Administrative Files Research Articles

Making University Fields for Chymistry: A Case Study of Helmstedt University

Current collections of the Herzog August Bibliothek (HAB) situated in Wolfenbüttel, Germany, contain nearly two thousand chymical books. Most of them were acquired immediately after publication, during a period extending from the fifteenth to the eighteenth century. The acquisition of these manuscripts and printed books by the former Wolfenbüttel court was closely connected to a university: the Wolfenbüttel Library and the erstwhile University of Helmstedt belonged to the same court of Braunschweig-Lüneburg. Both institutions exchanged book holdings several times. As a result, most of the books, as well as the administration files of the university, are today located in Wolfenbüttel. Those materials provide scholars with an opportunity to study the academic demarcations between Aristotelian natural philosophy and chymistry; and to examine the relationship between court chymistry and the university. This article offers some reflections on what chymistry was like at a “normal” early modern university by delineating chymistry’s position within the University of Helmstedt over the period of its existence, from 1576 to 1810.

Mortality among Workers at the Los Alamos National Laboratory, 1943-2017

Background During World War II, the Manhattan Engineering District established a secret laboratory in the mountains of northern New Mexico. The mission was to design, construct and test the first atomic weapon, nicknamed “the Gadget” that was detonated at the TRINITY site in Alamogordo, NM. After WWII, nuclear weapons research continued, and the laboratory became the Los Alamos National Laboratory (LANL). Materials and methods The mortality experience of 26,328 workers first employed between 1943-1980 at LANL was determined through 2017. Included were 6,157 contract workers employed by the ZIA Company. Organ dose estimates for each worker considered all sources of exposure, notably photons, neutrons, tritium, 238Pu and 239Pu. Vital status determination included searches within the National Death Index, Social Security Administration and New Mexico State Mortality Files. Standardized Mortality Ratios (SMR) and Cox regression models were used in the analyses. Results Most workers (55%) were hired before 1960, 38% had a college degree, 25% were female, 81% white, 13% Hispanic and 60% had died. Vital status was complete, with only 0.1% lost to follow-up. The mean dose to the lung for the 17,053 workers monitored for radiation was 28.6 weighted-mGy (maximum 16.8 weighted-Gy) assuming a Dose Weighting Factor of 20 for alpha particle dose to lung. The Excess Relative Risk (ERR) at 100 weighted-mGy was 0.01 (95%CI -0.02, 0.03; n = 839) for lung cancer. The ERR at 100 mGy was -0.43 (95%CI -1.11, 0.24; n = 160) for leukemia other than chronic lymphocytic leukemia (CLL), -0.06 (95%CI -0.16, 0.04; n = 3,043) for ischemic heart disease (IHD), and 0.29 (95%CI 0.02, 0.55; n = 106) for esophageal cancer. Among the 6,499 workers with measurable intakes of plutonium, an increase in bone cancer (SMR 2.44; 95%CI 0.98,5.03; n = 7) was related to dose. The SMR for berylliosis was significantly high, based on 4 deaths. SMRs for Hispanic workers were significantly high for cancers of the stomach and liver, cirrhosis of the liver, non-malignant kidney disease and diabetes, but the excesses were not related to radiation dose. Conclusions There was little evidence that radiation increased the risk of lung cancer or leukemia. Esophageal cancer was associated with radiation, and plutonium intakes were linked to an increase of bone cancer. IHD was not associated with radiation dose. More precise evaluations will await the pooled analysis of workers with similar exposures such as at Rocky Flats, Savannah River and Hanford.

