COVID-19 Emergency Research Articles

Culinary Learning Using Virtual Reality Based on Gamification Method

Culinary is a promising business and food is a basic need for human life. Many people fall ill due to improper diet. Since the emergence of Covid-19 a few years ago, most people tend to be careful in maintaining their diet, and awareness of healthy food has increased. Significantly, learning with virtual reality-based gamification in post-pandemic conditions, many people prefer digital learning. To increase creativity, motivation, innovation, and student involvement and ultimately open many businesses in the food sector, fun learning is needed with interesting content with virtual reality-based gamification scenarios. Ease of learning will have an impact on improving culinary learning outcomes. The purpose of this study is to learn using virtual reality-based gamification methods to increase student creativity in determining recipes, choosing the right ingredients, and using the right cooking utensils. Increase student learning motivation, and create innovation in the culinary field, from combining recipes to attractive presentations. Student involvement and its output is the creation of technopreneurs in the culinary field, considering that culinary is the backbone of a country's economy and is a promising business

Age-specific all-cause mortality trends in the UK: Pre-pandemic increases and the complex impact of COVID-19

ObjectivesThis study aims to analyse age-specific all-cause mortality trends in the UK before and after COVID-19 emergence to determine if pre-pandemic trends contributed to increased mortality levels in the post-pandemic era. Study designStatistical analysis of UK mortality data. MethodsWe utilised age-structured population and mortality data for all UK countries from 2005 to 2023. Mortality rates were calculated for each age group, and excess mortality was estimated using the Office for National Statistics (ONS) method. ResultsOur most concerning finding is an increase in all-cause mortality rates for middle-aged adults (30–54 years) starting around 2012. The COVID-19 pandemic may have further impacted these rates, but the pre-existing upward trend suggests that current elevated mortality rates might have been reached regardless of the pandemic. This finding is more alarming than the slowdown in the decline of cardiovascular disease death rates for individuals under 75 noted by the British Heart Foundation. ConclusionOur results highlight the importance of considering both immediate pandemic impacts and long-term mortality trends in public health strategies. This underscores the need for targeted interventions and improved healthcare planning to address both ongoing and future challenges.

Variables Associated With In-Hospital Lethality in COVID-19: A Prospective Cohort Study From Colombia.

The emergence of COVID-19 represents the most significant health crisis in recent history. Incidence and mortality rates depend on several factors. Many studies have focused on investigating which characteristics could be strongly related to higher mortality and lethality. This study aims to analyze the variables associated with in-hospital mortality among patients admitted in a reference northeastern region of a Colombian institution. An ambidirectional cohort, single-center studywas carried out in a reference hospital in northeastern Colombia. All patients admitted to the Fundación Oftalmológica de Santander (FOSCAL) between March 2020 and September 2021, with COVID-19 real-time polymerase chain reaction (PCR) positive test, were included. A total of 3,028 patients were included, of whom 2,034 (67.8%) survived and 994 (32.8%) died during their hospital stay; 48.8% (1,479) of the patients were female.The most common comorbidities were hypertension (1,236 patients, 40.8%), obesity (body mass index (BMI) ≥ 30; 656 patients, 21.6%), and diabetes (618 patients, 20.4%).The average age of the surviving patients was 52.2 years, while for the deceased patients, it was 70.3 years. The variables that showed significant association with in-hospital mortality were as follows: male sex ≥ 45 years, dyspnea, oxygen saturation (SatO2) < 85%, hypertension, chronic kidney disease (CKD), and a Charlson Comorbidity Index (CCI) score of >1. Male sex, age ≥ 45 years, dyspnea, SatO2 < 85%, hypertension, CKD, and a CCI score of >1 were associated with a higher risk of in-hospital mortality in COVID-19-infected patients.

"I probably shouldn't go in today": Inequitable access to paid sick leave and its impacts on health behaviors during the emergence of COVID-19 in the Seattle area.

