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1.
Circ Cardiovasc Qual Outcomes ; 14(11): e008242, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34749515

RESUMO

BACKGROUND: Despite its established benefit and strong endorsement in international guidelines, cardiac rehabilitation (CR) use remains low. Identifying determinants of CR referral and use may help develop targeted policies and quality improvement efforts. We evaluated the variation in CR referral and use across percutaneous coronary intervention (PCI) hospitals and operators. METHODS: We performed a retrospective observational cohort study of all patients who underwent PCI at 48 nonfederal Michigan hospitals between January 1, 2012 and March 31, 2018 and who had their PCI clinical registry record linked to administrative claims data. The primary outcomes included in-hospital CR referral and CR participation, defined as at least one outpatient CR visit within 90 days of discharge. Bayesian hierarchical regression models were fit to evaluate the association between PCI hospital and operator with CR referral and use after adjusting for patient characteristics. RESULTS: Among 54 217 patients who underwent PCI, 76.3% received an in-hospital referral for CR, and 27.1% attended CR within 90 days after discharge. There was significant hospital and operator level variation in in-hospital CR referral with median odds ratios of 3.88 (95% credible interval [CI], 3.06-5.42) and 1.64 (95% CI, 1.55-1.75), respectively, and in CR participation with median odds ratios of 1.83 (95% CI, 1.63-2.15) and 1.40 (95% CI, 1.35-1.47), respectively. In-hospital CR referral was significantly associated with an increased likelihood of CR participation (adjusted odds ratio, 1.75 [95% CI, 1.52-2.01]), and this association varied by treating PCI hospital (odds ratio range, 0.92-3.75) and operator (odds ratio range, 1.26-2.82). CONCLUSIONS: In-hospital CR referral and 90-day CR use after PCI varied significantly by hospital and operator. The association of in-hospital CR referral with downstream CR use also varied across hospitals and less so across operators suggesting that specific hospitals and operators may more effectively translate CR referrals into downstream use. Understanding the factors that explain this variation will be critical to developing strategies to improve CR participation overall.


Assuntos
Reabilitação Cardíaca , Intervenção Coronária Percutânea , Teorema de Bayes , Planos de Seguro Blue Cross Blue Shield , Hospitais , Humanos , Michigan/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Encaminhamento e Consulta , Estudos Retrospectivos , Fatores de Tempo
2.
Am J Forensic Med Pathol ; 42(4): 367-372, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34793410

RESUMO

ABSTRACT: In this report, we describe 13 cases of drug overdose in Michigan in which valeryl fentanyl was found in postmortem blood. Valeryl fentanyl is a schedule I opioid that is rarely found in drug overdoses in the United States. Although little data exist on the mortality and morbidity associated with valeryl fentanyl, its molecular structure indicates that it would be less potent than fentanyl.When analyzing blood samples for valeryl fentanyl, samples from peripheral sites were sometimes negative for quantitative levels; however, samples from central sites in the same decedent were positive. This could indicate unique pharmacokinetics for valeryl fentanyl, which could have implications for other fentanyl analogs. Given the paucity of pharmacodynamic information, the prohibition of its use, the potential to buttress law enforcement efforts in monitoring drug trafficking trends, and to determine the efficacy of current regulations, laboratories should test for valeryl fentanyl. When testing for valeryl fentanyl, and likely other fentanyl analogs, the site of sample collection is important: central sources of blood are preferred to peripheral sources.