The cumulative risk of jail incarceration

Research on incarceration has focused on prisons, but jail detention is far more common than imprisonment. Jails are local institutions that detain people before trial or incarcerate them for short sentences for low-level offenses. Research from the 1970s and 1980s viewed jails as "managing the rabble," a small and deeply disadvantaged segment of urban populations that struggled with problems of addiction, mental illness, and homelessness. The 1990s and 2000s marked a period of mass criminalization in which new styles of policing and court processing produced large numbers of criminal cases for minor crimes, concentrated in low-income communities of color. In a period of widespread criminal justice contact for minor offenses, how common is jail incarceration for minority men, particularly in poor neighborhoods? We estimate cumulative risks of jail incarceration with an administrative data file that records all jail admissions and discharges in New York City from 2008 to 2017. Although New York has a low jail incarceration rate, we find that 26.8% of Black men and 16.2% of Latino men, in contrast to only 3% of White men, in New York have been jailed by age 38 y. We also find evidence of high rates of repeated incarceration among Black men and high incarceration risks in high-poverty neighborhoods. Despite the jail's great reach in New York, we also find that the incarcerated population declined in the study period, producing a large reduction in the prevalence of jail incarceration for Black and Latino men.

Incidence, Predictors, and Outcomes of Acute Kidney Injury in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology National Cardiovascular Data Registry-Transcatheter Valve Therapy Registry.

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The medical history of Elsa Asenijeff in the context of the Saxon psychiatric institution and care system from the 1920s to 1941

This article aims to describe and discuss in detail the psychiatric medical history of the writer Elsa Asenijeff (1867-1941) in different mental institutions in the German state of Saxony. What can be discovered in preserved archive documents about the placement of Elsa Asenijeff in different mental institutions between 1923 and 1941? What is the historical context in which this individual medical history took place? Through systematic research in different archives a part of Elsa Asenijeffs medical records and relevant administrative files of the institutions could be found. The preserved documents provide an insight into the statements of the physicians and the conditions of Elsa Asenijeffs placement in the institutions of that time. The findings of our research suggest that, at least since 1927, Elsa Asenijeff was kept in mental institutions primarly for being an unmarried, destitute and more or less isolated woman. In other words, her stay was justified with social and not psychiatric-medical arguments.

Trends in Opioid Use among Social Security Disability Insurance Applicants

Several factors suggest that opioid use may be common among applicants to Social Security Disability Insurance (SSDI): the prevalence of opioid use, the suspected link between opioid use and declining rates of work, and the large share of new SSDI awardees who have conditions associated with opioid use. However, research-ready data on opioid use by these applicants, who are generally not eligible for Medicare, have not been available. SSDI applicants are required to report their medications, but they often do so in an open-ended text field, which requires additional coding before analysis. Our study is the first to provide statistics on opioid use among SSDI applicants. We used an innovative machine-learning method to identify opioids in medication text fields in SSDI administrative data. Specifically, we examined the prevalence of reported opioid use in a 30 percent random sample of initial-level SSDI applications stored in the Social Security Administration’s Structured Data Repository (SDR) from 2007 through 2017, considering differences by demographic and other factors. We supplemented the SDR with two SSA administrative data sources: the Disability Analysis File, which provided award information, and the Numerical Identification System, which provided information on deaths. Using these sources, we produced statistics on the association between (1) opioid use among SSDI applicants and (2) SSDI award and death. Understanding the prevalence of reported opioid use among these individuals and the association between opioid use and later SSDI application outcomes may help in forecasting the future composition of the SSDI caseload. The paper found that: Over the 11-year analysis period, more than 30 percent of SSDI applicants reported using one or more opioids. This is higher than the rate of opioid use in the general population (29 versus 19 percent in 2016).Reported rates of opioid use among SSDI applicants varied over the analysis period. Rates increased from 2007 to a peak of 32 percent in 2012, followed by a decline to the period low of 26 percent in 2017.Reported opioid use varied by age and demographic characteristics. SSDI applicants ages 40–49 were the most likely age group to report opioid use; women were 3-4 percentage points more likely to report opioid use than men; and people with some college were the most likely education group to report opioid use.Reported opioid use is also correlated with application type. SSDI-only applicants who reported opioid use were 4-6 percentage points more likely to report opioid use than concurrent SSDI and SSI applicants.Reported opioid use varied greatly between geographic areas. Applicants from Rhode Island, Massachusetts, and Washington, DC, reported lower-than-average rates of opioid use in 2007 and consistently throughout the analysis period. Conversely, applicants from Delaware, Nevada, and Michigan consistently reported the highest rates of opioid use.There was a positive and statistically significant association between (1) reported opioid use and SSDI awards and (2) reported opioid use SSDI award and death. These associations do not demonstrate a causal relationship. The policy implications of the findings are: Application for SSDI provides an opportunity to identify opioid users, understand more about the nature of their use, and, if warranted, connect them with helpful services and supports.Given the prevalence of reported opioid use among SSDI applicants, our study may open the door to future research on how opioid use affects post-adjudication well-being—for example, applicants’ employment outcomes after they are awarded or denied SSDI. Future studies might also consider tracking the trajectory of opioid use from application through award using Medicare data.This study also serves as a template for using previously untapped information in SSA administrative files. The machine learning approach used to identify opioid use in free-form text could be applied to other key indicators of interest to SSA.

