COVID-19 unemployment and access to statin medications in the United States.

Objective: To quantify the effect of the unemployment created by COVID-19 on access to (sales of) statin drugs in the United States population. Methods: Approximately half a billion transactions for statin drugs in the United States between January 2018 and September 2020 are analyzed. We studied the potential causal relation between abnormal levels of unemployment during the first wave of COVID-19 in the U.S. and abnormal levels of sales of statin products (both variables defined at the state/week level). Variables are analyzed using the Two-Stage Least Squares (2SLS) method, which exploits comparisons of statin sales between states where, given the occupational distribution of their workforce, unemployment was more structurally vulnerable to mobility restrictions derived from COVID-19 against states where it was less structurally vulnerable. Results: While we do not find unemployment effects on statin sales on most of the population, our estimates link COVID-fueled unemployment with a sharp sales reduction among Medicaid-insured populations, particularly those in working age. For the period between March and August of 2020, these estimates imply a 31% drop of statin sales among this population. Discussion: COVID-fueled unemployment may have had a negative and significant effect on access to statin populations among Medicaid-insured populations.

Association between universal health coverage and the disease burden of acute illness and injury at the global level.

BACKGROUND: This study examines the relationship between universal health coverage (UHC) and the burden of emergency diseases at a global level. METHODS: Data on Disability-Adjusted Life Years (DALYs) from emergency conditions were extracted from the Institute for Health Metrics and Evaluation (IHME) database for the years 2015 and 2019. Data on UHC, measured using two variables 1) coverage of essential health services and 2) proportion of the population spending more than 10% of household income on out-of-pocket health care expenditure, were extracted from the World Bank Database for years preceding our outcome of interest. A linear regression was used to analyze the association between UHC variables and DALYs for emergency diseases, controlling for other variables. RESULTS: A total of 132 countries were included. The median national coverage of essential health services index was 67.5/100, while the median national prevalence of catastrophic spending in the sample was 6.74% of households. There was a strong significant relationship between health service coverage and the burden of emergency diseases, with an 11.5-point reduction in DALYs of emergency medical diseases (95% CI -9.5, -14.8) for every point increase in the coverage of essential health services index. There was no statistically significant relationship between catastrophic expenditures and the burden of emergency diseases, which may be indicative of inelastic demand in seeking services for health emergencies. CONCLUSION: Increasing the coverage of essential health services, as measured by the essential health services index, is strongly correlated with a reduction in the burden of emergency conditions. In addition, data affirms that financial protection remains inadequate in many parts of the globe, with large numbers of households experiencing significant economic duress related to seeking healthcare. This evidence supports a strategy of strengthening UHC as a means of combating death and disability from health emergencies, as well as extending protection against impoverishment related to healthcare expenses.

Software educativo sobre algunas enfermedades transmisibles por vectores / Educative software about some vector-borne diseases

Introducción: Los vectores constituyen organismos vivos que pueden transmitir patógenos infecciosos entre personas, o de animales a personas. Muchos de esos vectores son insectos hematófagos que ingieren los microorganismos patógenos junto con la sangre de un portador infectado y, posteriormente, los transmiten a un nuevo portador, una vez replicado el patógeno. Objetivo: Diseñar un software educativo sobre enfermedades transmisibles por vectores, para favorecer el conocimiento de los estudiantes de la Facultad de Enfermería-Tecnología de la Salud en Santiago de Cuba. Métodos: Se realizó una investigación de desarrollo e innovación tecnológica con el programa CrheaSoft versión 3.3.3. De un universo de 327 estudiantes, se seleccionó una muestra de 130 de ellos, mediante el muestreo aleatorio simple. Se utilizaron los métodos teóricos, análisis-síntesis, histórico-lógico y sistémico-estructural. Resultados: Las valoraciones de docente y estudiantes fueron favorables, por facilitar la adquisición de nuevos conocimientos y ampliar los existentes, lo que demuestra la utilidad y necesidad del producto. Conclusiones: El software resultó pertinente para su utilización en la práctica, según criterios mayoritarios de docentes y estudiantes. Este constituye un material de consulta y de apoyo a la docencia, que puede utilizarse por los estudiantes de las carreras a la que van dirigidos y por el personal que labora en la Atención Primaria de Salud(AU)

Introduction: Vectors are living organisms that can transmit infectious pathogens between humans, or from animals to humans. Many of these vectors are hematophagous insects that ingest pathogenic microorganisms along with the blood of an infected carrier and subsequently transmit them to a new carrier, once the pathogen has replicated. Objective: To design an educative software about vector-borne diseases, in order to increase the knowledge of students from the School of Nursing and Health Technology in Santiago de Cuba. Methods: A technological development and innovation research was carried out with the CrheaSoft software, version 3.3.3. From a study universe of 327 students, a sample of 130 was selected by simple random sampling. The theoretical, analysis-synthesis, historical-logical and systemic-structural methods were used. Results: The evaluations provided by professors and students were favorable, since the acquisition of new knowledge was facilitated and the existing knowledge was expanded, which demonstrates the usefulness and necessity of the product. Conclusions: The software was suitable to be used in practice, according to the prevailing criteria provided by professors and students. It is a material for consultation and teaching support, which can be used by students of the majors for whom it has been designed and by the primary healthcare personnel(AU)

Use of online recruitment strategies in a randomized trial of cancer survivors.

BACKGROUND/AIMS: Despite widespread Internet adoption, online advertising remains an underutilized tool to recruit participants into clinical trials. Whether online advertising is a cost-effective method to enroll participants compared to other traditional forms of recruitment is not known. METHODS: Recruitment for the Survivorship Promotion In Reducing IGF-1 Trial, a community-based study of cancer survivors, was conducted from June 2015 through December 2016 via in-person community fairs, advertisements in periodicals, and direct postal mailings. In addition, "Right Column" banner ads were purchased from Facebook to direct participants to the Survivorship Promotion In Reducing IGF-1 Trial website. Response rates, costs of traditional and online advertisements, and demographic data were determined and compared across different online and traditional recruitment strategies. Micro-trials optimizing features of online advertisements were also explored. RESULTS: Of the 406 respondents to our overall outreach efforts, 6% (24 of 406) were referred from online advertising. Facebook advertisements were shown over 3 million times (impressions) to 124,476 people, which resulted in 4401 clicks on our advertisement. Of these, 24 people ultimately contacted study staff, 6 underwent prescreening, and 4 enrolled in the study. The cost of online advertising per enrollee was $794 when targeting a general population versus $1426 when accounting for strategies that specifically targeted African Americans or men. By contrast, community fairs, direct mail, or periodicals cost $917, $799, or $436 per enrollee, respectively. Utilization of micro-trials to assess online ads identified subtleties (e.g. use of an advertisement title) that substantially impacted viewer interest in our trial. CONCLUSION: Online advertisements effectively directed a relevant population to our website, which resulted in new enrollees in the Survivorship Promotion In Reducing IGF-1 Trial at a cost comparable to traditional methods. Costs were substantially greater with online recruitment when targeting under-represented populations, however. Additional research using online micro-trial tools is needed to evaluate means of more precise recruitment to improve yields in under-represented groups. Potential gains from faster recruitment speed remain to be determined.