Effect of COVID-19 pandemic psychological behavior of dental assistants in Saudi Arabia: A cross-sectional survey

Background: Dentists and dental auxiliaries are considered at high risk for the spread of COVID-19 due to their direct contact with the patient's oral cavity. The stress of being infected with the virus was high during the pandemic. This research aims to estimate the psychological impact of COVID-19 on dental assistants in Saudi Arabia during this pandemic. Methodology: This questionnaire-based cross-sectional study used a pre-validated Depression, Anxiety, Stress Scale with 21 Items (DASS-21) to assess the psychological impact on the mental health of dental assistants during the COVID-19 pandemic. The questionnaire was sent to the participants through the mail using Google Forms. One reminder email was sent after a week to fill out and submit the form. Data were entered using Microsoft Excel and later analyzed by the Statistical Package for the Social Sciences software. Results: The response rate was 75% (210 out of 280). Most participants were 20–40 years old and only 10 were above 50. Most participants were females (180) and were of non-Saudi origin. The results of a comparison of DASS scores between males and females were statistically significant (p = 0.001), with a higher mean total DASS score noted in males (20.03) compared to females (13.68). Conclusion: Healthcare workers in direct contact with patients, such as dental assistants, have a higher risk of contracting the infection, which increases their psychological stress and anxiety.

HEALTHCARE EXPENDITURE AND CARE SEEKING PATTERNS AMONG PEOPLE WITH CHRONIC CONDITIONS DURING THE PANDEMIC

Objective: Public health strategies resorted to world-wide, to reduce the transmission of COVID-19 had economic impacts which led to care seeking changes among people with pre-existing chronic diseases. We aimed to assess the household expenditure and, care seeking among people with chronic diseases due to COVID-19 pandemic in Sri Lanka. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants socio-demographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%;n = 173) responded that they experienced a negative impact on their main income. Nearly 30%(n = 130) of the participants had an additional source of income before the pandemic;and of them majority (74%;n = 97) reported a negative impact on the income. Twenty six percent (n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30)reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. The pandemic led to changes in healthcare utilization patterns among patients. Majority had to obtain the drugs from the pharmacy 65% (n = 70) and the laboratory tests from private labs 58% (n = 62). Forty-eight percent agreed that the pandemic led to delays in healthcare seeking, mostly because they were unaware of the services rendered. The incurred high OOPE during the pandemic. Of the participants, 9% (n = 39) and 3.2% (n = 14) had incurred catastrophic healthcare expenses at 10% and 25% of their total income. Conclusions: Residents of the Western-province were severely economically affected by the COVID-19 pandemic. Participants had incurred high out-of-pocket expenditures which led to changes in care seeking patterns among people chronic conditions. Strategies to ensure continuity of care especially for chronic conditions while protecting people from financial hardships is necessary to move towards Universal Health Coverage.

REDUCED HEALTHCARE UTILIZATION AMONG PATIENTS WITH CHRONIC DISEASES DURING THE PANDEMIC

Objective: Public-health strategies resorted to world-wide, to reduce the transmission of COVID-19 impacted the healthcare-utilization of people with preexisting chronic diseases. We aimed to assess the healthcare utilization, patientexperiences and economic impacts among people with chronic diseases due to COVID-19 pandemic. Design and Methods: An online survey was conducted in 2021 involving 449 adults living in the Western-Province of Sri Lanka. Data on participants sociodemographic and economic status, co-morbidities, healthcare utilization, and healthcare-seeking behaviours were collected using a pre-tested questionnaire. The questionnaire link was distributed through social media and by emails. Categorical data were expressed as proportions/percentages with 95% confidence intervals where relevant. Quantitative data, normally distributed, were summarized in terms of mean and standard deviation (SD) and non-normally distributed as the median and interquartile-range (IQR). Results: 449 respondents completed the survey. Majority (55%) responded that they experienced a negative impact on their main income. 26%(n = 115) mentioned that they had a doctor-diagnosed chronic disease or a disability and of them 72% (n = 83) were on regular medication. Nearly half (n = 55;48%) mentioned that there was a delay in seeking healthcare during the pandemic and 27% (n = 30) reported not having sought treatment during the lockdown period. Of the people with delayed healthcare seeking 25% had hypertension, 16% diabetes, and 12.2% asthma. Considering care seeking pattern among people with chronic illness, it declined in all institutions during the lockdown period. However careseeking in the private sector, only margially declined during the pandemic. Considering care seeking at a government hospital, a drastic drop was observed during the lockdown period (n = 13;= 11.3%). Of the respondents who sought healthcare for chronic illness during the pandemic in lockdown (n = 85;74%) and no-lock down (n = 107;93%), a considerable proportion mentioned that clinics were either not functioning on time or not functioning at all. Although the majority agreed that their perceived health despite the chronic illness was good, very good, or excellent, around 38% reported it as fair or poor. Conclusion: Health-care utilization among people with a chronic disease reduced due to supply and demand driven factors in healthcare. Efforts are necessary to ensure continuity of care for people with chronic disease to prevent complications. The government needs to invest in resilient health systems to be better equipped to provide uninterrupted care for NCDs in any circumstances. To support this, primary healthcare strengthening and tele-health options should be explored.

