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1.
Artículo en Inglés | MEDLINE | ID: mdl-33807503

RESUMEN

To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Vapeo , Adulto , California/epidemiología , Control de Enfermedades Transmisibles , Humanos , Humo , Fumadores
3.
Theor Biol Med Model ; 18(1): 10, 2021 03 09.
Artículo en Inglés | MEDLINE | ID: mdl-33750399

RESUMEN

BACKGROUND: The COVID-19 pandemic poses a serious threat to global health, and pathogenic mutations are a major challenge to disease control. We developed a statistical framework to explore the association between molecular-level mutation activity of SARS-CoV-2 and population-level disease transmissibility of COVID-19. METHODS: We estimated the instantaneous transmissibility of COVID-19 by using the time-varying reproduction number (Rt). The mutation activity in SARS-CoV-2 is quantified empirically depending on (i) the prevalence of emerged amino acid substitutions and (ii) the frequency of these substitutions in the whole sequence. Using the likelihood-based approach, a statistical framework is developed to examine the association between mutation activity and Rt. We adopted the COVID-19 surveillance data in California as an example for demonstration. RESULTS: We found a significant positive association between population-level COVID-19 transmissibility and the D614G substitution on the SARS-CoV-2 spike protein. We estimate that a per 0.01 increase in the prevalence of glycine (G) on codon 614 is positively associated with a 0.49% (95% CI: 0.39 to 0.59) increase in Rt, which explains 61% of the Rt variation after accounting for the control measures. We remark that the modeling framework can be extended to study other infectious pathogens. CONCLUSIONS: Our findings show a link between the molecular-level mutation activity of SARS-CoV-2 and population-level transmission of COVID-19 to provide further evidence for a positive association between the D614G substitution and Rt. Future studies exploring the mechanism between SARS-CoV-2 mutations and COVID-19 infectivity are warranted.


Asunto(s)
Sustitución de Aminoácidos , Glicoproteína de la Espiga del Coronavirus/genética , California/epidemiología , Humanos , Funciones de Verosimilitud , Pandemias
4.
JAMA Netw Open ; 4(3): e212816, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33688968

RESUMEN

Importance: Data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence in the United States are still emerging. Objective: To elucidate SARS-CoV-2 seroprevalence and symptom onset in a culturally linked community across 5 states in the United States. Design, Setting, and Participants: This cross-sectional study included adults (aged ≥18 years) recruited from the orthodox Jewish community across 5 states (California, Connecticut, Michigan, New Jersey, and New York) in 3 geographically distinct areas of the United States between May 13 and July 6, 2020. Participants completed an online survey and underwent SARS-CoV-2 antibody testing. Main Outcomes and Measures: Seroprevalence and date of symptom onset of SARS-CoV-2. Results: Overall, 9507 adults (mean [SD] age, 39.6 [15.0] years; 3777 [39.7%] women) completed the SARS-CoV-2 survey, of whom 6665 (70.1%) had immunoglobin G anti-SARS-CoV-2 antibody levels assessed. A high seroprevalence of SARS-CoV-2 antibodies was observed across all communities, with the highest proportion of positive testing observed in New Jersey (1080 of 3323 [32.5%]) and New York (671 of 2196 [30.6%]). Most individuals with a positive SARS-CoV-2 immunoglobin G antibody test reported a date of symptom-onset between March 9 and March 31, 2020 (California: 135 of 154 [87.7%]; Connecticut: 32 of 34 [94.1%]; Michigan: 44 of 50 [88.0%]; New Jersey: 964 of 1168 [82.5%]; New York: 571 of 677 [84.3%]). This start date was coincident with the Jewish festival of Purim, celebrated March 9 to 10, 2020, with extensive intracommunity spread in the weeks following (mean and mode of peak symptom onset, March 20, 2020), occurring in the absence of strong general and culture-specific public health directives. Conclusions and Relevance: This cross-sectional study of orthodox Jewish adults across the US found that socioculturally bound communities experienced early parallel outbreaks in discrete locations, notably prior to substantive medical and governmental directives. Further research should clarify optimal national, local, community-based, and government policies to prevent outbreaks in social and cultural communities that traditionally gather for holidays, assemblies, and festivals.


