Long term impact of COVID-19 pandemic on mammographic breast cancer screening.

Retrospective Analysis of Long-term Impact of COVID-19 Pandemic on Mammographic Breast Cancer Screening

The accuracy of mammography in breast cancer screening is influenced by different factors such as breast composition. However, previous studies did not evaluate the impact of breast size on examination accuracy. This study aimed to investigate the influence of breast size on the accuracy of mammography and ultrasonography in breast cancer screening using compressed breast thickness (CBT) on mammography as an indicator of breast size. This study included Japanese women in their 40s who underwent mammography alone (MG group) or mammography with adjunctive ultrasonography (MG + US group) at the Iwate Cancer Society (Iwate, Japan) in 2018 and 2019. Based on CBT, the participants were further divided into the L group (< 30mm) and U group (≥ 30mm). The recall rate, cancer detection rate, and positive predictive value of the L and U groups based on screening method and breast size were evaluated. Of 15,897 patients, 10,162 and 5735 underwent mammography alone and mammography with adjunctive ultrasonography, respectively. In the L group, the MG and MG + US groups did not significantly differ in terms of recall rate (1.9%, 95% CI 1.4-2.6 vs 1.9%, 1.2-2.9; p = 0.972). Moreover, the MG + US group had a higher cancer detection rate than the MG group. However, the difference was not significant (0.20%, 0.05-0.51 vs 0.63%, 0.25-1.29; p = 0.054). In the U group, the MG + US group had a significantly higher recall rate than the MG group (2.2%, 1.9-2.5 vs 2.9%, 2.5-3.4; p < 0.05). Nevertheless, there was no significant difference in the cancer detection rate (0.15%, 0.08-0.25 vs 0.28%, 0.15-0.48; p = 0.099). To the best of our knowledge, this study first showed that breast size, in addition to breast composition, influences the accuracy of mammography and ultrasonography in breast cancer screening. Hence, screening methods tailored to individual breast characteristics should be considered.

IntroductionCauses of COVID-19 burden in urban, suburban, and rural counties are unclear, as early studies provide mixed results implicating high prevalence of pre-existing health risks and chronic diseases. However, poor sleep health that has been linked to infection-based pandemics may provide additional insight for place-based burden. To address this gap, we investigated the relationship between habitual insufficient sleep (sleep <7 hrs./24 hr. period) and COVID-19 cases and deaths across urban, suburban, and rural counties in the US.MethodsCounty-level variables were obtained from the 2014–2018 American community survey five-year estimates and the Center for Disease Control and Prevention. These included percent with insufficient sleep, percent uninsured, percent obese, and social vulnerability index. County level COVID-19 infection and death data through September 12, 2020 were obtained from USA Facts. Cumulative COVID-19 infections and deaths for urban (n=68), suburban (n=740), and rural (n=2331) counties were modeled using separate negative binomial mixed effects regression models with logarithmic link and random state-level intercepts. Zero-inflated models were considered for deaths among suburban and rural counties to account for excess zeros.ResultsMultivariate regression models indicated positive associations between cumulative COVID-19 infection rates and insufficient sleep in urban, suburban and rural counties. The incidence rate ratio (IRR) for urban counties was 1.03 (95% CI: 1.01 – 1.05), 1.04 (95% CI: 1.02 – 1.05) for suburban, and 1.02 (95% CI: 1.00 – 1.03) rural counties.. Similar positive associations were observed with county-level COVID-19 death rates, IRR = 1.11 (95% CI: 1.07 – 1.16) for urban counties, IRR = 1.04 (95% CI: 1.01 – 1.06) for suburban counties, and IRR = 1.03 (95% CI: 1.01 – 1.05) for rural counties. Level of urbanicity moderated the association between insufficient sleep and COVID deaths, but not for the association between insufficient sleep and COVID infection rates.ConclusionInsufficient sleep was associated with COVID-19 infection cases and mortality rates in urban, suburban and rural counties. Level of urbanicity only moderated the relationship between insufficient sleep and COVID death rates. Future studies should investigate individual-level analysis to understand the role of sleep mitigating COVID-19 infection and death rates.Support (if any)NIH (K07AG052685, R01MD007716, R01HL142066, K01HL135452, R01HL152453

