Representação social da Covid-19 para a população de uma cidade de pequeno porte / Social representation of Covid-19 for the population of a small-sized city / Representación social del Covid-19 para la población de un pequeño pueblo

Objetivo: analisar a representação social da Covid-19 para a população geral de uma cidade de pequeno porte do Estado do Rio de Janeiro. Método: estudo qualitativo, apoiado na abordagem estrutural das representações sociais. Participaram 100 usuários de serviços de saúde. Os dados foram coletados por questionário sociodemográfico de evocações livres de palavras e roteiro de entrevista semiestruturada. Os dados foram analisados com o auxílio dos softwares Excel, EVOC 2005 e análise de conteúdo temático-categorial para contextualização das evocações respectivamente. Resultados: os termos do possível núcleo central foram: morte, sofrimento, cuidados, ansiedade-angústia e vacina. Na primeira periferia: medo e prevenção. À segunda periferia: informação-desinformação; desgoverno; ter-fé e proteção. A zona de contrate: doença; isolamento-social; dificuldades; catástrofe-mundial; desemprego e pandemia. Considerações finais: marcaram essa representação os impactos psicossociais negativos resultantes da desestruturação da vida e das mortes ocasionadas pela nova doença, no entanto o grupo aderiu as medidas de cuidados de proteção.

Objective: to analyze the social representation of Covid-19 among the general population of a small-sized city in the State of Rio de Janeiro. Method: Qualitative study, based on the structural approach of social representations. One hundred healthcare service users participated. Data were collected through a sociodemographic questionnaire, free word evocation, and a semi-structured interview guide. The data were analyzed using Excel software, EVOC 2005, and thematic-categorical content analysis for contextualization of the evocations, respectively. Results: the terms of the possible central core were: death, suffering, care, anxiety-distress, and vaccine. In the first periphery: fear and prevention. In the second periphery: information-misinformation; mismanagement; having faith and protection. The contrast zone: disease; social isolation; difficulties; global catastrophe; unemployment; and pandemic. Final considerations: this representation was marked by the negative psychosocial impacts resulting from the disruption of life and the deaths caused by the new disease; however, the group adhered to protective care measures.

Objetivo: analizar la representación social del Covid-19 para la población general de una pequeña ciudad del Estado de Río de Janeiro. Método: estudio cualitativo, basado en el enfoque estructural de las representaciones sociales. Participaron 100 usuarios de servicios de salud. Los datos se recolectaron mediante un cuestionario sociodemográfico con evocación libre de palabras y una guía de entrevista semiestructurada. Los datos fueron analizados utilizando lo software Excel y EVOC 2005 y análisis de contenido temático-categórico para contextualizar las evocaciones respectivamente. Resultados: los términos del posible núcleo central eran: muerte, sufrimiento, cuidados, ansiedad-angustia y vacuna. En la primera periferia: miedo y prevención. En la segunda periferia: información-desinformación; desgobierno; tener fe y protección. La zona de contraste: enfermedad; aislamiento-social; dificultades; catástrofe-mundial; desempleo y pandemia. Consideraciones finales: esta representación se caracterizó por los impactos psicosociales negativos derivados de la desestructuración de la vida y de las muertes causada por la nueva enfermedad, sin embargo, el grupo adhirió a las medidas de protección.

Impact on Fatality Rates and Years of Life Lost During the COVID-19 Pandemic: The Experience of the Mexican Public Health Incident Management Command.

