisher's exact test indicated a substantial increase in resistance towards certain antibiotics. Specifically, a significant rise in resistance was observed for E. coli to ciprofloxacin (P = 0.00), gentamicin and P. aeruginosa (P = 0.02), levofloxacin and A. baumannii (P = 0.01), piperacillin-tazobactam and A. baumannii (P = 0.04), and piperacillin-tazobactam and P. aeruginosa (P = 0.01).Conclusion. Our results display how the pandemic impacted bacterial infections and antibiotic resistance, indicating a general increase in resistance rates. These findings are crucial for guiding healthcare practices, emphasizing the need for continued surveillance and potentially checking antibiotic usage schemes.

Mental health analysis and resilience psychological factors during pandemic among port health 0fficers: A study in Sabang, Indonesia.

The coronavirus disease 2019 (COVID-19) pandemic has had a negative impact on the mental health of health workers worldwide. Many studies examined the mental health of the frontline health workers in hospitals, but similar research on health workers at the port entries has yet to be found. The aim of this study was to determine the mental health issue and its associated factors and to determine the psychological resilience factors of port health workers in Sabang, Indonesia during the COVID-19 pandemic. A retrospective mixed-method study was conducted among 38 port health officers. Total sampling included those working from January 2020 to March 2023. The information on age, gender, qualification, working time and working place of the respondents were collected and the mental health was assessed using the Depression Anxiety Stress Scale (DASS-21). The correlation and association between the socio-demographic data and mental health were tested with Spearman and chi-squared tests, respectively. The qualitative study on psychological resilience factors were performed with interviews and analyzed with NVivo. This study indicated that 47.4% of port health officers experienced depression, 63.1% anxiety and 50.0% stress. Age and working time significantly affected the mental health. Age correlated positively and significantly with anxiety (p<0.0001) and stress (p<0.0001), while working time significantly affected the anxiety (p=0.003). The psychological resilience factors identified were spirituality, positive emotions, official support, and personal well-being that helped the workers taking away learn lessons. In conclusion, mental health issues are high among frontline workers during the pandemic highlighting the importance of the prevention measures to ensure the work performance among employees.

Reflections on the Saudi FDA Regulatory Experience with Smart GxP Inspections.

Smart GxP inspections have gained increasing attention due to the COVID-19 pandemic, which, understandably, made it challenging for regulatory authorities to conduct on-site inspections. Smart GxP inspections are an oversight approach developed by the SFDA to enable remote compliance assessments of establishments. In this type of inspection, appropriate technical methods and tools (such as livestreaming video) are used without requiring the presence of inspectors onsite, ensuring efficient utilization of resources and the efficiency of inspection process. The objective of this research is to examine and document the shared encounters involving remote inspections and evaluations carried out by SFDA from 2020 to 2022. This will be achieved through the evaluation of the accuracy of document evaluation and the extent to which the objectives of smart GxP inspections were met. Data were collected from local and international smart inspections reports conducted by SFDA between 2020 and 2022, covering medical device manufacturers, pharmaceutical manufacturing sites, warehouses, accreditation offices, scientific offices, and food manufacturing facilities. The results indicate that smart GxP inspections were effective in achieving visit objectives, showing a high degree of document evaluation accuracy. The findings of this study support the use of smart GxP inspections as a valuable alternative to on-site inspections, offering a practical solution to regulatory compliance during the pandemic and beyond. Although the SFDA recognizes the usefulness of smart inspections in upholding regulatory oversight in the face of various challenges, it does not endorse the complete replacement of conventional on-site inspection methods. The SFDA acknowledges significant limitations associated with the current technological resources used in remote regulatory assessments, and these limitations will be explored in the relevant sections.

Impact of COVID-19 on arthritis with generative AI.