Asunto(s)
/epidemiología , Asistencia Sanitaria Culturalmente Competente , Transmisión de Enfermedad Infecciosa , Vacaciones y Feriados , Judíos/estadística & datos numéricos , Grupos Minoritarios , Salud Pública , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Connecticut/epidemiología , Estudios Transversales , Brotes de Enfermedades , Femenino , Humanos , Judaísmo , Masculino , Michigan/epidemiología , Persona de Mediana Edad , New Jersey/epidemiología , New York/epidemiología , Características de la Residencia , Estudios Seroepidemiológicos , Estados Unidos/epidemiología , Adulto Joven
5.
J Prim Care Community Health ; 12: 21501327211000235, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33729044

RESUMEN

BACKGROUND: To characterize the experience of converting a geriatrics clinic to telehealth visits in early stages of a pandemic. DESIGN: An organizational case study with mixed methods evaluation from the first 8 weeks of converting a geriatrics clinic from in-person visits to video and telephone visits. SETTING: Veteran's Health Administration in Northern California Participants Community-dwelling older Veterans receiving care at VA Palo Alto Geriatrics clinic. Veterans had a mean age of 85.7 (SD = 6.8) and 72.1% had cognitive impairment. INTERVENTION: Veterans with face-to-face appointments were converted to video or telephone visits to mitigate exposure to community spread of COVID-19. MEASUREMENTS: Thirty-two patient evaluations and 80 clinician feedback evaluations were completed. This provided information on satisfaction, care access during pandemic, and travel and time savings. RESULTS: Of the 62 scheduled appointments, 43 virtual visits (69.4%) were conducted. Twenty-six (60.5%) visits were conducted via video, 17 (39.5%) by telephone. Virtual visits saved patients an average of 118.6 minutes each. Patients and providers had similar, positive perceptions about telehealth to in-person visit comparison, limiting exposure, and visit satisfaction. After the telehealth appointment, patients indicated greater comfort with using virtual visits in the future. Thirty-one evaluations included comments for qualitative analysis. We identified 3 main themes of technology set-up and usability, satisfaction with visit, and clinical assessment and communication. CONCLUSION: During a pandemic that has limited the ability to safely conduct inperson services, virtual formats offer a feasible and acceptable alternative for clinically-complex older patients. Despite potential barriers and additional effort required for telehealth visits, patients expressed willingness to utilize this format. Patients and providers reported high satisfaction, particularly with the ability to access care similar to in-person while staying safe. Investing in telehealth services during a pandemic ensures that vulnerable older patients can access care while maintaining social distancing, an important safety measure.


Asunto(s)
Instituciones de Atención Ambulatoria/organización & administración , Geriatría/organización & administración , Telemedicina/organización & administración , Servicios de Salud para Veteranos/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Demencia/terapia , Accesibilidad a los Servicios de Salud , Humanos , Persona de Mediana Edad , Estudios de Casos Organizacionales , Atención Primaria de Salud/organización & administración , Investigación Cualitativa , Teléfono , Comunicación por Videocoferencia
7.
Sci Rep ; 11(1): 3044, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542262

RESUMEN

The role of children in the spread of the SARS-CoV-2 coronavirus has become a matter of urgent debate as societies in the US and abroad consider how to safely reopen schools. Small studies have suggested higher viral loads in young children. Here we present a multicenter investigation on over five thousand SARS-CoV-2 cases confirmed by real-time reverse transcription (RT) PCR assay. Notably, we found no discernable difference in amount of viral nucleic acid among young children and adults.