BACKGROUND: The SARS-CoV-2 pandemic challenged health systems worldwide. In Mexico, the Public Health Incident Management Command (COISS) strategy was implemented to improve health care for patients with COVID-19 who required hospitalization. AIM: To evaluate the impact of the COISS strategy on case fatality rates (CFR) and years of life lost (YLL) in hospitalized patients with COVID-19. MATERIALS AND METHODS: The COISS strategy included eight actions implemented in states with high epidemic risk (COISS states). A secondary analysis of the public database from the Mexican Ministry of Health was performed considering patients with confirmed diagnoses of SARS-CoV-2 infection. The COISS strategy effectiveness was evaluated by its impact on in-hospital CFR and YLL at the beginning (T0) and end (T1) of the third wave, and at the end of the fourth wave (T2) and compared to states without intervention (non-COISS states). RESULTS: At T0, COISS states showed a higher CFR for hospitalized patients than non-COISS states, which decreased after the strategy implementation. After correction for baseline conditions, lower relative CFR at T1 and T2, compared to T0, and a protective effect in different age groups, especially in those ≥65 years, were found in hospitalized patients in COISS states. The COISS strategy was associated with lower CFR in hospitalized patients with COVID-19 at both T1 and T2. At T0, YLLs were higher in COISS states, but there were no significant differences at T1 and T2. CONCLUSIONS: COISS interventions effectively reduced CFR in hospitalized patients with COVID-19, providing protection to vulnerable patients and reducing the YLL gap.

Healthcare Workers and Patient Loss During the COVID-19 Pandemic: Interaction Between Grief, Viral Anxiety, and Depression.

OBJECTIVE: Coronavirus disease-2019 (COVID-19) had a significant impact on the mental health of healthcare workers. Related assessments should be included in plans for future pandemics. We investigated the connections between grief, viral anxiety, depression, and preoccupation in the context of COVID-19 in healthcare workers, to determine which factors will need to be incorporated. METHODS: A total of 267 healthcare workers who had experienced the death of at least one patient during the COVID-19 pandemic were asked to respond to questionnaires assessing grief, viral anxiety, depression, loneliness, and preoccupation with COVID-19, based on their emotional state during the 2 weeks immediately after the death. Multivariate linear regression, causal mediation analysis and structural equation modeling were used to examine the psychological processes underlying grief. RESULTS: Linear regression showed that viral anxiety (ß=0.287, 95% confidence interval [CI]: 0.235-0.338, p<0.001) and depression (ß= 0.157, 95% CI: 0.073-0.241, p<0.001) had independent associations with preoccupation with COVID-19. Causal mediation analysis revealed that both viral anxiety (proportion mediated: 0.51, 95% CI: 0.37-0.66, p<0.001) and depression (proportion mediated: 0.77, 95% CI: 0.50-1.08, p<0.001) were mediators between grief and preoccupation with COVID-19. In a structural equation model, viral anxiety and depression mediated most of the effects of grief on preoccupation with COVID-19, and loneliness was a mediator between grief and depression. CONCLUSION: Contingency plans for the next pandemic are being formulated. Effective measures to protect the mental health of healthcare workers should be included, and such measures should consist of assessments for grief, viral anxiety, depression, and loneliness.

The relationships between the family impact and distress of the coronavirus disease-19 pandemic, parent insomnia, infant temperamental negative affectivity, and parent-reported infant sleep: a path analysis.

Study Objectives: The coronavirus disease 2019 (COVID-19) pandemic impact on infant sleep (IS) is understudied. The purpose of this study was to examine the relationships between family impact and distress from COVID-19 pandemic stressors, parental insomnia symptoms, infant temperamental negative affectivity, and parent-reported IS. Methods: Parents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited from February 27, 2021, to August 7, 2021. A sample of 70 parents (baby age 5.5 ±â€…3.5 months; parental age: 31.7 ±â€…5.0 years) completed the COVID-19 Exposure and Family Impact Survey (CEFIS) Impact and Distress scales, the Insomnia Severity Index (ISI), the Infant Behavioral Questionnaire-Revised Negative Affectivity subscale (IBQ-R-NA), and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Based on the transactional model of IS, path analyses were conducted to identify the direct effect of CEFIS scores and the indirect effects of parental ISI and infant IBQ-R-NA scores on BISQ-R scores. Results: The parent sample was predominantly female (94.3%), white (72.9%), and married or in a domestic partnership (98.6%). Although COVID-19 pandemic impact and distress were not directly related to parent-reported IS, pandemic distress was negatively related to parent-reported IS indirectly through infant negative affectivity, including BISQ-R total score (ß = -0.14, 95% CI [-0.32, -0.01]) and IS subscale score (ß = -0.12, 95% CI [-0.27, -0.01]). Conclusions: Heightened COVID-19 pandemic family distress was related to poorer parent-reported IS through greater parent-reported infant negative affectivity, suggesting the importance of addressing family stress and emotional regulation during crises.

