Exposición a pantallas de niñas, niños y adolescentes: recomendaciones, límites y controversias en el marco del distanciamiento social obligatorio: un estudio cualitativo / Child and Teenage Screen Exposure: Recommendations, Limits,and Controversies in the Context of Enforced Social Distancing: a Qualitative Study

Introducción: la utilización de pantallas durante la niñez y la preocupación por su potencial daño aumentaron en los últimos años. La recomendación de no superar dos horas diarias de uso resultó controvertida durante la pandemia por COVID-19. El objetivo principal de esta investigación fue explorar las opiniones y actitudes de los profesionales con respecto al uso de pantallas y comprender cómo se modificaron durante dicha pandemia. Materiales y métodos: estudio exploratorio con enfoque cualitativo y estrategia de teoría fundamentada, realizado entre 2020 y 2021.Participaron 23 profesionales (pediatras y generalistas) en cuatro grupos focales. Se realizaron lecturas del material desgrabado para interpretación del contenido. El análisis incluyó la generación de códigos que fueron agrupados en cinco ejes temáticos. Resultados: los ejes resultantes fueron: 1) temática de las pantallas en la consulta ambulatoria de niños sanos, 2) percepción sobre daños, 3) percepción sobre beneficios, 4) pantallas en épocas de ASPO (Aislamiento Social Preventivo y Obligatorio) y 5) pensamientos y acciones contradictorios sobre el uso de pantallas. Discusión: a la hora de recomendar sobre exposición a pantallas, en nuestros entrevistados predominó la intuición personal por sobre la evidencia científica disponible. Reconocieron que el contexto de ASPO visibilizó algunos beneficios asociados a la conectividad que brindan estos dispositivos. Conclusión: nuestros resultados muestran que la percepción sobre las pantallas se está volviendo cada vez más neutral en términos del balance entre sus riesgos y beneficios, conduciendo a que los profesionales sean más flexibles en sus recomendaciones al respecto. (AU)

Introduction: screen use during childhood and potential harm concerns have increased in recent years. Advice not to allow more than two hours of screen use per day was contested during the COVID-19 pandemic. The primary purpose of this research was to probe the opinions and attitudes of professionals regarding the use of screens and to understand how these changed during the pandemic. Materials and methods: this exploratory study, with a qualitative approach and theory-based strategy, was made between 2020 and 2021, and involved the participation of 23 professionals (pediatricians and general practitioners) in four focus groups. The recorded material was analyzed for content interpretation. The analysis included generating codes that were grouped into five thematic areas. Results: the resulting axes were: 1) the issue of screens in the outpatient practice of healthy children; 2) perception of harm; 3) perception of benefits; 4) screens in times of Preventive and Compulsory Social Isolation (ASPO, for its acronym in Spanish); and 5) contradictory thoughts and actions on the use of screens. Discussion: when making recommendations regarding screen exposure, the interviewees' intuition predominated over available scientific evidence. They recognized that the ASPO context highlighted some of the benefits associated with the connectivity provided by these devices. Conclusion: our results show that awareness of screen displays is becoming increasingly neutral concerning the trade-off between their risks and benefits, prompting practitioners to become more flexible in their recommendations. (AU)

[Cultivation of Cancer Medical Personnel Who Will Lead the Way in Advanced Cancer Treatment].

The Kyoto University has been promoting the"The 3rd Stage Cancer Professional Development Plan"in collaboration with Shiga University of Medical Science, Mie University, Osaka Medical and Pharmaceutical University, and Kyoto Pharmaceutical University. The theme of our plan is"Training of Cancer Professionals who will lead the way in advanced cancer treatment". As the distinctive educational programs, we have undertaken include: 1 )overseas training, 2 )a five-university collaborative short-term training program, 3 )a five-university collaborative medical forum, and 4 )an educational program of patient and public involvement. In the 3rd Stage of the program, 173 students have been accepted and 120 have obtained professional certifications as of the end of 2021. On the other hand, the 3rd Stage Cancer Professional Development Plan ended in FY2021, and it is difficult to continue the education of the students currently enrolled in the program. We sincerely hope that the sufficient budget will be allocated in FY2022 and beyond so that sustainable education can be implemented.

Health and Mortality in Korean Healthcare Workers.

BACKGROUND: To evaluate the health status of healthcare workers (doctors and nurses) compared to those in the general population based on the National Health Insurance Service database and the cause of death data from Statistics Korea. METHODS: The subjects of this study were 104,484 doctors and 220,310 nurses working in healthcare facilities from 2002 to 2017, and who had undergone at least one general medical examination. Based on the subject definition, the subject data were extracted from the National Health Insurance healthcare facility database and qualification database. We collected medical use details included in the research database, general medical examination results, medical history included in the health examination database, and additional data on the cause of death from the National Statistics database to analyze the main cause of death and mortality. RESULTS: In terms of the major causes of death and mortality among healthcare workers, the mortality rate associated with intentional self-harm, injury, transportation accident, heart disease, addiction, and falling was significantly higher than that in the general population. Further, the prevalence of respiratory and gastrointestinal diseases was high. When analyzing the proportional mortality ratio (PMR) by cause of death for healthcare workers, the PMR values for death related to malignant neoplasm was the highest. In terms of diseases, both doctors and nurses had higher rates of infectious diseases such as maternal sepsis, rubella, and measles. CONCLUSION: The health status of healthcare workers differs from that of the general population. Thus, it is important to consider the occupational characteristics of healthcare personnel. This study is unique in that it was conducted based on medical use indicators rather than survey data.

