Average Number Of Cases Research Articles

Temporal distribution of visceral leishmaniasis in Paraíba state, northeastern brazil, by geographic region, 2012-2017

This study aims to analyze the temporal distribution of human (HVL) and canine visceral leishmaniasis (CVL) in the state of Paraíba between 2012 and 2017, by Intermediate and Immediate Geographic Region (GR). As an ecological study with a quantitative approach, data were collected in the LACEN PB database; Dra. Telma Lobo Central Public Health Laboratory, Paraíba; and refer to positive cases of HVL and CVL presented in the state in the period under study. Poisson Regression Modeling was used to quantify the average number of cases from one year to another. The results revealed that the immediate GRs of Mamanguape - Rio Tinto, Campina Grande, and Cajazeiras present a statistically significant increasing trend in the average number of HVL cases. The immediate GRs of Campina Grande, Patos, Cuité - Nova Floresta, Itaporanga, and João Pessoa revealed a significant increase in the average number of CVL cases during the period analyzed. The need for reorganization of disease control operations and preventive actions was confirmed, especially in those regions identified with growth.

AFTERMATH OF PROLONGED MASK USAGE ON HEALTHCARE PROFESSIONALS IN COVID-19 ERA

Background: The novel coronavirus, referred to as SARS-COV 2, originated in Wuhan, China in December 2019. The first COVID-19 case was recorded in India on January 30,2020, and the country crossed 3 crore cases after 510 days. The average number of cases and fatality figures shows how disastrous it has been for our country. The virus spreads by respiratory droplets, so healthcare professionals are forced to wear protective gear for a prolonged period of time when caring for COVID-19 patients. Objective: Healthcare professionals report side effects of prolonged use of masks (N95, SURGICAL MASK, DOUBLE MASKING) when caring for COVID-19 patients. This study delves into various adverse effects of prolonged mask use and provides recommendations to ease the burden on healthcare professionals and better prepare them for a third wave. Methods: This is a retrospective cross-sectional study conducted through a digital survey among healthcare professionals, primarily located in Patna, who were involved in patient care during the COVID-19 pandemic. All respondents completed an anonymous survey consisting of fifteen questions regarding the side effects of mask they faced. Results: Among the 200 participants of this survey,61% (n=122) were females and 39% (n=78) were males. 53% (n=106) respondents reported adverse effects from prolonged mask use with nasal problems being the most common complaint (n= 37). Ocular symptoms(n=28), skin related symptoms(n=19) and headache(n=7) were some other reported problems. Conclusion: Prolonged use of masks by healthcare professionals during COVID-19 has caused adverse effects such suffocation, excessive nasal crusting, dryness of eyes, skin breakdown, mask acne and headache. Frequent breaks, improved hydration, proper rest pre and post duty hours, newly designed well fitted comfortable masks are some of the recommendations that can be adopted for these problems.

The Metrics Matter: Improving Comparisons of COVID-19 Outbreaks in Nursing Homes

ObjectivesIn the United States, nursing facility residents comprise fewer than 1% of the population but more than 40% of deaths due to Coronavirus Disease 2019 (COVID-19). Mitigating the enormous risk of COVID-19 to nursing home residents requires adequate data. The widely used Centers for Medicare & Medicaid Services (CMS) COVID-19 Nursing Home Dataset contains 2 derived statistics: Total Resident Confirmed COVID-19 Cases per 1000 Residents and Total Resident COVID-19 Deaths per 1000 Residents. These metrics provide a misleading picture, as facilities report cumulative counts of cases and deaths over different time periods but use a point-in-time measure as proxy for number of residents (number of occupied beds in a week), resulting in inflated statistics. We propose an alternative statistic to better illustrate the burden of COVID-19 cases and deaths across nursing facilities. DesignRetrospective cohort study. Setting and ParticipantsUsing the CMS Nursing Home Compare and COVID-19 Nursing Home Datasets, we examined facilities with star ratings and COVID-19 data passing quality assurance checks for each reporting period from May 31 to August 16, 2020 (n = 11,115). MethodsWe derived an alternative measure of the number of COVID-19 cases per 1000 residents using the net change in weekly census. For each measure, we compared predicted number of cases/deaths by overall star rating using negative binomial regression with constant dispersion, controlling for county-level cases per capita and nursing home characteristics. ResultsThe average number of cases per 1000 estimated residents using our method is lower compared with the metric using occupied beds as proxy for number of residents (44.8 compared with 66.6). We find similar results when examining number of COVID-19 deaths per 1000 residents. Conclusions and ImplicationsFuture research should estimate the number of residents served in nursing facilities when comparing COVID-19 cases/deaths in nursing facilities. Identifying appropriate metrics for facility-level comparisons is critical to protecting nursing home residents as the pandemic continues.