A Survey of Vascular Surgery Program Directors: Perspectives following USMLE Step 1 Conversion to Pass/Fail and Virtual Only Interviews

Background: Step 1 of the United States Medical Licensing Examination (USMLE), a historically important factor in the selection of vascular surgery residents and fellows, transitioned to completely pass/fail on January 26, 2022. Due to the COVID-19 pandemic, residency and fellowship interviews were conducted virtually during the 2020–21 and 2021–22 application cycles. Given these significant changes in the evaluation of candidates for residency training, we sought to understand vascular surgery program directors' (PDs) perspectives regarding the change in step 1 scoring and use of virtual interviews as well as determine which factors will assume importance when applying to vascular surgery training programs in the future. Methods: A 26-item survey questionnaire was created using Qualtrics survey tools with questions regarding attitudes toward the change in step 1 scoring and virtual interviews, the importance of additional factors utilized by programs in selecting candidates for interviews and ranking applicants for residency/fellowship selection, and programmatic demographics. This was distributed anonymously to all vascular surgery training programs over a 2-week period using a comprehensive list of 249 unique email addresses created by cross-referencing the Accreditation Council for Graduate Medical Education list of certified vascular training programs with email addresses from individual program websites identifying current program leadership. Responses were analyzed with descriptive statistics with values listed as average Likert scale weight ± standard deviation (SD) or percentages. Results: Sixty-eight of 249 (27.3%) program and associate PDs responded to the survey. Of which, 33.9% of respondents strongly disagreed with step 1 going completely pass/fail. In the absence of a scored USMLE step 1, letters of recommendation (average Likert scale weight ± SD, 4.43 ± 0.92), dedication to specialty (4.14 ± 1.03), and USMLE step 2 CK (4.06 ± 0.92) had the highest average scores for deciding which applicants to interview for integrated vascular surgery residency. For determining which candidates to interview for vascular surgery fellowship, letters of recommendation (4.51 ± 0.84), dedication to specialty (4.12 ± 0.90), and research (4.10 ± 0.80) had the highest average scores. For ranking residency candidates, the interviewee's perceived "fit” (4.61 ± 0.55), letters of recommendation (4.53 ± 0.76), and an overall interview experience (4.47 ± 0.62) had the highest average scores. Similarly, the factors with the highest average Likert scores for ranking fellowship candidates included the interviewee's perceived "fit” (4.69 ± 0.51), letters of recommendation (4.65 ± 0.52), and an overall interview experience (4.51 ± 0.59). The majority (72.2%) of PDs preferred in-person interviews;however, 50% of respondents were at least "somewhat satisfied” with virtual interviews during the 2021–22 application cycle as they could judge applicants' interview skills at least "moderately well.” The minority (18.8%) who preferred virtual interviews most commonly noted a "reduction of the financial burden for applicants” as the reason for this preference. Conclusions: Most vascular surgery program and associate PDs were dissatisfied with USMLE step 1 going pass/fail with most indicating prescreening applicants using both step 1 and step 2 clinical knowledge (CK) during the residency and fellowship selection processes. In the absence of a scored step 1, the top factors for interviewing and ranking integrated vascular surgery residency and fellowship candidates included letters of recommendation, dedication to specialty, research, USMLE step 2 CK, the interviewee's perceived "fit,” and overall interview experience. Though most PDs preferred face-to-face interviews, they were overall at least "somewhat satisfied” with the virtual format that took place during the 2021–22 cycle. © 2022 Elsevier Inc.