OBJECTIVE: The study aims to examine the effects of the COVID-19 pandemic on the prevalence of arthritis in the US using a specific generative AI tool. METHODS: The AI tool with Bing.com/copilot, designed to generate Python code, uses data from the Centers for Disease Control and Prevention (CDC) to visualize trends and uncover insights in four key areas: (1) The prevalence of arthritis in adults aged 18 years and older who have diabetes, (2) The prevalence of fair or poor health in adults aged 18 years and older who have arthritis, (3) The prevalence of activity limitations due to arthritis in adults aged 18 years and older with doctor-diagnosed arthritis, (4) The prevalence of arthritis in adults aged 18 years and older who are obese. This research did not require approval from an institutional review board or an ethics committee. RESULTS: The findings reveal a significant decline in the prevalence of arthritis among adults with conditions such as diabetes and obesity during the COVID-19 pandemic. There was also an observed improvement in activity limitations among patients with doctor-diagnosed arthritis. CONCLUSION: The study highlights the potential impact of the pandemic on chronic disease management, particularly arthritis. It underscores the importance of continued monitoring and care for patients with arthritis, especially during a global health crisis like the COVID-19 pandemic. The use of AI tools in generating insights from health data proves to be valuable in this context.

Evolving global responses to the pandemic: sustaining interprofessional education and collaborative practice.

The COVID-19 pandemic created global disruption in health professions education and healthcare practice, necessitating an abrupt move to digital delivery. A longitudinal survey was conducted to track the evolution of global responses to the pandemic. During the initial stages, educational and health institutions were forced to adapt quickly without careful consideration of optimal pedagogy, practices, and effectiveness of implemented approaches. In this paper, we report the results of Phase 3 of the global survey that was distributed between November 2021 and February 2022 through InterprofessionalResearch.Global (IPR.Global). The Phase 3 qualitative survey received 27 responses, representing 25 institutions from 13 countries in 6 regions. Using inductive thematic analysis, the data analysis resulted in three emerging themes: Impact of the pandemic on the delivery of interprofessional education and collaborative practice (IPECP); Impact of the pandemic on the healthcare system (team, population/client health, clients); and Sustainability and innovation. This study highlights the evolving nature of health education and collaborative practices in response to the COVID-19 pandemic. IPECP educators need to be resilient and deal with the complexities of face-to-face and digital learning delivery. Preparing for emerging forms of teamwork is essential for new work contexts and optimal health services.

An Unprecedented Experience: Personal and Socio-Political Impacts of the COVID-19 Lockdown in Saudi Arabia.

The COVID-19 pandemic provided an opportunity to understand the experiences of different cultures and the application of preventive measures during a pandemic. That understanding can lead to the development of important evidence to grasp the global situation and prepare for future health crises. This qualitative study explores the impact of COVID-19 lockdown measures on individuals in Saudi Arabia, focusing on personal and socio-political effects. Employing semi-structured interviews with 28 participants, the research delves into the lived experiences during the early stages of the pandemic, highlighting emotional coping mechanisms, behavioral changes, role responsibility adaptations, and perceptions of governmental actions. The findings reveal a spectrum of emotional responses, from worry and fear to acceptance and contentment, and significant shifts in behavior and societal norms. The study underscores the importance of understanding cultural contexts in pandemic responses and offers insights into the resilience and adaptability of the Saudi community. It suggests the need for tailored interventions that consider the complex interplay of emotional, behavioral, and socio-political factors in managing future health crises.

Telemedicine Clinics in General and Colorectal Surgery During the COVID-19 Pandemic: Patient-Reported Outcomes.

Introduction Telemedicine was introduced in place of face-to-face clinics during the COVID-19 pandemic to limit exposure and spread of the virus. This was an immediate transformation to surgical practice without prior training. Concerns were raised about whether this fulfilled the patient's expectations. In this study, we investigated patients' perspectives and feedback about surgical telemedicine clinics. We also investigated factors that may have influenced patient feedback. Methods We undertook a retrospective qualitative study between June and August 2020 at the Darent Valley Hospital, England, United Kingdom. A well-structured 5-point questionnaire was designed to capture patients' experiences with the help of non-medical volunteers. Patients were invited to participate, either online or through direct telephone calls. Ancillary data, such as demographics, previous visits, and the physician's grade, was also collected. A Mann-Whitney U test was used to compare variables. Results A total of 198 patients completed the questionnaire (online = 67, telephone = 133, median age 59 years, IQR 44-79, male: female = 1). A rating from 'good to excellent' for 'overall experience', 'opportunity to express concerns', and 'doctors consultation' was given by 90%, 93%, and 89.4%, respectively. About 79.8% felt reassured. Given the option, 63% would prefer face-to-face consultation in the future. Telemedicine clinics led by consultant surgeons had statistically significantly better ratings than junior grades. Conclusion This is the first study investigating patients' experiences of telemedicine in general and colorectal surgery. A high proportion of patients rated a satisfactory experience and felt reassured. The majority of patients would still prefer face-to-face consultations in the future. Based on the results of the current study, we would recommend the integration of telemedicine into future secondary care provision in general and colorectal surgery.

