THE ROLE OF TELEMEDICINE TOWARDS IMPROVED SUSTAINABILITY IN HEALTH CARE AND SOCIETAL PRODUCTIVITY IN TURKEY (preprint)

The COVID-19 pandemic increased utilization of telemedicine for diagnosis and treatment. While telemedicine is not the panacea for the increasing health care burden, it can alleviate the problem. Here, the hypothetical impact of delivering telehealth care to patients in a busy tertiary cardio-vascular clinic in Istanbul, Turkey, is examined. Additionally, the potential environmental and societal ramifications of telemedicine are also examined. Demographics, health care costs, wages, productivity, and patient-specific data were exploited to develop a hypothetical telemedicine framework for the Turkish health care landscape. Specifically, the distance traveled and travel time to receive care using real-life location of the clinics and patients addresses seeking care are tabulated. Data from August 3, 2015 to January 25, 2023 resulted in 45,602 unique encounters with 448 unique diagnoses recorded for the patient encounters. The patients in the top 5% of the most common diagnoses traveled 23.82 +/- 96.3 km to reach the clinics. Based on our model and the related literature that telehealth care for chronic diseases is not inferior to face-to-face care, 656,258 km would have been saved if all patients were to take the first visit in person followed by telemedicine visits. The travel-associated carbon footprint and wage losses for in-person care in lieu of telehealth appointments is calculated and it was observed that exploiting telemedicine could have saved approximately 30% carbon footprint and prevented approximately $878,000 wage loss. As a result, it is found that application of telemedicine could ease the burden on patients, environment, increase access, and prevent the wage losses caused by unnecessary hospital visits.

Optimal prevention strategies for chronic diseases in a compartmental disease trajectory model (preprint)

In countries with growing elderly populations, multimorbidity poses a significant healthcare challenge. The trajectories along which diseases accumulate as patients age and how they can be targeted by prevention efforts are still not fully understood. We propose a compartmental model, traditionally used in infectious diseases, describing chronic disease trajectories across 132 distinct multimorbidity patterns (compartments). Leveraging a comprehensive dataset from approximately 45 million hospital stays spanning 17 years in Austria, our compartmental disease trajectory model (CDTM) forecasts changes in the incidence of 131 diagnostic groups and their combinations until 2030, highlighting patterns involving hypertensive diseases with cardiovascular diseases and metabolic disorders. We pinpoint specific diagnoses with the greatest potential for preventive interventions to promote healthy aging. According to our model, a reduction of new onsets by 5% of hypertensive diseases (I10-I15) leads to a reduction in all-cause mortality over a period of 15 years by 0.57 (0.06)% and for malignant neoplasms (C00-C97) mortality is reduced by 0.57 (0.07)%. Furthermore, we use the model to assess the long-term consequences of the Covid-19 pandemic on hospitalizations, revealing earlier and more frequent hospitalizations across multiple diagnoses. Our fully data-driven approach identifies leverage points for proactive preparation by physicians and policymakers to reduce the overall disease burden in the population, emphasizing a shift towards patient-centered care.

Resolution of SARS-CoV-2 infection in human lung tissues is driven by extravascular CD163+ monocytes (preprint)

The lung-resident immune mechanisms driving resolution of SARS-CoV-2 infection in humans remain elusive. Using mice co-engrafted with a genetically matched human immune system and fetal lung xenograft (fLX), we mapped the immunological events defining resolution of SARS-CoV-2 infection in human lung tissues. Viral infection is rapidly cleared from fLX following a peak of viral replication. Acute replication results in the emergence of cell subsets enriched in viral RNA, including extravascular inflammatory monocytes (iMO) and macrophage-like T-cells, which dissipate upon infection resolution. iMO display robust antiviral responses, are transcriptomically unique among myeloid lineages, and their emergence associates with the recruitment of circulating CD4+ monocytes. Consistently, mice depleted for human CD4+ cells but not CD3+ T-cells failed to robustly clear infectious viruses and displayed signatures of chronic infection. Our findings uncover the transient differentiation of extravascular iMO from CD4+ monocytes as a major hallmark of SARS-CoV-2 infection resolution and open avenues for unravelling viral and host adaptations defining persistently active SARS-CoV-2 infection.

