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1.
BMC Med Educ ; 21(1): 312, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078364

RESUMO

BACKGROUND: Although it is accepted that providing medical students with opportunities to engage in research activity is beneficial, little data has been collated on how medical degree curricula may address this issue. This review aims to address this knowledge gap by conducting a scoping review examining curriculum initiatives that seek to enhance research experience for medical students. METHODS: This review looks to specifically look at 'doing research' as defined by the MEDINE 2 consensus rather than 'using research' for the bachelor component of the Bologna Cycle. The framework developed by Arksey & O'Malley was utilised and a consultation with stakeholders was incorporated to clarify and enhance the framework. RESULTS: A total of 120 articles were included in this scoping review; 26 related to intercalated degree options and 94 to non-intercalated degree options. Research initiatives from the United States were most common (53/120 articles). For non-intercalated research options, mandatory and elective research projects predominated. The included studies were heterogeneous in their methodology. The main outcomes reported were student research output, description of curriculum initiative(s) and self-reported research skills acquisition. For intercalated degree options, the three main findings were descriptions of more 'novel' intercalated degree options than the traditional BSc, student perspectives on intercalating and the effect of intercalating on medical student performance and careers. CONCLUSIONS: There are several options available to faculty involved in planning medical degree programmes but further research is needed to determine whether research activity should be optional or mandatory. For now, flexibility is probably appropriate depending on a medical school's resources, curriculum, educational culture and population needs.


Assuntos
Educação de Graduação em Medicina , Estudantes de Medicina , Currículo , Humanos , Estados Unidos
2.
Sci Rep ; 11(1): 11462, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34075090

RESUMO

An excessive immune response known as cytokine storm is the hallmark of severe COVID-19. The cause of this cytokine rampage is yet not known. Based on recent epidemiological evidence, we hypothesized that CD80/86 signaling is essential for this hyperinflammation, and that blocking this proinflammatory axis could be an effective therapeutic approach to protect against severe COVID-19. Here we provide exploratory evidence that abatacept, a drug that blocks CD80/86 co-stimulation, produces changes at the systemic level that are highly antagonistic of the proinflammatory processes elicited by COVID-19. Using RNA-seq from blood samples from a longitudinal cohort of n = 38 rheumatic patients treated with abatacept, we determined the immunological processes that are significantly regulated by this treatment. We then analyzed available blood RNA-seq from two COVID19 patient cohorts, a very early cohort from the epicenter of the pandemic in China (n = 3 COVID-19 cases and n = 3 controls), and a recent and larger cohort from the USA (n = 49 severe and n = 51 mild COVD-19 patients). We found a highly significant antagonism between SARS-CoV-2 infection and COVID-19 severity with the systemic response to abatacept. Analysis of previous single-cell RNA-seq data from bronchoalveolar lavage fluid from mild and severe COVID-19 patients and controls, reinforce the implication of the CD80/86 proinflammatory axis. Our functional results further support abatacept as a candidate therapeutic approach to prevent severe COVID-19.


Assuntos
Abatacepte/farmacologia , 59585/tratamento farmacológico , Síndrome da Liberação de Citocina/prevenção & controle , Imunossupressores/farmacologia , 59565/imunologia , Transdução de Sinais/efeitos dos fármacos , Abatacepte/uso terapêutico , Idoso , Artrite Reumatoide/sangue , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Antígeno B7-1/metabolismo , Antígeno B7-2/metabolismo , Líquido da Lavagem Broncoalveolar/citologia , 59585/sangue , 59585/complicações , 59585/imunologia , China , Síndrome da Liberação de Citocina/imunologia , Síndrome da Liberação de Citocina/virologia , Feminino , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Observacionais como Assunto , RNA-Seq , Índice de Gravidade de Doença , Transdução de Sinais/imunologia , Análise de Célula Única , Espanha , Estados Unidos , Regulação para Cima/efeitos dos fármacos , Regulação para Cima/imunologia
3.
BMC Health Serv Res ; 21(1): 552, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090431

RESUMO

BACKGROUND: Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital. METHODS: We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3-6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model. RESULTS: Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was > 84.1%, vs. < 24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status. CONCLUSIONS: Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.


