COVID-19 Pandemic Research Articles

Care Consistency With Care Preferences in Nursing Homes: A Cluster-Randomized Study of the Effects of an Advance Care Planning Program (BEVOR).

In this study (NCT04333303), we investigated whether a complex advance care planning (ACP) intervention improves care consistency with care preferences in nursing home residents. Forty-four German nursing homes were randomly assigned to an ACP intervention addressing the individual, institutional, and regional levels or to a control group (no intervention). The hospitalization rate over an observation period of 12 months (primary outcome) was analyzed as a surrogate for care consistency with care preferences at the nursing home level. Secondary outcomes comprised process-related and clinical parameters, including care consistency with care preferences (analysis level: residents/nursing homes). Outcomes were evaluated by means of Poisson and logistic regression models with incidence rate ratios (IRR) and odds ratios (OR) as effect estimators in an intention-to-treat analysis. Of 44 nursing homes, 23 received the intervention. The hospitalization rate did not differ between the two groups (IRR 1.0; 95% CI: [0.97; 1.1]) but declined to a similar extent in both during the COVID-19 pandemic. The consistency of care with care preferences was similar in both groups as well (OR 0.9 [0.4; 1.9]). The predefined exploratory analysis suggests that care consistency with care preferences was more likely in the 6 out of 23 nursing homes that met predefined adherence criteria (OR 1.9 [0.7; 5.3]). Written emergency plans were significantly more common in the intervention group (IRR 11.6 [8.2; 16.4]), and even more so in adherent nursing homes (IRR 30.1 [15.7; 57.6]). The intervention did not permeate sufficiently, especially due to the COVID-19 pandemic that may, in addition, have masked intrinsic shortcomings of the intervention. Thus, this trial does not allow a conclusive assessment of whether or not the intervention can promote care consistency with care preferences. However, exploratory analyses indicate that successful institutional implementation in conjunction with individual ACP conversations may increase care consistency with care preferences.

Timeout: COVID-19 and Lessons Learned from the Use of Hybrid Coaching for a High School Boys’ Basketball Program

Coaching high school basketball is a tough profession to navigate. Most coaches have a plan for student-athletes to follow to be successful for the upcoming season, with specific, tailor-made strategies. However, adding an external factor such as the COVID-19 pandemic can create challenges, particularly when there is no contingency plan for education, the continuation of play, and the safety of the student-athletes. This article introduces a hybrid coaching model that was used with a high school basketball team and how this method can be beneficial when in-person instruction is impossible.

Intergroup and intragroup dynamics of communication: Identity validation, trust, and action

ABSTRACT A key function of communication is to signify values and norms. In this paper, we tour some of our recent research as well as new evidence on social psychological processes affecting the impacts of group communication and its implications for so-called Intergroup Communication Principles. We contend that communication within and between groups is subjectively interconnected, specifically through the process of subjective group dynamics. These dynamics affect how groups respond to leaders (or groups) that depart from prevailing norms, when these communications initiate a norm shift rather than inviting opprobrium, and whether communication by outgroup members can break down prejudice. Using new evidence from the COVID-19 pandemic, we examine which communications are most trusted in an intergroup hierarchy, showing the critical role of local identity. Finally, we describe field studies demonstrating how group norm communications can promote prosocial environmental behavior. We conclude that group-based communication is likely to be strongly directed toward occupying the center ground of communicative practice that groups’ responses to their members are motivated by the desire to reinforce the validity of the group’s norms, and their receptiveness toward leaders is dependent on the leader’s advancement of the group’s subjective validity.

Delving into LLM-assisted writing in biomedical publications through excess vocabulary.