Reimagining health preparedness in the aftermath of COVID-19.

Efficiency is an essential part of sustainable healthcare, especially in emergency and acute care (including surgical) settings. Waste minimisation, streamlined processes, and lean principles are all important for responsible stewardship of finite health resources. However, the promotion of efficiency above all else has effectively subordinated preparedness as a form of waste. Investment in preparedness is an essential part of resilient healthcare. The ongoing COVID-19 pandemic has exposed the gap between efficient processes and resilient systems in many health settings. In anticipation of future pandemics, natural disasters, and mass casualty incidents, health systems, and individual healthcare workers, must prioritise preparedness to be ready for the unexpected or for crises. This requires a reframing of priorities to view preparedness as crucial insurance against system failure during disasters, by taking advantage of lessons learnt preparing for war and mass casualty incidents.

Protecting Nursing Home Residents and Staff from COVID-19.

Two new tools from the AHRQ help facilitate observational audits.

Healthcare Providers' Intention to Use Technology to Attend to Clients in Cape Coast Teaching Hospital, Ghana.

BACKGROUND: Patient records' relevance is associated with a variety of needs and objectives. Substantiating the health of patients perpetually and allowing professionals in the medical field to assess both signs and symptoms that fall in a relatively wider temporal point of view and contributions that lead to enhanced diagnoses and treatment are all quintessential of patient records. The advancement of information technology systems has led to the anticipation that development will be put into digitization and electronic means of storing patient records in order to grease their handling. Cape Coast Teaching Hospital (CCTH) is piloting implementation of patient's electronic health record system. The introduction of the electronic health record system known as Lightwave Hospital Information Management System (LHIMS) was to provide a permanent solution to patients' continuity of care. User's acceptance of new information technology is seen to be one of the most challenging issues in information system. This study assesses healthcare providers' (HP') behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital and other factors influencing it. METHODS: A nonexperimental cross-sectional study was used to obtain information from 84 HP recruited from the various departments and units in CCTH who use LHIMS to attend to clients. The sample size of 90, representing 8% of HP in CCTH, was randomly selected from the various departments and units. However, 84 (indicating 93.3% response rate) of the selected HP were available during the period of the research. RESULTS: Perceived ease of use (PEOU) of LHIMS had the strongest direct effect on perceived usefulness (PU), with a highly significant path coefficient of 0.75. PU had the greatest impact on attitude about HP' behavioural intention to use (BIU) LHIMS to attend to patients' healthcare delivery in CCTH (0.91). This relationship was highly significant at p < 0.001. PEOU did not have a significant direct effect on attitude about LHIMS use, as hypothesized in the original technology acceptance model. However, attitude towards use had a strong significant effect on HP' BIU of LHIMS, with a strong statistically significant path coefficient of 0.98 at p < 0.001. CONCLUSIONS: We conclude that attitude towards use have a significant influence on HP' behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital.

The Challenges of Managing Pediatric Diabetes and Other Endocrine Disorders During the COVID-19 Pandemic: Results From an International Cross-Sectional Electronic Survey.

Background: Frequency, dimensions, management, and outcomes of the COVID-19 pandemic in children with endocrine disorders and diabetes were assessed. Methods: A cross-sectional electronic survey was distributed to the global network of endocrine societies. Respondents' professional and practice profiles, clinic sizes, their country of practice, and the impact of COVID-19 on endocrine diseases were investigated. Results: Respondents from 131 pediatric endocrine centers in 51 countries across all continents completed the survey. Routine check-ups and education were altered in most pediatric endocrine clinics. Over 20% of clinics experienced a shortage of critical medications or essential supplies. ICU treatment was required for patients with diabetes and COVID-19 in 21.2% of centers. In diabetes, 44% of respondents reported increased diabetic ketoacidosis episodes in newly diagnosed cases and 30% in established cases. Biopsychosocial and behavioral changes were explicitly reported to be occurring among pediatric patients with endocrine disorders. Conclusions: This large global survey conducted during the COVID-19 pandemic highlights that diabetes is more challenging to manage than any other pediatric endocrine disorder, with an increased risk of morbidity. Psychological distress due to COVID-19 needs to be recognized and addressed. The importance of close contact with healthcare professionals should be emphasized, and medical supplies should be readily available to all patients.

Trends in Patch Testing by Health Care Providers Among US Medicare Beneficiaries.