Asunto(s)
Nasofaringe/virología , ARN Viral/análisis , Carga Viral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /virología , California/epidemiología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , /fisiología , Adulto Joven
8.
Mayo Clin Proc ; 96(2): 342-349, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33549255

RESUMEN

OBJECTIVE: To determine population-attributable risk (PAR) and exposure impact number (EIN) for mortality associated with impaired cardiorespiratory fitness (CRF), physical inactivity, and other risk markers among veteran subjects. METHODS: The sample included 5890 male subjects (mean age 58±15) who underwent a maximal exercise test for clinical reasons between January 1, 1992, and December 31, 2014. All-cause mortality was the end point. Cox multivariable hazard models were performed to determine clinical, demographic, and exercise-test determinants of mortality. Population-attributable risks and EIN for the lowest quartile of CRF and for inactive behavior were analyzed, accounting for competing events. RESULTS: There were 2728 deaths during a mean ± standard deviation follow-up period of 9.9±5.8 years. Having low CRF (<5.0 metabolic equivalents [METs]) was associated with an approximate 3-fold higher risk of mortality and a PAR of 12.9%. Each higher MET achieved on the treadmill was associated with a 15% reduction in mortality (hazard ratio [HR]=0.85; 95% confidence interval [CI], 0.83 to 0.88; P<.001). Nearly half the sample was inactive, and these subjects had a 23% higher mortality risk and a PAR of 8.8%. The least fit quartile (<5.0 METs) had relative risks of ≈6.0 compared with the most-fit group (HR=5.99; 95% CI, 4.9 to 7.3). The least-active tertile had ≈2-fold higher risks of mortality vs the most active subjects (HR=1.9; 95% CI, 0.91 to 4.1). The lowest EIN was observed for low fitness (3.8; 95% CI, 3.4 to 4.3, P<.001), followed by diabetes, smoking, hypertension, and physical inactivity (all P<.001 except for diabetes, P=.008). CONCLUSION: Both higher CRF and physical activity provide protection against all-cause mortality in subjects referred for exercise testing for clinical reasons. Encouraging physical activity with the aim of increasing CRF would have a significant impact on reducing mortality.


Asunto(s)
Capacidad Cardiovascular , Causas de Muerte , Ejercicio Físico , Veteranos , Adulto , Anciano , Anciano de 80 o más Años , California/epidemiología , Prueba de Esfuerzo , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
9.
Am J Epidemiol ; 190(2): 265-276, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33524118

RESUMEN

Polyunsaturated fatty acids (PUFAs) are critical for brain development and have been linked with neurodevelopmental outcomes. We conducted a population-based case-control study in California to examine the association between PUFAs measured in midpregnancy serum samples and autism spectrum disorder (ASD) in offspring. ASD cases (n = 499) were identified through the California Department of Developmental Services and matched to live-birth population controls (n = 502) on birth month, year (2010 or 2011), and sex. Logistic regression models were used to examine crude and adjusted associations. In secondary analyses, we examined ASD with and without co-occurring intellectual disability (ID; n = 67 and n = 432, respectively) and effect modification by sex and ethnicity. No clear patterns emerged, though there was a modest inverse association with the top quartile of linoleic acid level (highest quartile vs. lowest: adjusted odds ratio = 0.74, 95% confidence interval: 0.49, 1.11; P for trend = 0.10). Lower levels of total and ω-3 PUFAs were associated with ASD with ID (lowest decile of total PUFAs vs. deciles 4-7: adjusted odds ratio = 2.78, 95% confidence interval: 1.13, 6.82) but not ASD without ID. We did not observe evidence of effect modification by the factors examined. These findings do not suggest a strong association between midpregnancy PUFA levels and ASD. In further work, researchers should consider associations with ASD with ID and in other time windows.