Large language models (LLMs) like ChatGPT can generate and revise text with human-level performance. These models come with clear limitations, can produce inaccurate information, and reinforce existing biases. Yet, many scientists use them for their scholarly writing. But how widespread is such LLM usage in the academic literature? To answer this question for the field of biomedical research, we present an unbiased, large-scale approach: We study vocabulary changes in more than 15 million biomedical abstracts from 2010 to 2024 indexed by PubMed and show how the appearance of LLMs led to an abrupt increase in the frequency of certain style words. This excess word analysis suggests that at least 13.5% of 2024 abstracts were processed with LLMs. This lower bound differed across disciplines, countries, and journals, reaching 40% for some subcorpora. We show that LLMs have had an unprecedented impact on scientific writing in biomedical research, surpassing the effect of major world events such as the COVID pandemic.

Mental health and coping among graduate students during the COVID-19 pandemic: a gender-based analysis

IntroductionThe COVID-19 pandemic has profoundly impacted the mental health of young adults in Canada, with research showing high rates of depression and anxiety symptomatology. Graduate students, who already experience elevated mental health challenges, represent a particularly vulnerable population—yet research examining their experiences during the pandemic remains limited. This study aims to investigate mental health and well-being outcomes, negative impacts, coping strategies, and gender differences among Canadian graduate students during the COVID-19 pandemic.MethodsA cross-sectional survey was conducted among Canadian graduate students (N = 261) to assess mental health symptoms, well-being, negative impacts, coping strategies, and gender differences during the COVID-19 pandemic using a series self-report of questionnaires (e.g. BDI, BAI, DASS-S). Data were analyzed using descriptive statistics, chi-square tests and t-tests.ResultsFindings revealed significant mental health challenges among Canadian graduate students during the pandemic, with high rates of depression, anxiety, and stress reported. Female students reported worse mental health outcomes and experienced greater negative impacts compared to males. Coping strategies predominantly involved avoidant behaviors, such as watching TV and using social media, with gender differences in coping strategies.DiscussionCompared to pre-pandemic findings, graduate students in this pandemic sample reported elevated rates of mental health challenges. Women appeared to be disproportionately impacted, reflecting the heightened mental health burden they reported during this period. Avoidant coping strategies were most commonly used—aligning with the socially isolating conditions of the pandemic—with notable gender differences in types of strategies employed.ConclusionThe COVID-19 pandemic seems to have exacerbated the mental health crisis among Canadian graduate students, with higher rates of depression, anxiety, and stress reported compared to pre-pandemic findings. Female students face heightened challenges, emphasizing the need for gender-sensitive support strategies. Universities should prioritize mental health support and promote healthy coping mechanisms to address the impacts of the pandemic on graduate student well-being.

Promoting Exercise Behavior to Combat Stress: A Discussion Paper on Enhancing well-being and Job Performance of Social Workers in the nonprofit Sector

ABSTRACT This literature review identifies evidence supporting exercise as an effective stress management method for nonprofit sector workers, in particular those who identify as social workers. Given the heightened risks of burnout and stress in social work, exacerbated by the COVID-19 pandemic, the under-researched area of exercise as stress management with workers in the nonprofit sector warrants attention. The authors review prior research, outlining how exercise mitigates stress through distraction, endorphin release, and fostering a sense of control. They also identify obstacles to exercise, such as time limitations and resource scarcity. Strategies to encourage physical activity are proposed, including customizable exercise programs and supportive organizational practices. The need for future research on effective stress relief interventions for workers in nonprofit settings is acknowledged. The paper concludes by advocating for policy and practice shifts to integrate exercise into the nonprofit sector, thereby enhancing workers’ resilience and performance.

A - 45 The Role of Avoidant Coping in Depression: Barriers to Training Due to the COVID-19 Pandemic

A - 45 The Role of Avoidant Coping in Depression: Barriers to Training Due to the COVID-19 Pandemic

Technologically innovative teaching and learning strategies in contexts of crises: lessons from COVID-19 in selected primary schools in Masvingo District, Zimbabwe

