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1.
Archives of Bone and Joint Surgery-Abjs ; 10(10):871-876, 2022.
Artigo em Inglês | Web of Science | ID: covidwho-2082570

RESUMO

Background: The COVID-19 pandemic brought about the placement of severe social restrictions in the United Kingdom, limiting activity and impacting public behavior. Limited studies have been published on the relationship of the coronavirus pandemic with the presentation and management of upper limb fractures. The aims of this study were first to assess the change in the incidence of upper limb fractures at key points during the COVID-19 pandemic such as the enactment and lifting of lockdowns, and second to evaluate the relationship between local COVID-19 burden and measures of service efficiency across our trust.Methods: We undertook a retrospective analysis of all upper limb fracture referrals, admissions, and surgical procedures from the 1st of March 2020 to the 28th of February 2021. Changes in upper limb fracture incidence were mapped to significant changes in social restrictions. Measurements of service efficiency including time from admission to theatre and length of stay for admitted upper limb fracture patients were mapped to local COVID-19 burden. Subgroup analysis was undertaken to compare across age groups, including the pediatric population, all adults, and the elderly.Results: The study involved 1251, 659, and 641 patients with upper limb fracture referrals, admissions, and procedures across the trust, respectively. Referrals (n=128) and procedures (n=72) both peaked in August 2020. Admissions peaked in both May and December 2020 (63 for both). Admissions and procedures both demonstrated a decrease in March and April 2020 compared to the rest of the study period (40 and 38 admissions, as well as 48 and 29 procedures respectively). Across the cohort, referrals and admissions did not demonstrate a statistically significant relationship with the relaxing of social restrictions (P=0.504). There were statistically significant differences among referrals, admissions, and procedures when stratifying patients by age (P=<0.001). Length of stay demonstrated an inverse relationship with COVID-19 burden throughout the study period, with the shortest average length of stay recorded in months with the highest number of local COVID-19 cases. The average time from injury occurrence to theatre increased during the winter months (P=0.001).Conclusion: There is a relationship between changes in social restrictions and the incidence of upper limb fractures. These changes also had differing impacts on upper limb fracture rates when stratifying by patient age groups. The orthopedic service demonstrated adaptability in response to the local COVID-19 burden, and further research is needed to determine what effect this had on clinical outcomes.

2.
Sustainability ; 14(15), 2022.
Artigo em Inglês | Web of Science | ID: covidwho-1997758

RESUMO

The literature on urban travel behaviour in Africa is sparse, limiting our understanding of how urban transport policies respond to human and planetary needs. We conducted a cross-sectional household telephone survey on 1334 participants, using a 24 h time-use diary, to investigate travel behaviour and barriers to active travel (walking and cycling) in Yaounde, Cameroon. We found that two-thirds of all participants reported at least one trip;the median (IQR) numbers of trips per capita and per participant with trips were 2 (0-3) and 2 (2-3), respectively. The main trip modes were shared taxi (46%), walking (27%), private cars (11%), and motorcycle taxis (10%), with 25%, 56%, and 45% of all participants reporting the use of active, motorised, and public transport, respectively. The mean (IQR) trip duration was 48 (30-60) min;for participants who reported trips, the daily overall and active travel durations were 121 (60-150) and 28 (0-45) min, respectively. Women were less likely to travel, making fewer and shorter trips when they did. Participants in less wealthy households were more likely to travel. The primary barriers to both walking and cycling were the fear of road traffic injuries and the inconvenience of active travel modes. Therefore, local urban transport authorities need to improve the safety and convenience of active mobility and promote gender equity in transport. Restrictions to movements during the COVID-19 pandemic and the relatively small survey sample might have biased our results;thus, a representative travel survey could improve current estimates. More generally, high-quality research on travel behaviours and their correlates is needed in low-resource settings.

