Prescription Opioid Use Among Cancer Patients before and after the Onset of COVID-19: Evidence from Real-World Data

Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023

The Impact of the Sars-Cov-2 Pandemic (COVID-19) on the Incidence of Newly Diagnosed Multiple Myeloma Patients Using a Federated Network of Real-World Evidence in US and Germany

Objectives: COVID-19 had an impact on health care, including diagnostics. Early diagnosis of MM is a critical factor for prognosis. We examined the impact of COVID-19 on incidence of NDMM patients and on characteristics in NDMM patients in US and in Germany. Method(s): 44,164 NDMM patients were identified in TriNetX federated network across 55 healthcare organizations in US between January 2018 and December 2021. A bivariate analysis examined changes in patient characteristics in two cohorts before (Cohort 1;n=25513) and after (Cohort 2;n=18.651) the start of the COVID-19 pandemic in March 2020. 4172 NDMM patients were identified in the German database in a sample of across >100 healthcare organizations in the same time period. Similarly, bivariate analysis examined changes in patient characteristics before (Cohort 1;n=2252) and after (Cohort 2;n=1920) the start of pandemic. Result(s): Analysis of US data showed a significant decrease in incidence of NDMM. Bivariate analysis revealed that NDMM patients in Cohort 2 have a significantly higher risk profile compared with patients in Cohort 1, higher incidence of renal failure (13.5% v. 15.43%), heart failure (10.3% v 11.26%), bone lesions (12.6% v. 13.05%) and anemia (26.8% v. 29.75%). The German data indicated an increased risk profile in Cohort 2, with higher reporting of renal impairment (12.3% v. 15.5%) and cardiac impairment (8.3% v. 10.9%). The higher risk profile was reflected in a significant increase of all SLiM-CRAB criteria, notably hypercalcemia (24.1 % v. 36.9%), bone marrow plasma cell infiltration (28.1% v. 36.8%) and free light chain involvement (27.3% v. 41.3%). Conclusion(s): The results provide real-world evidence of a change in risk profile for patients with NDMM during COVID-19. This higher risk profile is observed in both the US and Germany, and may negatively impact outcomes such as progression-free and five-year overall survival.Copyright © 2023

Risk of exposure to Covid-19 in nursing assistants, nurses, and physicians in a university hospital in the face of pandemic.

Objective: Healthcare professionals were the workers most affected by Covid-19, espe-cially during the first waves of the pandemic. Thus, the aim of this study is to evaluate the perceived risk of exposure to Covid-19, the information received and the work participation between nurses, physicians and nursing assistants. Method(s): A cross-sectional study was conducted using an epidemiological survey among nurses, physicians and nursing assistants in a university hospital. Aspect and content validation, cognitive pretest, and piloting of the epidemiological survey was carried out with thirty subjects. A descriptive analysis was per-formed using mean and standard deviation (SD) for quantitative variables and absolute (n) and relative (%) frequencies for qualitative variables. The chi-square test and the ANOVA test were applied to assess the association of the responses with the variables: sex, type of worker, area of work and activity in Covid-19 Units. Result(s): Nurses, physicians and nursing assistants worked mainly in assistance areas and high risk of exposure units. Nursing assistants and nurses had a higher perception of risk. Nurses were less involved in the organiza-tion, but felt more supported by their colleagues. However, physicians felt more supported by their superiors and better care when they had a health problem. Conclusion(s): Nursing assistants and nurses presented higher risk perception, nurses were less involved in the organization of health care, while physicians felt more supported by their superiors.Copyright © 2023, Fundacion Index. All rights reserved.