Many developing countries, especially in Africa, depended on the traditional form of teaching and learning, which was reconfigured due to the restrictions that came with the management of the COVID-19 pandemic. In view of this, this study sought to explore technologically innovative teaching and learning strategies that can be employed by teachers in Zimbabwe to ensure that teaching and learning processes persist despite constraining circumstances, such as pandemics. A qualitative and instrumental case study design with in-depth interviews and focus group discussions was employed. The independence and autonomy theory was used to provide a grounding base for understanding effective technologies that can be used in the context of crises. The study sample of 12 general teachers, two information and communication technology teachers, two educational psychologists, and 24 learners was drawn from the target population through a purposive sampling process. It was revealed that the adoption of e-learning, the use of mobile learning, the use of social media, and the use of virtual classrooms could allow teaching and learning processes to continue in the context of crises. The study recommends that learning institutions should formalise the use of various electronic platforms in education. The research also recommends the adoption, control, and management of various platforms, such as e-learning, mobile learning, social media use, and the use of virtual classrooms in the teaching and learning process.

Due diligence: a bibliometric review and future research agenda

PurposeThis study aims to provide a comprehensive overview of the state-of-the-art research on the due diligence literature. This topic has recently become a key area of interest for both scholars and managers across multiple dimensions, particularly within the international business landscape.Design/methodology/approachUsing the PRISMA statement as the key guideline for the search and selection process, this paper examines 1,721 English articles from the Scopus database with titles and abstracts. Performance analysis was conducted to identify the overall volume, growth trajectory, and the most important research constituents among existing due diligence studies. In addition, VosViewer was used to perform science mapping techniques, namely co-authorship, bibliographic coupling and co-word analysis.FindingsThe findings reveal a marked increase in scholarly attention toward the topic of due diligence since 2020, charged by the interdisciplinary implications of the COVID-19 pandemic. In synthesizing the intellectual landscape of existing due diligence studies, the paper identifies several prominent themes such as (1) ‘‘mergers and acquisitions,” (2) ‘‘human rights,” (3) ‘‘supply chain and CSR” and (4) ‘‘venture capital investment.” ‘‘COVID-19, ESG, AI and relevant issues” also enters our observation as an emerging trend.Originality/valueThis paper enriches the knowledge of due diligence, a crucial practice in competitive global business. To the best of the authors’ knowledge, this is the inaugural bibliometric analysis focused on due diligence with a comprehensive approach. It explores the most important emerging themes, research trends and critical changes and then shows potential directions for future research on the topic of due diligence.

Global trends in antibiotic expenditure: analysis of pharmaceutical sales data, 2013 to 2023.

Human antibiotic consumption is a major contributing factor to antimicrobial resistance (AMR). Understanding the dynamics of the antibiotic market can help improve antibiotic stewardship efforts and encourage innovation. We used IQVIA MIDAS® quarterly pharmaceutical sales value and volume data to estimate aggregate and per capita real (inflation-adjusted) annual spending on antibiotics, along with unit values (ratio of sales value and quantity), in 62 countries from 2013 to 2023. We evaluated trends by broad classes of antibiotics and country income groups and conducted multivariate regression analyses to identify associations with factors such as income and health spending. Between 2013 and 2023, aggregate and per capita real spending on antibiotics decreased from $49.61 billion to $30.68 billion and from $12.08 to $7.92, respectively. Real spending per unit of antibiotic - which is an indicator of price but not necessarily the final consumer price- also declined from $0.85 (2013) to $0.45 (2023). Spending decreased across country income groups and converged, driven by more rapid reductions in high-income countries compared with other regions. In 2020, spending decreased sharply due to the COVID-19 pandemic, followed by a small rebound. In multivariate analysis, income, health spending, median age, and clean water access were associated positively, while schooling attainment, availability of doctors, and higher state capacity were associated negatively with per 1,000 people spending on antibiotics. Global spending on antibiotics declined and overall converged among countries from 2013 to 2023. More investment is necessary towards reducing antibiotic use and developing new effective antibiotics.

Global, regional, and national characteristics of the main causes of increased disease burden due to the covid-19 pandemic: time-series modelling analysis of global burden of disease study 2021.