Examining virtual research recruitment and participant diversity in a multi-center birth cohort, Childhood Allergy and the NeOnatal Environment" (CANOE)

Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, "Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that "virtual” recruitment methods (social media, websites, email) would surpass "traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: "Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity;however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment.

Overweight and associated factors in Basic Education teachers during the Covid-19 pandemic: gender differentials

Objective To estimate the prevalence of overweight among teachers in Minas Gerais during the Covid-19 pandemic and to review relevant gender associated factors. Methods Cross-sectional and analytical study, websurvey type, carried out with 15,641 teachers of public Basic Education in Minas Gerais, Brazil. Data collection took place from August to September 2020 with the use of a digital form. The dependent variable was overweight, calculated by the body mass index using the teachers' self-reported weight and height. Poisson regression was used, with robust variance. Results Among the participating teachers, 52.4% were overweight. When stratified by gender, 51.1% women and 58.2% men were considered overweight, with a significant difference between them (p<0.001). There was a higher prevalence of overweight among women in the age group of 30 to 59 years (PR=1.39) and in women 60 years or older (PR=1.45) living in the metropolitan region of the state (PR=1.06) who had children (PR=1.19), who were not exercising (PR=1.09) and with a worse dietary pattern during the pandemic (PR=1.12), much afraid of Covid-19 (PR=1.04) and with anxiety and/or depression during the pandemic (PR=1.14). Among men, there was a higher prevalence of overweight among those individuals aged 30 to 59 years (PR=1.19), who lived with a spouse (PR=1.15) working more than 40 hours per week (PR=1.12) and those with the worst dietary pattern during the pandemic (PR=1.10). Conclusion The results showed a 52.4% prevalence of overweight teachers and different associated factors between the genders.

Recruitment challenges for a prospective telehealth cohort study

Background: The COVID-19 pandemic presents challenges in participant recruitment strategies for clinical research involving people with opioid use disorders recently engaged in treatment. We describe challenges to participant recruitment in a trial comparing virtual buprenorphine treatment platform to office-based buprenorphine treatment. Methods: The parent study was a cohort trial of telehealth delivered buprenorphine treatment compared to office-based buprenorphine treatment, however, due to the pandemic potential participant recruitment for both arms became virtual. Between 9/27/2021 and 7/11/2022, telephone, email, flyers, and word-of-mouth were used to recruit study participants from each treatment setting. Recruitment tracking documents recorded the primary outcomes: number of outreach attempts and most effective contact methods. Results: Treatment settings provided contact information for 1485 potential study participants. Information was incorrect or disconnected for 282 (19%) individuals, 695 (47%) did not respond to outreach, and 508 (34%) responded to outreach. Of these responders, 369 were interested in study participation, 259 completed the online informed consent and screening assessment, and 148 met eligibility criteria and enrolled in the study. A total of 3804 virtual outreach attempts across 1485 potential participants were made, resulting in an average of 2.7 attempts per contact and a mean of 25.7 attempts per enrolled participant (n = 148). Conclusion: Conducting research during the COVID-19 pandemic required shifting from in-person to virtual recruitment strategies to contact and engage potential study participants. Virtual recruitment for this population during a pandemic appears to be less efficient and hindered efforts to meet recruitment goals. © 2022

Satisfaction and feasibility of videoconsultation (VC) in orthopaedic and trauma surgery in the context of the COVID-19 pandemic: Prospective study of 783 patients