This study examines inequities in access to paid sick leave (PSL) by race/ethnicity, income, and sex and the role of PSL access on leave-taking and care-seeking behaviors among Seattle-area workers in the months leading up to and during the emergence of COVID-19 in the region. Survey responses were collected online and in-person from individuals experiencing acute respiratory illness symptoms between November 2019 and March 2020 as part of a community-based respiratory viral surveillance study. Chi-square tests and log-binomial models were used to assess the association between PSL access and various socioeconomic indicators. A total of 66.6% (n = 2,276) respondents reported access to PSL. Proportionally, access to PSL was highest in respondents identifying as Asian (70.5%), followed by White (68.7%), Latine (58.4%), Multiracial (57.1%), Black (47.1%), and Other (43.1%). Access to PSL increased with household income. Eighty three percent of high-income respondents reported access compared to 52.9% of low-income households. Only 23.3% of the lowest-income households reported access to PSL. Fewer females (65.2%) than males (70.7%) reported access to PSL. Access to PSL is inequitably distributed across income, race/ethnicity, and sex. This study reinforces the vast body of knowledge on how socioeconomic inequalities increase individual and community-level vulnerability to the impacts of infectious disease outbreaks. It also supports the role of labor and economic policy in mitigating (or exacerbating) these impacts. Exemplified by the COVID-19 pandemic, universal access to PSL, especially for marginalized populations, benefits all.

From Tweets to Streets: Observational Study on the Association Between Twitter Sentiment and Anti-Asian Hate Crimes in New York City from 2019 to 2022.

Anti-Asian hate crimes escalated during the COVID-19 pandemic; however, limited research has explored the association between social media sentiment and hate crimes toward Asian communities. This study aims to investigate the relationship between Twitter (rebranded as X) sentiment data and the occurrence of anti-Asian hate crimes in New York City from 2019 to 2022, a period encompassing both before and during COVID-19 pandemic conditions. We used a hate crime dataset from the New York City Police Department. This dataset included detailed information on the occurrence of anti-Asian hate crimes at the police precinct level from 2019 to 2022. We used Twitter's application programming interface for Academic Research to collect a random 1% sample of publicly available Twitter data in New York State, including New York City, that included 1 or more of the selected Asian-related keywords and applied support vector machine to classify sentiment. We measured sentiment toward the Asian community using the rates of negative and positive sentiment expressed in tweets at the monthly level (N=48). We used negative binomial models to explore the associations between sentiment levels and the number of anti-Asian hate crimes in the same month. We further adjusted our models for confounders such as the unemployment rate and the emergence of the COVID-19 pandemic. As sensitivity analyses, we used distributed lag models to capture 1- to 2-month lag times. A point increase of 1% in negative sentiment rate toward the Asian community in the same month was associated with a 24% increase (incidence rate ratio [IRR] 1.24; 95% CI 1.07-1.44; P=.005) in the number of anti-Asian hate crimes. The association was slightly attenuated after adjusting for unemployment and COVID-19 emergence (ie, after March 2020; P=.008). The positive sentiment toward Asian tweets with a 0-month lag was associated with a 12% decrease (IRR 0.88; 95% CI 0.79-0.97; P=.002) in expected anti-Asian hate crimes in the same month, but the relationship was no longer significant after adjusting for the unemployment rate and the emergence of COVID-19 pandemic (P=.11). A higher negative sentiment level was associated with more hate crimes specifically targeting the Asian community in the same month. The findings highlight the importance of monitoring public sentiment to predict and potentially mitigate hate crimes against Asian individuals.

A Comparative Review of Cytokines and Cytokine Targeting in Sepsis: From Humans to Horses.

With the emergence of COVID-19, there is an increased focus in human literature on cytokine production, the implications of cytokine overproduction, and the development of novel cytokine-targeting therapies for use during sepsis. In addition to viral infections such as COVID-19, bacterial infections resulting in exposure to endotoxins and exotoxins in humans can also lead to sepsis, resulting in organ failure and death. Like humans, horses are exquisitely sensitive to endotoxin and are among the veterinary species that develop clinical sepsis similar to humans. These similarities suggest that horses may serve as a naturally occurring model of human sepsis. Indeed, evidence shows that both species experience cytokine dysregulation, severe neutropenia, the formation of neutrophil extracellular traps, and decreased perfusion parameters during sepsis. Sepsis treatments that target cytokines in both species include hemoperfusion therapy, steroids, antioxidants, and immunomodulation therapy. This review will present the shared cytokine physiology across humans and horses as well as historical and updated perspectives on cytokine-targeting therapy. Finally, this review will discuss the potential benefits of increased knowledge of equine cytokine mechanisms and their potential positive impact on human medicine.