Economic Analyses for Disease Surveillance Planning and Advocacy.

Public health disease surveillance can guide a range of decisions related to the protection of populations. Economic analysis can be used to assess how surveillance for specific diseases can substitute for or complement other public health interventions and how to structure surveillance most efficiently. Assessing the value and costs of different disease surveillance options as part of broader disease prevention and control efforts is important for both using available resources efficiently to protect populations and communicating the need for additional resources as appropriate.

VIRAL DISEASES AND THE ENVIRONMENT RELATIONSHIP.

Viral diseases have been present throughout human history, with early examples including influenza (1500 B.C.), smallpox (1000 B.C.), and measles (200 B.C.). The term "virus" was first used in the late 1800s to describe microorganisms smaller than bacteria, and significant milestones include the discovery of the polio virus and the development of its vaccine in the mid-1900s, and the identification of HIV/AIDS in the latter part of the 20th century. The 21st century has seen the emergence of new viral diseases such as West Nile Virus, Zika, SARS, MERS, and COVID-19. Human activities, including crowding, travel, poor sanitation, and environmental changes like deforestation and climate change, significantly influence the spread of these diseases. Conversely, viral diseases can impact the environment by polluting water resources, contributing to deforestation, and reducing biodiversity. These environmental impacts are exacerbated by disruptions in global supply chains and increased demands for resources. This review highlights the intricate relationship between viral diseases and environmental factors, emphasizing how human activities and viral disease progression influence each other. The findings underscore the need for integrated approaches to address the environmental determinants of viral diseases and mitigate their impacts on both health and ecosystems.

Encountering and Identifying Different Forms of Domestic Violence in Shelters and Community Care Services in Finland During the COVID-19 Pandemic.

During the COVID-19 pandemic, restrictions such as lockdowns and social distancing have been used to control coronavirus. These restrictions may increase the risk of domestic violence (DV) and discourage victims from getting help. We examined the consequences that the pandemic had on different forms of DV and different victim groups of DV. An online survey of shelter clients (N = 47), interviews with clients in community care services (N = 2), and eight focus group interviews with professionals (N = 27) working in shelters and community care services were used for data. We used a mixed-methods approach in the analysis, which showed that clients in shelters reported more violence during the pandemic than prepandemic. Psychological, controlling, and financial violence increased the most during the pandemic, according to the survey data. Coercive control was the most visible type of violence from the perspective of three vulnerable groups: intimate partners, children, and migrants. The research findings will help us arrange services to identify and better manage pandemic lockdown-associated violence.

Impact of the COVID-19 pandemic on cancer mortality in Brazil.

BACKGROUND: In the first year of the COVID-19 pandemic, data projections indicated an increase in cancer mortality for the following years due to the overload of health services and the replacement of health priorities. The first studies published with data from mortality records have not confirmed these projections. However, cancer mortality is not an outcome that occurs immediately, and analyses with more extended follow-up periods are necessary. This study aims to analyze the impact of the COVID-19 pandemic on the mortality from all types and the five most common types of cancer in Brazil and investigate the relationship between the density of hospital beds and mortality from COVID-19 in cancer patients in Brazil's Intermediate Geographic Regions (RGIs). METHODS: The Brazilian Mortality Information System provided data on the deaths from trachea, bronchus, and lung, colorectal, stomach, female breast, and prostate cancer and all types of cancer, and from COVID-19 in individuals who had cancer as a contributing cause of death. Predicted rates for 2020-2022 were compared with the observed ones, through a rate ratio (RR). An association analysis, through multivariate linear regression, was carried out between mortality from COVID-19 in cancer patients, the rate of hospital beds per 100,000 inhabitants, and the Human Development Index of the 133 RGIs of Brazil. RESULTS: In 2020, 2021, and 2022, mortality from all cancers in Brazil was lower than expected, with an RR of 0.95, 0.94, and 0.95, respectively, between the observed and predicted rates. Stomach cancer showed the largest difference between observed and expected rates: RR = 0.89 in 2020 and 2021; RR = 0.88 in 2022. Mortality from COVID-19 in cancer patients, which reached its peak in 2021 (6.0/100,000), was negatively associated with the density of hospital beds in the public health system. CONCLUSIONS: The lower-than-expected cancer mortality during 2020-2022 seems to be partly explained by mortality from COVID-19 in cancer patients, which was probably underestimated in Brazil. The findings suggested a protective role of the availability of hospital care concerning deaths due to COVID-19 in this population. More extensive follow-up is needed to understand the impact of the COVID-19 pandemic on cancer mortality.