Follow-up after post-exposure prophylaxis before and during the COVID-19 pandemic in Brazil (preprint)

Although post-exposure prophylaxis (PEP) is a powerful tool to abort HIV infection within 72 hours of exposure, blocking the establishment of chronic infection, follow-up metrics of this intervention are scarce. As antiretroviral use delays diagnosis biomarkers, the moment to perform serological evaluations must be considered this to avoid missed diagnosis opportunities. We assessed the return adherence after PEP dispensation in service in the Sao Paulo metropolitan area and reviewed the literature, both showing limited adherence to current protocols and leading to difficulties in diagnosing early HIV infection. The current proposed date for the first return after PEP is associated with low adherence and may have limited capability to detect antibodies if the infection is present. Guidelines should allow a longer time after PEP discontinuation along with message reminders to encourage adherence and avoid false negative results that can be detrimental both to the patient and to the community.

Faith-based leaders’ perceptions on the implementation of programs to promote healthy lifestyles in churches in Barbados- a mixed-methods analysis (preprint)

Background: There is a high burden of chronic diseases such as hypertension and diabetes in small island developing states (SIDS). SIDS governments have committed to a range of public health, healthcare, and fiscal measures to reduce this burden including community-based health education in collaboration with civil society organizations. We sought to explore perceived acceptability, appropriateness, and feasibility of implementing self-management health programs in 20 faith-based organizations in the small island developing state of Barbados. Methods: This was a concurrent mixed methods study - a quantitative online survey and a qualitative inquiry using semi-structured interviews. Acceptability, appropriateness and feasibility of the intervention were assessed using the following quantitative assessment tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Thirteen in-depth interviews were conducted virtually, recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis based on deductive codes from Proctor’s implementation outcomes definitions. Results: From the 52 respondents of the survey, the median and interquartile ranges for the AIM, IAM and FIM scales were 16 (15-20), 16 (16-20) and 16 (15-17) (out of 20), respectively. We found high levels of acceptability, 82% (95% CI (69%, 95%)) of leaders indicating that health programs in churches met with their approval; and high levels of appropriateness- 90% (95% CI (80%, 100%)) indicating health programs in churches were “fitting” and “a good match”. Feasibility scores were lower, with 60% (95% CI (44%, 76%)) indicating that health programs in churches would be easy to use.  In interviews, leaders expressed acceptance of healthy lifestyle programs in churches and described their appropriateness through alignment with church doctrines stating, “the body is the temple of God”. They felt that economic impacts from COVID-19 were likely to be a barrier to the success of programs. Leaders expressed the need for support from healthcare providers who are sensitive and respectful of church culture. Conclusion: We found that health-based programs in churches align well with church doctrines, but the success of these programs will depend on establishing trust through the engagement of church-based champions, tailoring programming to include a biblical perspective and engaging entire households.

The impact of COVID-19 pandemic restrictions lifting on the health of the elderly :evidence from a quasi- experiment (preprint)

The lifting of COVID-19 restrictions has brought about positive changes, yet the adaptation of the elderly in the post-pandemic era still faces challenges. The purpose of this study is to investigate the health changes in the elderly after the lifting of COVID-19 restrictions through a quasi-natural Experiment design, to unravel the effects of the lifting of the pandemic restrictions. The article is based on the data of the elderly in China and South Korea from 2020 to 2022 and employs the PSM-DID method for empirical testing to examine the impact of the lifting of pandemic restrictions on the health of the elderly. The results show that: (1) The lifting of the pandemic restrictions significantly improved the physical health of the elderly. (2) The lifting of the pandemic restrictions effectively improved the mental health of the elderly and significantly reduced their depression scores. (3) Heterogeneity tests indicate that the lifting of the pandemic restrictions had a more treatment effect on improving the health of elderly groups that are female, younger, lower-income, and suffering from chronic diseases. The gradual recovery of health in the elderly in the post-pandemic era is an important phenomenon, but more research is needed on the potential health impacts of pandemic lockdown measures to provide information for the fields of public health and elderly health.