Contexte: L'épidémie COVID-19 a contraint les spécialistes à recourir à la vidéo-téléconsultation (VTC) afin d'assurer un lien médical. Les consultations physiques (CP) et les interventions chirurgicales ayant été annulées, la VTC devait être privilégiée. Il n'existe aucune étude française récente portant sur la VTC comme principale solution de consultation. Aussi, nous avons mené une étude prospective afin d'évaluer: 1) la satisfaction des patients;2) l'accessibilité et l'avenir de la VTC;3) les motifs de refus à la VTC dans ce contexte. Hypothèse: La VTC a été appréciée favorablement par les patients. Patients et méthode: Nous avons mené une étude prospective monocentrique observationnelle d'une série continue de patients, contactés pendant la période du confinement du 16 mars au 11 mai 2020, leur proposant de modifier le format de la CP en VTC. L'ensemble des patients étaient considérés dans l'étude, qu'ils aient accepté ou non la VTC. Les motifs de refus étaient recueillis lors de la proposition. En cas d'acceptation, le chirurgien envoyait par mail au patient un questionnaire anonyme de satisfaction après la VTC. Résultats: Sept cent quatre-vingt-trois CP étaient programmées, 291 VTC ont été réalisées (37,2%), 408 patients (52,1%) ont refusé la VTC, 84 (10,7%) n'ont pu être contactés par téléphone et ont donc été exclus. Le taux d'acceptation à la VTC était de 37% (291/783). Le taux de participation au questionnaire était de 80,1% (233/291), dont 2 réponses très partielles non prises en compte dans le reste des analyses, laissant 231 patients en analyse. Il s'agissait d'une première consultation avec le chirurgien pour 28,6% (66/231) des patients, alors que 71,4% (165/231) avaient déjà rencontré le chirurgien et, parmi ces derniers, 51,6% (85/165) consultaient pour un suivi après chirurgie. L'expérience globale de la VTC était cotée en moyenne à 4,3 ± 0,8 sur une échelle de 0 à 5. Au total, 69,7% (161/231) évaluaient la VTC identique à une CP, mais pour 7,8% (18/231), l'expérience était plus mauvaise, et pour 3% (7/231), elle était meilleure;19,5% (45/231) restaient sans avis. Si le choix entre CP et VTC avait été possible pendant ce premier confinement, 72,7% (168/231) des patients auraient choisi une CP. En revanche, 85,7% (198/231) choisiront une CP après le confinement. Le groupe ayant refusé la VTC était en moyenne significativement plus âgé (57,8 ± 16,4 ans vs 48 ± 14,4 ans (p < 0,0001)) et habitait à une distance moins importante de l'institution (p < 0,0001), mais il n'y avait pas différence selon le sexe avec 42,9% d'hommes (175/408) en cas de refus de VTC vs 46,8% d'hommes (108/231) (p = 0,39)). Le principal motif de refus était la volonté de rencontrer physiquement le praticien dans 65,7% des cas (268/408). Les patients les plus âgés (≥ 65 ans) ont le plus largement évoqué des problèmes matériels (accès équipement et internet), les patients les plus jeunes (≤ 35 ans) préféraient attendre une CP. Conclusion: Un taux élevé de satisfaction a été constaté. Les motifs (articulation, pathologie dégénérative ou traumatique, première VTC, première consultation ou suivi avant ou après chirurgie) n'avaient pas d'influence significative sur la satisfaction. Bien qu'une majorité évaluait la VTC identique à la CP, la population est encore attachée au lien physique lors de la consultation, d'autant plus parmi les plus jeunes. En dehors du contexte épidémique, la CP reste encore le mode de consultation souhaité par une large majorité de nos patients. Niveau de preuve: IV;étude prospective sans groupe contrôle. © 2022 Elsevier Masson SAS