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides , Fentanila , Humanos , Michigan , Estados Unidos
3.
J Hand Surg Asian Pac Vol ; 26(4): 666-683, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789093

RESUMO

Background: Patient-reported outcome measures are largely used in clinical practice and scientific community. Michigan hand questionnaire (MHQ) is widely recognized as a standardized reliable instrument for the assessment of any kind of hand disorders. Aim of the study: translation, cross-cultural adaptation and validation of the Italian version of MHQ. Methods: The study was composed by two phases. Phase 1 consisted in translation and cross-cultural adaptation of MHQ, from original language version (English) into Italian, according to the standard procedure of translation and back translation. The final Italian version of MHQ was tested on 136 Italian patients with hand disorders (Phase 2), in addition to Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Visual analogue scale (VAS) for pain assessment and grip strength, to psychometric properties of the new version, 55 patients repeated the questionnaire after 7 days for test-retest to assess the reproducibility of the questionnaire. All data were subsequently analyzed (descriptive statistics, multitrait analysis, reliability and construct validity assessment). Results: Phase 1 was performed without major problems, thus the final Italian version was approved for Phase 2. The questionnaire was clear and easily understood (missing data 0-2.9%). Multitrait analysis brought very good results for each outcome measure. High reliability (Cronbach's alpha: 0.91-0.99) and very good reproducibility (Intraclass correlation coefficients: 0.83-0.98) were revealed. High to moderate correlation was found between MHQ and DASH, grip strength and VAS. Conclusions: The Italian version of MHQ has demonstrated to be reliable and valid.


Assuntos
Comparação Transcultural , Idioma , Avaliação da Deficiência , Humanos , Itália , Michigan , Reprodutibilidade dos Testes , Inquéritos e Questionários
4.
Ophthalmic Surg Lasers Imaging Retina ; 52(11): 593-600, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34766850

RESUMO

BACKGROUND AND OBJECTIVE: To investigate the effect of the coronavirus disease 2019 (COVID-19) lockdown on the presentation and management of acute, primary rhegmatogenous retinal detachment (RRD). PATIENTS AND METHODS: This was a single-center, consecutive case series with historic controls, examining patients during the COVID-19 "stay-at-home" order (March 24 to June 1, 2020), the subsequent reopening phase (June 1 to July 31, 2020), and corresponding preceding intervals (March 24 to July 31, 2016 to 2019). RESULTS: Despite a significant increase in patients presenting with macula-off RRD during the COVID-19 lockdown compared to the 2016 to 2019 timeframe (P = .03), the rate of single surgery anatomical success was similar between all groups (P = .66), as was final visual acuity (P = .61). No delays between presentation and surgical intervention were observed during the lockdown (P = .49). CONCLUSIONS: Despite the limitations of the COVID-19 lockdown, patients underwent surgery in a timely manner and achieved comparable visual outcomes to controls before COVID-19. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:593-600.].


Assuntos
COVID-19 , Descolamento Retiniano , Controle de Doenças Transmissíveis , Humanos , Michigan , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , SARS-CoV-2 , Centros de Atenção Terciária , Resultado do Tratamento , Vitrectomia
5.
J Prim Care Community Health ; 12: 21501327211053519, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34704487

RESUMO

OBJECTIVES: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents' perceptions of health and experiences interacting with the health care system to identify gaps in care. METHODS: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. CONCLUSION: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most-93% (n = 13)-reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. CONCLUSION: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities.


Assuntos
Fazendeiros , Saúde da População Rural , Grupos Focais , Humanos , Michigan , População Rural , Estados Unidos
6.
Medicine (Baltimore) ; 100(37): e27265, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664879

RESUMO

ABSTRACT: During the spring 2020 COVID-19 surge, hospitals in Southeast Michigan were overwhelmed, and hospital beds were limited. However, it is unknown whether threshold for hospital admission varied across hospitals or over time.Using a statewide registry, we performed a retrospective cohort study. We identified adult patients hospitalized with COVID-19 in Southeast Michigan (3/1/2020-6/1/2020). We classified disease severity on admission using the World Health Organization (WHO) ordinal scale. Our primary measure of interest was the proportion of patients admitted on room air. We also determined the proportion without acute organ dysfunction on admission or any point during hospitalization. We quantified variation across hospitals and over time by half-month epochs.Among 1315 hospitalizations across 22 hospitals, 57.3% (754/1,315) were admitted on room air, and 26.1% (343/1,315) remained on room air for the duration of hospitalization. Across hospitals, the proportion of COVID-19 hospitalizations admitted on room air varied from 32.3% to 80.0%. Across half-month epochs, the proportion ranged from 49.4% to 69.4% and nadired in early April 2020. Among patients admitted on room air, 75.1% (566/754) had no acute organ dysfunction on admission, and 35.3% (266/754) never developed acute organ dysfunction at any point during hospitalization; there was marked variation in both proportions across hospitals. In-hospital mortality was 13.7% for patients admitted on room air vs 26.3% for patients requiring nasal cannula oxygen.Among patients hospitalized with COVID-19 during the spring 2020 surge in Southeast Michigan, more than half were on room air and a third had no acute organ dysfunction upon admission, but experienced high rates of disease progression and in-hospital mortality.