An Open Information Model-Based Repository for Sustainable Re-Use of Heterogeneous Pandemics Research Data.

The COVID-19 Research Network Lower Saxony (COFONI) is a German state network of experts in Coronavirus research and development of strategies for future pandemics. One of the pillars of the COFONI technology platform is its established research data repository (Available at https://forschungsdb.cofoni.de/), which enables provision of pseudonymised data and cross-location data retrieval for heterogeneous datasets. The platform consistently uses open standards (openEHR) and open source components (EHRbase) for its data repository, taking into account the FAIR criteria. Available data include both clinical and socio-demographic patient information. A comprehensive AQL query builder interface and an integrated research request process enable new research approaches, rapid cohort assembly and customized data export for researchers from participating institutions. Our flexible and scalable platform approach can be regarded as a blueprint. It contributes, to pandemic preparedness by providing easily accessible cross-location research data in a fully standardised and open representation.

Nurses' Experiences in Communicating With Immigrant Populations During COVID-19: Insights and Suggestions for Future Health Crises.

INTRODUCTION: When providing health information in a diverse society and during health crises, it is crucial that nurses can adapt their communication to immigrants, as this may have an impact on their health outcomes. This study seeks to identify how nurses experienced and assessed their communication and information work with immigrants during COVID-19 and to discuss measures to improve practice. METHOD: The study has an interpretive and explorative qualitative design, analyzing 10 semi-structured interviews with nurses from the municipal health service in Norway. RESULTS: Three themes were created as follows: multilingual infection control teams and cooperation with volunteers, challenges when providing COVID-19 information, and the nurses' suggestions for improvements in the event of a new pandemic or other health crisis. DISCUSSION: Nurses' cultural competence and their knowledge of immigrants' health literacy can help them understand how immigrants think and behave during illness. It is important that nurses use discretion during health crises.

Evaluation of score-based tertiary triage policies during the COVID-19 pandemic: simulation study with real-world intensive care data.

OBJECTIVE: The explicit prohibition of discontinuing intensive care unit (ICU) treatment that has already begun by the newly established German Triage Act in favor of new patients with better prognoses (tertiary triage) under crisis conditions may prevent saving as many patients as possible and therefore may violate the international well-accepted premise of undertaking the "best for the most" patients. During the COVID-19 pandemic, authorities set up lockdown measures and infection-prevention strategies to avoid an overburdened health-care system. In cases of situational overload of ICU resources, when transporting options are exhausted, the question of a tertiary triage of patients arises. METHODS: We provide data-driven analyses of score- and non-score-based tertiary triage policies using simulation and real-world electronic health record data in a COVID-19 setting. Ten different triage policies, for example, based on the Simplified Acute Physiology Score (SAPS II), are compared based on the resulting mortality in the ICU and inferential statistics. RESULTS: Our study shows that score-based tertiary triage policies outperform non-score-based tertiary triage policies including compliance with the German Triage Act. Based on our simulation model, a SAPS II score-based tertiary triage policy reduces mortality in the ICU by up to 18 percentage points. The longer the queue of critical care patients waiting for ICU treatment and the larger the maximum number of patients subject to tertiary triage, the greater the effect on the reduction of mortality in the ICU. CONCLUSION: A SAPS II score-based tertiary triage policy was superior in our simulation model. Random allocation or "first come, first served" policies yield the lowest survival rates, as will adherence to the new German Triage Act. An interdisciplinary discussion including an ethical and legal perspective is important for the social interpretation of our data-driven results.