FULLY REMOTE INITIATION OF HOME BLOOD PRESSURE MONITORING INCLUDING ELECTRONIC TRANSMISSION OF RESULTS

Objective: The pressure exerted on the health care system from COVID-19 pandemic is unprecedented. Social distancing and self-isolation called for innovative, readily implementable, and effective short-term health solutions. The objective of this study was to assess the feasibility of a remote initiation of home health surveillance, including home blood pressure monitoring (HBPM), carried out by confined hypertensive adults diagnosed with COVID-19. Design and method: Individuals included in the study were between 40 and 69 years old with a known diagnosis of hypertension and a recent positive SARSCoV- 2 PCR test. During the initial phone contact and following electronic consent, participants were directed to a secure online platform to obtain all the information needed to participate in the study. Each participant received at home the equipment needed for vital signs assessment, including a LifeSource® UA- 651BLE BP monitoring device. The Sphygmo® mobile app was used by the participants for the electronic transmission of results. Participants had to assess their symptoms and completed vital signs including two BP measurements, twice a day, for 14 consecutive days. Electronic and written guidance was also provided to participants on the correct method to perform the various vital signs measurements and data collection. Results: A total of 46 participants completed the study. The mean age was 54.1 ± 6.9 years and 54% of participants were men. On average, participants performed 12.3 days of measurements, 4.4 BP measurements per day for an average total of 54 BP measurements, Among the 46 participants, 11(24%) sent an email and two participants (4%) made a phone call for technical assistance. Conclusions: In a pandemic context, among hypertensive participants with a positive SARS-CoV-2 PCR test, the completed remote initiation of HBPM with electronic transmission of results is feasible. Moreover, participants were able to perform nearly fourteen days of BP measurements including self-assessment of symptoms, twice a day, and transmit their data using a mobile app and a webbased platform.

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Introduction: As part of the COVID-19 pandemic response, the Ontario Ministry of Health funded a virtual care pilot program intended to support emergency department (ED) diversion of patients with low acuity complaints and reduce the need for face-to-face contact. The objective was to describe the demographic characteristics, outcomes and experience of patients using the provincial pilot program. Methods: This was a prospective cohort study of patients using virtual care services provided by 14 ED-led pilot sites from December 2020 to September 2021. Patients who completed a virtual visit were invited by email to complete a standardized, 25-item online survey, which included questions related to satisfaction and patient-reported outcome measures. Results: There were 22,278 virtual visits. When patients were asked why they contacted virtual urgent care, of the 82.7% patients who had a primary care provider, 31.0% said they could not make a timely appointment with their family physician. Rash, fever, abdominal pain, and COVID-19 vaccine queries represented 30% of the presenting complaints. Of 19,613 patients with a known disposition, 12,910 (65.8%) were discharged home and 3,179 (16.2%) were referred to the ED. Of the 2,177 survey responses, 94% rated their overall experience as 8/10 or greater. More than 80% said they had answers to all the questions they had related to their health concern, believed they were able to manage the issue, had a plan they could follow, and knew what to do if the issue got worse or came back. Conclusions: Many presenting complaints were low acuity, and most patients had a primary care provider, but timely access was not available. Future work should focus on health equity to ensure virtual care is accessible to underserved populations. We question if virtual urgent care can be safely and more economically provided by non-emergency physicians. © 2022, The Author(s), under exclusive licence to Canadian Association of Emergency Physicians (CAEP)/ Association Canadienne de Médecine d'Urgence (ACMU).

93. Institutional Benchmarking Survey: Registered Dietitian Practices in Outpatient Pediatric Eating Disorder Care

Purpose: An interdisciplinary team approach is recommended by numerous practice guidelines for management of eating disorder (ED) care in pediatric populations. Registered dietitians (RDs), with their unique clinical nutrition knowledge and skill play a valuable role in treating adolescents with eating disorders and their inclusion on an interdisciplinary team is integral to the team approach. Despite this, there is little guidance on standards of care for RDs working in this setting, as well as limited research on outcomes of RD managed nutrition support which may result in inconsistent and inequitable care. During the COVID-19 pandemic, cases of youth presenting with eating disorders have increased causing unprecedented demands on healthcare resources. The pandemic has also resulted in the rapid evolution of care delivery models, including the wide adoption of telemedicine services. This study fills a considerable gap in the evidence base by seeking to understand RD practices across institutional pediatric outpatient eating disorder care settings. This is a vital step to inform the development of care standards and pave the way for future research to assess outcomes of RD involvement in eating disorder care. Methods: We surveyed 18 dietitians at tertiary care institutions across all regions of the United States using a 24-question web-based questionnaire. Participants were recruited by purposeful sampling of institutional program RDs following email referral by medical leadership in affiliated eating disorder programs. Our survey addressed topics such as frequency and duration of nutrition appointments, individuals present for nutrition appointments, use of family-based treatment (FBT), content and approaches included in nutrition appointments, and disciplines with whom RDs coordinated care. Results: Most RDs surveyed practiced within interdisciplinary teams utilizing a Family Based Treatment (FBT) approach. A majority of respondents used telemedicine for at least a portion of their eating disorder appointments;nearly half of respondents (47%) reported using telemedicine for 50-100% of their eating disorder appointments. Survey responses regarding care delivery topics, such as visit frequency and duration, nutrition education content, and approach were highly variable among participants. Conclusions: This study maintains that RDs prioritize individualized care, however it highlights a gap in guidance and practice standards for their role in outpatient eating disorder care. Furthermore, our results emphasize the importance of addressing variability in nutrition practice when interpreting outcomes of RD involvement in eating disorder care. With recent changes in health care delivery as a result of the COVID-19 pandemic, there is value in understanding how nutrition care is evolving in order to meet all patient's needs. Sources of Support: Seattle Children's Hospital provided statistics support. No funding was provided.