Impact of COVID-19 Pandemic on Headache Evaluations in the Pediatric Emergency Department

To evaluate the accuracy of mammography in breast cancer screening in Asian women. 8718 community women in Chengdu were examined by mammography during the routine physical examination from Mar. 2002 to Sep. 2007. Pathological diagnosis and following up results were used as the gold standards for X-ray-positive and -negative findings. The sensitivity, specificity and diagnosis odds ratio were calculated as accuracy indexes. Large scale follow-up studies of breast cancer screening in community in Asian women were collected to evaluate the pooled accuracy of mammography. Diagnosis meta-analysis was conducted with Meta-Disc software to estimate the pooled sensitivity, specificity and DOR, and draw the summary receiver operating characteristic (SROC). The data of seven studies were included with a total of 223 619 women received mammography for screening breast cancer. The sensitivity (95%CI) and specificity (95%CI) of mammography of community-based follow-up study in Chengdu were 0.889 (0.741 - 0.970) and 0.991 (0.987 - 0.993), respectively. Referring to meta-analysis, random effects models were adopted due to existed heterogeneity among studies. The pooled sensitivity, specificity, DOR with their 95% confidence intervals were 0.845 (0.821 - 0.870), 0.930 (0.929 - 0.931) and 117.271 (65.060 - 211.412), respectively. The Area Under the Curve (AUC) of SROC was 0.9144. Due to its high accuracy, mammography deserves to be recommend in breast cancer screening in Asian women.

COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health.

Background The COVID-19 pandemic resulted in severe psychological, social, and economic stress. Countries applied different anti-pandemic strategies that substantially impacted citizens' psychosocial stress and health. Takotsubo syndrome (TS) is frequently triggered by emotional stress. Previous studies from the USA have reported a severalfold increase in TS incidence during pandemics. Purpose To determine the incidence and outcomes of TS in Sweden before (2015-March 2020) and during (April 2020-December 2022) the pandemic. Methods We assessed the incidence rate ratio (IRR) for all patients with TS referred for coronary angiography in Sweden using the nationwide Swedish Coronary Angiography and Angioplasty Registry. Incidence rate ratios (IRRs) before and during the pandemic were calculated with Poisson regression adjusted for age and sex. We evaluated mortality with multivariable Cox proportional hazards regression, which accounted for clustering of patients within hospitals. The following variables were used for adjustment: age, sex, diabetes, smoking status, hypertension, hyperlipidemia, previous myocardial infarction, and Killip class. Results We identified 3,180 patients (2,128 [76.0%] women) hospitalized with TS during the study period; 2,189 (69%) pre-pandemic and 991 (31%) during the pandemic. The average age was 68.3 ± 11.2 years. The median follow-up time was 1250 days (IQR 562-1995). The crude all-cause mortality rate was 2.57% at 30 days and 15.5% after long-term follow-up. The incidence of TS was 11% lower during the pandemic compared with the pre-pandemic period (IRR 0.90, 95% CI 0.83-0.98, P=0.009, Fig. 1). We found no difference in 30-day mortality (adjusted HR 1.12, 95% CI 0.69-1.78, P= 0.642) or long-term mortality (adjusted HR 0.96, 95% CI 0.73-1.28, P= 0.816) among patients with TS between the pre-pandemic and pandemic periods. When only data after 2016 are used, we found no difference in TS incidence (IRR 1.00, 95% CI 0.92-1.08, P=1.00). Conclusions In this observational study, the incidence of TS was lower during than before the pandemic but mortality was unchanged. The lower incidence of TS could be related to the specific anti-pandemic strategies applied at the national level in Sweden.Figure 1

The COVID-19 Pandemic and Eating Disorders: A Wake-Up Call for the Future of Eating Disorders Among Adolescents and Young Adults

Mammography screening for breast cancer-the UK Age trial.