Muslim Notables, French Colonial Officials, and the Washers of the Dead

Abstract For many decades, scholars of gender and women's history in the Middle East and North Africa have challenged prevailing visions of an unchanged patriarchy, showing how patriarchy was transformed in relation to colonialism, and how some women struggled against it. To the contrary, this article aims to challenge our understanding of women's agency, taking Mzab as a case study. It explores the ways in which women of this Berber speaking region, inhabited by Ibadi Muslims and conquered by the French in 1882, contributed to the colonial reinforcement of male domination. Reading together works of ethnography, colonial administrative files, legal disputes, and Arabic-language newspapers, this article shows that, together with the colonial legal framework, other informal legal discourses and institutions shaped women's condition. Down the road, forms of patriarchy and notions of gender shifted.

Muslim Notables, French Colonial Officials, and the Washers of the Dead

For many decades, scholars of gender and women’s history in the Middle East and North Africa have challenged prevailing visions of an unchanged patriarchy, showing how patriarchy was transformed in relation to colonialism, and how some women struggled against it. To the contrary, this article aims to challenge our understanding of women’s agency, taking Mzab as a case study. It explores the ways in which women of this Berber speaking region, inhabited by Ibadi Muslims and conquered by the French in 1882, contributed to the colonial reinforcement of male domination. Reading together works of ethnography, colonial administrative files, legal disputes, and Arabic-language newspapers, this article shows that, together with the colonial legal framework, other informal legal discourses and institutions shaped women’s condition. Down the road, forms of patriarchy and notions of gender shifted.

One-Year Medicare Costs Associated With Delirium in Older Patients Undergoing Major Elective Surgery