Vulnerability and antimicrobial resistance

It is now well-recognised that antimicrobial resistance (AMR), or the ability of organisms to resist currently available antibiotics and other antimicrobial drugs, represents one of the greatest dangers to human health in the 21st Century. As of 2022, AMR is a top-10 global public health threat. Various national and transnational initiatives have been implemented to address accelerating AMR, and the pressure to find local and global solutions is increasing. Despite this urgency, surprisingly limited progress is being made in rolling back or even slowing resistance. A multitude of perspectives exist regarding why this is the case. Key concerns include an enduring dependency on market-driven drug development, the lacklustre governance and habitual over-prescribing of remaining antimicrobial resources, and rampant short-termism across societies. While rarely presented in such terms, these disparate issues all speak to the social production of vulnerability. Yet vulnerability is rarely discussed in the AMR literature, except in terms of 'disproportionate effects' of AMR. In this paper, we offer a reconceptualisation of vulnerability as manifest in the AMR scene, showing that vulnerability is both a predictable consequence of AMR and, critically, productive of AMR to begin with. We underline why comprehending vulnerability as embodied, assembled, multivalent and reproduced through surveillance matters for international efforts to combat resistance.Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Hiv Infection Increases Risk of Pasc While Covid-19 Vaccination Is Protective

Background: People with HIV (PWH) are at a higher risk of severe acute COVID-19;however, their risk of subsequently developing post-acute sequelae of SARS-CoV2 (PASC) remains unclear. Furthermore, although vaccination has been shown to be protective against PASC in the general population, few studies have evaluated its effectiveness in PWH. Method(s): We used the TriNetX health research database to source data from 69 healthcare organizations within the US. We included any adults aged >= 18 years with positive SARS-CoV-2 between January 1, 2020 and September 16, 2022 and categorized them based on their HIV status, baseline sociodemographic characteristics, comorbidities and COVID-19 vaccination status. The primary outcome was risk of PASC, compared by HIV and vaccination status after 1:1 propensity score matching. PASC was defined as either the persistence of COVID-attributable symptoms or the occurrence of new-onset health conditions at least 28 days following COVID-19 diagnosis. For all analysis, statistical significance was set at p < 0.05. Result(s): Of 3,048,792 people with confirmed SARS-CoV-2 infection, 1% (n=28,904) were PWH, with 9% of PWH (n=2592) vaccinated. At 28 days post-COVID-19 diagnosis, PWH had lower mortality compared with their non-HIV counterparts (OR 0.78, 95% CI 0.70-0.87), but higher risk of developing new-onset diabetes (DM) (OR 1.26, 95% CI 1.11-1.42), heart disease (OR 1.27, 95% 1.14-1.41), malignancy (OR 1.66, 95% CI 1.45-1.89), thrombosis (OR 1.25, 95% CI 1.12-1.39) and mental health disorders (OR 1.70 (95% CI 1.53-1.90). Furthermore, vaccinated PWH had significantly lower odds of death (OR 0.63, 95% CI 0.42- 0.93) and each new-onset PASC outcome, as follows: DM (OR 0.51, 95% CI 0.32- 0.82), heart disease (OR 0.44, 95% CI 0.29-0.67), malignancy (OR 0.43 (95% CI 0.25-0.74), thrombosis (OR 0.51, 95% CI 0.33-0.78) and mental health disorders (OR 0.49, 95% CI 0.30-0.79). The risk of PASC was higher during the pre-Delta variant period but did not vary based on CD4 count or HIV viremia. Conclusion(s): HIV infection confers a higher risk of PASC. Importantly, COVID-19 vaccination significantly lowered mortality and was protective against PASC among PWH. With the increase in the number of COVID-19 survivors, vaccination offers an effective preventive strategy to address a burgeoning public health problem. (Table Presented).

Integrated surveillance and early warning system for emerging infectious diseases based on One Health concept: Structures and innovations.

One Health is an upgrade and optimization of health concepts, which recognizes the integrated health of the human-animal-environment. It emphasizes the use of interdisciplinary collaboration, multi-sectoral coordination, and multi-organizational One Health approaches to solve scientific questions. The surveillance and early warning system is the basis of public health emergency prevention and control. The COVID-19 pandemic and the emerging infectious disease (EID) have put great challenges on the existing surveillance and early warning systems worldwide. Guided by the concept of One Health, we attempt to build a new pattern of integrated surveillance and early warning system for EID. We will detail the system including the One Health-based organizational structure, zoonotic and environmental science surveillance network, EID reporting process, and support and guarantee from education and policy. The integrated surveillance and early warning system for EID constructed here has practical and application prospects, and will provide guidance for the prevention and control of COVID-19 and the possible EID in the future.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.