Assuntos
Hospitais , Medicare , Idoso , Estudos de Coortes , Continuidade da Assistência ao Paciente , Estudos Transversais , Humanos , Estudos Retrospectivos , Estados Unidos
4.
J Pak Med Assoc ; 71(5): 1357-1368, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34091615

RESUMO

OBJECTIVE: To assess the prevalence and severity of fibromyalgia in hospital-visiting patients. METHODS: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from July, 2018, to January, 2019, and comprised patients aged 18-75 years of either gender. Demographic information, comorbidities and previous medications were recorded for each patient. The modified American College of Rheumatology preliminary diagnostic criteria 2010-11 for fibromyalgia diagnosis. If diagnosed, the fibromyalgia impact questionnaire was administered to assess its severity. Data was analysed using SPSS 25. RESULTS: Of the 750 hospital-visiting patients, fibromyalgia was diagnosed in 250(33.3%); 190(76%) of them being females (p<0.0001). Comorbidities, age and increased elevated body mass index were significantly associated with fibromyalgia. Severity was not influenced by comorbidities, marital status, education or economic status (p>0.05). Menarche at a later age and menstrual irregularity were associated with fibromyalgia severity (p<0.05). CONCLUSIONS: The hospital-based prevalence of fibromyalgia was found to be high, especially among females.


Assuntos
Fibromialgia , Estudos Transversais , Feminino , Fibromialgia/epidemiologia , Hospitais , Humanos , Paquistão/epidemiologia , Prevalência , Índice de Gravidade de Doença , Estados Unidos
5.
No Shinkei Geka ; 49(3): 491-499, 2021 May.
Artigo em Japonês | MEDLINE | ID: mdl-34092554

RESUMO

Recently, Japan's population has been aging with a declining birth rate at an unprecedented rate compared to that worldwide, and Kumamoto Prefecture is no exception. In this chapter, we examine whether the recent changes in vital statistics have affected the incidence of glioma based on data from the latest Kumamoto Prefecture Brain Tumor Data Bank. We compare the age-adjusted incidence of glioma extracted from the Brain Tumor Registry of Japan and Central Brain Tumor Registry of the United States(CBTRUS)for the period from 1990 to 2017 when data on the annual transition of the population composition in Kumamoto Prefecture were obtained. This chapter also outlines whether there are differences in survival rates between Japan and the United States. We hope that this chapter will help you determine the future direction of glioma treatment in Japan.


Assuntos
Neoplasias Encefálicas , Glioma , Neoplasias Encefálicas/epidemiologia , Glioma/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Sistema de Registros , Estados Unidos
6.
World J Gastroenterol ; 27(20): 2603-2614, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34092978

RESUMO

BACKGROUND: Long-term outcomes and monitoring patterns in real-world practice are largely unknown among patients with celiac disease. AIM: To understand patterns of follow-up and management of patients with celiac disease, and to characterize symptoms and villous atrophy after diagnosis. METHODS: A retrospective chart review study was performed using medical chart data of patients diagnosed with celiac disease. Three gastroenterology referral centers, with substantial expertise in celiac disease, participated in the United Kingdom, United States, and Norway. Demographic and clinical data were collected from medical charts. Descriptive analyses were conducted on patients with biopsy-confirmed celiac disease, diagnosed between 2008 and 2012, with at least one follow-up visit before December 31, 2017. Patient demographic and clinical characteristics, biopsy/serology tests and results, symptoms, and comorbidities were captured at diagnosis and for each clinic visit occurring within the study period (i.e., before the study end date of December 31, 2017). RESULTS: A total of 300 patients were included in this study [72% female; mean age at diagnosis: 38.9 years, standard deviation (SD) 17.2]. Patients were followed-up for a mean of 29.9 mo (SD 22.1) and there were, on average, three follow-up visits per patient during the study period. Over two-thirds (68.4%) of patients were recorded as having ongoing gastrointestinal symptoms and 11.0% had ongoing symptoms and enteropathy during follow-up. Approximately 80% of patients were referred to a dietician at least once during the follow-up period. Half (50.0%) of the patients underwent at least one follow-up duodenal biopsy and 36.6% had continued villous atrophy. Patterns of monitoring varied between sites. Biopsies were conducted more frequently in Norway and patients in the United States had a longer follow-up duration. CONCLUSION: This real-world study demonstrates variable follow-up of patients with celiac disease despite most patients continuing to have abnormal histology and symptoms after diagnosis.