Assessing COVID-19 Vaccine Effectiveness in Frail Long-Term Care Facilities Residents in a Middle-Income Country (preprint)

Background: During the COVID-19 pandemic, individuals residing in long-term care facilities (LTCF) are particularly vulnerable to adverse outcomes due to their higher rates of frailty, disabilities, cognitive impairment, dementia, and chronic illnesses. In low and middle-income nations, research on immunizing frail populations is lacking, while most studies on COVID-19 in LTCF come from wealthier nations and may not fully capture the situation in emerging countries.  Methods: We aimed to evaluate the effectiveness of first, second and third COVID-19 vaccine doses, against infections, hospitalizations, and deaths, and their association with frailty, age, sex and chronic disease, among older adults, in a social vulnerability context. This retrospective cohort study, comprises a total of 712 older adults, in a social vulnerability context, of 29 LTCF, in Brazil. Continuous variables were described by medians and interquartile ranges and categorical variables were represented by absolute and relative frequencies. The Mann-Whitney test was used. For evaluating the relation between categorical variables, Pearson's chi-square test was used. When comparing proportions, the Z test of proportion was applied. A significance level of 5% was considered.  Results: Median age was 81.37 years, 72.8% were female, 94.61% were frail, 79.97% had a cognitive impairment, 69.54% had a mobility impairment, 78.37% have, at least, one chronic disease and 72.73% use five or more medications per day. Before the vaccine, mobility impairment was associated with great contamination rates (p=.03); frailty (p=.02) and previous pulmonary disease (p=.03) with symptoms of gravity; frailty (p=.02), pulmonary disease (p=.04) and male sex (p=.02) with emergency care or hospital admission. After the third vaccine dose, only frailty remains associated with admissions (p=.03). The number of positive cases (p=.001), symptomatic patients (p<.001), admissions (p=.001) and deaths (p<.001) were substantially reduced after the three vaccine doses.  Conclusions and Implications: Even in a frail population, the vaccine was effective, in the reduction of positive cases, the number of symptomatic patients, admission to emergency or hospital care and deaths. Before the vaccine, frailty, previous pulmonary disease and male sex were associated with worse outcomes. After the vaccine, frailty remains associated with a major number of admissions.

Unveiling the Landscape of COVID-19 Vaccination in Saudi Arabia: A Socio-Demographic, Clinical, and Vaccine Profile Analysis (preprint)

The worldwide competition to vaccinate against COVID-19 has highlighted the importance of immunization measures in containing the virus. Saudi Arabia, like the rest of the globe, must assess socio-demographic subtleties, chronic illnesses, vaccination effects, and public health policy implications as it navigates this complicated environment. This cross-sectional study examined Saudi COVID-19 vaccine in many ways. It examined the socio-demographic makeup of vaccine recipients, the prevalence of chronic conditions in this population, vaccine administration patterns, post-vaccination side effects, and vaccine-infection rates. A questionnaire-based online survey of 401 participants ensured gender, nationality, age, weight, and educational diversity. We analyzed vaccine manufacturer choice for each dosage, side effects after the first and second doses, and chronic diseases in the sample. Pfizer/BioNTech vaccines are preferred for all three doses, reflecting worldwide vaccination acceptance patterns. Side effects were not significantly different between vaccination kinds. Interestingly, immunization reduced infection rates, demonstrating the efficacy of COVID-19 vaccines. The data fills important information gaps and illuminates Saudi COVID-19 vaccination kinetics. These data support the global preference for mRNA vaccines, demonstrating the faith in this breakthrough technology. They also sponsor COVID-19 vaccine safety and effectiveness studies. The dramatic drop in infection rates among vaccinated people shows how vaccinations suppress the pandemic. These findings inform Saudi Arabia's immunization efforts. As booster doses become more common, long-term vaccination research is crucial. Vaccine reluctance, especially in certain demographics, must be addressed. Due to vaccines' protective potential, equitable vaccine distribution and large immunization programs are essential for herd immunity and pandemic management. This thorough cross-sectional study helps policymakers and healthcare practitioners build successful and inclusive COVID-19 immunization regimens in Saudi Arabia.

