Evaluation of teledermatology during a pandemic indicates high patient satisfaction, positive impact on patient-related costs and clinical effectiveness

Aim: Telehealth is becoming an increasingly important way of delivering health services accelerated by the COVID-19 pandemic. The aim of the study is to evaluate teledermatology by assessing patient satisfaction, patientrelated costs and clinical effectiveness. Method: This was a single-centre cross-sectional study. A three-part questionnaire-Dermatology life quality index (DLQI), patient satisfaction questionnaire (PSQ) and cost evaluation questionnaire-was sent out to all teledermatology patients attending the Royal Melbourne Hospital. The Spearman rank-order correlation coefficient was used to measure the association between the DLQI and PSQ. We evaluated the clinical effectiveness in psoriasis patients on biologic therapy as a sub-cohort by comparing PASI and DLQI pre and post implementation of teledermatology, using Wilcoxon signed-rank test. Results: 191/747 patients responded (51% male, 73% living in metropolitan victoria). The mean DLQI was 5.2 +/- 6.25. PSQ was divided into four categories (Positive attitude, hotel, photo anxiety and interaction). There is a negative correlation between DLQI and PSQ, with all categories showing significant correlation except the 'positive attitude' category. Analysis of the cost evaluation questionnaire showed that a majority of patients reported that telehealth appointments save time (99%), reduce time off work (41%) and help avoid costs of transport (96%). When assessing patients with psoriasis on biologic therapy, there was no significant difference in PASI scores before (mean of 1.59) and after (mean of 1.44) implementation of teledermatology (p-value 0.542). There was a significant reduction in DLQI in 59 psoriasis patients on biologic therapy, as an indicator of clinical effectiveness. The mean DLQI before implementation of teledermatology was 2.73 and after implementation was 1.69 (p-value 0.0126). Conclusions: Overall this study indicates high patient satisfaction, positive impact on patient-related costs and good clinical effectiveness of teledermatology which warrant further evaluation in larger prospective studies.

Industrial Camps in Northern British Columbia: The Politics of ‘Essential' Work and the Gendered Implications of Man Camps

This place and gender-based paper arises from bearing witness to, and critically engaging, the heightened vulnerabilities that a global pandemic (COVID-19) brings to the geographies of so-called northern British Columbia (BC), Canada. We consider how vulnerabilities in northern geographies are produced through layers of coloniality and racialized extractive-capitalism and then, subsequently, how those heightened vulnerabilities are ignored and disregarded in support of corporate interests. We explore the risks and gendered nature of industrial camps—or ‘man camps.‘ By focusing on man camps, we demonstrate how, by continuing to operate during a pandemic and in regions where people have pleaded for them to shut down, man camps are environments that amplify physical, environmental, health, and sociocultural risks. We also outline how man camps further subject northern communities to corporate colonial violence, especially by ignoring many Indigenous leaders’ demands for camps to close. Using anti-colonial and place-based analytical lenses and methods in critical feminist iterative discourse analysis, we also draw from statements by health workers, Indigenous leaders, and media articles to highlight the predicted spread of the virus across northern BC geographies. The paper interrogates how and why extractive facilities, and the man camps they rely upon, are deemed essential services despite extractive facilities relying on transient workforces housed in industrial camps that had (predictable) COVID-19 outbreaks. Importantly, we celebrate voices (often of women-identifying Indigenous activists, matriarchs, and front-line workers) tirelessly calling for attention to the gendered and racialized impacts of industrial ‘man camps.' © 2021. All Rights Reserved.

Pervasive misinformation, covid-19 vaccine hesitancy, and lack of trust in science

Employing recent research results covering pervasive misinformation, COVID-19 vaccine hesitancy, and lack of trust in science, and building our argument by drawing on data collected from Horizon Research, KFF, OECD, and RSC, we performed analyses and made estimates regarding COVID-19 vaccine attitudes and behaviors. Descriptive statistics of compiled data from the completed surveys were calculated when appropriate. © 2021, Addleton Academic Publishers. All rights reserved.

Smartphone based symbol digit modalities test reliably measures cognitive function in multiple sclerosis patients

Background: Neurological examination is a powerful tool for diagnosing and measuring progression of neurodegenerative diseases. However, examinations are resource intensive and thus not practical for comprehensive measurement of neurological disability in chronic diseases. A remote digital solution may be more practical and particularly relevant now due to the ongoing COVID-19 pandemic. Objectives: To clinically validate a digital adaptation of the Symbol Digit Modalities Test (SDMT) developed as part of a smartphone test suite replicating aspects of a neurological exam. Methods: Participants consisted of healthy volunteers (HV;n=39) and multiple sclerosis (MS;n=154) patients, with a longitudinal subcohort that performed tests at home (n=15). During clinic visits, the smartphone test suite was administered alongside a full neurological exam. The smartphone SDMT featured randomization of symbol-digit code and testing sequence. The subjects also underwent written SDMT and brain MRI. Results: Performance differed significantly between HV and MS cohorts (p<.0001). Performance on smartphone and written SDMT had strong evidence of association (R2=0.71, concordance coefficient CCC=0.69, p<.0001). Smartphone SDMT had higher criterion validity than written SDMT measured by correlation with T2 lesion load and brain atrophy. Correlations with NeurEx subdomains identified neurological functions involved in performance of each of the 3 functional cognitive tests. Correcting for these contributing non-cognitive disabilities generated linear regression models strongly predicting the amount of MS-related brain injury measured by volumetric MRI (R2 = 0.75, p < 0.0001 vs R2 = 0.62, p < 0.0001). Of the longitudinal cohort, 87% of patients demonstrated practice effects measured by non-linear regression. Averaging multiple sequential post-learning results significantly decreased threshold for identifying true test deteriorations on a patient level. Conclusions: Smartphone SDMT allows for less resource intensive remote administration. The clinometric properties of smartphone SDMT compare to or outperform written SDMT. This study expands the validation of multiple neurological tests administered via smartphone and bring us closer to a patient-autonomous neurological examination.