Assuntos
Doença Celíaca , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Feminino , Humanos , Masculino , Noruega , Estudos Retrospectivos , Reino Unido , Estados Unidos
7.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 38(6): 513-520, 2021 Jun 10.
Artigo em Chinês | MEDLINE | ID: mdl-34096016

RESUMO

The use of whole exome sequencing (WES) for the detection of disease-causing variants of genetic diseases and for non-invasive prenatal screening (NIPS) of fetal aneuploidies are two major clinical applications of next generation sequencing (NGS). This article has summarized the official documents developed and updated by the American College of Medical Genetics and Genomics (ACMG) on governing WES and NIPS. These include the development of expert consensus policies and position statements on an ongoing basis to guide clinical application of NGS technology and variant analysis, establish evidence-based practical resources, as well as standards and guidelines to govern diagnosis and screening. These ACMG documents are valuable references to Chinese geneticists, but direct adoption of these standards and guidelines may not be practical due to the differences in disease-associated variant frequencies in Chinese population, socioeconomic status, and medical practice between the two countries. It is hoped that this review could facilitate the development of NGS and NIPS standards and guidelines that are consistent with international standards and concordant with medical genetics practice in China to provide high-quality, efficient and safe clinical services for patients and their families with genetic diseases.


Assuntos
Genômica , Sequenciamento de Nucleotídeos em Larga Escala , China , Consenso , Feminino , Humanos , Gravidez , Tecnologia , Estados Unidos
8.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 292-295, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096239

RESUMO

Based on 18 hospitals including the Chinese People's Liberation Army General Hospital and Peking University People's Hospital, and based on the "Specifications for Perioperative Data", explore the construction and application of perioperative multi-center data centers in the era of medical big data. The use of data ferry technology avoids hidden safety hazards in hospitals, realizes the integration and sharing of perioperative medical data of various medical institutions, and forms a complete data chain combining patient medical data and follow-up data.


Assuntos
Hospitais Militares , Militares , Humanos , Estados Unidos
9.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 315-320, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096244

RESUMO

OBJECTIVE: Discuss the working ideas of the dynamic adjustment mechanism of medical device classification in the United States, and provide reference for the construction of medical device related mechanisms in China. METHODS: Collect and interpret the documents of regulatory background, procedures and orders of the dynamic adjustment mechanism of the medical device classification in the United States, and summarize the overall situation and specific cases of the medical device classification adjustment under this mechanism in recent years. RESULTS: The US work idea of the medical device classification dynamic adjustment mechanism is based on the latest valid scientific evidence, conducting risk analysis and identification, and determining the corresponding measures. CONCLUSIONS: During the adjustment process, industry stakeholders have repeatedly discussed and achieved final agreement. Its procedures and working ideas can be used as a reference for China's work.