Determining Screen Time of Children Between 3-9 Years During COVID-19 Pandemic And Investigation of Factors Related To Screen Time

Objective: The first COVID-19 case in Turkey was detected on March 11, 2020, and measures were taken to prevent the epidemic's progression. As the schools were closed and curfew was imposed on children with periodically updated bans, children had to spend more time at home during the day. In the study, we aimed to determine how the COVID-19 pandemic has influenced the screen time of children aged 3-9 in Turkey and examine the factors affecting screen time. Material(s) and Method(s): This descriptive cross-sectional study was conducted between May 3, 2020, and May 30, 2020. Throughout Turkey, mothers or fathers with at least one child between the ages of 3 and 9 were invited to the online survey via social media, telephone message groups, or e-mail. The parents who voluntarily answered the online questionnaire constituted the study participants. Result(s): A total of 9483 parents with children between the ages of 3 and 9 participated in the study. It was determined that 82.9% of the children participating in the study had increased screen time compared to the pre-pandemic period. The mean increase in screen time was 151+/-96 minutes/day. The increase was more than one hour per day in 74.9% of the participants (n=5122). The average daily screen time of the children participating in the study on the dates specified during the pandemic period was 193+/-124, the average time spent for online education was 67+/-62 minutes/day, and for leisure activities with the screen was 133+/-121 minutes/day. Screen time was significantly higher in children whose parent did not have a plan for child's screen use (OR: 3.085, 95% CI, 2.723 to 3.494, p<.001) or children who did not use the screen under parental control (OR: 1.533, 95% CI, 1.352 to 1.73, p<.001). Conclusion(s): During the pandemic, daily screen time increased in a significant number of children, and the time they spent in front of the screen was relatively high. The purpose and duration of screen use varied between preschoolers and school children. Parental attitudes and behaviors were related to children's screen time during the pandemic period. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.

Socio-economic groups of study participants in an observational study in the elective surgical population

Inequalities exist in health literacy and engagement with healthcare [1]. We aim to offer trial participation equitably to our peri-operative population. Trials should represent the populations they aim to study and broadening access helps makes research relevant to all. Although there are many under-served groups in our communities, one type of disadvantage is socio-economic deprivation. This can be represented by the 'Index of Multiple Deprivation' (IMD) decile where decile 1 represents the most deprived and 10 the least. Relative deprivation is analysed by postcode [2] and includes a number of contributing domains. We ran a single-centre observational trial on post-COVID-19 peri-operative outcomes. We tried to broaden access by avoiding exclusions such as 'not able to read and understand English' and offering participation via a number of routes such as face to face, by post and by email. We aimed to find out whether we had enabled participation from a cross-section of the population. Methods Between January and June 2021, sequential patients listed for elective surgery were approached for consent prior to admission. IMD deciles were generated;postcodes are attributed to a decile of deprivation between 1 and 10. Results Of 515 patients approached, 410 participated. IMD deciles were available for 395 of the 410 and are shown with IMD deciles for Leeds City Council in Fig. 1. Discussion Our active peri-operative research team attempts to promote access to studies via a range of interactions, which do not all rely on technology and by offering e.g. questionnaires via an interpreter. This appears to have been successful in this example;however, there are a number of limitations and areas to address. We find that observational studies are easier to recruit to and representation may be poorer in more complex studies. We could not collect data on those who declined participation. Socio-economic deprivation is just one aspect of underserved communities. IMD deciles are compared to those of the city council, which may differ from the peri-operative population. We have ongoing project work with local communities to promote understanding and uptake of peri-operative research and we work to create more inclusive and representative trials, participation and outputs relevant to underserved groups. (Figure Presented).