Delirium is a common, serious, and potentially preventable problem for older adults, associated with adverse outcomes. Coupled with its preventable nature, these adverse sequelae make delirium a significant public health concern; understanding its economic costs is important for policy makers and health care leaders to prioritize care. To evaluate current 1-year health care costs attributable to postoperative delirium in older patients undergoing elective surgery. This prospective cohort study included 497 patients from the Successful Aging after Elective Surgery (SAGES) study, an ongoing cohort study of older adults undergoing major elective surgery. Patients were enrolled from June 18, 2010, to August 8, 2013. Eligible patients were 70 years or older, English-speaking, able to communicate verbally, and scheduled to undergo major surgery at 1 of 2 Harvard-affiliated hospitals with an anticipated length of stay of at least 3 days. Eligible surgical procedures included total hip or knee replacement; lumbar, cervical, or sacral laminectomy; lower extremity arterial bypass surgery; open abdominal aortic aneurysm repair; and open or laparoscopic colectomy. Data were analyzed from October 15, 2019, to September 15, 2020. Major elective surgery and hospitalization. Cumulative and period-specific costs (index hospitalization, 30-day, 90-day, and 1-year follow-up) were examined using Medicare claims and extensive clinical data. Total inflation-adjusted health care costs were determined using data from Medicare administrative claims files for the 2010 to 2014 period. Delirium was rated using the Confusion Assessment Method. We also examined whether increasing delirium severity was associated with higher cumulative and period-specific costs. Delirium severity was measured with the Confusion Assessment Method-Severity long form. Regression models were used to determine costs associated with delirium after adjusting for patient demographic and clinical characteristics. Of the 566 patients who were eligible for the study, a total of 497 patients (mean [SD] age, 76.8 [5.1] years; 281 women [57%]; 461 White participants [93%]) were enrolled after exclusion criteria were applied. During the index hospitalization, 122 patients (25%) developed postoperative delirium, whereas 375 (75%) did not. Patients with delirium had significantly higher unadjusted health care costs than patients without delirium (mean [SD] cost, $146 358 [$140 469] vs $94 609 [$80 648]). After adjusting for relevant confounders, the cumulative health care costs attributable to delirium were $44 291 (95% CI, $34 554-$56 673) per patient per year, with the majority of costs coming from the first 90 days: index hospitalization ($20 327), subsequent rehospitalizations ($27 797), and postacute rehabilitation stays ($2803). Health care costs increased directly and significantly with level of delirium severity (none-mild, $83 534; moderate, $99 756; severe, $140 008), suggesting an exposure-response relationship. The adjusted mean cumulative costs attributable to severe delirium were $56 474 (95% CI, $40 927-$77 440) per patient per year. Extrapolating nationally, the health care costs attributable to postoperative delirium were estimated at $32.9 billion (95% CI, $25.7 billion-$42.2 billion) per year. These findings suggest that the economic outcomes of delirium and severe delirium after elective surgery are substantial, rivaling costs associated with cardiovascular disease and diabetes. These results highlight the need for policy imperatives to address delirium as a large-scale public health issue.

Geographic Variation of Statin Use Among US Nursing Home Residents With Life-limiting Illness.

Medically compromised nursing home residents continue to be prescribed statins, despite questionable benefits. To describe regional variation in statin use among residents with life-limiting illness. Cross-sectional study using 2016 Minimum Data Set 3.0 assessments linked to Medicare administrative data and health service utilization area resource files. Nursing homes (n=14,147) within hospital referral regions (n=306) across the United States. Long-stay residents (aged 65 y and older) with life-limiting illness (eg, serious illness, palliative care, or prognosis <6 mo to live) (n=361,170). Prevalent statin use was determined by Medicare Part D claims. Stratified by age (65-75, 76 y or older), multilevel logistic models provided odds ratios with 95% confidence intervals. Statin use was prevalent (age 65-75 y: 46.0%, 76 y or more: 31.6%). For both age groups, nearly all resident-level variables evaluated were associated with any and high-intensity statin use and 3 facility-level variables (ie, higher proportions of Black residents, skilled nursing care provided, and average number of medications per resident) were associated with increased odds of statin use. Although in residents aged 65-75 years, no associations were observed, residents aged 76 years or older located in hospital referral regions (HRRs) with the highest health care utilization had higher odds of statin use than those in nursing homes in HRRs with the lowest health care utilization. Our findings suggest extensive geographic variation in US statin prescribing across HRRs, especially for those aged 76 years or older. This variation may reflect clinical uncertainty given the largely absent guidelines for statin use in nursing home residents.

Assessing the accuracy of record linkages with Markov chain based Monte Carlo simulation approach

Record linkage is the process of finding matches and linking records from different data sources so that the linked records belong to the same entity. There is an increasing number of applications of record linkage in statistical, health, government and business organisations to link administrative, survey, population census and other files to create a complete set of information for more complete and comprehensive analysis. To make valid inferences using a linked file, it has become increasingly important to have effective and efficient methods for linking data from different sources. Therefore, it becomes necessary to assess the ability of a linking method to achieve high accuracy or to compare between methods with respect to accuracy. This motivates the development of a method for assessing the linking process and facilitating decisions about which linking method is likely to be more accurate for a particular linking task. This paper proposes a Markov Chain based Monte Carlo simulation approach, MaCSim for assessing a linking method and illustrates the utility of the approach using a realistic synthetic dataset received from the Australian Bureau of Statistics to avoid privacy issues associated with using real personal information. A linking method applied by MaCSim is also defined. To assess the defined linking method, correct re-link proportions for each record are calculated using our developed simulation approach. The accuracy is determined for a number of simulated datasets. The analyses indicated promising performance of the proposed method MaCSim of the assessment of accuracy of the linkages. The computational aspects of the methodology are also investigated to assess its feasibility for practical use.