Health-Seeking Behaviour and Its Determinants Following the COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to determine the change in behaviour of individuals towards any health issues they faced after the coronavirus disease 2019 (COVID-19) pandemic and to compare the health-seeking behaviour of people who were infected by the virus and those who were not infected. METHODS: A cross-sectional study was conducted among 400 participants visiting Shifa International Hospital, Islamabad, Pakistan, and Pakistan Institute of Medical Sciences Hospital, Islamabad, Pakistan. Data was collected through a pilot-tested questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). RESULTS: In 286 participants (71.6%), health-seeking behaviours were significantly altered by the COVID-19 pandemic. Overall, this research showed that COVID-19 was linked to poor health-seeking behaviour. CONCLUSION: Most of the participants' health-seeking behaviours were significantly altered by the COVID-19 pandemic. A significant change in how people behaved towards any health problem was reported. As a result, public awareness campaigns should focus on delivering more information about COVID-19 to promote their health-seeking behaviour.

Impact of COVID-19 on cancer incidence, presentation, diagnosis, treatment and survival in Northern Ireland.

The COVID-19 pandemic had a major impact on cancer patients and services but has been difficult to quantify. We examined how the entire cancer pathway-from incidence, presentation, diagnosis, stage, treatment and survival-was affected in Northern Ireland during April-December 2020 compared to equivalent 2018-2019 periods using retrospective, observational cancer registry data from the Northern Ireland Cancer Registry (NICR). There were 6748 cancer cases in April-December 2020 and an average 7724 patients in April-December 2018-2019. Incident cases decreased by 13% (almost 1000). Significant differences were found across age cohorts and deprivation quintiles, with reductions greatest for younger people (<55 years; 19% decrease) and less deprived (22% decrease). A higher proportion had emergency admission (16%-to-20%) with lower proportions diagnosed pathologically (85%-to-83%). There was a significant stage shift, with lower proportions of early stage (29%-to-25%) and higher late-stage (21%-to-23%). Lower proportions received surgery (41%-to-38%) and radiotherapy (24%-to-22%) with a higher proportion not receiving treatment (29%-to-33%). One-year observed-survival decreased from 73.7% to 69.8% and 1-year net-survival decreased from 76.1% to 72.9%, with differences driven by five tumours; Lung (40.3%-to-35.0%), Head-and-Neck (77.4%-to-68.4%), Oesophageal (53.5%-to-42.3%), Lymphoma (81.1%-to-75.2%) and Uterine cancer (87.4%-to-80.4%). Our study reveals profound adverse impact of COVID-19 on the entire cancer patient pathway, with 13% fewer cases, greater emergency admissions and significant stage-shift from early to more advanced-stage disease. There was major treatment impact with lower rates of surgery and radiotherapy and higher proportions receiving no treatment. There were significant reductions in 1-year survival. Our study will support service recovery and protect cancer services in future pandemics or disruptions.

Work readiness of pharmacy graduates: An exploratory study.