To quantify and identify the main causes of increased disease burden due to coronavirus disease 2019 (covid-19) pandemic. Time-series modelling study. Global Burden of Disease Study 2021. Absolute and relative rate differences were calculated, along with their 95% confidence intervals (95% CIs), between the observed and expected rates for 174 causes of increases in incidence, prevalence, disability adjusted life years (DALYs) and deaths in 2020-2021. A statistically significant increase was indicated if the 95% CIs of the rate differences were above 0. Globally, the rate of age standardised DALYs increased in absolute difference per 100 000 and relative rate difference by 97.9 (95% CI 46.9 to 148.9) and 12.2% (95% CI 5.8% to 18.5%) for malaria, 83.0 (79.2 to 86.8) and 12.2% (11.7% to 12.8%) for depressive disorders, and 73.8 (72.2 to 75.4) and 14.3% (14.0% to 14.7%) for anxiety disorders, which were prominent and statistically significant, followed by stroke, tuberculosis, and ischaemic heart disease. Additionally, the age standardised incidence and prevalence per 100 000 significantly increased for depressive disorders (618.0 (95% CI 589.3 to 646.8) and 414.2 (394.6 to 433.9)) and anxiety disorders (102.4 (101.3 to 103.6) and 628.1 (614.5 to 641.7)), as well as notable rises in age standardised prevalence for ischaemic heart disease (11.3 (5.8 to 16.7)) and stroke (3.0 (1.1 to 4.8)). Furthermore, age standardised mortality due to malaria significantly increased (1.3 (0.5 to 2.1) per 100 000). Depressive and anxiety disorders were the most predominant causes of increased DALY burden globally, especially among females; while malaria had the most severe increased DALY burden in the African region, typically affecting children younger than five years; and stroke and ischaemic heart disease in the European region and in individuals aged 70 and older. The covid-19 pandemic significantly increased the burden of several non-covid conditions, particularly mental health disorders, malaria in young children in the African region, and stroke and ischaemic heart disease in older adults, with notable disparities across age and sex. These findings underscore the urgent need to strengthen health system resilience, enhance integrated surveillance, and adopt syndemic-informed strategies to support equitable preparedness for future public health emergencies.

Mapping research trends in obsessive-compulsive disorder before and after the COVID-19 pandemic: a bibliometric analysis focusing on its molecular mechanisms

Obsessive-compulsive disorder (OCD) is a psychiatric disorder that primarily develops during adolescence, and is characterized by obsessive thoughts and compulsive behaviors. Although multiple factors including heredity, environment, and abnormalities in neural networks and synapses are involved in the onset and exacerbation of OCD, their underlying molecular mechanisms have not been fully elucidated. In addition, recent studies have demonstrated that the novel coronavirus disease (COVID-19) pandemic worsened OCD phenotypes. Hence, this global crisis may have changed the field of molecular-focused OCD research. We conducted a brief bibliometric analysis to investigate changes in prevalent topics in molecular-focused OCD research before (2015-2019) and after (2020-2025) the COVID-19 pandemic using Web of Science and VOSviewer. “Schizophrenia” and “metaanalysis” remained highly ranked terms in molecular-focused OCD research. In terms of neurotransmitters, the term “serotonin” became more prevalent than “dopamine” after the COVID-19 pandemic. In addition, research interest shifted toward younger populations, and there was a noticeable increase in terms related to neural networks such as “connectivity”. However, only a few specific molecular mechanisms or cellular physiological pathways by which COVID-19 exacerbates OCD have been identified. To address this gap, an additional post hoc analysis focusing on inflammation-related terms was conducted, revealing the emergence of “oxidative stress” and “c-reactive protein” in studies published after the COVID-19 pandemic. The findings of this study highlight several potential clues for elucidating the pathophysiology of OCD and identifying aggravating factors such as COVID-19, while also emphasizing the importance of continued molecular-focused research to establish novel therapeutic targets.

Risk and protective factors associated with change in well-being and mental health during the COVID-19 pandemic in South Africa.