Estimating the time-varying reproduction number of COVID-19 with a state-space method.

After slowing down the spread of the novel coronavirus COVID-19, many countries have started to relax their confinement measures in the face of critical damage to socioeconomic structures. At this stage, it is desirable to monitor the degree to which political measures or social affairs have exerted influence on the spread of disease. Though it is difficult to trace back individual transmission of infections whose incubation periods are long and highly variable, estimating the average spreading rate is possible if a proper mathematical model can be devised to analyze daily event-occurrences. To render an accurate assessment, we have devised a state-space method for fitting a discrete-time variant of the Hawkes process to a given dataset of daily confirmed cases. The proposed method detects changes occurring in each country and assesses the impact of social events in terms of the temporally varying reproduction number, which corresponds to the average number of cases directly caused by a single infected case. Moreover, the proposed method can be used to predict the possible consequences of alternative political measures. This information can serve as a reference for behavioral guidelines that should be adopted according to the varying risk of infection.

A spatial queuing model for the location decision of emergency medical vehicles for pandemic outbreaks: the case of Za'atari refugee camp

PurposeRefugee camps can be severely struck by pandemics, like potential COVID-19 outbreaks, due to high population densities and often only base-level medical infrastructure. Fast responding medical systems can help to avoid spikes in infections and death rates as they allow the prompt isolation and treatment of patients. At the same time, the normal demand for emergency medical services has to be dealt with as well. The overall goal of this study is the design of an emergency service system that is appropriate for both types of demand.Design/methodology/approachA spatial hypercube queuing model (HQM) is developed that uses queuing-theory methods to determine locations for emergency medical vehicles (also called servers). Therefore, a general optimization approach is applied, and subsequently, virus outbreaks at various locations of the study areas are simulated to analyze and evaluate the solution proposed. The derived performance metrics offer insights into the behavior of the proposed emergency service system during pandemic outbreaks. The Za'atari refugee camp in Jordan is used as a case study.FindingsThe derived locations of the emergency medical system (EMS) can handle all non-virus-related emergency demands. If additional demand due to virus outbreaks is considered, the system becomes largely congested. The HQM shows that the actual congestion is highly dependent on the overall amount of outbreaks and the corresponding case numbers per outbreak. Multiple outbreaks are much harder to handle even if their cumulative average case number is lower than for one singular outbreak. Additional servers can mitigate the described effects and lead to enhanced resilience in the case of virus outbreaks and better values in all considered performance metrics.Research limitations/implicationsSome parameters that were assumed for simplification purposes as well as the overall model should be verified in future studies with the relevant designers of EMSs in refugee camps. Moreover, from a practitioners perspective, the application of the model requires, at least some, training and knowledge in the overall field of optimization and queuing theory.Practical implicationsThe model can be applied to different data sets, e.g. refugee camps or temporary shelters. The optimization model, as well as the subsequent simulation, can be used collectively or independently. It can support decision-makers in the general location decision as well as for the simulation of stress-tests, like virus outbreaks in the camp area.Originality/valueThe study addresses the research gap in an optimization-based design of emergency service systems for refugee camps. The queuing theory-based approach allows the calculation of precise (expected) performance metrics for both the optimization process and the subsequent analysis of the system. Applied to pandemic outbreaks, it allows for the simulation of the behavior of the system during stress-tests and adds a further tool for designing resilient emergency service systems.