Assuntos
COVID-19/complicações , Hospitalização/estatística & dados numéricos , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores de Tempo
10.
Health Aff (Millwood) ; 40(10): 1637-1643, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34606344

RESUMO

Addressing health inequities for racial and ethnic minority populations is challenging. After passage of the Affordable Care Act, Michigan launched its Healthy Michigan Plan, which expanded Medicaid eligibility in the state. Our evaluation of the expansion provided the opportunity to study its impact on racial and ethnic minority groups, including Arab American and Chaldean American enrollees, an understudied population. Using data from telephone surveys collected in 2016, 2017, and 2018, we conducted an analysis to study the plan's impact on access to a regular source of care and health status among racial and ethnic minority groups. More than 90 percent of respondents of all racial and ethnic groups reported having a regular source of care after plan enrollment compared with 74.4 percent before enrollment. Respondents who identified as non-Hispanic White, African American, and Hispanic reported improvements in health status after plan enrollment. Our study demonstrates the potential of health insurance access to narrow health inequities between racial and ethnic groups.


Assuntos
Grupos Étnicos , Medicaid , Acesso aos Serviços de Saúde , Nível de Saúde , Humanos , Michigan , Grupos Minoritários , Patient Protection and Affordable Care Act , Autorrelato , Estados Unidos
12.
BMC Public Health ; 21(1): 1874, 2021 10 17.
Artigo em Inglês | MEDLINE | ID: mdl-34657616

RESUMO

BACKGROUND: Lead poisoning prevention efforts include preparing and disseminating informational materials such as brochures and pamphlets to increase awareness of lead poisoning, lead exposures and lead poisoning prevention. However, studies have demonstrated that patient education materials for diseases and health conditions are prepared at a reading level that is higher than the recommended 7th-8th grade reading level. This study, therefore, aims to assess the reading levels of lead poisoning informational materials. METHODS: Lead poisoning materials (N = 31) were accessed from three states; Michigan, New York and Pennsylvania. The readability levels of the materials were assessed using the Flesh Kincaid Grade Level readability test. The Kruskal-Wallis test was conducted to determine if the readability levels differed between the materials obtained from the different states. Thematic content analyses were carried out to assess the inclusion of four themes; definition of lead poisoning, risk factors and exposures, testing and referral and prevention covering 12 subtopics. The Wilcoxon rank sum test was used to examine if there was a difference in the number of subtopics by readability level (dichotomized to >8th grade and < 8th grade). RESULTS: The median readability level of the informational materials was 6.7 (IQR: 5.1-8.1). However, there was variability in the readability levels of the materials (range 3.5 to 10.6); materials obtained from Michigan had the highest median reading level of 8.1 (IQR: 6.9-9.0) followed by Pennsylvania. Heterogeneity was observed in the content of the materials. Most of the materials (80%) from Michigan focused on water as a source of lead poisoning, whereas materials from New York and Pennsylvania focused on lead-based paint and other sources. The materials prepared at >8th grade reading level contained fewer topics than materials prepared at <8th grade reading level. CONCLUSIONS: We find that the materials were often prepared at reading levels lower than the recommended 8th grade reading level. However, there is variability in the reading levels and in the content of the materials. While the materials met the general readability guidelines, they did not necessarily meet the needs of specific groups, especially groups at risk.