The COVID-19 pandemic and associated restrictive measures affected the mental health and well-being of individuals globally. We assessed non-modifiable and modifiable factors associated with the change in well-being and mental health from pre- to during the COVID-19 pandemic in South Africa. A cross-sectional online survey was conducted from 26-April-2020 to 22-April-2021. Paired samples t-tests were conducted to assess change in well-being (measured on The World Health Organization-Five Well-Being Index (WHO-5)) and mental health (a validated composite psychopathology p-score). Sociodemographic, environmental, clinical and behavioral factors associated with change in outcomes were examined. The sample comprised of 1866 adults (M age=44.26±17.36 years, female=78.9%). Results indicated a significant decrease in well-being (p<0.001) and increase in p-score (p<0.001) from pre- to during the pandemic. Having a prior mental health condition was associated with a worsening well-being score, while being female was associated with a worsening p-score. Being of Black African descent was associated with improved p-score and higher socioeconomic status (SES) was associated with improved well-being. Factors associated with worsening of both well-being and the p-score included adulthood adversity, financial loss since COVID-19, and placing greater importance on direct contact/interactions and substance use as coping strategies. Higher education level and endorsing studying/learning something new as a very important coping strategy were associated with improved well-being and p-score. Findings inform the need for targeted interventions to reduce and prevent adverse well-being and mental health outcomes during a pandemic, especially among vulnerable groups.

“I didn't want them to see that I was spent”: educators' stress and emotional labor during the COVID-19 pandemic

Research has demonstrated the difficulties faced by educators during the COVID-19 pandemic. In these unprecedented conditions, educators were asked to manage their emotions in new and challenging ways, thus exacerbating their relatively high levels of stress levels and burnout. We contribute to research on the pandemic's impact on educators through a qualitative case study conducted with 88 educators working in six schools across New York State. In this paper, we explore these educators' experiences of emotional labor during the pandemic, drawing attention to the ways educators managed emotions along display rules that compelled them to mask signs of stress and maintain a positive attitude. Through the constant-comparison method of data analysis, we found collegial support to be a crucial resource which participants drew on to manage their emotions in this highly stressful context. These findings have important implications for educators and policymakers as stress is a major contributor to the workforce shortages many schools across the United States are currently experiencing.

Resurgence of Death from Respiratory Infections after COVID-19 Pandemic

Introduction: Numerous studies have reported a global decline in respiratory infection-related deaths during the COVID-19 pandemic. This decrease was primarily attributed to implementing precautionary measures and changes in public behavior. However, respiratory infections have increased since the pandemic ended, and normal social activities have resumed. Methods: Data from e-Stat, Japan’s official database, covered influenza (2011–2024) and invasive pneumococcal diseases (2013–2024). The study period was divided into pre-pandemic, pandemic (April 2020–September 2021), and post-pandemic eras. The Mann-Whitney U test was used for comparisons. Results: Influenza-related deaths declined sharply during the pandemic era compared to the pre-pandemic period (P &lt; 0.001), dropping from 3,353 in 2019 to 19 in 2022. However, mortality increased in the post-pandemic era, reaching 1,220 by mid-2024 (P = 0.005). Similarly, deaths from invasive pneumococcal diseases decreased significantly during the pandemic (P &lt; 0.001) but rose again in the post-pandemic era. Conclusion: The COVID-19 pandemic significantly reduced deaths from influenza and invasive pneumococcal diseases due to public health measures. However, there has been a noticeable resurgence in these deaths after the lifting of most restrictions. Ongoing monitoring and the maintenance of basic infection prevention measures are crucial to prevent future outbreaks.

Molecular epidemiology of a carbapenem-resistant Serratia marcescens outbreak during the COVID-19 pandemic