The Fellowship Effect: Does Surgical Subspecialty Training Affect Pediatric Surgery Case Volume?

The Accreditation Council for Graduate Medical Education (ACGME) monitors fellow case numbers. Previous literature has shown new fellowships detrimentally affecting general surgery residency case numbers. We hypothesize that an increase in pediatric otolaryngology and pediatric urology fellowships would decrease overlapping case numbers in pediatric surgery fellowships. A review of each specialties' fellowship match results was performed. Publicly available pediatric surgery cases logs were reviewed for overlapping cases including thyroidectomy, parathyroidectomy, branchial cleft cyst excision, thyroglossal duct cyst excision, major neck tumor excision, nephrectomy, orchidopexy, inguinal hernia, and testicular torsion. Analyzed data included average case numbers and number of fellows each year. Linear regression analysis was performed. We identified a significant increase in fellowship graduates from 2003 to 2018 (p < 0.006). Reviewed cases showed little fluctuation despite an increase in graduates. A decrease in tumor-related nephrectomies and orchidopexies was identified for pediatric surgery fellows (p < 0.001; p < 0.004). Though significant, nephrectomy fluctuation was between 2 and 4 cases. Similarly, we identified a significant rise in thyroidectomies (p < 0.001). Again, the increase was by 3 cases each year. Despite the increase in number of fellowships, there has been a minimal overall effect on pediatric surgery case volume. Continuing to monitor these trends will help ensure adequate training for all pediatric surgical subspecialties.

Alternative pediatric metabolic syndrome definitions impact prevalence estimates and socioeconomic gradients.

There is no consensus regarding the definition of pediatric metabolic syndrome (MetS). This study assessed the impact of alternative definitions on the prevalence, children identified, and association with socioeconomic status (SES). Data were from the prospective multigenerational Dutch Lifelines Cohort Study. At baseline, 9754 children participated, and 5085 (52.1%) with average follow-up of 3.0 (SD = 0.75) years were included in the longitudinal analyses; median ages were 12 (IQR = 10-14) and 14 years (IQR = 12-15), respectively. We computed MetS prevalence according to five published definitions and measured the observed proportion of positive agreement. We used logistic regression to assess the SES-MetS association, adjusted for age and sex. Longitudinal models were also adjusted for baseline MetS. MetS prevalence and positive agreement varied between definitions, from 0.7 to 3.0% and from 0.34 (95% CI: 0.28; 0.41) to 0.66 (95% CI: 0.58; 0.75) at baseline, respectively. We consistently found a socioeconomic gradient; in the longitudinal analyses, each additional year of parental education reduced the odds of having MetS by 8% (95% CI: 1%; 14%) to 19% (95% CI: 7%; 30%). Alternative MetS definitions had differing prevalence estimates and agreed on 50% of the average number of cases. Additionally, regardless of the definition, low SES was a risk factor for MetS. Little is known about the impact of using different definitions of pediatric metabolic syndrome on study results. Our study showed that the choice of pediatric metabolic syndrome definition produces very different prevalence estimates. We also showed that the choice of definition influences the socioeconomic gradient. However, low socioeconomic status was consistently a risk factor for having pediatric metabolic syndrome. In conclusion, studies using different definitions of metabolic syndrome could be reasonably compared when investigating the association with socioeconomic status but not always validly when comparing prevalence studies.

Status of Scabies Cases in COVID-19 Pandemic Days.

Background:In Turkey, an increase of scabies cases was detected since the last quarter of 2019. During the same period, Turkey was also under the influence of the COVID-19 pandemic affecting the whole world. This study aimed to determine the current situation of scabies cases in increasing incidence during COVID-19 pandemic days and to create a scientific resource for the measures to be taken.Methods:This descriptive study was carried out in July 2020 and the records of patients diagnosed with scabies in health institutions in Kırklareli Province between Jan 2017-June 2020 were retrospectively analyzed.Results:Average number of cases before Sep 2019, when cases began to exceed the expected value, was calculated as 31.7±12.0 and after Sep 2019 it was calculated as 129.8±53.6 (P<0.001, CI 95%). The number of scabies cases which increased before the pandemic and reached the epidemic level, decreased dramatically in Mar and Apr 2020. This period was also the period in which the measures taken for the COVID-19 pandemic were most strictly applied. In May and June, the epidemic continued from where it left off.Conclusion:COVID-19 pandemic which affects the whole world may create a new opportunity to combat infectious diseases. Not only for COVID-19 but also many infectious diseases, it is necessary to fix the negative socioeconomic and socio-cultural conditions and ensure the sustainability of the new social conditions to be created.