BACKGROUND: Although patch testing has historically been done by dermatologists, allergists are also patch testing. Little is known about the current utilization of patch testing by medical specialists. OBJECTIVE: The aim was to determine trends in utilization of patch testing in Medicare beneficiaries by various clinicians and demographics. METHODS: Data from the 2012-2017 Medicare Public Use File were analyzed, including 82,241 total unique clinicians of whom 312 filed a patch testing claim. RESULTS: Dermatologists had a steady share of patch tests (annual clinicians; annual patches) from 2012 (158; 258,735) to 2017 (199; 351,994), an increase of 25.9% and 36.0%, respectively. Allergists, however, had a marked increase in utilization of patch tests from 2012 (84; 62,498) to 2017 (187; 182,480), an increase of 122.6% and 192.0%, respectively. In multivariable logistic regression models, male dermatologists and allergists had increased odds of patch testing (P < 0.001 for both), as did clinicians in the Northeast and Southern United States (P ≤ 0.003 for both). LIMITATIONS: Data are only available for Medicare Part B patients; changes in utilization may be different for individuals, private insurance, or Medicare Advantage Plans. CONCLUSIONS: Relative to dermatologists, patch testing is increasing among allergists. Addressing barriers to patch testing may increase rates of patch testing by dermatologists.

Economic impact of COVID-19 pandemic on healthcare facilities and systems: International perspectives.

International hospitals and healthcare facilities are facing catastrophic financial challenges related to the COVID-19 pandemic. The American Hospital Association estimates a financial impact of $202.6 billion in lost revenue for America's hospitals and healthcare systems, or an average of $50.7 billion per month. Furthermore, it could cost low- and middle-income countries ~ US$52 billion (equivalent to US$8.60 per person) each four weeks to provide an effective healthcare response to COVID-19. In the setting of the largest daily COVID-19 new cases in the US, this burden will influence patient care, surgeries, and surgical outcomes. From a global economic standpoint, The World Bank projects that global growth is projected to shrink by almost 8% with poorer countries feeling most of the impact, and the United Nations projects that it will cost the global economy around 2 trillion dollars this year. Overall, a lack of preparedness was a major contributor to the struggles experienced by healthcare facilities around the world. Items such as personal protective equipment (PPE) for healthcare workers, hospital equipment, sanitizing supplies, toilet paper, and water were in short supply. These deficiencies were exposed by COVID-19 and have prompted healthcare organizations around the world to invent new essential plans for pandemic preparedness. In this paper, we will discuss the economic impact of COVID-19 on US and international hospitals, healthcare facilities, surgery, and surgical outcomes. In the future, the US and countries around the world will benefit from preparing a plan of action to use as a guide in the event of a disaster or pandemic.

Telemedicine and current clinical practice trends in the COVID-19 pandemic.

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.

Clinical recommendations for in-hospital airway management during aerosol-transmitting procedures in the setting of a viral pandemic.

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.

Considerations for acute care staffing during a pandemic.

The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.

Adaptation and restructuring of an academic anesthesiology department during the COVID-19 pandemic in New York City: Challenges and lessons learned.

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.

The opportunities and challenges of social media in interstitial lung disease: a viewpoint.

Social media is an increasingly popular source of health information, and the rarity and complexity of interstitial lung disease (ILD) may particularly draw patients with ILD to social media for information and support. The objective of this viewpoint is to provide an overview of social media, explore the benefits and limitations of ILD-related social media use, and discuss future development of healthcare information on social media. We describe the value of integrating social media into the practice of ILD health professionals, including its role in information dissemination, patient engagement, knowledge generation, and formation of health policy. We also describe major challenges to expanded social media use in ILD, including limited access for some individuals and populations, abundance of misinformation, and concerns about patient privacy. Finally, for healthcare professionals looking to join social media, we provide practical guidance and considerations to optimize the potential benefits and minimize the potential pitfalls of social media.

Risk for SARS-CoV-2 infection in healthcare workers outside hospitals: A real-life immuno-virological study during the first wave of the COVID-19 epidemic.

OBJECTIVES: Most COVID-19 related infections and deaths may occur in healthcare outside hospitals. Here we explored SARS-CoV-2 infections among healthcare workers (HCWs) in this setting. DESIGN: All healthcare providers in Stockholm, Sweden were asked to recruit HCWs at work for a study of past or present SARS-CoV-2 infections among HCWs. Study participants This study reports the results from 839 HCWs, mostly employees of primary care centers, sampled in June 2020. RESULTS: SARS-CoV-2 seropositivity was found among 12% (100/839) of HCWs, ranging from 0% to 29% between care units. Seropositivity decreased by age and was highest among HCWs <40 years of age. Within this age group there was 19% (23/120) seropositivity among women and 11% (15/138) among men (p<0.02). Current infection, as measured using PCR, was found in only 1% and the typical testing pattern of pre-symptomatic potential "superspreaders" found in only 2/839 subjects. CONCLUSIONS: Previous SARS-CoV-2 infections were common among younger HCWs in this setting. Pre-symptomatic infection was uncommon, in line with the strong variability in SARS-CoV-2 exposure between units. Prioritizing infection prevention and control including sufficient and adequate personal protective equipment, and vaccination for all HCWs are important to prevent nosocomial infections and infections as occupational injuries during an ongoing pandemic.