Impact of COVID-19 pandemic on bone and soft tissue sarcoma patients’ consultation and diagnosis

The coronavirus disease (COVID-19) pandemic negatively affected the diagnosis and treatment of several cancer types. However, this pandemic’s exact impact and extent on bone and soft tissue sarcomas need to be clarified. We aimed to investigate the effect of the COVID-19 pandemic and emergency declaration by the local government on consultation behavior and clinical stage at diagnosis of bone and soft tissue sarcoma. A total of 403 patients diagnosed with bone and soft tissue sarcoma who initially visited three sarcoma treatment hospitals between January 2018 and December 2021 were included. The monthly number of newly diagnosed soft tissue sarcoma patients was reduced by 25%, and the proportion of soft tissue patients with stage IV disease at diagnosis significantly increased by 9% during the COVID-19 pandemic compared to before the COVID-19 pandemic. Furthermore, the monthly number of new primary bone and soft tissue sarcoma patients significantly decreased by 43% during the state of emergency declaration. The COVID-19 pandemic had a negative impact on soft tissue sarcoma patients’ consultation behavior and increased the proportion of advanced-stage patients at initial diagnosis. An emergency declaration by the local government also negatively affected primary bone and soft tissue sarcoma patients’ consultation behavior.

The evolutionary features and roles of single nucleotide variants and charged amino acid mutations in influenza outbreaks during NPI period

The epidemic and outbreaks of influenza B Victoria lineage (Bv) during 2019–2022 led to an analysis of genetic, epitopes, charged amino acids and Bv outbreaks. Based on the National Influenza Surveillance Network (NISN), the Bv 72 strains isolated during 2019–2022 were selected by spatio-temporal sampling, then were sequenced. Using the Compare Means, Correlate and Cluster, the outbreak data were analyzed, including the single nucleotide variant (SNV), amino acid (AA), epitope, evolutionary rate (ER), Shannon entropy value (SV), charged amino acid and outbreak. With the emergence of COVID-19, the non-pharmaceutical interventions (NPIs) made Less distant transmission and only Bv outbreak. The 2021–2022 strains in the HA genes were located in the same subset, but were distinct from the 2019–2020 strains (P < 0.001). The codon G → A transition in nucleotide was in the highest ratio but the transversion of C → A and T → A made the most significant contribution to the outbreaks, while the increase in amino acid mutations characterized by polar, acidic and basic signatures played a key role in the Bv epidemic in 2021–2022. Both ER and SV were positively correlated in HA genes (R = 0.690) and NA genes (R = 0.711), respectively, however, the number of mutations in the HA genes was 1.59 times higher than that of the NA gene (2.15/1.36) from the beginning of 2020 to 2022. The positively selective sites 174, 199, 214 and 563 in HA genes and the sites 73 and 384 in NA genes were evolutionarily selected in the 2021–2022 influenza outbreaks. Overall, the prevalent factors related to 2021–2022 influenza outbreaks included epidemic timing, Tv, Ts, Tv/Ts, P137 (B → P), P148 (B → P), P199 (P → A), P212 (P → A), P214 (H → P) and P563 (B → P). The preference of amino acid mutations for charge/pH could influence the epidemic/outbreak trends of infectious diseases. Here was a good model of the evolution of infectious disease pathogens. This study, on account of further exploration of virology, genetics, bioinformatics and outbreak information, might facilitate further understanding of their deep interaction mechanisms in the spread of infectious diseases.

Lessons learned: drive-through COVID-19 clinic testing during an adaptive epidemic response and a point-of-care test assessment of a computer-read rapid lateral flow immunoassay with fluorescence-based detection.

Background. The COVID-19 pandemic demonstrated a need for robust SARS-CoV-2 test evaluation infrastructure to underpin biosecurity and protect the population during a pandemic health emergency.Gap statement. The first generation of rapid antigen tests was less accurate than molecular methods due to their inherent sensitivity and specificity shortfalls, compounded by the consequences of self-testing. This created a need for more accurate point-of-care SARS-CoV-2 detection methods.Aim. Here we present the lessons-learned during the COVID-19 emergency response in Western Australia including the detailed set-up, evaluation and operation of rapid antigen test in a state-run drive-through sample collection service during the COVID-19 pandemic after the strict border shutdown ended.Methods. We report a conformity assessment of a novel, second-generation rapid antigen test (Virulizer) comprising a technician-operated rapid lateral flow immunoassay with fluorescence-based detection.Results. The Virulizer rapid antigen test demonstrated up to 100% sensitivity (95% CI: 61.0-100%), 91.94% specificity (95% CI: 82.5-96.5%) and 92.65% accuracy when compared to a commercial PCR assay method. Wide confidence intervals in our series reflect the limits of small sample size. Nevertheless, the Virulizer assay performance was well-suited to point-of-care screening for SARS-CoV-2 in a drive-through clinic setting.Conclusion. The adaptive evaluation process necessary under changing pandemic conditions enabled assessment of a simple sample collection and point-of-care testing process, and showed how this system could be rapidly deployed for SARS-CoV-2 testing, including to regional and remote settings.