Assuntos
Letramento em Saúde , Intoxicação por Chumbo , Compreensão , Escolaridade , Humanos , Internet , Intoxicação por Chumbo/prevenção & controle , Michigan , Folhetos
13.
Medicine (Baltimore) ; 100(40): e27422, 2021 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-34622851

RESUMO

ABSTRACT: As severe acute respiratory syndrome coronavirus 2 continues to spread, easy-to-use risk models that predict hospital mortality can assist in clinical decision making and triage. We aimed to develop a risk score model for in-hospital mortality in patients hospitalized with 2019 novel coronavirus (COVID-19) that was robust across hospitals and used clinical factors that are readily available and measured standardly across hospitals.In this retrospective observational study, we developed a risk score model using data collected by trained abstractors for patients in 20 diverse hospitals across the state of Michigan (Mi-COVID19) who were discharged between March 5, 2020 and August 14, 2020. Patients who tested positive for severe acute respiratory syndrome coronavirus 2 during hospitalization or were discharged with an ICD-10 code for COVID-19 (U07.1) were included. We employed an iterative forward selection approach to consider the inclusion of 145 potential risk factors available at hospital presentation. Model performance was externally validated with patients from 19 hospitals in the Mi-COVID19 registry not used in model development. We shared the model in an easy-to-use online application that allows the user to predict in-hospital mortality risk for a patient if they have any subset of the variables in the final model.Two thousand one hundred and ninety-three patients in the Mi-COVID19 registry met our inclusion criteria. The derivation and validation sets ultimately included 1690 and 398 patients, respectively, with mortality rates of 19.6% and 18.6%, respectively. The average age of participants in the study after exclusions was 64 years old, and the participants were 48% female, 49% Black, and 87% non-Hispanic. Our final model includes the patient's age, first recorded respiratory rate, first recorded pulse oximetry, highest creatinine level on day of presentation, and hospital's COVID-19 mortality rate. No other factors showed sufficient incremental model improvement to warrant inclusion. The area under the receiver operating characteristics curve for the derivation and validation sets were .796 (95% confidence interval, .767-.826) and .829 (95% confidence interval, .782-.876) respectively.We conclude that the risk of in-hospital mortality in COVID-19 patients can be reliably estimated using a few factors, which are standardly measured and available to physicians very early in a hospital encounter.


Assuntos
COVID-19/mortalidade , Mortalidade Hospitalar/tendências , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Grupos de Populações Continentais , Creatinina/sangue , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Oximetria , Prognóstico , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos
14.
Allergy Asthma Proc ; 42(5): 400-402, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34474709

RESUMO

Background: On January 20, 2020, the first documented case of novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019 [COVID-19]) was reported in the United States. The U.S. Centers for Disease Control and Prevention continues to report more morbidity and mortality in adults than in children. Early in Pandemic, there was a concern that patients with asthma would be affected disproportionately from COVID-19, but this was not manifested. It is now recognized that angiotensin-converting enzyme 2 receptors that are used by the coronavirus for infection have low expression in children with atopy that may contribute to decreased infectivity in children who are atopic. There are several early reports of decreased emergency department (ED) visits for children with asthma. The authors previously reported a decrease in pediatric ED visits in the spring of 2020, which correlated with school closure. Objective: To determine if this trend of decreased ED visits for pediatric asthma was sustained throughout the first COVID-19 pandemic year. Methods: ED data from one inner city children's hospital were collected by using standard medical claims codes. Conclusion: We reported a sustained year of decreased ED visits for children with asthma in one pediatric ED in an inner-city hospital; this seemed to be secondary to school closure and decreased exposure to upper respiratory infections.