Assuntos
United States Food and Drug Administration , China , Estados Unidos
10.
BMC Res Notes ; 14(1): 226, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082823

RESUMO

OBJECTIVE: Marijuana policies in the United States have become more permissive, motivating research on demographic and policy-based differences in behaviors and attitudes towards driving after marijuana use. The Traffic Safety Culture Index is an annual survey with national scope and multiple measures relevant to driving after marijuana use. We tabulated responses to questions about driving after marijuana use from the Traffic Safety Culture Index based on demographic factors, recreational and medical marijuana policies, and per-se marijuana laws. RESULTS: Male, younger, lower-income, and lower-education respondents self-reported driving after marijuana use more than their demographic counterparts, more often reported such behavior to be personally acceptable, and exhibited lower support per-se laws. Drivers in states that legalized medical marijuana self-reported driving after marijuana use slightly more than drivers in states where both medical and recreational were illegal. Support for per-se laws was higher among those in states that legalized recreational marijuana and in states with per-se laws. Demographic differences in our outcomes were consistent and cohesive. On the other hand, we found no predominant pattern suggesting that those in states with liberal marijuana policies were more tolerant of driving after marijuana use.


Assuntos
Uso da Maconha , Atitude , Demografia , Humanos , Masculino , Uso da Maconha/epidemiologia , Políticas , Gestão da Segurança , Estados Unidos/epidemiologia
11.
BMC Res Notes ; 14(1): 228, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34082835

RESUMO

OBJECTIVE: The 340B Drug Pricing Program allows hospitals to purchase covered drugs at a discount and potentially generate profit if they are reimbursed at rates that exceed 340B acquisition prices. Disproportionate share hospitals (DSH) are eligible to participate in 340B if their DSH adjustment-a measure that identifies hospitals that treat a disproportionate share of low income Medicare or Medicaid patients-is above 11.75%. To assess whether hospitals behave strategically to gain access to the program, we examined data on the number of hospitals just above versus below the DSH adjustment threshold for 340B eligibility and conducted McCrary density tests to assess statistical significance. RESULTS: In 2014-2016, the number of hospitals increases by 41% just above the 340B eligibility threshold. McCrary density tests found this increase to be statistically significant across a range of bandwidths in 2014-2016 (p < 0.01). From 2011-2013, the findings are sensitive to the bandwidth around the threshold, but insignificant in 2008-2010. We found no comparable change among hospitals ineligible for the 340B program. These data are consistent with the hypothesis that some hospitals adjust their DSH to gain 340B eligibility. Our findings support recent calls from the Government Accountability Office to improve oversight of the 340B program.


Assuntos
Custos de Medicamentos , Medicare , Idoso , Custos e Análise de Custo , Hospitais , Humanos , Medicaid , Estados Unidos
12.
BMC Public Health ; 21(1): 1025, 2021 05 31.
Artigo em Inglês | MEDLINE | ID: mdl-34059023

RESUMO

BACKGROUND: Over one-quarter of all smokers in the United States identify as non-daily smokers and this number is projected to rise. Unlike daily smokers who typically maintain consistent levels of nicotine exposure with regular smoking, non-daily smokers have variable patterns of smoking that likely result in high intraindividual variability in nicotine intake. The current study aimed to characterize the weekly intraindividual variability in cotinine and identify smoking-related predictors in nondaily smokers. METHODS: An ecological momentary assessment of 60 non-daily smokers ages 24-57 years was conducted over a consecutive 7-day at-home protocol to log each smoking session, assessments of mood and social activity during smoking, and collection of daily saliva samples in a convenience sample from Pennsylvania, USA. Hierarchical linear regression analyses were conducted to determine the effects of smoking characteristics on total cotinine exposure measured by pharmacokinetic area under the curve and the range, maximum, and minimum cotinine values during the week controlling for demographic variables. RESULTS: The mean daily cotinine level was 119.2 ng/ml (SD = 168.9) with individual values that ranged from nondetectable to 949.6 ng/ml. Menthol predicted increased total cotinine levels (P < 0.05). Shorter time to the first cigarette of the day predicted significantly higher minimum (P < 0.05), maximum (P < 0.05), and total cotinine values (P < 0.05) after controlling for covariates. Negative emotions and social interactions with others were also significantly associated with higher cotinine metrics. There was no significant effect of the nicotine metabolite ratio. CONCLUSIONS: Our findings highlight the variability in nicotine exposure across days among non-daily smokers and point to the role of smoking context in nicotine exposure. The findings suggest the need to develop better assessment methods to determine health and dependence risk and personalized cessation interventions for this heterogeneous and growing group of smokers.