Recent Scenario of the Indian Healthcare System Post COVID-19 Emergence and in Severely ill Patients

Abstract: The coronavirus disease 2019 pandemic has brought fundamental changes to our priorities and problems, especially those related to the healthcare sector. The COVID-19 pandemic put even the world's most advanced healthcare systems to the test and India's healthcare system has been rattled as well. In this accordance, the Indian government has introduced many new policies and schemes like free vaccination drive, Atmanirbhar Bharat, and free COVID care under Ayushman Bharat. With the continuation of COVID-19, problems like Self-medication and hoarding of medicines among the common population keep on rising and this was due to flu-like symptoms of COVID-19, miss information on social media, or due to less or no interaction between patients and doctors as the population is now shifting to telemedicine which offers the benefit of consultation at their own home. These situations served as a boon to the Pharma sector as stocks of many pharma companies and industries have been reported to have increased in the past 2 years of the pandemic due to an increase in demand and manufacturing and consumption of pharmaceutical goods and also reportedly being increased by alot in coming years. However, this rapid growth of the pharmaceutical sector is beneficial for pharmacists, businessmen, and others who are directly or indirectly associated with the healthcare fraternity but in our opinion, it will negatively impact the Indian economy or can be viewed as a problem which can lead to the downfall of the qualitative aspect of the pharma sector in the long term.

Características de la mortalidad por COVID-19 durante y después de la pandemia en el Perú

Introduction. The COVID-19 emergency caused a pandemic with a great impact on mortality in Peru. Objective. To analyze the magnitude of mortality due to COVID-19 and identify some sociodemographic characteristics. Methods. A descriptive ecological study was carried out, analyzing data on deaths due to COVID-19 during the period 2020-2023, as well as publicly accessible socioeconomic and demographic indicators. The variables included in the study were: year of death, number of deaths, sex, age group, province of origin, natural region, macroregion, human development index (HDI), unmet basic needs (UBN) and population density. Results. 220,628 deaths due to COVID-19 were reported, of which 219,374 (99.43%) occurred during the pandemic and 1,254 (0.57%) in the post-pandemic period; The cumulative mortality rate was 6.76 deaths/1000 inhabitants. The COVID-19 death curve shows that between 2020-2023, five waves occurred, with the second wave having the highest mortality, followed by the first wave. Mortality predominated in men, older adults (69.77%) and adults (28.11%). The macroregion of Metropolitan Lima and Callao had the highest mortality rates with 9.36 deaths/1000 inhabitants. The provinces with the highest cumulative mortality rates were those located on the coast, in quintiles with less NBI, in quintiles with a higher HDI and in those provinces with a higher population density. Conclusions. The COVID-19 pandemic caused high mortality in Peru, being higher in males, older adults, from coastal cities, with higher population density and better socioeconomic indicators.

Contextual Acceptance of COVID-19 Mitigation Mobile Apps in the United States: Mixed Methods Survey Study on Postpandemic Data Privacy.

The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic ("COVID-19 mitigation apps"). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people's acceptance of various COVID-19 mitigation apps deployed throughout the pandemic. This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people's contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people's acceptance of data sharing and data retention practices in various social contexts. A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents' basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people's acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results. Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents' acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios. This study showed that people's acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations.