Assuntos
Asma , COVID-19/prevenção & controle , Progressão da Doença , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Doença Aguda , Adolescente , Asma/etiologia , Asma/fisiopatologia , Asma/terapia , Criança , Pré-Escolar , Exposição Ambiental/prevenção & controle , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Masculino , Michigan , Distanciamento Físico , Instituições Acadêmicas , Saúde da População Urbana
15.
Front Public Health ; 9: 740367, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34568268

RESUMO

Vaccination is the only way to reach herd immunity and help people return to normal life. However, vaccination rollouts may not be as fast as expected in some regions due to individuals' vaccination hesitation. For this reason, in Detroit, Michigan, the city government has offered a $50 prepaid card to people who entice city residents to visit vaccination sites. This study examined vaccination rates in the US using Detroit, Michigan, as the setting. It sought to address two issues. First, we analyzed the vaccination diffusion process to predict whether any region would reach a vaccination completion level that ensures herd immunity. Second, we examined a natural experiment involving a vaccination incentive scheme in Detroit and discovered its causal inference. We collected weekly vaccination data and demographic Census data from the state of Michigan and employed the Bass model to study vaccination diffusion. Also, we used a synthetic control method to evaluate the causal inference of a vaccination incentive scheme utilized in Detroit. The results showed that many Michigan counties-as well as the city of Detroit-would not reach herd immunity given the progress of vaccination efforts. Also, we found that Detroit's incentive scheme indeed increased the weekly vaccination rate by 44.19% for the first dose (from 0.86 to 1.25%) but was ineffective in augmenting the rate of the second dose. The implications are valuable for policy makers to implement vaccination incentive schemes to boost vaccination rates in geographical areas where such rates remain inadequate for achieving herd immunity.


Assuntos
Motivação , Vacinação , Cidades , Difusão , Humanos , Michigan
16.
BMJ Open Respir Res ; 8(1)2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34551962

RESUMO

IMPORTANCE: Use of non-invasive respiratory modalities in COVID-19 has the potential to reduce rates of intubation and mortality in severe disease however data regarding the use of high-flow nasal cannula (HFNC) in this population is limited. OBJECTIVE: To interrogate clinical and laboratory features of SARS-CoV-2 infection associated with high-flow failure. DESIGN: We conducted a retrospective cohort study to evaluate characteristics of high-flow therapy use early in the pandemic and interrogate factors associated with respiratory therapy failure. SETTING: Multisite single centre hospital system within the metropolitan Detroit region. PARTICIPANTS: Patients from within the Detroit Medical Center (n=104, 89% African American) who received HFNC therapy during a COVID-19 admission between March and May of 2020. PRIMARY OUTCOME: HFNC failure is defined as death or intubation while on therapy. RESULTS: Therapy failure occurred in 57% of the patient population, factors significantly associated with failure centred around markers of multiorgan failure including hepatic dysfunction/transaminitis (OR=6.1, 95% CI 1.9 to 19.4, p<0.01), kidney injury (OR=7.0, 95% CI 2.7 to 17.8, p<0.01) and coagulation dysfunction (OR=4.5, 95% CI 1.2 to 17.1, p=0.03). Conversely, comorbidities, admission characteristics, early oxygen requirements and evaluation just prior to HFNC therapy initiation were not significantly associated with success or failure of therapy. CONCLUSIONS: In a population disproportionately affected by COVID-19, we present key indicators of likely HFNC failure and highlight a patient population in which aggressive monitoring and intervention are warranted.


Assuntos
COVID-19 , Oxigenoterapia , Insuficiência Respiratória , Afro-Americanos , Idoso , Idoso de 80 Anos ou mais , COVID-19/terapia , Cânula , Feminino , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Insuficiência Respiratória/terapia , Insuficiência Respiratória/virologia , Estudos Retrospectivos
18.
Artigo em Inglês | MEDLINE | ID: mdl-34501973