Assuntos
Nicotina , Fumar , Adulto , Cotinina , Humanos , Pessoa de Meia-Idade , Pennsylvania , Fumantes , Fumar/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
13.
Rev Bras Epidemiol ; 24: e210028, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34076147

RESUMO

OBJECTIVES: This study investigated the impact of the COVID-19 pandemic on the provision of dental care procedures performed by the Brazilian Unified Health System (SUS) nationally and by regions. Considering that the most underprivileged population disproportionately suffers with the reduction in dental care provision, the study hypothesis suggests the presence of a syndemic nature. METHODOLOGY: The SUS Outpatient Information System (SIA-SUS) was assessed to gather data on dental care activities and procedures performed between April and July 2018, 2019, and 2020 by dentists registered in the SUS. The 30 most frequent activities and procedures performed by dentists were selected and classified into three categories (urgent dental care, nonemergency dental care, and case-dependent urgency procedures), based on the guidance for dental care during the pandemic published by the American Dental Association. RESULTS: Results demonstrated a reduction in the provision of dental care of all categories during the pandemic. Urgency dental consultations and procedures in primary and specialized dental care services decreased by 42.5 and 44.1%, respectively, between 2020 and 2019. Non-urgent procedures decreased by 92.3%. Although decreases in dental care activities and procedures were reported in all Brazilian regions, the largest relative decreases in urgent procedures - that should have been maintained during the pandemic - occurred in the North and Northeast regions, which are the poorest regions of the country. CONCLUSIONS: These results suggest that the COVID-19 pandemic has a syndemic behavior. Further investigation into the pandemic-syndemic impacts on oral disease burden is necessary.


Assuntos
Pandemias , Brasil/epidemiologia , Odontologia , Humanos , Sindemia , Estados Unidos
14.
Bone Joint J ; 103-B(6): 1142-1149, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058874

RESUMO

AIMS: Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI. METHODS: We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI. RESULTS: Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI. CONCLUSION: A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142-1149.


Assuntos
Sarcoma/mortalidade , Sarcoma/cirurgia , Tempo para o Tratamento , Idoso , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Sistema de Registros , Estudos Retrospectivos , Sarcoma/patologia , Taxa de Sobrevida , Tórax , Estados Unidos/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-34062806

RESUMO

Studies documenting coronavirus disease 2019 (COVID-19) racial/ethnic disparities in the United States were limited to data from the initial few months of the pandemic, did not account for changes over time, and focused primarily on Black and Hispanic minority groups. To fill these gaps, we examined time trends in racial/ethnic disparities in COVID-19 infection and mortality. We used the Veteran Health Administration's (VHA) national database of veteran COVID-19 infections over three time periods: 3/1/2020-5/31/2020 (spring); 6/1/2020-8/31/2020 (summer); and 9/1/2020-11/25/2020 (fall). We calculated COVID-19 infection and mortality predicted probabilities from logistic regression models that included time period-by-race/ethnicity interaction terms, and controlled for age, gender, and prior diagnosis of CDC risk factors. Racial/ethnic groups at higher risk for COVID-19 infection and mortality changed over time. American Indian/Alaskan Natives (AI/AN), Blacks, Hispanics, and Native Hawaiians/Other Pacific Islanders experienced higher COVID-19 infections compared to Whites during the summertime. There were mortality disparities for Blacks in springtime, and AI/ANs, Asians, and Hispanics in summertime. Policy makers should consider the dynamic nature of racial/ethnic disparities as the pandemic evolves, and potential effects of risk mitigation and other (e.g., economic) policies on these disparities. Researchers should consider how trends in disparities change over time in other samples.