New Onset Autoimmune Disease More Common after Covid-19

Background: Viral infections including SARS-CoV-2 may trigger autoimmune disease through T-cell-mediated autoimmune response through molecular mimicry-cross-reactive T-cell recognition or bystander T-cell activation. Autoantibodies have been detected in patients with COVID-19 and some human proteins have homologous regions with SARS-CoV-2 peptides that could function as autoantigens. While there are scattered reports of various autoimmune diseases diagnosed after COVID-19, the risk is not known. Method(s): TriNetX (a global federated health research network providing access to electronic medical records across 72 large healthcare organizations) was utilized to define a cohort of adults 18 years or older seen on or after January 1, 2020 with at least one follow-up visit after an index date. Exposure was defined as COVID-19 diagnosis by ICD10 code or positive laboratory test. Controls did not have COVID-19 (by the same criteria) and were propensity score-matched to patients who had COVID-19 by age and female sex. Index date was the date of COVID-19 diagnosis or first provider visit for any reason during the study period for controls. Outcomes (see table) were assessed starting one month after index date (to exclude prior undiagnosed autoimmune disease) until one year after. Patients with a specific outcome prior to the index date or within one month after the index date were excluded from the analysis for that outcome. Incidence by COVID-19 exposure status and risk ratios for each outcome were assessed. Result(s): 4,016,472 patients were included (2,008,236 in both groups). Overall, mean (SD) age was 49.2 (17.9) and 57.7% were female. Patients who had COVID-19 were more likely to be white (63 vs 56.9%;p< 0.001). Rheumatoid arthritis, psoriasis and type 1 diabetes mellitus had the highest incidence after COVID-19 (0.24, 0.22 and 0.19%, respectively). While the incidence of most of the autoimmune diseases assessed were low in both groups, the risk ratios for all but one condition (Grave's) showed statistically significant higher risk in patients after COVID-19 than in those without COVID-19 (see table). Risk ratios were highest for polyarteritis nodosa (4.43, 3.27-6.01), reactive arthritis (3.56, 2.05-6.2) and ANCA-associated vasculitis (3.36, 2.6-4.34). Conclusion(s): Autoimmune diseases were more likely to be diagnosed within the first year after COVID-19 than in age-, sex-matched controls. Future work will assess the validity of autoantibodies in predicting autoimmune disease after COVID-19. (Table Presented).