A Review of Orthopaedic Resident Case Logs to Identify Fluctuations in Exposure to Adult Orthopaedic Procedures.

Introduction:Orthopaedic surgery resident case exposure is an important component of surgical training and is monitored by the Accreditation Council for Graduate Medical Education (ACGME) to ensure resident readiness for graduation. The purpose of this study was to investigate trends in exposure to adult orthopaedic surgical procedures and analyze the impact of the 2013 update in ACGME case logging expectations.Methods:A retrospective review of ACGME case log data was conducted for adult orthopaedic procedures performed by graduating orthopaedic surgery residents from 2012 to 2020. Trends in the number of cases logged and the case share by anatomical location were investigated. Linear regression analysis was performed to analyze changes in case number over the 9-year period.Results:For all surgical categories, there was stability in the average case number per resident from 2012 to 2013, followed by a precipitous decrease from 2013 to 2014. From 2014 to 2020, there has been a gradual increase in case number for all categories except “other musculoskeletal (MSK),” resulting in a total 46% recovery since the 2014 decline. Concomitant with the decline, there was a relative increase in pelvis/hip and femur/knee procedures and decrease in shoulder, other MSK, and spine procedures. From 2014 to 2020, shoulder, humerus/elbow, pelvis/hip, leg/ankle, foot/toes, and spine cases have gradually accounted for a larger proportion of total cases while femur/knee and “other MSK” cases have accounted for less.Conclusions:The 2013 update in ACGME case logging expectations was associated with a significant decrease in case number. This is likely a reflection of residents correctly entering 1 primary Current Procedural Terminology code for each surgical case. Programs should be aware of a general increase in case number since 2014 and acknowledge the fact that some procedure types may be given priority from a logging standpoint when multiple Current Procedural Terminology codes apply.

COVID-19 Australia: Epidemiology Report 31: Fortnightly reporting period ending 6 December 2020.

Nationally, COVID-19 notifications remained at low levels this fortnight. Testing rates also decreased during the surveillance period. The daily average number of cases was eight compared to an average of 11 cases for the previous fortnight. There were 109 cases of COVID-19 and no deaths this fortnight, bringing the cumulative case count to 28,049 and 908 deaths. New South Wales reported the highest proportion of cases again this fortnight (54%; 59/109), with the majority of these acquired overseas (97%; 57/59). Locally-acquired cases accounted for 5% (5/109) of all cases reported this fortnight, with one of these from an unknown source. FluTracking data indicated that 47% of people in the community with ‘fever and cough’ and 19% of those with ‘runny nose and sore throat’ were tested for SARS-CoV-2, which was a decrease from the previous reporting period. Testing rates decreased to 9.3 tests per 1,000 population per week during this reporting period, representing a 29% decrease in fortnightly tests conducted compared to the last reporting period. The overall positivity rate for the reporting period remains at 0.03%.

COVID-19 Australia: Epidemiology Report 30: Fortnightly reporting period ending 22 November 2020.