COMMISIONER FOR PROTECTION AGEINST DISCRIMINATION: A COMPARATIVE ANALISIS IN THE CONTEXT OF ENSURING AGE EGUALITY

The article considers the activity of the Commissioner for Protection against Discrimination. Particular attention is paid to comparative analysis in the context of guaranteeing age equality. In the framework of this scientific article we will turn to the experience of two countries – Albania and Latvia. Here, the guarantee mechanism is reduced to the existence of a special Commissioner who deals with anti-discrimination and equality. Consideration of foreign experience made it possible to state the effectiveness of the institution of a special Commissioner for Combating Discrimination. Its effect extends to a wide area and includes both private and public relations. The main authority is to consider situations of violation of the principle of equality on any grounds, which is known from the appeals of applicants, competent authorities and independent work. The investigation procedure involves gathering information on the matter, inspection or hearing. After analyzing the facts gathered on the basis of the investigation procedure, the Commissioner issues a decision within 90 days from the date of registration of the complaint. The Commissioner conducts an administrative investigation after receiving reliable information about violations of the law, imposes administrative sanctions and files a lawsuit to protect the principle of equality and non-discrimination on issues related to collective interests. The efficiency of work is ensured not only by the possibility of ascertaining the violation, but also by the application of administrative sanctions to the offender. The Commissioner carries out activities to improve legislation and bring acts issued by public authorities in line with international and constitutional requirements (through an appeal to the Constitutional Court – Albania; individual consideration of the Commissioner – Lithuania). It is proved that this form of institutional guarantee is endowed with the ability to overcome the problems of multiple discrimination. Monitoring activities, analysis of statistics, public sentiment, public opinion polls and preventive and explanatory work are also important powers of a specialized ombudsman.

Examination on the Usefulness of Administrative Support Files for Children with Developmental Disabilities

Examination on the Usefulness of Administrative Support Files for Children with Developmental Disabilities

Рыбная отрасль Калмыкии в 1926–1932 гг.

Introduction. The article analyzes the development of Kalmykia’s fishing industry between 1926 and 1932. Goals. The paper seeks to review the formation and development processes within the regional fishing industry during the NEP era, providing insight into local peculiarities thereof to be traced through documented collectivization and industrialization activities among seminomadic Kalmyks in the Lower Volga and Northern Caspian. Materials and Methods. The work employs a number of historical research methods, such as chronological and problem-chronological ones that made it possible to shed light on the topic mentioned above. The study involves quite diverse sources, namely: materials mentioning the development of fishing industry in the territory of Kalmyk Autonomous Oblast (including unrelated scholarly papers), administrative files and reports from different archives, field observations, etc. The main criteria the research rests on are accuracy and objectiveness. Results and Conclusions. The conducted analysis reveals certain practices and business models adopted during the shaping and infrastructure development of the autonomy, clarifies mechanisms and results of interaction between the central Government and regional authorities exercised throughout the process. The paper also illustrates all the stages passed and challenges faced by the newly reestablished ethnic region and its executives to create a sustainable fishing industry for further prosperity of the territory and its population.