Assuntos
Grupos Étnicos , Hawaii , Disparidades nos Níveis de Saúde , Hispano-Americanos , Humanos , Grupos Minoritários , Estados Unidos/epidemiologia
16.
Medicina (Kaunas) ; 57(5)2021 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-34065050

RESUMO

Background and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care and related patient outcomes. Telehealth has quickly become an advantageous tool in assisting outpatient providers in this challenge, which has also come with an adaptation of U.S. government policy, procedures, and, as a result, organizational protocols surrounding the delivery of telehealth care. Materials and methods: This systematic review identified three primary facilitators to the implementation and establishment of telehealth services for the outpatient segment of the United States health care industry: patient engagement, operational workflow and organizational readiness, and regulatory changes surrounding reimbursement parity for telehealth care. Results: Researchers identified three barriers impacting the implementation and use of telehealth resources: patient telehealth limitations, lack of clinical care telehealth guidelines, and training, technology, and financial considerations. Conclusions: This systematic review's identified facilitators and barriers for telehealth implementation initiatives in the United States can assist future outpatient providers as the global pandemic and associated public health initiatives such as physical distancing continue.


Assuntos
Telemedicina , Feminino , Humanos , Pacientes Ambulatoriais , Pandemias , Gravidez , Estados Unidos/epidemiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-34067736

RESUMO

Background: There has been an alarming increase in discrimination and violence towards Asians during the coronavirus (COVID-19) pandemic amid reports that the virus was first detected in China. In an incident involving a COVID-19-related physical assault, this study examined whether economic hardship experienced by participants during the pandemic and the race of the victim (Chinese, White) would influence support to compensate a victim and punish the assailant. The study also explored whether the perception that the victim experienced emotional and physical suffering due to the assault would mediate the relationships. Method: Participants in India and the United States reported on their own economic hardship due to the pandemic. They then read about an incident in which an innocent person suffered a COVID-19-related physical and verbal attack, and indicated if they would support punishing the assailant and financially compensating the victim. Results: When the victim was Chinese, participants experiencing a high degree of COVID-19 economic hardship were less likely to support financially compensating the victim or punishing the assailant compared to when the victim was White. Furthermore, when the victim was Chinese, the negative associations between economic hardship and financially compensating the victim and punishing the assailant were mediated by reduced recognition that the victim suffered emotional trauma and pain as a result of the attack. Conclusions: COVID-19-driven economic hardship experienced by participants predicted an array of reactions that reflected reduced recognition of the civil and human rights of a victim of a COVID-19-related assault. These findings have significant implications for mental health, public health, and the justice system, and underscore the pressing need for prompt action to mitigate economic hardship and to address racism and discrimination.


Assuntos
Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Humanos , Índia/epidemiologia , Punição , Estados Unidos/epidemiologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34071783

RESUMO

We aimed to determine how COVID-19 affected the number and type of pediatric primary care visits in April 2020, compared to April 2019, and which characteristics were associated with obtaining care in 2020. We performed a retrospective chart review of patients receiving care in April 2019 and April 2020 from four large, academic institutions across two states. The subjects were included if they were aged 0-18 years and were seen in a pediatric clinic in April 2019 or April 2020. We extracted the number of visits, visit type, and visit diagnosis; and the patient characteristics, including age, race/ethnicity, and insurance status. Logistic regression analysis identified characteristics associated with obtaining care in April 2020. We included 120,230 visits. Participants were 50% white and half had Medicaid. In 2020 there were significantly fewer visits for both well and acute visits with 42,670 visits in 2020 compared to 77,560 in 2019; 6616 were telehealth visits in 2020. Visits for chronic conditions were significantly decreased in 2020. Attending a visit in 2020 was more likely if the participant was black or Hispanic, younger, attending an acute visit, or had private insurance. During the COVID-19 pandemic, pediatric primary care decreased substantially for both well visits and follow-up of chronic conditions.