3.
Lung Cancer ; 165:S46, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-1996674

RESUMO

Background and objectives: Pembrolizumab monotherapy given 3-weekly (3w) (200mg) is approved for the treatment of nonsmall cell lung cancer (NSCLC). In June 2019, NICE endorsed the 6w regimen (400mg) based on computer modelling data (Lala, Eur J Cancer 2020), which has been used during the COVID-19 pandemic to reduce hospital visits. This study compared immune-related adverse events (irAEs), discontinuation rates, and patient experience of 3w vs 6w patients treated at The Christie NHS Foundation Trust, Manchester, UK. Methodology: Pharmacy records were used to identify NSCLC patients treated with pembrolizumab, 1st, 2nd or 3rd line. IrAEs and discontinuation rates were analysed using Kaplan Meier curves to compare the 3w vs 6w cohorts. A sample of the cohort who received 3w then 6w undertook a questionnaire assessing patient experience. Results: 38 patients received pembrolizumab 6w, and 91 received pembrolizumab 3w, of the 3w, 51 switched to 6w. Baseline characteristics were similar. Any grade irAEs and G1-2 irAEs were significantly higher in the 6w cohort (p=0.006 and p=0.04, respectively). Both cohorts showed low rates of G3-5 irAEs at 6 months, 2.3% vs 14.5%, 3w vs 6w, p=0.3. Discontinuation rates at 6 months due to any irAES, G1-2 irAEs or G3-5 irAEs were insignificant in both cohorts (3w to 6w respectively): 4.5% vs 11.2%, p=0.2;2.8% vs 8.7%, p=0.4;2.0% vs 2.5%, p=0.3. Quality of life questionnaires showed stability (60%) or improvement (20%) in the 6w cohort compared to 3w. 90% said their mental health did not differ between regimens. 45% and 40% of patients preferred 6w and 3w respectively, 15% had no preference. Conclusion: NSCLC patients treated with 6w pembrolizumab appear to experience more low-grade irAEs compared to 3w. Highgrade irAEs and discontinuation rates due to irAEs were insignificant in both cohorts. Patients preferred the 6w regiment and found it tolerable.

4.
Hepatology ; 74(SUPPL 1):546A-547A, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-1508687

RESUMO

Background: Increased hepatitis C virus (HCV) testing among people in prison (PIP) is key for HCV elimination efforts to be successful. Efforts to improve health care in all British Columbia (BC) Provincial Correctional Centres (PCCs) have been made in recent years, beginning with the transfer of health services from BC Corrections to BC Provincial Health Services Authority (PHSA) in 2017. However, the state of emergency declared in BC in early 2020 in response to the COVID-19 pandemic may have undermined these efforts. This study aims to examine patterns in HCV screening and diagnosis in all 10 BC PCCs before and during the COVID-19 pandemic. Methods: Data from the BC Sexually Transmitted and Blood-Borne Infections Data Mart, which contains laboratory data accounting for >95% of all anti-HCV and >99% of all HCV RNA and genotype tests performed in BC, were used for this study. The number of anti-HCV, HCV RNA and HCV genotype tests that were ordered from BC PCCs between April 1 2011 and March 31 2021 was determined for quarterly periods. New HCV diagnoses were defined as the number of 1st-time HCV-positive test episodes (anti-HCV, RNA or genotype) among HCV tests ordered from BC PCCs. Total intake numbers were provided by BC Corrections per calendar year. Results: The number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 1st quarter of 2020 had increased by 412% (n=486), 530% (n=252) and 827% (n=139) respectively (Figure 1), compared to the 1st quarter of 2017 (prior to the transfer of health services to PHSA). Following the beginning of the COVID-19 pandemic, the number of HCV antibody, RNA, and genotype tests ordered from BC PCCs in the 2nd quarter of 2020 had decreased by 66% (n=165), 67% (n=83) and 68% (n=44), respectively (Figure 1), compared to the 1st quarter of 2020. The total number of HCV tests as a proportion of intakes to BC PCCs in 2019 was 17% (2518/15303), which increased to 23% (2112/9283) in 2020. Conclusion: The transfer of health services in BC PCCs to PHSA led to increased volume of HCV screening, with concomitant increases in new HCV diagnoses among PIP in BC from 4th quarter 2017 onwards. The COVID-19 pandemic led to health care challenges in prisons in BC (including the suspension of non-urgent HCV testing in the entire province for several weeks), and at the same time, the number of HCV tests and new diagnoses decreased. This may have been partly due to reduced intakes to BC PCCs over 2020, as the total number of HCV tests ordered as a proportion of intakes increased in 2020, compared to the previous year. Those people diverted away from the correctional system due to decarceration efforts triggered by COVID-19 may have missed out on HCV screening during 2020, therefore further efforts to increase HCV screening in correctional settings and the community will be needed.

5.
Journal of Global Health Reports ; 5(e2021002), 2021.
Artigo em Inglês | CAB Abstracts | ID: covidwho-1124772

RESUMO

Background: Adherence to preventative measures designed to mitigate transmission of COVID-19 depends on individual's understanding and perception of COVID-19. The objective of this study was to assess the knowledge, perceptions, behavioural adaptation and psychological well-being related to COVID-19 among students attending Newcastle University Medicine Malaysia.

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