Survey analysis of patient satisfaction and sexual issues in the management of vulvar lichen sclerosus (preprint)

Objective Vulvar lichen sclerosus (VLS) is an underestimated chronic disease. It can cause significant symptom burden and sexual dysfunction. This study aimed to evaluate patient satisfaction and current challenges in the management of VLS in a certified dysplasia unit, particularly during the COVID-19 pandemic.Methods This survey analyzed patients who had been diagnosed with VLS and treated at our DKG-certified dysplasia unit. The study was conducted during the COVID-19 pandemic in the Department of Gynecology and Obstetrics at the University of Aachen. The questionnaire contained 43 questions covering general treatment, diagnostic delays, psychological and sexual issues and specific questions about the COVID-19 pandemic. The questionnaire was distributed between January 2021 and September 2023.Results This study included 103 patients diagnosed with VLS who were treated at our certified dysplasia unit. Overall, 48% of the patients were satisfied with the success of the therapy. Most participants reported psychological problems (36.8%), fear of cancer (53.3%), or sexual restrictions (53.3%). Among the patients, 38% were bothered by the regular application of topical cortisone. However, 72% were willing to undergo treatment for more than 24 months. The COVID-19 outbreak in March 2020 had a significant negative impact on general VLS care from the patient’s perspective (3,83/5 before vs. 3,67/5 after; p = 0.046). There was a general request for booklets to inform and educate patients about their disease. Furthermore, the respondents demanded a telephone hotline to answer the questions and wished for follow-up visits via e-mail to cope better with their current situation.Conclusion This study highlights the need for more effective treatments for VLS and an increased awareness of psychological and sexual distress. To ensure patient well-being and satisfaction, it is imperative to offer individualized care in a team of specialists from various disciplines.

Comparing surveyed adults with long COVID and those with just a positive test helps put COVID into perspective (preprint)

Introduction: Among adults who test positive for COVID-19, some develop long COVID (symptoms lasting [≥]3 months), and some do not. We compared 3 groups on selected measures to help determine strategies to reduce COVID impact. Methods: Using Stata and data for 385,617 adults from the 2022 Behavioral Risk Factor Surveillance System, we compared adults reporting long COVID, those with just a positive test, and those who never tested positive, on several health status and risk factor measures plus vaccination rates (data for 178,949 adults in 29 states). Results: Prevalence of just COVID was 26.5% (95% CI 26.2-26.8) and long COVID was 7.4% (7.3-7.6). Compared with adults with just COVID those with long COVID had worse rates for 13 of 17 measures of chronic disease, disability, and poor health status, while those with just COVID had the best results for 15 of the 17 measures among all 3 groups. The 5 risk factors (obesity, diabetes, asthma, cardiovascular disease, and COPD) previously associated with COVID deaths, increased long COVID but not just COVID rates, which were highest among younger and higher income adults. Adults with long COVID had the highest rate among the 3 groups for any COVID risk factors and data from 29 states showed they had the lowest rates for [≥]3 vaccine doses of 35.6%, vs. 42.7% and 50.3% for those with just a positive test, and neither, respectively. Vaccination with [≥]3 vaccines vs. <3 reduced long COVID rates by 38%, and just COVID rates by 16%. Conclusions: Results show the seriousness of long COVID vs. just a positive test and that increasing vaccine coverage by targeting adults with risk factors shows promise for reducing COVID impact.