Introduction: The recent global pandemic of Covid-19 caused various disruptions. Among them were face-to-face teaching and learning activities being switched to virtual sessions in accordance with health authorities recommendations. The impact of these changes on work readiness of pharmacy graduates is unknown. Aim: This study aims to determine the impact of pharmacy graduate's work readiness, particularly those that had their studies disrupted from the pandemic. Methods: Practicing pharmacists with supervisory experience were interviewed on their opinions on work readiness of early career and intern pharmacists. Specifically, they were asked to comment on work readiness of pharmacy graduates who had their later stage of pharmacy education impacted by the pandemic. Data was transcribed verbatim and thematically analysed. This was also supplemented with quantitative data from graduating students in 2020 and 2021 using the Work Readiness Scale. Results: Qualitative feedback showed four themes related to workforce readiness: work competence, social intelligence, personal characteristics, and organizational acumen. Preceptors interviewed noted differences in communication abilities when interacting with patients. However, this improved with time. Quantitative data collected from graduates via the validated Work-Readiness Scale also showed a more positive agreement towards perceived work readiness. These graduates were comfortable with using technology as they had used these extensively in their learning during the pandemic and thus was comfortable in adopting digital health tools in their practice. Conclusion: Although graduates reported to be work ready, there were gaps in communication skills and confidence levels when interacting with patients, as reported by supervising preceptors. Graduates also described this sense of 'missing out' from not having the opportunity to attend face-to-face activities like their originally planned hospital placements and how it impacted their choice of career. As pharmacists continue to play vital roles as members of the broader healthcare workforce, both in clinical and nonclinical settings, learnings from this study should be considered in designing educational activities to train and develop the workforce of the future.

Perceived Epidemic Impacts and Mental Symptom Trajectories in Adolescents Back to School After COVID-19 Restriction: A Longitudinal Latent Class Analysis.

PURPOSE: This study aimed to assess the impacts of COVID-19 epidemic on various life aspects and identify the trajectories of common mental symptoms among adolescents back to school after COVID-19 restriction. Furthermore, potential predictors associated with those trajectories were investigated. METHODS: This longitudinal study, with five data collection points and a total follow-up of 68.4 days, was conducted among 1,393 junior high school students (mean age: 13.8 years; male, 53.3%) shortly after school reopened during the first COVID-19 outbreak in China. Questions on sociodemographics and perceived COVID-19 epidemic impacts were completed at the baseline while the Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Insomnia Severity Index were measured throughout the study for depression, anxiety, and insomnia symptoms, respectively. Trajectories of mental symptoms were classified by longitudinal latent class analysis, and the associated predictive factors were identified with multinomial regression modelling. RESULTS: Our study revealed high but steadily declining prevalence of depression, anxiety, and insomnia symptoms (p trend < .001). Five distinctive trajectories were identified for both depression and anxiety ("resistance," "low symptom," "recovery," "chronic dysfunction," and "delayed dysfunction") and three for insomnia ("resistance," "low symptom," and "chronic dysfunction"). Besides the significant association between the mental symptom trajectories and students' perceived COVID-19 impacts on study practice, family income, and family relationship, female gender, lower school grade, and higher body mass index were found to be predictive of high severity trajectories. DISCUSSION: Our findings may help locate the most psychologically vulnerable adolescents during the epidemic and foster better implementation of targeted intervention.

The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis.

BACKGROUND: There has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications for future mortality and morbidity. We aimed to estimate the change in diagnosed prevalence, treatment and prescription indicators for AF and hypertension and assess corresponding geographical inequalities. METHODS: Using the Quality and Outcomes Framework (2016/17 to 2021/22) and the English Prescribing Datasets (2018 to 2022), we described age standardised prevalence, treatment and prescription item rates for hypertension and AF by geography and over time. Using an interrupted time-series (ITS) analysis, we estimated the impact of the pandemic (from April 2020) on missed diagnoses and on the percentage change in medicines prescribed for these conditions. Finally, we described changes in treatment indicators against Public Health England 2029 cardiovascular risk targets. RESULTS: We observed 143,822 fewer (-143,822, 95%CI:-226,144, -61,500, p = 0.001) diagnoses of hypertension, 60,330 fewer (-60,330, 95%CI: -83,216, -37,444, p = 0.001) diagnoses of AF and 1.79% fewer (-1.79%, 95%CI: -2.37%, -1.22%), p < 0.0001) prescriptions for these conditions over the COVID-19 impact period. There was substantial variation across geography in England in terms of the indirect impact of the COVID-19 pandemic on the diagnosis, prescription, and treatment rates of hypertension and AF. 20% of Sub Integrated Care Boards account for approximately 62% of all missed diagnoses of hypertension. The percentage of individuals who had their hypertension controlled fell from 75.8% in 2019/20 to 64.1% in 2021/22 and the percentage of individuals with AF who were risk assessed fell from 97.2% to 90.7%. CONCLUSIONS: Hypertension and AF detection and management were disrupted during the COVID-19 pandemic. The disruption varied considerably across diseases and geography. This highlights the utility of administrative and geographically granular datasets to inform targeted efforts to mitigate the indirect impacts of the pandemic through applied secondary prevention measures.