An innovative approach to identify past exposure to asbestos integrating questionnaire information and administrative data

Reconstruction of work history of subjects exposed to occupational carcinogens might be extremely challenging and provide unreliable results. This study, carried out in Italy from February to November 2014, aimed to explore the validity of an innovative approach to reconstruct the occupational history of workers who have previously been exposed to asbestos combining the administration of structured questionnaire with the use of administrative data. Subjects recruited in this study were enrolled in the cohorts of COSMOS 1 and 2 studies. Participants indicating an exposure to asbestos were contacted and a structured questionnaire was administered to them to verify the validity of the self-reported asbestos exposure. Subsequently, work histories of respondents were investigated using administrative information. The record linkage with social security archives allowed the reassembling of the complete work history of 487 participants. In detail, administrative files allow the retrieval of 98 % of workers declaring not to be exposed, versus 77 % using the questionnaire. Furthermore, the percentage of retrieved cases is not relevant for high risk sectors but it is almost double for industries with probable presence of asbestos. The combined and integrated use of structured questionnaire with administrative data proved effective in accurately identifying subjects who actually had an asbestos exposure. This innovative strategy, being cost-effective and easily adaptable to other carcinogens, could be particularly useful in selecting subjects to recruit in specific screening and control programs for the early diagnosis of occupational cancers.

Assessing the accuracy of individual link with varying block sizes and cutoff values using MaCSim approach

Record linkage is the process of matching together records from different data sources that belong to the same entity. Record linkage is increasingly being used by many organizations including statistical, health, government etc. to link administrative, survey, and other files to create a robust file for more comprehensive analysis. Therefore, it becomes necessary to assess the ability of a linking method to achieve high accuracy or compare between methods with respect to accuracy. In this paper, we evaluate the accuracy of individual link using varying block sizes and different cutoff values by utilizing a Markov Chain based Monte Carlo simulation approach (MaCSim). MaCSim utilizes two linked files to create an agreement matrix. The agreement matrix is simulated to generate re-sampled versions of the agreement matrix. A defined linking method is used in each simulation to link the files and the accuracy of the linking method is assessed. The aim of this paper is to facilitate optimal choice of block size and cutoff value to achieve high accuracy in terms of minimizing average False Discovery Rate and False Negative Rate. The analyses have been performed using a synthetic dataset provided by the Australian Bureau of Statistics (ABS) and indicated promising results.

Immigrants’ net direct fiscal contribution: How does it change over their lifetime?

AbstractLife‐cycle direct public fiscal contributions and transfers are studied using longitudinal income tax data from 1982 to 2016 and administrative files for immigrants landed in Canada from 1980 to 2016. Relative to a comparison group comprising the Canadian‐born and immigrants landed before 1980, immigrants since 1980 have a lower average net direct fiscal contribution (NDFC) during their working years due to their lower taxes and social security contributions but a higher average NDFC after 65 years of age because of reduced public pension eligibility and entitlement. Immigrants who landed at younger than 19 years old have much higher direct fiscal contributions than other age‐at‐arrival groups and reach their peak of contributions around 10 years earlier in life than other age‐at‐arrival groups. Immigrants whose age at arrival is above 65 have a less negative average NDFC than other age‐at‐arrival groups over the above‐65 life cycle. These life‐cycle age𠄁at‐arrival trajectories are stable for immigrants in different landing cohorts. We apply the life‐cycle estimates to project the present discounted value of lifetime NDFCs for immigrants who landed in 2016. For each landing age group, refugees and family class immigrants have negative or zero average present values of life‐cycle NDFCs, much below that of economic immigrants.