Asunto(s)
Trastorno del Espectro Autista/epidemiología , Ácidos Grasos Insaturados/sangre , Discapacidad Intelectual/epidemiología , Segundo Trimestre del Embarazo/sangre , Trastorno del Espectro Autista/etnología , Peso al Nacer , California/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Edad Gestacional , Humanos , Discapacidad Intelectual/etnología , Masculino , Oportunidad Relativa , Embarazo , Factores Sexuales , Factores Socioeconómicos
10.
J ECT ; 37(1): 71-73, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33600120

RESUMEN

ABSTRACT: We describe the case of a patient, hospitalized in a California community medical ICU for over a month, with severe neuroleptic malignant syndrome (NMS), unresponsive to medical management, but responsive to electroconvulsive therapy (ECT). We discuss the medical, logistical, and legal challenges in providing ECT in this setting. We also describe a previously unpublished use of dexmedetomidine, which aided in the safe and rapid reduction of benzodiazepines and permitted a successful ECT course. The rapid delivery and efficacy of ECT were essential because of the burgeoning coronavirus pandemic. The patient's treatment required exemplary efforts by providers across multiple disciplines, ongoing medicolegal consultation with the county mental health medical director, as well as consultation with expert members of the International Society for ECT and Neurostimulation. We conclude with a discussion of the unique challenges of providing emergency ECT to patients in California, including during a serious pandemic, when courts are closed. This case illustrates the importance of cultivating and maintaining high-quality ECT expertise in community hospitals and keeping ECT services available even during pandemics. Also, this case demonstrates that ECT is not "merely an elective procedure" but a vital, life-saving treatment, even during the era of COVID-19. To our knowledge, this is the first such published case of emergency ECT performed in California.


Asunto(s)
/epidemiología , Dexmedetomidina/uso terapéutico , Terapia Electroconvulsiva , Hipnóticos y Sedantes/uso terapéutico , Síndrome Neuroléptico Maligno/terapia , California/epidemiología , Terapia Combinada , Femenino , Humanos , Persona de Mediana Edad , Pandemias
11.
Sci Rep ; 11(1): 3081, 2021 02 04.
Artículo en Inglés | MEDLINE | ID: mdl-33542329

RESUMEN

Clinic-based estimates of SARS-CoV-2 may considerably underestimate the total number of infections. Access to testing in the US has been heterogeneous and symptoms vary widely in infected persons. Public health surveillance efforts and metrics are therefore hampered by underreporting. We set out to provide a minimally biased estimate of SARS-CoV-2 seroprevalence among adults for a large and diverse county (Orange County, CA, population 3.2 million). We implemented a surveillance study that minimizes response bias by recruiting adults to answer a survey without knowledge of later being offered SARS-CoV-2 test. Several methodologies were used to retrieve a population-representative sample. Participants (n = 2979) visited one of 11 drive-thru test sites from July 10th to August 16th, 2020 (or received an in-home visit) to provide a finger pin-prick sample. We applied a robust SARS-CoV-2 Antigen Microarray technology, which has superior measurement validity relative to FDA-approved tests. Participants include a broad age, gender, racial/ethnic, and income representation. Adjusted seroprevalence of SARS-CoV-2 infection was 11.5% (95% CI: 10.5-12.4%). Formal bias analyses produced similar results. Prevalence was elevated among Hispanics (vs. other non-Hispanic: prevalence ratio [PR] = 1.47, 95% CI 1.22-1.78) and household income < $50,000 (vs. > $100,000: PR = 1.42, 95% CI: 1.14 to 1.79). Results from a diverse population using a highly specific and sensitive microarray indicate a SARS-CoV-2 seroprevalence of ~ 12 percent. This population-based seroprevalence is seven-fold greater than that using official County statistics. In this region, SARS-CoV-2 also disproportionately affects Hispanic and low-income adults.