Telemedicine Adoption During COVID-19 Pandemic: Perspectives from Primary Care Clinicians in Safety-Net Settings.

OBJECTIVE: The objective of this study is to describe the facilitators and barriers of telemedicine during the COVID-19 pandemic for primary care clinicians in safety-net settings. METHODS: We selected 5 surveys fielded between September 2020 and March 2023 from the national "Quick COVID-19 Primary Care Survey" by the Larry A. Green Center, with the Primary Care Collaborative. We used an explanatory sequential mixed method approach. We compared safety-net practices (free & charitable organization, federally qualified health center (FQHC), clinics with a 50% or greater Medicaid) to all other settings. We discuss: 1) telemedicine services provided; 2) clinician motivations; 3) and telemedicine access. RESULTS: All clinicians were similarly motivated to implement telemedicine. Safety-net clinicians were more likely to report use of phone visits. These clinicians felt less "confident in my use of telemedicine" (covariate-adjusted OR = 0.611, 95% CI 0.43 - 0.87) and were more likely to report struggles with televisits in March 2023 (covariate-adjusted OR = 1.73, 95% CI 1.16 - 2.57), particularly with physical examinations. Safety-net clinicians were more likely to endorse reductions in no-shows (covariate-adjusted OR = 1.77, 95% CI 1.17 - 2.68). Telemedicine increased access and new patient-facing demands including portal communications. CONCLUSIONS: This study enhances our understanding of the use of telemedicine within the safety-net setting. Clinician perceptions are important for identifying barriers to telemedicine following the end of the Federal COVID-19 Public Health Emergency. Clinicians highlighted significant limitations to its use including clinical appropriateness, quality of physical examinations, and added patient-facing workload.

The extended impact of the COVID-19 pandemic on long-term care residents in Medicare with frailty or dual Medicaid enrollment.

BACKGROUND: Although many healthcare settings have since returned to pre-pandemic levels of operation, long-term care (LTC) facilities have experienced extended and significant changes to operations, including unprecedented levels of short staffing and facility closures, that may have a detrimental effect on resident outcomes. This study assessed the pandemic's extended effect on outcomes for LTC residents, comparing outcomes 1 and 2 years after the start of the pandemic to pre-pandemic times, with special focus on residents with frailty and dually enrolled in Medicare and Medicaid. METHODS: Using Medicare claims data from January 1, 2018, through December 31, 2022, we ran over-dispersed Poisson models to compare the monthly adjusted rates of emergency department use, hospitalization, and mortality among LTC residents, comparing residents with and without frailty and dually enrolled and non-dually enrolled residents. RESULTS: Two years after the start of the pandemic, adjusted emergency department (ED) and hospitalization rates were lower and adjusted mortality rates were higher compared with pre-pandemic years for all examined subgroups. For example, compared with 2018-2019, 2022 ED visit rates for dually enrolled residents were 0.89 times lower, hospitalization rates were 0.87 times lower, and mortality rates were 1.17 higher; 2022 ED visit rates for frail residents were 0.85 times lower, hospitalization rates were 0.83 times lower, and mortality rates were 1.21 higher. CONCLUSIONS: In 2022, emergency department and hospital utilization rates among long-term residents were lower than pre-pandemic levels and mortality rates were higher than pre-pandemic levels. These findings suggest that the pandemic has had an extended impact on outcomes for LTC residents.

COVID-19 and Neurodevelopmental Delays in Early Childhood: A Longitudinal Analysis of Developmental Outcomes in Korean Children.