The impact of mental health and the COVID-19 pandemic on employability and learning outcomes: evidence from Taiwanese University students

In response to the emergence of COVID-19, schools were forced to adopt online learning, which later transitioned into a hybrid mode of teaching. However, these changes in the teaching and learning mode may have an adverse effect on mental health, thereby affecting learning outcomes. Therefore, providing immediate resource support for disadvantaged groups may improve students’ learning outcomes. This study investigated the impact of mental health on employability, learning outcomes in the context of blended learning, and the support provided by school resources among college students. We then analyzed survey data from university students and examined the associations among mental health, employability, learning outcomes before and after blended learning, frequency of seeking counseling, and school resource support. The research findings indicate that as the severity of mental health worsened, participants perceived lower learning ability for their future careers. Moreover, during the pandemic, there were variations in learning outcomes for students exposed to blended learning, but it was found that female students demonstrated better learning outcomes. It was also determined that it is beneficial for disadvantaged students to promptly apply for school resource support, as such support can contribute to improved learning effectiveness. Establishing mental health prevention mechanisms and providing school and external resources in a timely manner are the best solutions for helping students learn.

Reflections from EBA Support Points in Emergency Distance Education

The purpose of this research is to identify the problems experienced by teachers working at EBA Support Points, which were established to ensure the participation of students who could not participate in the distance education process due to the lack of technology infrastructure during the Covid-19 emergency distance education period, and to offer solution suggestions in order to make the emergency distance education processes more effective. For this purpose, the study was carried out in accordance with the case study method in a holistic single case design. The sample in the study consists of 15 teachers working at 15 different EBA Support Points. A semi-structured interview form was used during the data collection phase. The data collected from the recorded interviews were analyzed using the content analysis method. As a result of the research, the problems encountered by teachers working at EBA Support Points in the working environment during the emergency distance education period and the solution suggestions for the problems were collected under the headings of students, teachers and school administrators. When the themes were examined, it was determined that the problems experienced with teachers were about technical support requests, the problems experienced with students were about non-compliance with pandemic rules, and the problems experienced with school administrators were long working hours, inappropriate course schedules and deficiencies in planning. Various suggestions are also given in the study to solve the problems experienced at EBA Support Points.

Public perception on face mask wearing during COVID-19 pandemic in Malaysia: A cross sectional study.

Since the emergence of COVID-19, the Malaysian government has made wearing a face mask in public mandatory since August 1, 2020, as an effort by the government to control the transmission of COVID-19. However, Malaysians' willingness to wear face masks in public is unknown. Thus, this study aimed to evaluate their perception of face mask wearing during COVID-19 and its contributing factors. A total of 1024 respondents, aged ≥ 18 years, participated in this online cross-sectional survey from October 2021 to December 2021. The Face Mask Perception Scale (FMPS) was used to measure their perceptions. Most of the respondents perceived wearing a face mask as uncomfortable. Our findings also revealed statistically significant differences and a small effect (f2 = 0.04) in which respondents who were concerned about being infected by the virus perceived face mask wearing appearance positively (B = - 0.09 units of log-transformed, 95% CI = - 0.15, - 0.04), whereas married respondents perceived it negatively (B = 0.07 units of log-transformed, 95% CI = 0.03, 0.09). There were no statistically significant differences in other domains of FMPS. In conclusion, discomfort was a major complaint. Marital status and fear of COVID-19 infection affected their perceptions. The public health implications of these findings highlight the importance of addressing discomfort and societal perceptions, particularly those influenced by factors such as marital status and COVID-19 experience, to promote widespread acceptance and consistent usage of face masks, which is crucial in mitigating the spread of COVID-19.

Exam scheduling under pandemic conditions: A mathematical model and decision support system

The scheduling of university exams is a complex task that involves various constraints such as administrative limits, pedagogical needs, student volume, and different courses. The emergence of Covid-19 and future pandemics has added new constraints related to infection prevention and contact tracing. To address these challenges, this study proposes a multi-objective mathematical model that considers university resources, reduced classroom occupancy, and minimized student interaction. The model aims to minimize violations of pandemic-related constraints and categorize exams by difficulty. To facilitate scheduling for entire faculties or universities, a Genetic Algorithm based web-based decision support system is developed. With these tools, the study successfully created an optimal schedule for eight departments simultaneously.

The COVID-19 Pandemic and Emergencies in Otolaryngology-Head and Neck Surgery: An Analysis of Patients Presenting to Emergency Rooms in South-West Germany: A Bi-Center Study.

This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (-3.0%) and globus sensation (-3.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (-51.2%), tonsillitis (-55.6%), sinusitis (-59%), and otitis media (-70.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany.