Health Inequality due to Changes in Income Following COVID-19: Preventive Activity (preprint)

Background Preventive measures are crucial for improving the survival and quality of life of patients and reducing healthcare costs. The COVID-19 pandemic has induced various social changes, including to socioeconomic status, behavior, and income. We evaluated changes in income following COVID-19 as well as the effects on individual engagement in preventive activities.Methods Data from the 2021 Community Health Survey were used to select individuals aged 30–65 years who were involved in economic activities. We used logistic regression models to evaluate associations between changes in household income following COVID-19 and engagement in preventive activities.Results Of the 89,992 study participants, 36,193 (36.3%) experienced a decrease in household income due to COVID-19. Compared to individuals who had stable or increased income due to COVID-19, those whose income declined had a lower likelihood of participating in preventive activities, including vaccination(OR: 0.824, 95% CI: 0.794–0.856), medical checkups(OR: 0.625, 95% CI: 0.596–0.656), and cancer screening(OR: 0.815, 95% CI: 0.782–0.849). These differences were particularly significant in men and younger individuals, without chronic diseases and who were less satisfied with medical infrastructure.Conclusion Individuals who experienced a decreased in income due to COVID-19 encountered challenges in participating in prevention programs, leading to health inequality. For individuals with low rates of preventive activity, it is crucial to implement measures that encourage screening, such as providing incentives for individuals.

COMPARISON OF ANXIETY LEVELS AMONG HEALTHCARE WORKERS WITH BECK ANXIETY INVENTORY DURING COVID-19 PANDEMIC (preprint)

Aim: The aim of this study is to investigate the anxiety levels of healthcare workers (HCWs) in hospitals in Istanbul, which is one of the cities most affected by the COVID-19 pandemic. Methods: The study was conducted online with 177 HCWs (127 doctors, 31 nurses, 15 paramedics, 4 health technicians) due to the pandemic. Beck Anxiety Invantory (BAI) was used for anxiety levels. Results: The anxiety levels of HCWs were found as 48% “minimal”, 23.7% “mild”, 17.5% “moderate”, 10.7% “severe”. The mean BAI score of other HCWs is from doctors (15.94 ± 12.776 vs 9.53 ± 8.868), the mean BAI score of women is from men (14.07 ± 10.899 vs 7.61 ± 8.681), for those who have no children, the mean BAI score is from those with a child (13.77 ± 11.713 vs 9.66 ± 9.260), and the mean BAI score of those who were over 65 years old or had a relative with chronic disease at home was higher than the others (14.11 ± 9.752 vs 10.44 ± 9.752) (p <0.05). The mean BAI score of those who did not examine COVID-19 patients were higher than the examiners (11.47 ± 10.693 vs 1.23 ± 10.394), and the mean BAI score of night shift workers (12.42 ± 11.063 vs 9.515 ± 9.255) than the others (p> 0.05). Conclusion: Healthcare workers actively working during the COVID-19 pandemic have high levels of anxiety. Working conditions of health workers should be improved and psychosocial support activities for them should be implemented continuously.

Analysis of long-term antibody response in COVID-19 patients by symptoms grade, gender, age, BMI, and treatments regimens (preprint)

Objective: The severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) and the resulting COVID-19 pandemic pose significant challenges in terms of diagnosis and recurrent infections. Literature data suggest that age, gender and BMI factors are associated with immune response. The first aim of the study was to analyze the change in antibody titer at 15-day intervals until 60 days post symptom onset (PSO) The second aim was to analyze relationship between antibody titer and symptom grade, gender, age, BMI, therapeutic drugs, vitamin supplements, and herbal therapies. Materials and methods: Blood samples were collected from 43 patients (5 mild, 21 moderate, 17 severe diseases), 18 women (41.9 %), and 25 men (58.1 %), on 15, 30, 45, and 60 days PSO after COVID-19 infection. The serum antibody titers were determined by measuring the COVID-19 IgG antibodies by ELISA. Associations between the duration of symptoms, demographic and clinical parameters, medications and vitamins used, and herbal therapies were evaluated by interviewing the participants. Results: Within the first 15 days of illness, 81.4% of the patients were positive. From day 45 PSO, seropositivity was 89.5%. The anti-SARS-CoV-2 antibody titers were statistically higher in men than women at all-time (p<0.01). Antibody titer was higher in older participants compared to younger participants (p<0.02). Plaquenil or Favipiravir use did not effect antibody response (p>0.05). Men had higher fever (p=0.006), shortness of breath (p=0.004), and chest pain (p=0.03) than women. Conclusion: We found powerful antibody response by sixty days PSO, as well as higher antibody response and severity of symptoms in men gender. Data also showed that SARS-CoV-2 antibodies are higher in individuals with older age, whereas BMI, coexisting chronic disease, and drug used had no effect on antibody titers.