Suicide is a leading cause of death in the United States. Worldwide, over 700,000 people die by suicide each year. Healthcare workers are more vulnerable to suicide risk factors than the general population. The global COVID-19 pandemic presents additional workplace and health concerns that relate to suicide risk factors in healthcare workers. It is important to recognise suicide risk factors in healthcare workers and to implement strategies to reduce these risk factors. This study describes the impact of the global COVID-19 pandemic on risk factors for suicide in healthcare workers and identifies evidence-based strategies and resources to reduce suicide risk factors in healthcare workers. The authors conducted a thematic analysis and narrative review of the literature. Using health science databases, the authors searched the literature, selected and analyzed studies, identified themes, synthesised findings and created a narrative review. The STROBE checklist was used in this study. Two themes were identified (1) The impact of the COVID-19 pandemic on work-related suicide risk factors in healthcare workers; (2) The impact of the COVID-19 pandemic on mental health-related suicide risk factors in healthcare workers. The pandemic has affected suicide risk factors in healthcare workers. Many studies discussed evidence-based strategies and resources that can be used to reduce suicide risk factors. The global COVID-19 pandemic has negatively impacted suicide risk factors in healthcare workers. It is time for individuals and healthcare delivery systems to implement suicide risk prevention strategies to protect healthcare workers now and in the future. This review increases awareness of the pandemic's impact on healthcare workers' risk factors for suicide and identifies evidence-based suicide risk prevention strategies and resources for healthcare workers. Library services supported this research by generating search strategies and providing resources and tools.

Introduction: The COVID-19 pandemic's impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia. Hypothesis: We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic's impact at a Bangladesh tertiary cardiac centre. Methods: Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams. Results: Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p&lt;0.001). Patient and procedure volumes reached almost pre-pandemic levels by Q1 of 2021. A decline of admissions and procedures was seen in March-April 2021 as compared with 2020, coinciding with the Delta variant. By Q4 of 2021, patient visits, outpatient procedures and catheterization volumes had reached near pre-pandemic levels again. During the Omicron surge (Q1 of 2022), a small decline in outpatient visits (Δ-10.9%) and procedures (Δ-6.83%) was seen. However, in-patient admissions (Δ4.39%) and catheterization procedures (Δ5.7%) showed a rise in February 2022, compared to January, with ER visits showing the steepest rise (Δ 41.9%). Although ER visits remained relatively blunted post-pandemic (2020-2021), this trend was not reflected in outpatient visits/procedures, admissions and catheterization procedures, which all increased to pre-pandemic levels by end 2021. Conclusion: Two years on from the pandemic, cardiology services and cath lab volumes have reached almost pre-pandemic levels in 2022, except for ER visits which remained low, albeit gradually rising. Procedure volumes reduced during the Delta variant, but not during the Omicron surge, a positive indication of the learning and adaptability of healthcare system to surges.

Impact of the COVID-19 pandemic on cancer incidence and mortality

Impact of COVID-19 pandemic on accesses for seizures in the pediatric emergency department

MP75-09 RURAL AND URBAN GENITOURINARY CANCER INCIDENCE AND MORTALITY IN THE PENNSYLVANIA CANCER REGISTRY FROM 1990-2019

This study tries to assess the impact of the unexpected COVID-19 pandemic, and the various policy options adopted by different countries to mitigate its effect, on the Malawi economy. The study employs the structural macroeconometric model developed for developing countries by the Economic Commission for Africa. Among others, the results show that the Malawi economy has been severely affected by the pandemic, with GDP growth expected to be below its pre-pandemic projection levels, and with worsened fiscal deficits and debt levels. This calls for a comprehensive policy agenda that tackles the country’s vulnerabilities to generate a transformational and inclusive recovery process. There is a need for the government to enhance its domestic revenue mobilization efforts and public service delivery with fiscal and monetary policy measures that would create an enabling economic environment and strengthen the government’s long-term commitment to structural transformation and long-term growth of the economy.