IntroductionSerratia marcescens is a significant causative agent of hospital-acquired infections (HAIs), particularly in intensive care units (ICUs). Carbapenem resistance represents a major concern in HAI management, as carbapenem-resistant bacteria can trigger outbreaks in hospital settings. While molecular evaluation of outbreaks typically relies on pulse field gel electrophoresis (PFGE) or core genome multilocus sequence typing (cgMLST) methods, alternative rapid, reliable, and cost-effective methods for assessing clonal relatedness are needed.MethodsThis study aimed to characterize a carbapenem-resistant S. marcescens outbreak that occurred during the COVID-19 pandemic in a tertiary care hospital, using the flagellin gene as a single-locus sequence typing (SLST) method. In addition, we evaluated the genetic context of carbapenemase genes through whole-genome sequencing (WGS).ResultsAmong the 170 carbapenem-resistant Serratia marcescens isolates recovered, high resistance to gentamicin, ciprofloxacin, and cefepime was observed. The predominant carbapenemase gene detected by qPCR-HRM was blaKPC (92.2%). Phylogenetic analysis of the flagellin gene grouped the sequences into two distinct clades, with all outbreak-related blaKPC-positive S. marcescens isolates clustering within clade B. The blaKPC gene was carried on an IncP6 plasmid.DiscussionOur findings indicate that the flagellin gene serves as an effective marker for characterizing carbapenem-resistant S. marcescens carrying blaKPC, confirming that the outbreak was caused by the clonal expansion of isolates harboring blaKPC on an IncP6 plasmid.

The Journey of a Musikero: Challenges, Adaptive Strategies and Insights of Local Musicians in Benguet during the COVID-19 Pandemic.

The COVID-19 Pandemic has made sweeping disruptions in the lives of the populace, including the music industry. This study investigated the effects of the Pandemic on the local Musikeros who reside in Baguio City and Benguet, Philippines. Specifically, it sought to understand the circumstances of the local Musikeros as to their financial situations, challenges they faced in different areas of their lives, coping strategies, and lessons they learned during the pandemic. Utilizing a qualitative approach, Key Informant Interviews (KII) and Focus Group Discussions (FGD) were conducted with local Musikeros whose livelihoods were severely affected by the Pandemic restrictions. Through thematic analysis, four interrelated themes emerged: The first theme, Compliance with IATF Guidelines, described how the general public’s compliance with these restrictions caused two other themes to occur: Disruptions to Work as a Musikero and Personal Challenges. The first refers to the inability of the Musikeros to rely on their livelihood as performers, while the latter encapsulates the difficulties that Musikeros faced in the Socio-Economic, Physical-Mental, and Moral-Spiritual aspects of their lives. Despite these challenges, the Musikeros developed coping strategies through the theme Resilience in order to survive the Pandemic. The study describes the accounts of local Musikeros – their difficulties and triumphs – as they lived through one of the most turbulent events of the century. Insights from this research contribute to understanding the broader implications of the pandemic on the local music industry. It also emphasizes the necessity of support from Local Government Units and other institutions in helping the Musikeros to achieve stability in their livelihood.

Stability of cytokine and immunoglobulin concentrations in the general population: prepandemic basal concentrations and intraindividual changes until the COVID-19 pandemic

BackgroundWhile there is wide evidence on concentrations of cytokines in patients attending health care facilities, evidence is scant on physiological, basal concentrations of cytokines in the general population and across sociodemographic groups, as well as on their potential stability over time. Furthermore, from a public health perspective it is remarkable that no studies have analyzed intraindividual changes in such concentrations from before the COVID-19 pandemic until its outbreak.ObjectivesTo investigate: (a) prepandemic concentrations of cytokines and immunoglobulins to viral exposures in a general, non-institutionalized population, and their associated sociodemographic variables; (b) the intraindividual change in such concentrations between a prepandemic period (2016–17) and the initial pandemic period (2020–21); and (c) whether such change was similar in participants who in 2020–21 were SARS-CoV-2 seronegative and seropositive, and between participants who did and did not develop COVID-19.MethodsWe conducted a prospective cohort study in 240 individuals from the general population of Barcelona, Spain. Thirty cytokines and 31 immunoglobulins were measured in paired serum samples collected in 2016–17 and 2020–21 in the same individuals.ResultsThe median value of the relative intraindividual change in cytokine concentrations between 2016 and 2020 was &amp;lt;15% for 29 of the 30 cytokines. A substantial number of participants had an intraindividual increase or decrease ≥15% in some cytokines. No major differences in intraindividual changes of cytokine and immunoglobulin levels between 2016 and 2020 were observed between participants who did and did not develop COVID-19.ConclusionWe provide novel information on physiological, basal ex-vivo concentrations of cytokines and immunoglobulins in a general population, which should be relevant for clinical practice and public health. Intraindividual changes in cytokines and immunoglobulins during the 4 years from 2016–17 to 2020–21 were moderate, and they did not differ between participants who in 2020–21 were SARS-CoV-2 seropositive and seronegative, nor between participants who did and did not develop COVID-19 disease. These findings are also novel and relevant for medicine and public health. In particular, the stability in the biomarkers is relevant to assess the role of the immunological and inflammatory state (measured through baseline levels of cytokines and immunoglobulins) in the development of SARS-CoV-2 seropositivity and COVID-19 disease, as well as in the susceptibility to other infections and pathologies.