Asunto(s)
Anticuerpos Antivirales/análisis , Grupos Étnicos/estadística & datos numéricos , Adolescente , Adulto , Sesgo , /epidemiología , California/epidemiología , Femenino , Humanos , Inmunoglobulina G/análisis , Inmunoglobulina M/análisis , Masculino , Persona de Mediana Edad , Prevalencia , Vigilancia en Salud Pública , Estudios Seroepidemiológicos , Adulto Joven
12.
J Prim Care Community Health ; 12: 2150132721993631, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33615883

RESUMEN

The onset of the COVID-19 pandemic and subsequent county shelter-in-place order forced the Cardinal Free Clinics (CFCs), Stanford University's 2 student-run free clinics, to close in March 2020. As student-run free clinics adhering to university-guided COVID policies, we have not been able to see patients in person since March of 2020. However, the closure of our in-person operations provided our student management team with an opportunity to innovate. In consultation with Stanford's Telehealth team and educators, we rapidly developed a telehealth clinic model for our patients. We adapted available telehealth guidelines to meet our patient care needs and educational objectives, which manifested in 3 key innovations: reconfigured clinic operations, an evidence-based social needs screen to more effectively assess and address social needs alongside medical needs, and a new telehealth training module for student volunteers. After 6 months of piloting our telehealth services, we believe that these changes have made our services and operations more robust and provided benefit to both our patients and volunteers. Despite an uncertain and evolving public health landscape, we are confident that these developments will strengthen the future operations of the CFCs.


Asunto(s)
/epidemiología , Innovación Organizacional , Pandemias , Clínica Administrada por Estudiantes/organización & administración , California/epidemiología , Humanos
13.
J Contin Educ Nurs ; 52(3): 115-117, 2021 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-33631020

RESUMEN

The global pandemic presented an opportunity for using technology in expanded ways to meet mandated restrictions posed by the crisis. Nursing professional development practitioners redesigned onboarding structures and curriculum to accommodate the surge of new hires, taking into consideration restrictions set forth by regulatory institutions. Mobile technology and virtual learning were the platform used for this innovative approach. [J Contin Educ Nurs. 2021;52(3):115-117.].


Asunto(s)
/epidemiología , Computadoras de Mano , Educación Continua en Enfermería/métodos , California/epidemiología , Competencia Clínica , Curriculum , Humanos , Innovación Organizacional , Pandemias , Entrenamiento Simulado
14.
JAMA Netw Open ; 4(2): e211320, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33616667

RESUMEN

Importance: Describing the changes in trauma volume and injury patterns during the course of the coronavirus disease 2019 (COVID-19) pandemic could help to inform policy development and hospital resource planning. Objective: To examine trends in trauma admissions throughout Los Angeles County (LAC) during the pandemic. Design, Setting, and Participants: In this cohort study, all trauma admissions to the 15 verified level 1 and level 2 trauma centers in LAC from January 1 to June 7, 2020 were reviewed. All trauma admissions from the same period in 2019 were used as historical control. For overall admissions, the study period was divided into 3 intervals based on daily admission trend analysis (January 1 through February 28, March 1 through April 9, April 10 through June 7). For the blunt trauma subgroup analysis, the study period was divided into 3 similar intervals (January 1 through February 27, February 28 through April 5, April 6 through June 7). Exposures: COVID-19 pandemic. Main Outcomes and Measures: Trends in trauma admission volume and injury patterns. Results: A total of 6777 patients in 2020 and 6937 in 2019 met inclusion criteria. Of those admitted in 2020, the median (interquartile range) age was 42 (28-61) years and 5100 (75.3%) were men. Mechanisms of injury were significantly different between the 2 years, with a higher incidence of penetrating trauma and fewer blunt injuries in 2020 compared with 2019 (penetrating: 1065 [15.7%] vs 1065 [15.4%]; blunt: 5309 [78.3%] vs 5528 [79.7%]). Overall admissions by interval in 2020 were 2681, 1684, and 2412, whereas in 2019 they were 2462, 1862, and 2613, respectively. There was a significant increase in overall admissions per week during the first interval (incidence rate ratio [IRR], 1.02; 95% CI, 1.002-1.04; P = .03) followed by a decrease in the second interval (IRR, 0.92; 95% CI, 0.90-0.94; P < .001) and, finally, an increase in the third interval (IRR, 1.05; CI, 1.03-1.07; P < .001). On subgroup analysis, blunt admissions followed a similar pattern to overall admissions, while penetrating admissions increased throughout the study period. Conclusions and Relevance: In this study, trauma centers throughout LAC experienced a significant change in injury patterns and admission trends during the COVID-19 pandemic. A transient decrease in volume was followed by a quick return to baseline levels. Trauma centers should prioritize maintaining access, capacity, and functionality during pandemics and other national emergencies.