Purchasing Quality Nursing Home Care in the Veterans Health Administration

Abstract Background and Objectives U.S. Department of Veterans Affairs Medical Centers (VAMCs) contract with nursing homes (NHs) in their community to serve Veterans. This study compares the characteristics and performance of Veterans Affairs (VA)-paid and non-VA-paid NHs both nationally and within local VAMC markets. Research Design and Methods VA-paid NHs were identified, characterized, and linked to VAMC markets using data drawn from VA administrative files. NHs in the United States in December 2015 were eligible for the analysis, including. 1,307 VA-paid NHs and 14,253 non-VA-paid NHs with NH Compare measures in 128 VAMC markets with any VA-paid NHs. Measurements were derived from the Centers for Medicare and Medicaid Services (CMS) five-star rating system, NH Compare. Results VA-paid NHs had more beds, residents per day, and were more likely to be for-profit relative to non-VA-paid NHs. Nationally, the average CMS NH Compare star rating was slightly lower among VA-paid NHs than non-VA-paid NHs (3.05 vs. 3.21, p = .04). This difference was seen in all 3 domains: inspection (3.11 vs. 3.23, p &amp;lt; .001), quality (2.68 vs. 2.83, p &amp;lt; .001), and total nurse staffing (3.36 vs. 3.42, p &amp;lt; .10). There was wide variability across VAMC markets in the ratio of average star rating of VA-paid and non-VA-paid NHs (mean ratio = 0.93, interquartile range = 0.78–1.08). Discussion and Implications With increased community NH use expected following the implementation of the MISSION Act, comparison of the quality of purchased services to other available services becomes critical for ensuring quality, including for NH care. Methods presented in this article can be used to examine the quality of purchased care following the MISSION Act implementation. In particular, dashboards such as that for VA-paid NHs that compare to similar non-VA-paid NHs can provide useful information to quality improvement efforts.

Abortion’s Coded Visibility

Censor Joseph Breen took issue with Ellen Berent, the lead character in Leave Her to Heaven (1945), terminating her pregnancy by dramatically throwing herself down a flight of stairs, even though the Production Code would not explicitly forbid on-screen abortions until 1951. Yet the abortion ultimately made it into the final print because, by Breen’s logic, an abortion is unrecognizable as such so long as it is not named. However, archival research suggests that Breen was wrong on both counts. Considering a wide array of archival records—Production Code Administration files and correspondence, early script drafts, audience preview screening responses, reviews, and more—this article argues that the discrepancies between Leave Her to Heaven’s censorship history and its reception illustrate popular morality eclipsing prescribed morality. The film was both a catalyst of the 1951 Code amendment banning abortion and an early harbinger of the dissolution of the PCA’s stranglehold over abortion as taboo.

Consequences of the COVID-19 pandemic on the continuum of care in a cohort of people living with HIV followed in a single center of Northern Italy

IntroductionDuring the COVID-19 pandemic, hospitals faced increasing pressure, where people living with HIV risked to either acquire SARS-CoV-2 and to interrupt the HIV continuum of care.MethodsThis is a retrospective, observational study. We compared the numbers of medical visits performed, antiretroviral drugs dispensed and the number of new HIV diagnosis and of hospitalizations in a cohort of people living with HIV (PLWH) followed by the Spedali Civili of Brescia between the bimester of the COVID-19 pandemic peak and the bimester of October–November 2019. Data were retrieved from administrative files and from paper and electronic clinical charts. Categorical variables were described using frequencies and percentages, while continuous variables were described using mean, median, and interquartile range (IQR) values. Means for continuous variables were compared using Student’s t-tests and the Mann–Whitney test. Proportions for categorical variables were compared using the χ2 test.ResultsAs of December 31st, 2019, a total of 3875 PLWH were followed in our clinic. Mean age was 51.4 ± 13 years old, where 28% were females and 18.8% non-Italian. Overall, 98.9% were on ART (n = 3834), 93% were viro-suppressed. A total of 1217 and 1162 patients had their visit scheduled at our out-patient HIV clinic during the two bimesters of 2019 and 2020, respectively. Comparing the two periods, we observed a raise of missed visits from 5 to 8% (p < 0.01), a reduction in the number of new HIV diagnosis from 6.4 in 2019 to 2.5 per month in 2020 (p = 0.01), a drop in ART dispensation and an increase of hospitalized HIV patients due to COVID-19. ART regimens including protease inhibitors (PIs) had a smaller average drop than ART not including PIs (16.6 vs 21.6%, p < 0.05). Whether this may be due to the perception of a possible efficacy of PIs on COVID19 is not known.ConclusionsOur experience highlights the importance of a resilient healthcare system and the need to implement new strategies in order to guarantee the continuum of HIV care even in the context of emergency.