Anxiety and obsessive-compulsive disorder among undergraduate medial students in Syria during war and COVID-19: A cross-sectional study (preprint)

Introduction: Syria has been suffering war for 10 years and COVID-19 added particular stress to people. Medical students are more prone than general population to anxiety and obsessive-compulsive disorder (OCD) which we are going to assess in this study. Methods This is a cross-section study that used online questionnaires were distributed in Social Media groups that included medical students. They included demographics, Zung self-Rating Anxiety Scale (SAS) and Yale-Brown OCD Scale (YBCOS). Results Overall, 180 participants were included, of which, 67 (37.2%) were males. Females and interns had higher OCD scores compared with males and more junior students p<0.05. OCD scores were not associated with social status, work, smoking, residency status, or having chronic diseases. Factors that were associated with higher anxiety scores were female gender and smoking p<0.05. In contrast, anxiety had no significant association with social status, residence status, academic year, work, and chronic diseases. Anxiety scores were not correlated with the consumption of tea, coffee, mate, or alcohol. OCD scores were also not correlated with coffee, mate, or alcohol consumption, but they were significantly correlated with tea consumption. When using regression, OCD and anxiety were associated with only sex, smoking and with each other. Conclusion These numbers were not higher than most of other studies. Further studies are needed for further evaluation to determine the cause whether it was from war having equal effect on mental health or COVID did not affect people as much in Syria.

Comparing the severity of Outcomes of SARS-CoV-2 between RT-PCR-positive and RT-PCR-negative Individuals in Iran Comparing the severity of Outcomes of SARS-CoV-2 between RT-PCR-positive and RT-PCR-negative Individuals in Iran (preprint)

The aim of this study was to compare the outcomes of SARS-CoV-2 RT-PCR-positive and RT-PCR negative Patients in Iran. This cohort study performed on 81393 patients with COVID-19 in six provinces of Iran during 2020. The studied variables include demographic and clinical. To examine the associations between RT-PCR test and death or ICU admission as dependent variable the multiple Bayesian logistic regression model was used by R software. 81393 individual (44.9 % female) with a mean age of 52.98 ± 20.8 years were included to the analysis. At all, 25434 tests (31.2 %) were positive RT-PCR, including 10772 men (44.9%) and 14662 women (55.1%). The multiple Bayesian logistic regression model showed a significant positive association between RT-PCR test results and COVID-19 mortality rate (OR: 1.46; 95% Crl: 1.29- 1.64). Also, males, older age, individual with chronic disease have higher risk of COVID-19 death, however, negative association observed between history of contact and COVID-19 death. We observed a significant inverse association between RT-PCR test results and ICU admission, while, the risk of ICU admission increased significantly by 1.2 times (95% Crl for odds ratio: 1.09, 1.34) among patients with negative RT-PCR test compared to positive RT-PCR test. People with positive RT-PCR test, male gender, older age, having a history of underlying disease have a higher risk of death and hospitalization in the ICU. Therefore, paying attention to these factors will be effective in reducing the risk of death and hospitalization in ICU.