Asunto(s)
/epidemiología , Hospitalización/tendencias , Centros Traumatológicos , Heridas y Traumatismos/epidemiología , Escala Resumida de Traumatismos , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adulto , Mordeduras y Picaduras/epidemiología , California/epidemiología , Femenino , Humanos , Puntaje de Gravedad del Traumatismo , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Violencia/estadística & datos numéricos , Heridas por Arma de Fuego/epidemiología , Heridas Punzantes/epidemiología
15.
MMWR Morb Mortal Wkly Rep ; 70(7): 236-239, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33600382

RESUMEN

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with manifestations that vary widely in severity. Although minority populations are at higher risk for SLE and have more severe outcomes (1), population-based estimates of mortality by race and ethnicity are often lacking, particularly for Asian and Hispanic/Latino persons. Among 812 patients in the California Lupus Surveillance Project (CLSP) during 2007-2009 (2,3), who were matched to the 2007-2017 National Death Index (NDI), 16.6% had died by 2017. This proportion included persons of White (14.4%), Black (25%), Asian (15.3%), and Hispanic/Latino (15.5%) race/ethnicity. Standardized mortality ratios (SMRs) of observed-to-expected deaths among persons with SLE within each racial/ethnic group were 2.3, 2.0, 3.8, and 3.9, respectively. These findings provide the first population-based estimates of mortality among Asian and Hispanic/Latino persons with SLE. Coordination of robust care models between primary care providers and rheumatologists could ensure that persons with SLE receive a timely diagnosis and appropriate treatments that might help address SLE-associated mortality.


Asunto(s)
Americanos Asiáticos/estadística & datos numéricos , Hispanoamericanos/estadística & datos numéricos , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/mortalidad , Grupos Minoritarios/estadística & datos numéricos , Adolescente , Adulto , Anciano , California/epidemiología , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Adulto Joven
16.
J Am Board Fam Med ; 34(Suppl): S229-S232, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33622844

RESUMEN

The threat to the public health of the United States from the COVID-19 pandemic is causing rapid, unprecedented shifts in the health care landscape. Community health centers serve the patient populations most vulnerable to the disease yet often have inadequate resources to combat it. Academic medical centers do not always have the community connections needed for the most effective population health approaches. We describe how a bridge between a community health center partner (Roots Community Health Center) and a large academic medical center (Stanford Medicine) brought complementary strengths together to address the regional public health crisis. The 2 institutions began the crisis with an overlapping clinical and research faculty member (NKT). Building on that foundation, we worked in 3 areas. First, we partnered to reach underserved populations with the academic center's newly developed COVID test. Second, we developed and distributed evidence-based resources to these same communities via a large community health navigator team. Third, as telemedicine became the norm for medical consultation, the 2 institutions began to research how reducing the digital divide could help improve access to care. We continue to think about how best to create enduring partnerships forged through ongoing deeper relationships beyond the pandemic.