Nationally, COVID-19 notifications remained at low levels this fortnight. The daily average number of cases for this reporting period was nine, which was similar to last fortnight’s average. There were 123 cases of COVID-19 and no deaths this fortnight, bringing the cumulative case count to 27,892 and 907 deaths. Hospitalisations for COVID-19 dropped further in the past two fortnights: there were just two cases admitted to FluCAN participating hospitals and there were no admissions to ICU in SPRINT-SARI sites during this four-week period. New South Wales reported the highest proportion of cases this fortnight (46%; 56/123), all of which were overseas acquired. Locally-acquired cases accounted for 15% (19/123) of all cases reported this fortnight all of which were attributed to a cluster of cases in South Australia. At the end of this reporting period, it had been 24 days since there was a locally-acquired case of unknown source. Testing rates increased to 12.0 tests per 1,000 population per week during this reporting period, driven by a significant increasing in testing in South Australia. The overall positivity rate for the reporting period was 0.03%, will all jurisdictions reporting a positivity rate ≤ 0.10%.

Repurposing a Small Community Hospital Surgical Residency Program in an Epicenter of the COVID-19 Pandemic.

COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1month before and 5weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5weeks. Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.

COVID-19 Australia: Epidemiology Report 29: Fortnightly reporting period ending 8 November 2020.

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was nine, compared to an average of 14 cases per day in the previous fortnight. There were 123 cases of COVID-19 and two deaths this fortnight, bringing the cumulative case count to 27,743 and 904 deaths. New South Wales reported the highest proportion of cases this fortnight (56%; 69/123), the majority of which were overseas acquired (54). Locally-acquired cases accounted for 15% (18/123) of all cases reported this fortnight. Victoria has seen a continuing decline of cases: at the end of this reporting period, 10 days had passed since the last locally-acquired case was reported in this jurisdiction. Testing rates increased during the reporting period and remain high overall at 11.0 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.03%, with the Northern Territory reporting a positivity rate of 0.12% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.

COVID-19 Australia: Epidemiology Report 28: Fortnightly reporting period ending 25 October 2020.

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was 13 compared to an average of 18 cases per day in the previous fortnight. There were 176 cases of COVID-19 and 7 deaths this fortnight, bringing the cumulative case count to 27,582 and 905 deaths. New South Wales reported the highest proportion of cases this fortnight (42%; 74/176), the majority of which were overseas acquired (52). Locally-acquired cases accounted for 31% (54/176) of all cases reported this fortnight. While the majority of these were reported from Victoria (33/54), there continues to be a decrease in new cases in this state resulting from public health interventions. Testing rates increased during the reporting period and remain high overall at 10.3 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.05%, with Western Australia reporting a positivity rate of 0.21% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.

COVID-19 Australia: Epidemiology Report 28: Fortnightly reporting period ending 25 October 2020

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was 13 compared to an average of 18 cases per day in the previous fortnight. There were 176 cases of COVID-19 and 7 deaths this fortnight, bringing the cumulative case count to 27,582 and 905 deaths. New South Wales reported the highest proportion of cases this fortnight (42%; 74/176), the majority of which were overseas acquired (52). Locally-acquired cases accounted for 31% (54/176) of all cases reported this fortnight. While the majority of these were reported from Victoria (33/54), there continues to be a decrease in new cases in this state resulting from public health interventions. Testing rates increased during the reporting period and remain high overall at 10.3 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.05%, with Western Australia reporting a positivity rate of 0.21% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.

COVID-19 Australia: Epidemiology Report 27: Fortnightly reporting period ending 11 October 2020.

Nationally, there was a continuing downward trend in notifications of COVID-19. The daily average number of cases for this reporting period was 14 compared to an average of 23 cases per day in the previous fortnight. There were 192 cases of COVID-19 and 23 deaths this fortnight, bringing the cumulative case count to 27,344 and 898 deaths. While the majority of cases in this reporting period were from Victoria (60%; 116/192), there continues to be a decrease in cases in this state resulting from public health interventions. During this fortnight, 66% (127/192) of all cases were reported as locally acquired, with the majority reported from Victoria (108/127). The highest proportion of overseas-acquired cases was reported in New South Wales (75%; 38/51), followed by Western Australia (22%; 11/51). Although testing rates declined, they remain high overall at 9.2 tests per week per 1,000 persons. There was variability in the testing rate by jurisdiction, with testing rates depending on the epidemic context. The overall positivity rate for the reporting period was 0.05%, with Victoria reporting a positivity rate of 0.08% for this reporting period. In all other jurisdictions the positivity rate was ≤ 0.06%.