This study employed a longitudinal analysis to evaluate the association between the coronavirus disease 2019 pandemic and neurodevelopment by analyzing over 1.8 million children from the Korean Developmental Screening Test for Infants and Children included in South Korea's National Health Screening Program. We compared the developmental outcomes in five age groups-9-17 months, 18-29 months, 30-41 months, 42-53 months, and 54-65 months-between the pre-pandemic (2018-2019) and pandemic (2020-2021) periods. Significant increases in potential developmental delays were observed during the pandemic in communication, cognitive, social interaction, self-care, and fine motor skills across most age groups. All five age groups experienced notable disruptions in communication and fine motor skills. Children from socioeconomically disadvantaged backgrounds faced higher risks across all domains. These findings highlight the need for targeted interventions and continuous monitoring to support the developmental needs of children affected by pandemic-related disruptions.

COVID-19 and stroke in women: impact on clinical, psychosocial and research aspects.

Despite the growing interest in gender medicine, the influence of sex and gender on human diseases, including stroke, continues to be underestimated and understudied. The COVID-19 pandemic has overall impacted not only the occurrence and management of stroke but has also exacerbated sex and gender disparities among both patients and healthcare providers. This paper aims to provide an updated overview on the influence of sex and gender in stroke pathophysiology and care during COVID-19 pandemic, through biological, clinical, psychosocial and research perspectives. Gender equity and awareness of the importance of sexual differences are sorely needed, especially in times of health crisis but have not yet been achieved to date. To this purpose, the sudden yet worldwide diffusion of COVID-19 represents a unique learning experience that highlights critical unmet needs also in gender medicine. The failures of this recent past should be kept as food for thought to inspire proper strategies reducing inequalities and to address women's health and wellbeing issues, particularly in case of future pandemics.

The caregiving work experience of healthcare workers in Chile during the COVID-19 pandemic and its impact on mental health: A qualitative study based on the international initiative HEROES. / Experiencia de trabajo de cuidados de trabajadores de la salud en Chile durante la pandemia COVID-19 y su impacto en la salud mental: estudio cualitativo a partir de la iniciativa internacional HEROES.

Introduction: The COVID-19 pandemic has impacted the mental health of healthcare workers. Studying the care perspective is essential to understanding the causes of specific mental health findings and proposing strategies to address them. Methods: Cross-sectional study with a thematic analytical approach, derived from the international initiative "The Health Care Workers Study" (HEROES), conducted among healthcare workers in Chile during the second semester of 2022 and the first of 2023 through semi-structured interviews and inductive coding. Results: A narrative synthesis of 35 interviews in four themes: care at work: the presence of changes in work tasks, concern about becoming infected, collective "mystique", stigma due to being a healthcare worker, conflicts with patients; care at home: multiple ways of arranging household tasks, the relevance of living with others, interrelation with work dynamics, "double burden" among women; relationship with one's own mental health: recognition of mental health impact, the stress associated with change and uncertainty, perception of work overload, feelings of guilt or responsibility for infecting family members; and beliefs and values about the pandemic and its effects: acceptance of psychological impact on healthcare workers, organizational culture as a relevant element in postponing one's own mental health, initial disbelief in the effects of the pandemic, similarities with previous periods of social upheaval, and equality among people in terms of vulnerability to the disease. Conclusions: Five elements emerge as potential areas for intervention: gender perspective, previous exposure to crisis experiences, self-care spaces, peer support, and institutional response. The care perspective helps study the relationship between some stressors and healthcare workers' mental health in the context of a pandemic.