Adversity Builds Character? Restricted health service utilization and subsequent positive self-care behavior during the early COVID-19 pandemic in China (preprint)

Background During the COVID-19 pandemic, the reallocation of health resources and the restrictions on daily life imposed by epidemic prevention and control measures to some extent have severely affected the healthcare demand of the general population, but those impacts on adults’ self-care behavior and daily lives remain unclear. This study aimed to investigate the effect of restricted health service utilization arising from the COVID-19 pandemic on self-care behavior among different populations, particularly vulnerable groups, the correlations between restricted health service utilization and self-care behavior were also quantified and compared by subgroup analysis.Methods Data on demographics, socioeconomic, health status, and self-care behavior were collected in “The Early China COVID-19 Survey”, it is a cross-sectional anonymous online survey of the general population in China. Self-care behavior was measured by four indicators: weight control(WC), physical activity(PA), prevention behavior(PB) and Online medical consultation(OMC). The multiple linear models and binary logistic regression were used to examine whether restricted health service utilization (RHSU) is associated with self-care behaviors; also, adjusted multivariate logistic regression was used to analyse subgroup heterogeneity.Results In total, 8,428 adult participants completed the survey, the mean OMC score was 1.51(SD 1.34), the mean PB score was 18.17 (SD 3.44), and the proportion of participants who engaged in WC and PA was 42.30% and 62.57%, respectively. According to the multiple regression model, the RHSU was significantly positively correlated with all four indicators of self-care(WC: OR = 1.34, p < 0.001, PA: OR = 1.34, p < 0.05, MC: OR = 1.30, p < 0.001, PB:coef = 0.16, p < 0.05). Also we observed some significant differences in the intensity of this relationship by subgroup analysis, precisely, OMC(high vs moderate vs. low infection-risk level: OR = 1.48; 1.41; 1.19, p < 0.1), PA(high vs Moderate and low infection-risk level: OR = 1.51, p < 0.05), PB(Chronic disease groups vs no: coef = 0.46;0.1, p < 0.05).Conclusions Restricted health service utilization due to the pandemic had positive correlations with self-care behavior outcomes, and the intensity of partial correlation was significantly different in the subgroups of living area infection risk levels and chronic diseases. These findings have practical value for improving self-care behavior in adult populations during the pandemic.

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study (preprint)

Background Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the elderly in Jiangsu, China is relatively lacking. Methods We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patternsin old adults. Results The mean age of these patients was 72.0±8.7 years, and the male-to-female ratio was 1:1.53. These patients during the COVID-19 period(from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases(I10-I15)", "Other forms of heart disease(I30-I52)", "Diabetes mellitus(E10-E14)", "lschaemic heart diseases(I20-I25)" and "Cerebrovascular diseases(I60-I69)". The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by Diabetes mellitus, Other forms of heart disease, and lschaemic heart diseases(I20-I25). Conclusion In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in gerontal patients. More efforts to improve the understanding of multimorbidity patterns would help us develop new clinical and family care models.

Transistors platform for rapid and parallel detection of multiple pathogens by nanoscale-localized multiplexed biological activation (preprint)

The rise in antibiotic-resistant pathogens, highly infectious viruses, and chronic diseases has prompted the search for rapid and versatile medical tests that can be performed by the patient. An electronic biosensing platform based on field-effect transistors (FETs) is particularly attractive due to sensitivity, fast turn-around, and compatibility with semiconductor manufacturing. However, the lack of methods for pathogen-specific functionalization of individual FETs prevents parallel detection of multiple pathogens. Indeed, so far functionalization of FET based biosensors is achieved by drop casting without any spatial selectivity. Here, we propose a paradigm shift in FET’s biofunctionalization. Specifically, we use thermal scanning probe lithography (tSPL) with a thermochemically sensitive polymer that can be spin-coated on any FET material. We demonstrate that this scalable, CMOS compatible methodology can be used to functionalize individual FETs with different bioreceptors on the same chip, at sub-20 nm resolution, paving the way for massively parallel FET detection of multiple pathogens. Antibody- and aptamer-modified FET sensors are then realized, achieving an ultra-sensitive detection of 5 aM of SARS-CoV-2 spike proteins and 10 human SARS-CoV-2 infectious live virus particles/ml, and selectivity against human influenza A (H1N1) live virus.