Covid-19 Vaccine Coverage among People with Hiv in the Vaccine Safety Datalink

Background: People with HIV (PWH) may be at increased risk for severe COVID-19 outcomes compared with people without HIV. However, COVID-19 vaccination coverage among PWH is largely unknown, especially among those with advanced HIV or comorbidities. Method(s): We conducted a cohort study to evaluate coverage of the initial COVID-19 vaccine primary series and factors associated with the completion in adult PWH (>=18 years) enrolled in 8 healthcare organizations participating in the Vaccine Safety Datalink (VSD) project during December 1, 2020- December 31, 2021. Completion of two doses of the Pfizer-BioNTech or Moderna mRNA COVID-19 vaccines or one dose of the single-dose Janssen COVID-19 vaccine was assessed. Multivariable analysis was conducted using a robust Poisson regression model to estimate the rate ratio (RR) for factors associated with primary series completion, accounting for follow-up time. Result(s): A total of 22,063 PWH were identified, among which 89% were male and 93% were viral suppressed (viral load, VL <=200 copies/ml). Chronic comorbid conditions were prevalent, with 25% having a Charlson comorbidity score of 1-2 and 13% having a score of 3 or greater. About 23% were overweight and 17% were obese. The majority (90%) completed the primary series and 1,782 PWH (8%) did not receive any dose during the study period. A rapid uptake was achieved within the 6 months after the national COVID-19 vaccination program launched on December 14, 2020. (Figure 1) PWH who received one dose of mRNA vaccine (i.e., partially vaccinated) were excluded (n=314) from the analysis for the primary series completion. Having received an influenza vaccination in the past 2 years was the strongest predictor of completion (RR=1.17, 95%CI: 1.15, 1.20). Males (RR= 1.06, 95%CI: 1.04-1.08) and those of Asian race (RR=1.05, 95%CI: 1.03-1.06, vs. White) were more likely to complete the primary series. However, PWH with baseline CD4 counts < 200 (RR=0.97, 95%CI: 0.94-0.99) and those failing to achieve viral suppression (VL= 201-10k: RR= 0.89, 95%CI: 0.85-0.94;VL >10k: RR= 0.92, 95%CI: 0.87-0.98) were less likely to complete the primary series. Body mass index, Charlson comorbidity score, and neighborhood household income level were not associated with completion. Conclusion(s): Coverage of the COVID-19 vaccine primary series was high in adult PWH in the VSD. However, targeted vaccination outreach is warranted for PWH with low CD4 counts and uncontrolled HIV viral load.

Occupational stress and its influencing factors of primary health care workers during COVID-19.

[Background] Since the outbreak of COVID-19, primary health care workers have been facing un-precedented work pressure, and their occupational stress should be taken seriously. [Objective] To analyze the occupational stress situation and its influencing factors of primary health care workers in Guangdong Province, and to propose targeted interventions. [Methods] Using a multi-stage stratified random sampling method, each prefecture-level city in Guangdong Province was classified into "good", "medium", or "poor" category based on its gross domestic product (GDP) in 2019 released by the Guangdong Provincial Bureau of Statistics. In September 2021, four primary health care institutions were randomly selected from each stra-tum, and a total of 1 327 staff members were selected for the study. The Core Occupational Stress Scale (COSS) and a basic information questionnaire designed by the authors were used. Mann-Whitney U test was used to compare the means between two groups, and Kruskal-Walis H test was used to compare the means among multiple groups. The comparison of categorical data was performed by trend chi2 test or Pearson chi2 test;the analysis of factors influencing occupational stress was performed by dichotomous multiple logistic regression analysis. [Results] There were 365 health care workers reporting occupational stress in this survey, and the positive rate of occupational stress was 27.5%. The total occupational stress score in M (P25, P75) and the scores of social support, organization and reward, demand and effort, and control were 45.0 (40.0, 50.0), 20.0 (17.0, 21.0), 14.0 (12.0, 17.0), 12.0 (10.0, 15.0), and 5.0 (4.0, 6.0), re-spectively. The results of dichotomous multiple logistic regression analysis showed that high education, low income, doctor positions, long working hours in a day, and shift work were associated with the occurrence of reporting occupational stress (P < 0.05). [Conclusion] Education, average monthly income, job category, daily working hours, and shifts are factors influencing the occurrence of reporting occupational stress in primary health care workers;targeted interventions should be implemented to reduce their occupational stress levels.Copyright © 2023, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

Environmental Wellness Coping Strategies During Covid-19 Among Australian Families

The worldwide outbreak of the COVID-19 pandemic affected every part of human lives, including the environment. Though not a welcoming era, it is certain that the 2019 pandemic was not the first of its kind nor is it going to be the last to affect human wellness. The various protocols implemented to mitigate the spread of the pandemic had significant effects on the wellness dimension relating to the environment. This study intended to explore the environmental wellness challenges experienced by some families in Melbourne, Australia, during COVID-19 and the strategies they used as they transitioned through the pandemic. The study outcome indicated that, the pandemic had both positive and negative effects on the environmental wellness of the families in this study. The strategies of the families are worthy of notice, for future approaches to deal with any pandemic. The study framed five possible inductive themes along the environmental wellness situation before COVID-19, overall effect of COVID-19 on environmental wellness, impact of COVID-19 on specific aspects of environmental wellness, pathways to the management of environmental wellness during COVID-19 and critically analyzing recommended changes to environmental wellness by the families in the study. It is expected that the proper implementation of the proposed strategies will significantly contribute toward environmental wellness for individuals and families facing environmental wellness challenges.Copyright © 2023, Codon Publications. All rights reserved.