Asunto(s)
Centros Médicos Académicos/organización & administración , Centros Comunitarios de Salud/organización & administración , Atención Primaria de Salud/métodos , /epidemiología , California/epidemiología , Conducta Cooperativa , Humanos , Pandemias , Telemedicina/organización & administración
17.
BMJ Open ; 11(1): e042804, 2021 01 06.
Artículo en Inglés | MEDLINE | ID: mdl-33408208

RESUMEN

OBJECTIVE: Nursing homes' residents and staff constitute the largest proportion of the fatalities associated with COVID-19 epidemic. Although there is a significant variation in COVID-19 outbreaks among the US nursing homes, we still do not know why such outbreaks are larger and more likely in some nursing homes than others. This research aims to understand why some nursing homes are more susceptible to larger COVID-19 outbreaks. DESIGN: Observational study of all nursing homes in the state of California until 1 May 2020. SETTING: The state of California. PARTICIPANTS: 713 long-term care facilities in the state of California that participate in public reporting of COVID-19 infections as of 1 May 2020 and their infections data could be matched with data on ratings and governance features of nursing homes provided by Centers for Medicare & Medicaid Services (CMS). MAIN OUTCOME MEASURE: The number of reported COVID-19 infections among staff and residents. RESULTS: Study sample included 713 nursing homes. The size of outbreaks among residents in for-profit nursing homes is 12.7 times larger than their non-profit counterparts (log count=2.54; 95% CI, 1.97 to 3.11; p<0.001). Higher ratings in CMS-reported health inspections are associated with lower number of infections among both staff (log count=-0.19; 95% CI, -0.37 to -0.01; p=0.05) and residents (log count=-0.20; 95% CI, -0.27 to -0.14; p<0.001). Nursing homes with higher discrepancy between their CMS-reported and self-reported ratings have higher number of infections among their staff (log count=0.41; 95% CI, 0.31 to 0.51; p<0.001) and residents (log count=0.13; 95% CI, 0.08 to 0.18; p<0.001). CONCLUSIONS: The size of COVID-19 outbreaks in nursing homes is associated with their ratings and governance features. To prepare for the possible next waves of COVID-19 epidemic, policy makers should use these insights to identify the nursing homes who are more likely to experience large outbreaks.


Asunto(s)
/epidemiología , Casas de Salud/estadística & datos numéricos , Pandemias , Anciano , California/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino
18.
J Nurs Educ ; 60(1): 52-55, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-33400810

RESUMEN

BACKGROUND: This article describes one school's process to maintain their undergraduate nursing simulation program during campus closure and clinical placement suspension due to the COVID-19 pandemic. METHOD: After the campus closure, faculty replaced clinical hours with simulation using virtual clinical education such as telehealth with standardized patients (SPs), virtual simulations using commercial products, and virtual faculty skills instruction. RESULTS: Using virtual clinical education and SP-based telehealth simulations provided an alternative for 50% of the required direct patient care hours. Virtual simulation accounted for 18,403 clinical hours completed by 244 students. CONCLUSION: Preparation for emergencies that force campus and clinical site closures should include processes to provide virtual simulation and remote simulations with SPs to replace clinical hours. Planning for the impacts of COVID-19 on the operation of this school of nursing highlights the importance of having a detailed plan to address campus closure due to emergencies. [J Nurs Educ. 2021;60(1):52-55.].


Asunto(s)
Bachillerato en Enfermería/organización & administración , Docentes de Enfermería/psicología , Entrenamiento Simulado/organización & administración , California/epidemiología , Curriculum , Educación a Distancia , Humanos , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Facultades de Enfermería/organización & administración , Telemedicina
19.
JAMA Netw Open ; 4(1): e2033484, 2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33394004