Growth of the Uk and Ireland Paediatric Rheumatology Nurses' Group

Introduction/Background: The Paediatric Rheumatology Clinical Nurse Specialist often has to manage a large caseload of children and young people. Paediatric Rheumatology is an umbrella term of over 80 conditions, most of which are long-term chronic illnesses which can be challenging for families to manage. The Clinical Nurse Specialist is therefore the first point of contact for families who want answers and guidance in caring for their child/young person. The UK and Ireland Paediatric Rheumatology Nurses Group, in turn, provides peer support to these nurses. This will present the growth of this network, particularly over the last two years. Description/Method: Over two decades ago, a UK Paediatric Rheumatology Nurses group was established. Since the group's formation, membership has grown from 20 to over 100 nurses, and has expanded into the Republic of Ireland. All nurses work in paediatrics and most are working solely in Rheumatology as Clinical Nurse Specialists (various titles exist). However, the group also contains nurses who may not solely focus on Rheumatology, but who also manage a number of specialities (one being Rheumatology), and those who have developed their own specialist interest in Rheumatology, often derived from providing clinical support to weekly Rheumatology clinics. The group's Lead Nurse has also encouraged Clinical Research Nurses supporting Paediatric Rheumatology studies to join, as the shared learning is useful to support their clinical practice too. Currently we only have one Paediatric Rheumatology Senior Clinical Research Nurse, but we do have some nurses who manage Paediatric Rheumatology studies as part of their wider clinical roles. Members are located across 37 different centres in the UK and Ireland. Four of these centres have joined in the last month, with nurses hearing about the group and approaching the steering committee about their participation. The centres range from district general hospitals through to specialist regional Children's hospitals. The seniority of our members ranges from band 5 through to band 8b, with three members managing Rheumatology services in a matron capacity. In fifteen of these centres, there is only one Paediatric Rheumatology Nurse within that centre, which can be isolating. The UK and Ireland group is accessible through email and WhatsApp and is always available for a quick question or check in. Keeping membership up to date, particularly with some nurses only joining for short periods of time to cover maternity leave, can be challenging. Tomorrow the numbers may have changed again! Discussion/Results: The growth of this group, particularly over the last two years, could be for a number of reasons: 1. Regular virtual meetings have been advertised on social media channels, especially via the British Society of Rheumatology (BSR). These don't have to be sighted by Rheumatology nurses themselves but may have been noticed from other Rheumatology multidisciplinary team members, who then encouraged their nurses to make contact. 2. Having regular virtual meetings ensures that all of the Paediatric Rheumatology Nurses are invited and can take turns in attending and sharing best practice, so it is in a team's best interest to encourage more hesitant nurses to ask to join. 3. The development of the WhatsApp group has provided quick and instantaneous responses and has clearly proven beneficial according to member feedback. 4. During the Covid-19 pandemic, working patterns changed with nurses being allowed to work from home. This change contributed to nurses feeling isolated from their peers, and also not having the wider multi-disciplinary team easily on hand and therefore asked the group their clinical questions. 5. Some members of the group have taken on additional roles, either within BSR or the Royal College of Nursing and this offers wider communication channels and increased visibility of the group through advertising. 6. Membership growth appears to mirror the growth seen in Rheumatology services, for example some centres have appointed veitis Clinical Nurse Specialist posts to work in conjunction with the Rheumatology Nursing Team. 7. The change in societal ways of working, with more work and meetings occurring virtually, and outside of the 9-5 office hours, means that nurses can attend meetings easier than having to expend time and finances to travel to face-to-face meetings. 8. New members joining naturally increases word of mouth and the wider reach of the group. Key learning points/Conclusion: Raising and maintaining the profile of this group is important. We know that there is no similar group for adult Rheumatology Nurse Specialists in the UK. Also, there is no other similar European Paediatric Rheumatology Nurses group. Paediatric Rheumatology is a huge speciality with nurses needing to be able to support families in their management of conditions outside of hospital appointments to prevent hospital admissions. The scope of the Rheumatology nurse is also always increasing, with pressure on nurses to undertake postgraduate studies, become nurse prescribers, carry out joint examinations, deliver nurse-led clinics and manage patients on immunomodulatory therapies in the community. The Paediatric Rheumatology Nurse also requires knowledge and skills in best practices for young people transitioning into adult services and be an expert in child development stages and the implications of these, whilst managing the needs and expectations of the child's main carer and wider family. For these reasons alone, it is vital that we protect the Paediatric Rheumatology Nurse Specialist and ensure that they are supported, developed and valued, and therefore, stay in Rheumatology. The ask of the wider multidisciplinary team is to allow Paediatric Rheumatology Nurses time to attend group meetings, encourage them to ask questions of the wider nursing group and to promote the group to new nurses or those who may not be aware of the group, to reach out and seek expert peer support.