A Prospective Cohort Analysis of COVID-19 Positive and Negative Patients Admitted to a Single Centre in the North-East of England During the Peak of a Pandemic

Objectives: To investigate the clinical haematological, radiological and biochemical factors associated with outcome in COVID-19 positive patients in North East England (NEE) where mortality rates were higher during the peak of the pandemic.Design: Prospective single-centre cohort study.Setting: Acute Medical Admissions service at Darlington Memorial Hospital in North East England.Participants: 275 patients were admitted with either fever and/or respiratory symptoms of cough, chest pain or shortness of breath over a three-week period from 26th March 2020 to 12th April 2020, during the peak of the COVID-19 pandemic.Main Outcome Measures: Patient outcome (mortality) and admission to the intensive care unit or high dependency unit.Results: Mortality rates for COVID-19 positive patients treated at the DMH in NEE was higher than the UK-wide data, 30.8% vs 26% respectively. Similar to other studies, COVID-19 positive patients had a median age of 70 years, a higher proportion of males and a high level of comorbidities (such as type 2 diabetes and hypertension), but they were mot associated with outcome. Comparison with the UK wide data highlighted a much higher number of obese patients with a BMI >30 (DMH 60.8% vs UK 10.5%, p2 ≤93%) and an immunocompromised status. Conclusions: We report a regional study from a hospital in NEE which has been designated by the UK government to have a higher than average number of cases and a substantially worse outcome. This study shows higher mortality than the UK national statistics and the independent risk factors identified in our study differed from national and international data. This analysis of COVID-19 positive patients demonstrates the importance of understanding the variability of risk profiling in different regions of the UK and will contribute to better management of local lockdowns and similar pandemics in the future.Funding Statement: No specific funding received.Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.Ethics Approval Statement: Data was collected as part of the DARlington CoVid Epidemiology (DarCoVE) Audit (registration number 889, Clinical Audit Department, County Durham & Darlington NHS Foundation Trust, exempt from ethical approval for analysis of anonymised healthcare data and clinical service evaluation).

S1254 Impact of COVID-19 on a Large, Vertically Integrated Gastroenterology Community Practice

INTRODUCTION: The COVID-19 pandemic has led to immediate, profound, and potentially permanent changes to the practice of gastroenterology. Here, we describe the progression of change in a large community practice gastroenterology clinic resulting from COVID-19. Additionally, we examine implications on staffing, requirements for personal protection equipment and the use of telemedicine. METHODS: We looked at practice data from a vertically integrated community-based gastroenterology practice of 30 physicians, and 16 non-physician providers (NPPs) based in the Puget Sound Region of the Pacific Northwest. The practice operates 9 clinics, 7 endoscopy centers and 2 ambulatory infusion centers. In 2019 collectively, the practice performed approximately 3800 endoscopic procedures, 350 infusions and 4300 clinic visits per month. We examined data in the immediate months before March 19, 2020 state mandated closure for Covid-19 and two months following. RESULTS: At the height of its impact in April, we saw an approximate decrease of 75% in RVU's, 45% in clinic visits, and 100% reduction in endoscopic procedures. Telemedicine, which previously was not utilized in our practice, evolved rapidly within less than a week to approximately 90% of clinical visits and was embraced by both physicians and patients. There was an increase in clinic visits per MD as clinical contact increased and procedure volume was reduced. With the reopening of the endoscopy centers in May, we noted a 15.25% increase in costs per procedure, secondary to utilization of PPE, increasing staffing per procedure and a reduction of the average number of cases per physician per month from 130 to 50. Infusion volumes were minimally impacted by the epidemic and stay at home orders. CONCLUSION: The COVID-19 pandemic has led to immediate and profound changes on the practice and delivery of gastroenterology care. Many of these changes will be temporary as we embrace efficiencies. However, there will be fundamental alterations to the practice of gastroenterology that will remain even after a vaccine or very effective treatment for COVID-19 has been secured such as the use of PPE, requirements for clinical space and the use of telemedicine. We anticipate PPE cost will decrease over time, with efficiency of AEC throughput, and testing/ screening requirements Future studies will be valuable to look at those trends and changes in practice patterns as this epidemic evolves.