RESUMO

We develop a local, spatial measure of educational isolation (EI) and characterize the relationship between EI and our previously developed measure of racial isolation (RI). EI measures the extent to which non-college educated individuals are exposed primarily to other non-college educated individuals. To characterize how the RI-EI relationship varies across space, we propose a novel measure of local correlation. Using birth records from the State of Michigan (2005-2012), we estimate associations between RI, EI, and birth outcomes. EI was lower in urban communities and higher in rural communities, while RI was highest in urban areas and parts of the southeastern United States (US). We observed greater heterogeneity in EI in low RI tracts, especially in non-urban tracts; residents of high RI tracts are likely to be both educationally and racially isolated. Associations were also observed between RI, EI, and gestational length (weeks) and preterm birth (PTB). For example, moving from the lowest to the highest quintile of RI was associated with a 1.11 (1.07, 1.15) and 1.16 (1.10, 1.22) increase in odds of PTB among NHB and NHW women, respectively. Moving from the lowest to the highest quintile of EI was associated with a 1.07 (1.02, 1.12) and 1.03 (1.00, 1.05) increase in odds of PTB among NHB and NHW women, respectively. This work provides three tools (RI, EI, and the local correlation measure) to researchers and policymakers interested in how residential isolation shapes disparate outcomes.


Assuntos
Nascimento Prematuro , Grupos de Populações Continentais , Escolaridade , Feminino , Humanos , Recém-Nascido , Michigan , Gravidez , Nascimento Prematuro/epidemiologia , Sudeste dos Estados Unidos
19.
Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34518939

RESUMO

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Economia Hospitalar/organização & administração , Gastroenterologia/educação , Administração Hospitalar/métodos , SARS-CoV-2 , Cidades/economia , Cidades/epidemiologia , Educação de Pós-Graduação em Medicina/organização & administração , Gastroenterologia/economia , Administração Hospitalar/economia , Humanos , Internato e Residência , Michigan/epidemiologia , Afiliação Institucional/economia , Afiliação Institucional/organização & administração , Estudos Prospectivos , Faculdades de Medicina/organização & administração
20.
BMJ Open ; 11(9): e054964, 2021 09 17.
Artigo em Inglês | MEDLINE | ID: mdl-34535489

RESUMO

INTRODUCTION: A considerable literature implicates prenatal stress as a critical determinant of poor psychological functioning in childhood and beyond. However, knowledge about whether the timing of prenatal stress differentially influences the development of child outcomes, including psychopathology, is virtually unknown. The primary aim of our study is to examine how the timing of prenatal stress differentially affects early childhood regulatory functioning as a marker of psychopathology. Our second aim is to examine the mediating effects of maternal physiological and psychological factors during pregnancy. Our third aim is to examine the moderating effects of postnatal factors on child regulatory functioning. Our project is the first longitudinal, prospective, multimethod study addressing these questions. METHODS AND ANALYSIS: Our ongoing study recruits pregnant women, oversampled for intimate partner violence (a common event-based stressor allowing examination of timing effects), with data collection starting at pregnancy week 15 and concluding 4 years post partum. We aim to have n=335 mother-child dyads. We conduct a granular assessment of pregnancy stress (measured weekly by maternal report) in order to reveal sensitive periods during fetal life when stress particularly derails later functioning. Pattern-based statistical analyses will be used to identify subgroups of women who differ in the timing of their stress during pregnancy and then test whether these patterns of stress differentially predict early childhood self-regulatory outcomes. ETHICS AND DISSEMINATION: Due to the high-risk nature of our sample, care is taken to ensure protection of their well-being, including a safety plan for suicidal ideation and a safety mechanism (exit button in the online weekly survey) to protect participant data privacy. This study was approved by Michigan State University Institutional Review Board. Dissemination will be handled by data sharing through National Institute of Child Health and Human Development Data and Specimen Hub (DASH), as well as through publishing the findings in journals spanning behavioural neuroendocrinology to clinical and developmental psychology.


Assuntos
Gestantes , Ideação Suicida , Pré-Escolar , Feminino , Humanos , Lactente , Estudos Longitudinais , Michigan , Gravidez , Estudos Prospectivos , Estresse Psicológico
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