The attitude of Dutch community pharmacists towards vaccination qualification and the willingness to vaccinate

Background: In the Netherlands, pharmacists are not qualified to vaccinate. KNMP would like to advocate for this qualification. In order to do so, it is important to know the attitude of Dutch community pharmacists towards vaccination qualifications, the willingness to be trained to vaccinate and towards a possible different scenario: pharmacy-based vaccination by a nurse. Purpose(s): To assess the attitude of Dutch community pharmacists towards vaccination qualification of pharmacists, the willingness to be trained to vaccinate and the attitude towards pharmacy-based vaccination by a nurse. Method(s): We developed a questionnaire and spread it by email to all KNMP members. Result(s): Sisty-six percent (66%) of the responders were positive about vaccination qualification of pharmacists (17% neutral and 17% negative), and even 78% were willing to be trained to vaccinate (ten percent neutral and 12% negative). On the other hand, only 34% was positive about pharmacy-based vaccination by a nurse (27% neutral and 39% negative). 95% of the responders were community pharmacists, of which 12% were hospital-based community pharmacists, five percent were hospital pharmacists and five percent were other pharmacists. The total number of respondents was 60, that is a response rate of two percent. Conclusion(s): We have a positive impression of the attitude of Dutch community pharmacists towards vaccination qualification of pharmacists and the willingness to be trained to vaccinate. This is a much more popular scenario than vaccination by a nurse who could vaccinate in the pharmacy. Because the total response to the questionnaire was low, we cannot be sure whether this is representative of Dutch community pharmacists or not. We considered sending the questionnaire again after the COVID-19 crisis, to gain higher response.

Galenic preparations for the prevention of the spread of COVID-19

Background: A.P.P.A. Project is the main activity of the nonprofit organisation Aid Progress Pharmacist Agreement (A.P.P.A.) which is the result of the cooperation between the University of Turin and Italian Pharmacists and it operates in the field of International Health Cooperation. The objective of the Project is the realisation of Galenic laboratories within healthcare facilities located in Developing Countries. Seven Projects are currently on-going in Madagascar, Angola, Chad and Haiti. Purpose(s): In view of the pandemic caused by COVID19, and to reduce its spread as much as possible in the hospitals where the Project is active, the goal was to implement specific procedures on site for the production of alcoholic solutions, liquid soaps and disinfectant gels in accordance with WHO guidelines. Method(s): The A.P.P.A. labs have been promptly equipped with standard procedures for the preparation of disinfectant formulations. The procedures have been developed in a very simple way to allow their introduction on site even remotely and without a specific training path that requires to be carried out in person. Result(s): Since the manual skills have been acquired during the preparation of Galenic formulations over time, local operators had no difficulty with the new formulations;if necessary specific indications are given by email or by phone calls. In the labs where these formulations had already been introduced in the past for the prevention of nosocomial infections, the setting up has been enhanced by the reorganisation of the production activities. Conclusion(s): The Galenic preparation, also in these contexts, resulted a good strategy for healthcare personnel and for hospitalised patients.