"Play How We Practice": A Residency Program's Snapshot of Pediatric Resident Perspectives on Education During the COVID-19 Pandemic.

OBJECTIVES: Our objective was to understand the perspectives of current and recently graduated pediatric residents concerning the impact of the COVID-19 pandemic, and subsequent curriculum changes, to their education. INTRODUCTION: Residency programs have experienced unprecedented alterations to education in the form of changing expectations, schedules, and opportunities during the COVID-19 pandemic. Little is known regarding resident perceptions of how these changes impact their education and ultimate career preparation. METHODS: An anonymous and voluntary electronic IRB exempt survey was sent to pediatric residents at a mid-sized residency program in the mid-Atlantic in August of 2020. This cross-sectional study survey consisted of a series of multiple choice questions with optional short answer responses. RESULTS: Twenty-two pediatric residents across all training years completed the survey for a response rate of 36%. The majority of residents, 59.1%, were interested in directly caring for COVID + patients; however, the minority (36%) felt prepared to care for COVID + patients. Most residents (63%) responded that graduate medical education programs should not have authority to exclude residents from taking care of patients with certain diagnoses and 95% of respondents indicated that they would prefer an opt out system instead. CONCLUSION: The majority of resident respondents had a strong interest in caring for COVID + patients and report that they value frequent updates from program leadership to guide their patient care. Residents also overwhelmingly support an opt out system when caring for future patients with particular infectious diagnoses rather than a mandated exclusion approach.

A systematic review of the direct and indirect COVID-19's impact on food security and its dimensions: pre-and post-comparative analysis.

BACKGROUND: Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and to identify which, if any, food security dimensions were specifically compromised. METHODS: Primary research articles were initially identified through four online databases (Scopus, PubMed, Google Scholar, and Web of Science), with the references of each paper then also reviewed for additional article. The food security status of individuals and the wider community, both before and after the emergence of COVID-19, were examined. RESULTS: Of the 2,057 studies initially identified, a total of ten were included in the final review. The included studies confirmed that COVID-19 had substantially impacted food security, with individuals, households and the wider community experiencing food insecurity. Nine of the included studies aruged that the food accessibility dimension was the most compromised. CONCLUSION: To address the identified direct and indirect food security issues associated with COVID-19, it is proposed that a combination of prevention practices and proactive food security activities is required. Integrating food security interventions, supporting and facilitating food security resilience, and conducting further studies on the food security of COVID-19 are also recommended.

What Do Medical Students Learn about Community Care from Discussions with General Physicians? A Thematic Analysis.

Background and Objectives: Sustainable healthcare is fundamentally rooted in community medicine education. The COVID-19 pandemic disrupted global advancement in integrating traditional teaching and experiential learning. Additionally, an alarming decline in interest in community care has been observed among senior medical students. Here, we examined the perspectives on community care obtained from conversations with general physicians in rural medical universities. Materials and Methods: Using a constructivist lens, a qualitative methodology was employed to examine the perceptions of second-year medical students from Shimane University Medical School regarding community care, informed by dialogues with general physicians. We conducted a thematic analysis at Shimane University, Japan, an area known for its aging population. In 2023, 116 second-year students participated, none of whom had prior formal training in community care. The study was structured into three phases: (1) Pre-education: Students wrote essays about their initial understanding of community care, its advantages, disadvantages, and potential improvements; (2) Dialogue: Grouped by topic, students engaged in discussions that culminated in a comprehensive session with general physicians; and (3) Reflection: After discussions, students wrote essays reflecting any shift in their views on community care. A thematic analysis of essays from the pre-education and reflection phases provided a comparative perspective on the students' understanding. Results: Five dominant themes emerged from the thematic analysis: (1) Re-evaluating community care: Recognizing diversity and addressing societal challenges; (2) Interdisciplinary collaboration: Promoting shared roles and teamwork; (3) Learning and practice: Emphasizing hands-on experience and self-reflection; (4) Technological influence: The mutual relationship between community care and technological advancements; and (5) Challenges and resolutions: Identifying problems and crafting solutions. Conclusions: This study sheds light on the evolution of medical students' views on community care and underscores the importance of continuous adaptation in medical education programs.