A Multifaceted Approach to Health Crisis in the Philippines Comment on "Experiences and Implications of the First Wave of the COVID-19 Emergency in Italy: A Social Science Perspective"

The COVID-19 pandemic changed the landscape of every country’s healthcare system. May it be a developed nation like Italy or a developing one, like Philippines, it has seriously impacted the different aspects of people’s everyday living. While the epidemiological/pharmacological interventions is the top priority to battle the health crisis, considering the social science perspective in crafting any health policy is a must to develop holistic, relevant, and effective programs for policy-makers. This is not to underestimate the effectiveness of the former but it simply signifies the essential support of the latter for a higher success rate since it is a multifaceted approach. It is important to note that a human is not only composed of physicality, but all the other aspects that are connected to one another, including social, political, and spiritual ones.

Comparison of Team-Based and Problem-Based Approaches to Dementia Care in Nursing Homes and Their Effects on Resident Outcomes During the COVID-19 Pandemic: A Mixed-Methods Study

ObjectivesCompare the effectiveness of 2 nonpharmacologic approaches to dementia care in nursing homes on 12- and 18-month resident outcomes, which was after the emergence of COVID-19. Design and InterventionA cluster randomized pragmatic trial, which included an embedded convergent mixed-methods design. Nursing homes were randomized to a team-based (TB) or problem-based (PB) intervention arm. Setting and ParticipantsResidents (n = 2658 at baseline) and staff (n = 327) from 52 nursing homes in the United States. MethodsThe exploratory quantitative analysis used a difference-in-differences model to compare the change in TB arm resident outcomes between baseline, 12 months, and 18 months relative to the PB arm using the Minimum Data Set 3.0. Outcomes included antipsychotic medication use, behavioral symptoms, wandering, and rejection of care. Staff interview data were analyzed in a 3-phase team-based rapid qualitative analysis approach, after which data were integrated. ResultsRejection of care decreased by 5.9 percentage points in the TB arm relative to the PB arm at 12 months (95% CI –11.7 to −0.2). Emergent results indicated that COVID-19 visitation restrictions prevented PB staff from working with families to manage rejection of care as was done before the pandemic, whereas TB staff described using collaboration strategies not hindered by the pandemic. There was no statistically significant difference between arms in antipsychotic medication use, behavioral symptoms, and wandering at either follow-up period. When integrated, qualitative data provided contradictory information on antipsychotic medication use and confirmatory information on behavioral symptoms and wandering. Conclusions and ImplicationsThe exploratory nature and mixed results of the quantitative data analysis limited the ability to determine a clear benefit of one approach over the other. Findings suggest that dementia care delivery faced complex challenges during COVID-19 and required engagement from a broad range of nursing home staff underscoring the importance of equipping all staff with foundational dementia care knowledge.

Dermatologic manifestations of patients with severe and non-severe COVID-19 infection: A cross-sectional study

Introduction: Since the emergence of COVID-19 in late 2019, multiple concerns have been raised regarding the unknown nature of the disease, including dermatologic complications. In this study, we discussed dermatologic manifestations of patients with COVID-19 infection who visited our clinic. Methods: Eighty- six patients were involved based on our inclusion and exclusion criteria (50 female and 36 male). All patients with definite diagnosis of COVID-19 who were referred to our dermatologic clinic were enrolled in this cross-sectional study. Only lesions which occurred 1 week prior to or 3 months after first COVID-19 symptoms were included. The photographs of all lesions were independently reviewed by four experienced dermatologists and an infectious disease specialist to reach the objectives stated above. Qualitative data presented as frequency (%) and compared using chi-squared or Fisher’s exact test, and quantitative data presented as mean±SD or median (IQR) based on normality, with P value≤0.05 considered statistically significant. Results: Eighty- six patients were enrolled in the study (mean±SD age=36.95±17.78). Eighteen specific types of dermatologic complications were seen. The most common lesions included maculopapular rash and scalp hair loss. The only lesions with a statistically significant difference regarding COVID-19 symptom onset time were maculopapular rash, telogen effluvium, and papular urticaria. The only lesions with statistically significant difference regarding COVID-19 severity were maculopapular rash, telogen effluvium, and urticaria. Conclusion: Our study revealed that a wide range of skin lesions may occur in patients with COVID-19. We found a statistically significant relation between disease severity and certain dermatologic manifestations.