Assuntos
Pandemias , Criança , Humanos , Atenção Primária à Saúde , Estudos Retrospectivos , Estados Unidos
19.
Compend Contin Educ Dent ; 42(6): 314-321, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34077668

RESUMO

The SARS-CoV-2 pandemic created societal upheaval well beyond what anyone, but the oldest of Americans, has seen in their lifetime. As the pandemic begins to subside, it is leaving behind a legacy of permanently changed practices, including enhanced environmental controls in clinical settings, reconsideration of modes of personal protective equipment outsourcing, changes and/or reinterpretation of dental practice acts, and entirely new approaches to testing and vaccine design, among many others. This article focuses on one change that the authors hope will prevail: greater trust in the dental profession as a valuable public resource during healthcare crises. The article cites the initial low perception of dentistry as an important component of a health surge response by public health authorities, then describes how a group of eight institutions came together to form the "Testing for Tomorrow Collaborative" to help each other and the dental profession identify modes of testing and practice conduct that make dentistry safer to practice. The importance of the public's trust in the profession is underscored, and pathways to improving that trust are proffered.


Assuntos
Odontologia , Humanos , Pandemias , Confiança , Estados Unidos
20.
MMWR Morb Mortal Wkly Rep ; 70(22): 818-824, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34081685

RESUMO

Disparities in vaccination coverage by social vulnerability, defined as social and structural factors associated with adverse health outcomes, were noted during the first 2.5 months of the U.S. COVID-19 vaccination campaign, which began during mid-December 2020 (1). As vaccine eligibility and availability continue to expand, assuring equitable coverage for disproportionately affected communities remains a priority. CDC examined COVID-19 vaccine administration and 2018 CDC social vulnerability index (SVI) data to ascertain whether inequities in COVID-19 vaccination coverage with respect to county-level SVI have persisted, overall and by urbanicity. Vaccination coverage was defined as the number of persons aged ≥18 years (adults) who had received ≥1 dose of any Food and Drug Administration (FDA)-authorized COVID-19 vaccine divided by the total adult population in a specified SVI category.† SVI was examined overall and by its four themes (socioeconomic status, household composition and disability, racial/ethnic minority status and language, and housing type and transportation). Counties were categorized into SVI quartiles, in which quartile 1 (Q1) represented the lowest level of vulnerability and quartile 4 (Q4), the highest. Trends in vaccination coverage were assessed by SVI quartile and urbanicity, which was categorized as large central metropolitan, large fringe metropolitan (areas surrounding large cities, e.g., suburban), medium and small metropolitan, and nonmetropolitan counties.§ During December 14, 2020-May 1, 2021, disparities in vaccination coverage by SVI increased, especially in large fringe metropolitan (e.g., suburban) and nonmetropolitan counties. By May 1, 2021, vaccination coverage was lower among adults living in counties with the highest overall SVI; differences were most pronounced in large fringe metropolitan (Q4 coverage = 45.0% versus Q1 coverage = 61.7%) and nonmetropolitan (Q4 = 40.6% versus Q1 = 52.9%) counties. Vaccination coverage disparities were largest for two SVI themes: socioeconomic status (Q4 = 44.3% versus Q1 = 61.0%) and household composition and disability (Q4 = 42.0% versus Q1 = 60.1%). Outreach efforts, including expanding public health messaging tailored to local populations and increasing vaccination access, could help increase vaccination coverage in high-SVI counties.


Assuntos
/administração & dosagem , Disparidades em Assistência à Saúde/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , /prevenção & controle , Cidades/epidemiologia , Humanos , Fatores Socioeconômicos , Estados Unidos/epidemiologia
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