Diabetes related emergency department visits among adults during the COVID-19 pandemic - an analysis of data from the New York City syndromic surveillance system (preprint)

ObjectiveNew York City was an early epicenter of the COVID-19 pandemic. We aim to describe population level epidemiological trends in diabetes related emergency department (ED) visits among adults in New York City, for the period prior to and encompassing the first four waves of the pandemic. Research Design and MethodsWe used data from the New York City ED syndromic surveillance system during December 30, 2018 through May 21, 2022. This system captures all visits from EDs in the city in near-real time. We matched these visits to laboratory confirmed COVID-19 positivity data beginning with February 15, 2020. ResultsCompared to pre-pandemic baseline levels, diabetes related ED visits noticeably increased during the first wave in spring 2020, though this did not necessarily translate to net increases overall during that period. Visits for diabetic ketoacidosis, particularly among adults with type 2 diabetes, sharply increased before returning to pre-pandemic levels, most notably during wave 1 and wave 4 in winter 2021-2022. Trajectories of diabetes-related ED visits differed by diabetes type, age, and sex. Some ED visit trends did not return to pre-pandemic baseline levels. ConclusionsThe COVID-19 pandemic, especially the first wave in the spring of 2020, coincided with a dramatic shift in diabetes related ED utilization in New York City. Our findings highlight the importance of on-going surveillance of health care utilization for chronic diseases during population-level emergencies like pandemics. A robust syndromic surveillance system that includes infectious and non-infectious syndromes is useful to better prepare, mitigate, and respond to population-level events. Article HighlightsO_LIDiabetes related emergency department (ED) visits in New York City increased dramatically with the emergence of the COVID-19 pandemic in spring 2020. C_LIO_LIThe trajectory of diabetes-related ED visits differed by diabetes type, age, sex, and pandemic wave. C_LIO_LIThe diabetes complication of diabetic ketoacidosis among adults with type 2 diabetes showed sharp increases in the first and fourth waves of the pandemic, respectively its initial emergence in spring 2020 and the Omicron variant in winter 2021-2022. C_LIO_LIOur findings highlight the importance of on-going surveillance of health care utilization for chronic diseases during population-level emergencies like pandemics. C_LI SummaryData from NYCs syndromic surveillance system showed major increases in #type2diabetes complications (e.g. diabetic ketoacidosis) during #COVID-19 waves 1 and 4 (Omicron) - this tool may be useful for population-level monitoring of chronic disease complications during emergencies

Knowledge, attitude and practice of Kegel exercise among pregnant women in Abha, Saudi Arabia (preprint)

Background: Kegel exercise or pelvic floor muscle exercise helps in improving strength of the pelvic floor muscles and build up their function. Objective: To assess the knowledge, attitude and practice of Kegel exercise among pregnant women in PHC setting in Abha city, Saudi Arabia. Methods: A cross-sectional study was conducted with a sample of 370 pregnant women. Data were collected using a structured questionnaire that assessed the practice of Kegel exercises and various characteristics of the participants. Descriptive statistics, chi-square tests, and p-values were used to analyze the data.  Results: The results showed that educational level and income were significantly associated with the practice of Kegel exercises. Pregnant women with a higher level of education and an income of 5000 to 10000 SAR demonstrated a higher proportion of good practice. The presence of specific chronic diseases among participants, such as psychiatric disorders and diabetes mellitus, was significantly associated with poor practice. Physicians were identified as the primary source of information about Kegel exercises, followed by social media and family/friends.  Conclusion: The findings suggest that education, income level, chronic diseases, and the source of information play significant roles in the practice of Kegel exercises among pregnant women. Healthcare providers should prioritize providing comprehensive education, irrespective of educational background, and ensure equal access to resources for all pregnant women. Tailored support should be provided to women with chronic diseases, and healthcare professionals should actively discuss Kegel exercises during antenatal visits. The study emphasizes the importance of multidimensional approaches to promote the practice of Kegel exercises during pregnancy and enhance pelvic floor health.