Worldwide responses of health systems to the financial challenges of the COVID-19 pandemic

The SARS-CoV-2 coronavirus (COVID-19) pandemic is a major public health issue;it is the greatest challenge facing humanity in the 21st century, and a sharp increase in the prevalence of the disease has resulted in an increase in morbidity and mortality in many countries. The global health community, in an effort to reduce the spread of the virus, has been taking precautionary measures to address the crisis and alleviate the economic impact of the pandemic on healthcare services. Global information exchange is vital for health systems to meet these challenges. Health systems, even those in developed countries, appear to have been unprepared to meet this challenge, partly because of pre-existing problems. This study identifies some important features of health systems around the world, and the policies implemented by those responsible for addressing this global health crisis caused by SARSCoV-2. In addition, it highlights the government decisions and mechanisms that were implemented to strengthen and finance health systems, and to mitigate the cost of the pandemic. The response of health systems to the requirements created by the coronavirus pandemic shows adaptation to successive changes, allowing recovery and satisfaction of their needs for the protection of public health.Copyright © Athens Medical Society.

Effect of real-time remote-based cardiac rehabilitation on subjective satisfaction and objective performance during the coronavirus disease 2019 pandemic

Background: Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose(s): This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Method(s): We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospitalbased CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [DELTA]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Result(s): Sixteen patients (72.2+/-10.4 years) completed remote-based CR and fifteen patients (77.3+/-4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0+/-2.7 mL min-1 kg-1;after: 14.9+/-3.9 mL min-1 kg-1;p<0.05) and the WHOQOL-BREF score (before: 77.4+/-12.8 points;after: 93.9+/-12.9 points;p<0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9+/-13.2 points;after: 11.3+/-6.8 points;p<0.05) after rehabilitation than at baseline. The post- CR physical function differed significantly between the two groups (DELTApeak VO2, remote: 2.8+/-3.0 mL min-1 kg-1;hospital: 0.84+/-1.8 mL min-1 kg-1;p<0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (DELTAWHODAS 2.0 score, remote: -8.56+/-14.2 points;hospital: 2.14+/-7.6 points;p<0.01). Conclusion(s): Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed.

Diabetes Care for You: leadership, followership, partnership

The 2022 Mary MacKinnon lecture reminds us of some of the history of the development of out of hospital specialist diabetes services in the United Kingdom. There have been multiple clarion calls across the years to collaborate, share information and values and break down traditional boundaries in the pursuit of improved patient care and outcomes. Along with this, we note the roles of clinical and managerial leadership, followership and partnership in working together with people living with diabetes to co-produce a model of diabetes care and then to ensure through good stewardship of shared resources that the expectations of that change are delivered for our population. We go on to discuss how the Diabetes Care for You team has continued to innovate and provide care during the pandemic and conclude with a vision of the future and a challenge for decision makers to put the needs of the population at the forefront of future planning. Copyright © 2023 John Wiley & Sons.Copyright © 2023 John Wiley & Sons, Ltd.

Anticipating a Post COVID-19 World and the Pivotal Role of Science and Technology

Currently, the Coronavirus disease (COVID-19) has transformed into a severe public health crisis and wreaking havoc worldwide. The ongoing pandemic has exposed the public healthcare system's weaknesses, and highlighted the urgent need for investments in scientific programs and policies. A com-prehensive program utilizing the science and technology-driven strategies combined with well-resourced healthcare organizations appears to be essential for current and future outbreak management.Copyright © 2021 Bentham Science Publishers.