Exploring stroke survivor and employer experiences of disruption within the RETurn to work After stroKE (RETAKE) trial during the COVID-19 pandemic

IntroductionReturning to work is a goal for many stroke survivors, with benefits for individuals and society. The ReTurn to work After stroKE (RETAKE) trial, which aimed to improve stroke survivors’ work outcomes through early stroke-specific vocational rehabilitation (ESSVR), was ongoing during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on stroke survivors’ work ability and return-to work support.MethodsNine stroke survivors and five employers were interviewed. Thematic analysis informed by Normalisation Process Theory, found that biographical disruption experienced as a result of stroke was compounded by disruption on a global scale due to the pandemic.ResultsAttempts to mobilise resources in response to disruption were hampered by pandemic-related issues. Although returning to work offered continuity in pre-stroke identity, businesses were also disrupted by the pandemic. Findings suggest that returning to work was easier for stroke survivors able to work from home and those receiving ESSVR. The opportunity to work from home helped stroke survivors adapt to new ways of working necessitated by the impact of stroke and social distancing rules during the pandemic.DiscussionPost-pandemic, remote working is more acceptable, which may benefit future stroke survivors aiming to return to work whilst managing post-stroke fatigue. This may mitigate disruption to lives and post-stroke identities.

Trends in Remote Patient Monitoring Before and After the COVID-19 Public Health Emergency Declaration in the United States: A Comparison Between Rural/Urban and Racial/Ethnic Group.

Background: This study assesses the trend in remote patient monitoring (RPM) utilization among Medicare beneficiaries in the United States with differing rural/urban and racial/ethnic statuses. Methods: Using Medicare fee-for-service claims from January 2018 to December 2020, monthly rates of beneficiaries utilizing RPM per 100,000 beneficiaries enrolled in both Medicare Parts A and B were calculated. Comparative interrupted time series models delineated differences in level and trend of RPM utilization between beneficiaries with differing rural/urban status, race/ethnicity, and race/ethnicity as stratified by rural/urban status using March 2020, the start of COVID-19 public health emergency (PHE) in the United States, as interruption time. Results: RPM utilization increased from 2 to 240 RPM claims per 100,000 Medicare beneficiaries from January 2018 to December 2020. Urban beneficiaries experienced a 24.20 RPM user-level change per month at the start of PHE. Trend difference for urban versus rural beneficiaries increased by 7.85 RPM users per month before and after the start of PHE (p < 0.0001). The trend difference for non-Hispanic Black versus White beneficiaries significantly increased by 12.43 RPM users per 100,000 beneficiaries per month after declaration of PHE (p < 0.0001). Similarly, the trend difference for beneficiaries of Hispanic and of other races significantly increased by 7.48 and 16.93 RPM users per 100,000 beneficiaries per month, respectively, after the declaration of the PHE (p < 0.0001 for both). Trends for racial/ethnic minorities stratified by rural/urban status were similar to the overall trends by racial/ethnic group. Discussion: Inequities in RPM utilization exist and were exacerbated by the COVID-19 pandemic. Targeted interventions are needed to increase RPM utilization broadly, particularly among rural residents.