Introducción: La pandemia por COVID-19 ha impactado la salud mental de los trabajadores de salud. La perspectiva de cuidados se ha identificado como necesaria de estudiar, para entender causas atribuibles asociadas a hallazgos específicos en materia de salud mental y proponer cursos de acción para abordarla. Métodos: Estudio de carácter transversal con enfoque analítico temático, derivado de la iniciativa internacional (HEROES) Fue realizado entre trabajadores de salud en Chile, durante el segundo semestre de 2022 y el primero de 2023, a través entrevistas semiestructuradas y codificación inductiva. Resultados: Síntesis narrativa de 35 entrevistas, en cuatro temas: cuidados en el trabajo: presencia de cambios de funciones, preocupación por contagio, "mística" colectiva, estigma por condición de trabajador de la salud, conflictos con pacientes; cuidados en el hogar: diversas formas de arreglos de tareas domésticas, relevancia de la convivencia con otros, interrelación con dinámicas laborales, "doble carga" entre mujeres; relación con la propia salud mental: reconocimiento de afectación en salud mental, estrés asociado a cambio e incertidumbre, percepción de sobrecarga laboral, sentimientos de culpa o responsabilidad por contagio a familiares; y creencias y valores sobre la pandemia y sus efectos: aceptación de afectación psíquica de trabajadores de la salud, cultura organizacional como elemento relevante en postergación de propia salud mental, incredulidad inicial ante efectos de la pandemia, similitudes con periodos de conmoción social previos, igualdad entre personas respecto a vulnerabilidad frente a enfermedad. Conclusiones: Cinco elementos surgen como potenciales áreas de intervención: perspectiva de género, exposición previa a experiencias de crisis, espacios de autocuidado, apoyo de pares y respuesta institucional. La perspectiva de cuidados es útil para estudiar la relación entre algunos factores estresantes y la salud mental de los trabajadores de salud en el contexto de pandemia.

Impact of COVID-19 on Chronic Ambulatory-Care-Sensitive Condition Emergency Department Use Among Older Adults.

BACKGROUND: The COVID-19 pandemic social distancing requirements encouraged patients to avoid public spaces including in-office health care visits. Ambulatory-care-sensitive conditions (ACSCs) represent conditions that can be managed with quality primary care and when access is limited, these conditions can lead to avoidable emergency department (ED) visits. METHODS: Using national data on ED visits from 2019 to 2021 in the National Hospital Ambulatory Care Survey, we examined the impact of COVID-19 pandemic on ACSC ED visits among older adults (aged ≥65). RESULTS: The proportion of ED visits among older adults that were for ACSCs increased between 2019 (17.4%) and 2021 (18.5%). The trend in both rural (26.4%-28.6%) and urban areas (15.4%-16.8%) shows a significant jump from 2019 to 2021 (P < .001). CONCLUSIONS: This rise in ACSC ED use is consistent with a delay in normal primary care during the pandemic.

Conference Report: LPMHealthcare Emerging Viruses 2023 (EVOX23): Pandemics-Learning from the Past and Present to Prepare for the Future.

The emergence of SARS-CoV-2 has meant that pandemic preparedness has become a major focus of the global scientific community. Gathered in the historic St Edmund Hall college in Oxford, the one-day LPMHealthcare conference on emerging viruses (6 September 2023) sought to review and learn from past pandemics-the current SARS-CoV-2 pandemic and the Mpox outbreak-and then look towards potential future pandemics. This includes an emphasis on monitoring the "traditional" reservoirs of viruses with zoonotic potential, as well as possible new sources of spillover events, e.g., bats, which we are coming into closer contact with due to climate change and the impacts of human activities on habitats. Continued vigilance and investment into creative scientific solutions is required for issues including the long-term physical and psychological effects of COVID-19, i.e., long COVID. The evaluation of current systems, including environmental monitoring, communication (with the public, regulatory authorities, and governments), and training; assessment of the effectiveness of the technologies/assays we have in place currently; and lobbying of the government and the public to work with scientists are all required in order to build trust moving forward. Overall, the SARS-CoV-2 pandemic has shown how many sectors can work together to achieve a global impact in times of crisis.

Paramedics' experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic-a qualitative study.

BACKGROUND: As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic. METHODS: This qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis. RESULTS: The emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere. CONCLUSIONS: Crisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.

Description of a telehealth mental health programme in the framework of the COVID-19 pandemic in Colombia.

BACKGROUND: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia]. OBJECTIVES: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021. METHODS: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics. RESULTS: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person. CONCLUSIONS: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.