RESUMEN

Importance: Violence is a significant public health problem that has become entwined with the coronavirus disease 2019 (COVID-19) pandemic. Objective: To describe individuals' concerns regarding violence in the context of the pandemic, experiences of pandemic-related unfair treatment, prevalence of and reasons for firearm acquisition, and changes in firearm storage practices due to the pandemic. Design, Setting, and Participants: This survey study used data from the 2020 California Safety and Well-being Survey, a probability-based internet survey of California adults conducted from July 14 to 27, 2020. Respondents came from the Ipsos KnowledgePanel, an online research panel with members selected using address-based sampling methods. Responses were weighted to be representative of the adult population of California. Main Outcomes and Measures: Topics included worry about violence for oneself before and during the pandemic; concern about violence for someone else due to a pandemic-related loss; experiences of unfair treatment attributed to the pandemic; firearm and ammunition acquisition due to the pandemic; and changes in firearm storage practices due to the pandemic. Results: Of 5018 invited panel members, 2870 completed the survey (completion rate, 57%). Among respondents (52.3% [95% CI, 49.5%-55.0%] women; mean [SD] age, 47.9 [16.9] years; 41.9% [95% CI, 39.3%-44.6%] White individuals), self-reported worry about violence for oneself was significantly higher during the pandemic for all violence types except mass shootings, ranging from a 2.8 percentage point increase for robbery (from 65.5% [95% CI, 62.8%-68.0%] to 68.2% [95% CI, 65.6%-70.7%]; P = .008) to a 5.6 percentage point increase for stray bullet shootings (from 44.5% [95% CI, 41.7%-47.3%] to 50.0% [47.3%-52.8%]; P < .001). The percentage of respondents concerned that someone they know might intentionally harm themselves was 13.1% (95% CI, 11.5%-15.3%). Of those, 7.5% (95% CI, 4.5%-12.2%) said it was because the other person had experienced a pandemic-related loss. An estimated 110 000 individuals (2.4% [95% CI, 1.1%-5.0%] of firearm owners in the state) acquired a firearm due to the pandemic, including 47 000 new owners (43.0% [95% CI, 14.8%-76.6%] of those who had acquired a firearm). Of owners who stored at least 1 firearm in the least secure way, 6.7% (95% CI, 2.7%-15.6%) said they had adopted this unsecure storage practice in response to the pandemic. Conclusions and Relevance: In this analysis of findings from the 2020 California Safety and Well-being Survey, the COVID-19 pandemic was associated with increases in self-reported worry about violence for oneself and others, increased firearm acquisition, and changes in firearm storage practices. Given the impulsive nature of many types of violence, short-term crisis interventions may be critical for reducing violence-related harm.


Asunto(s)
Ansiedad/epidemiología , Discriminación Social/estadística & datos numéricos , Violencia/psicología , Adulto , Afroamericanos , Ansiedad/psicología , Americanos Asiáticos , California/epidemiología , Comercio , Grupo de Ascendencia Continental Europea , Miedo/psicología , Femenino , Armas de Fuego/estadística & datos numéricos , Hispanoamericanos , Humanos , Internet , Masculino , Persona de Mediana Edad , Propiedad , Policia , Seguridad , Discriminación Social/etnología , Encuestas y Cuestionarios
20.
World Neurosurg ; 148: e172-e181, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33385598

RESUMEN

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Asunto(s)
/epidemiología , Hospitales Universitarios/organización & administración , Neurocirugia/organización & administración , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Centros Médicos Académicos/organización & administración , Neoplasias Encefálicas/cirugía , California/epidemiología , Derivaciones del Líquido Cefalorraquídeo/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos , Procedimientos Endovasculares/estadística & datos numéricos , Capacidad de Camas en Hospitales , Departamentos de Hospitales/organización & administración , Humanos , Control de Infecciones , Difusión de la Información/métodos , Unidades de Cuidados Intensivos , Laboratorios de Hospital , Sistemas Multiinstitucionales , Quirófanos , Política Organizacional , Equipo de Protección Personal/provisión & distribución , Estudios Retrospectivos , Medición de Riesgo , Capacidad de Reacción , Triaje , Procedimientos Quirúrgicos Vasculares/estadística & datos numéricos , Ventiladores Mecánicos/provisión & distribución , Heridas y Traumatismos/cirugía
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