Pediatric metabolic syndrome definitions impact prevalence and socioeconomic gradients

Abstract Background The choice of pediatric metabolic syndrome (MetS) definition influences prevalence estimates, but further implications, especially on the association with socioeconomic status (SES), are not well-known. This hampers a synthesis of the evidence to help guide the relevant stakeholders. For this reason, we aim to assess the impact of alternative definitions on the prevalence of MetS, the children that are identified, and the association between SES and MetS. Methods Data were used from the Lifelines Cohort Study, a prospective multigenerational cohort in the Netherlands. At baseline 9,754 children participated, of which 5,085 (52.1%) were included in the longitudinal analyses. We computed the prevalence of MetS according to five published definitions and measured the observed positive agreement between pairs of definitions, indicating the proportion of agreement across the average number of MetS cases. Logistic regression was used to assess the association between SES and MetS. All models were adjusted for age and sex; the longitudinal models were also adjusted for baseline MetS status. Results The prevalence rates of MetS varied between definitions (0.7-3.0% at baseline), but positive agreement between MetS definitions was generally fair to good ranging from 0.34 (95% confidence interval (CI) 0.28; 0.41) to 0.66 (95%CI 0.58; 0.75) at baseline. At both assessments, we found an inverse association between baseline SES and MetS, which ranged from 0.81 (95%CI 0.70; 0.93) to 0.92 (95%CI 0.86; 0.98) per definition in the longitudinal analyses with a mean follow-up (SD) of 3.0 (0.75) years. Conclusions Alternative definitions of MetS lead to differing prevalence estimates, and they agreed on 50% of the average number of cases of MetS. The alternative definitions also lead to similar socioeconomic gradients; regardless of which definition was used we concluded low SES was a risk factor for developing MetS. Key messages Evidence regarding different definitions of metabolic syndrome in children can be combined because the agreement among definitions is generally fair to good. As low socioeconomic status is a consistent risk factor for developing metabolic syndrome, preventive interventions should preferentially target children from low socioeconomic backgrounds.

Pediatric cannabis poisonings in France: more and more frequent and severe

Context Accidental pediatric cannabis poisonings are an incidental effect of cannabis use. The average THC content of cannabis resin and the number of consumers are rising sharply in the USA and in most European countries. The objective is to study the evolution of prevalence and severity of pediatric exposures to cannabis in France. Method This is a retrospective observational study of cases detected by French poison centers between January 1st 2010 and December 31st 2017 of cannabis exposure by ingestion in children aged ten or younger. The clinical severity was assessed using the Poisoning Severity Score (PSS). The criteria used for assessing the overall severity were as follows: PSS ≥ 2, admission to pediatric intensive care, coma and respiratory depression (univariate and multivariate logistic regression). Results A total of 965 cases of poisoning were covered. The annual average number of cases was 93 between 2010 and 2014 and 167 between 2015 and 2017. The median age was 15 months (range, 6 months–10 years) and the sex ratio was 1:1. The form of cannabis ingested was mainly resin (75%). During the period covered by the study, 26.1% of children (n = 252) presented with a PSS ≥ 2, 4.5% (n = 43) coma, 4.6% (n = 44) with respiratory depression and 11.7% (n = 113) were admitted into pediatric intensive care (out of 819 hospitalizations). No fatal cases were reported. In comparison to the 2010–2014 period, the length of hospital stays was significantly higher (p < 0.0001) and the comas were significantly deeper (lower score on the Glasgow coma scale, p < 0.005) in 2015–2017. Following adjustments made for the sex, age and weight of the children, the data show that the severity of the poisonings was significantly greater in 2015–2017 in terms of PSS score, the number of comas and monitoring in intensive care (p < 0.001). Conclusion The data indicates a significant increase in the number of cases of pediatric exposure to cannabis and a rise in the seriousness of poisonings between 2010 and 2017.