Covid-19 : les transferts internationaux de patients de réanimation, une solution pour les départements frontaliers

La crise sanitaire de la Covid-19 a imposé une adaptabilité jamais réalisée de notre système de santé. Les services de réanimation et les structures de médecine d'urgence ont dû innover et développer des stratégies novatrices pour garantir des soins de qualité à tous les patients relevant de réanimation. La région Grand-Est, et plus particulièrement les départements de Moselle, du Bas-Rhin et du Haut-Rhin, a été particulièrement touchée. Parmi les 349 patients transférés hors de la région, 164 l'ont été vers des pays européens (Allemagne, Autriche, Luxembourg et Suisse) entre le 14 mars et le 4 avril 2020. Ces transferts internationaux, organisés par l'Agence régionale de santé et les Samu-Centre 15, ont essentiellement fait appel à des moyens aériens des hôpitaux, de l'armée et de la protection civile. L'accompagnement des patients, soigneusement sélectionnés, était assuré par un binôme médecin‒ infirmier spécialisés. Le choix de cette stratégie a permis d'éviter la saturation des services de réanimation et d'avoir à faire un choix entre les patients pouvant ou non bénéficier de soins aigus. L'adaptabilité des professionnels de santé et une organisation au plus près du terrain ont permis de réaliser ces transferts dans de bonnes conditions. Cet épisode témoigne de l'importance de laisser la gestion des crises sanitaires aux professionnels de la santé. Cet article présente l'organisation mise en place en région Grand-Est pour préparer et réaliser ces transferts internationaux.Alternate : The COVID-19 health crisis has imposed an unprecedented adaptability of our health system. Intensive care units and emergency departments had to innovate and develop new strategies to guarantee quality care for patients needing intensive care. The "Grand-Est” region and particularly the counties of Moselle, Bas-Rhin and Haut-Rhin, were strongly impacted. Among the 349 patients transferred out of region, 164 were transferred to European countries (Austria, Germany, Luxembourg, and Switzerland) between March 14 and April 4, 2020. These international transfers, organized by the regional health agency and the emergency medical call centers, mainly use flying ambulances belonging to hospitals, army, and civil protection. The support of these patients was provided by a specialized physiciannurse team. The choice of this strategy made it possible to avoid saturation of intensive care units and to make a choice between patients admitted or not in intensive care. Adaptability of health care providers and an organization as close as possible to the field allowed these transfers to be carried out under good conditions. This episode demonstrates the importance of leaving the management of health crisis to health professionals. This article presents the organization set up to prepare and carry out these international transfers.

Barriers to health care services among US-based undocumented Latinx immigrants within the sociopolitical climate under the Trump administration: A comparative analysis between client experiences and provider perceptions

As President Biden's administration works towards a 'fair and humane' immigration overhaul, it becomes critical to examine the implications of immigration policies/laws under the Trump administration on the well-being of undocumented residents to inform equitable reformations. We investigate challenges faced by undocumented Latinx immigrants in accessing health care services in the sociopolitical climate under the Trump administration. This study, which follows a similar study among frontline service providers, presents key findings from 23 in-depth interviews with Latinx individuals. Understanding their experiences is necessary to advance access to health-promoting services and uphold the human right to health. Our study participants' narratives document multiple barriers to health care services, many notably exacerbated by increasingly restrictive immigration policies/laws and heightened punitive interior enforcement practices under the Trump administration. As the nation awaits equitable immigration reform, health care organizations should immediately incorporate, amplify, or alter programs/practices to facilitate access among their undocumented clients. Focused organizational changes have the potential to reduce unmet health needs, minimize financial burdens for families, and curtail potential public health threats, the latter a particularly imperative goal within the current COVID-19 pandemic. We also distill conclusions drawn from our interviews with clients and their convergence with and divergence from conclusions drawn from our related research with providers. While providers recognize the negative impact of sociopolitical factors on their clients' access to health care services, client experiences illuminate potential gaps in their understanding. Bridging understanding between providers and clients can improve access, utilization, and retention in health care services.Copyright © 2022 The Authors