Trends of infections and mortality due to hepatitis B virus (2005-2022) and the potential impact of the COVID-19 pandemic: a population-based study in Poland.

Aim of the study: To analyze the hepatitis B virus (HBV) infection and mortality in Poland according to sociodemographic characteristics, trends over time, and the impact of the COVID-19 pandemic on hepatitis B epidemiology. Material and methods: We examined HBV infection cases and deaths reported by national registries and used Joinpoint analysis to estimate time trends in the years 2005-2021. To assess the impact of the COVID-19 pandemic on HBV infection, we used monthly information and compared 2020-2022 with 2019. Results: The Joinpoint analysis showed that in Poland between 2005 and 2021, there were pronounced decreasing trends of acute HBV infection, and during the pandemic period, acute HBV infection dramatically decreased (annual percent change, APC2019-2021 for men -57.65%, and women -42.10%, both ptrend < 0.05). There was a fluctuation in trends for chronic HBV infection, shifting from positive to negative in both genders in 2016, and over the pandemic, there were decreasing trends (APC2019-2021 for men -26.94% and women -28.96%, both ptrend < 0.05). From March to July 2022, the value of the diagnosis rate of HBV infection was lower compared to the respective months in 2019, but from September to December 2022, the rate changes were positive. Mortality due to HBV infection decreased in both genders, mainly within the 2005-2019 period. Conclusions: During the COVID-19 pandemic, a sharp decrease in HBV diagnosis rates in Poland, especially in acute cases, was observed. However, trends of hepatitis B infection require further monitoring. It is necessary to introduce a national screening program that also encompasses the population of migrants and improve the linkage to care.

Assessing the impact of COVID-19 lockdown on surface water quality in Ireland using advanced Irish water quality index (IEWQI) model.

The COVID-19 pandemic has significantly impacted various aspects of life, including environmental conditions. Surface water quality (WQ) is one area affected by lockdowns imposed to control the virus's spread. Numerous recent studies have revealed the considerable impact of COVID-19 lockdowns on surface WQ. In response, this research aimed to assess the impact of COVID-19 lockdowns on surface water quality in Ireland using an advanced WQ model. To achieve this goal, six years of water quality monitoring data from 2017 to 2022 were collected for nine water quality indicators in Cork Harbour, Ireland, before, during, and after the lockdowns. These indicators include pH, water temperature (TEMP), salinity (SAL), biological oxygen demand (BOD5), dissolved oxygen (DOX), transparency (TRAN), and three nutrient enrichment indicators-dissolved inorganic nitrogen (DIN), molybdate reactive phosphorus (MRP), and total oxidized nitrogen (TON). The results showed that the lockdown had a significant impact on various WQ indicators, particularly pH, TEMP, TON, and BOD5. Over the study period, most indicators were within the permissible limit except for MRP, with the exception of during COVID-19. During the pandemic, TON and DIN decreased, while water transparency significantly improved. In contrast, after COVID-19, WQ at 7% of monitoring sites significantly deteriorated. Overall, WQ in Cork Harbour was categorized as "good," "fair," and "marginal" classes over the study period. Compared to temporal variation, WQ improved at 17% of monitoring sites during the lockdown period in Cork Harbour. However, no significant trend in WQ was observed. Furthermore, the study analyzed the advanced model's performance in assessing the impact of COVID-19 on WQ. The results indicate that the advanced WQ model could be an effective tool for monitoring and evaluating lockdowns' impact on surface water quality. The model can provide valuable information for decision-making and planning to protect aquatic ecosystems.