Non-health Care Research Articles

Economic analysis of the ‘Take Charge’ intervention for people following stroke: Results from a randomised trial

Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults (n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving.

Nonmental Healthcare Professionals’ Attitudes Toward Mental Health Services in Asir Region, KSA

Objectives: Most patients who visit other clinics are surprised when they referred to psychiatric clinics, which may be related to the social stigma of mental illness or nonmental health professionals’ (NMHPs) negative attitude toward psychiatric illness. The study aimed to assess attitudes toward mental health services among NMHPs in Asir region, Kingdom of Saudi Arabia (KSA), and to correlate the results with different variables. Methods: We conducted a cross-sectional study among NMHPs (n=358) in Asir region of the kingdom of Saudi Arabia by using an electronic questionnaire through WhatsApp application. Results: Young age, female gender, single marital status, did not ever had known or shared in giving care to a mentally ill person, work experience less than 10 years, nursing specialty, and holding diploma degree represented the significant statistical correlation with negative attitudes toward mental health services scale (p-value = <0.001; 0.01; 0.003; 0.02; <0.001; 0.02 and <0.001, respectively). Conclusion: This study demonstrates positive attitude toward mental health services among NMHPs. There is need for better educational measures and more training courses at the undergraduate level of NMHPs in order to improve such attitude. Future research could investigate the outcomes of these measures and courses.

A Cross-Sectional Analysis to Evaluate Knowledge, Attitude And Practices Among Pregnant Women During COVID-19 Pandemic.

ObjectiveTo assess knowledge, attitude and practices (KAP) towards COVID-19 among pregnant women at a tertiary care hospital.MethodsThis was a questionnaire-based cross-sectional analysis pertaining to COVID-19 which was conducted at a tertiary care obstetric facility in India among 200 consecutive consenting pregnant women. They were assessed for demographic details and KAP score (knowledge—17 questions, attitude—9 questions and practice—8 questions). Analysis of data was done using Statistical Package for the Social Sciences (SPSS) version 25.0.ResultsThe participants had adequate mean knowledge score (± SD) of 22.5 (± 3.5) were following good practices [mean score (± SD) = 15.5 (± 2.6)] and showed positive attitude for preventive measures against COVID-19 [n (%) = 194(96%)]. Low knowledge score (p-value 0.030) was seen in non-health care workers.ConclusionThis study demonstrated that majority of the pregnant women had satisfactory knowledge, positive attitude and were following practices in right manner regarding COVID-19 but continued efforts for generating awareness were warranted. As India is battling the second COVID-19 wave and in the absence of definitive cure, strengthening of health policies directed at pregnant women should be prioritized with special focus on significant gaps in KAP.

Macro level influences on strategic responses to the COVID-19 pandemic - an international survey and tool for national assessments.

BackgroundVariation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitators and inhibitors during the pandemic and to inform the development of an assessment tool for pandemic response planning.MethodsA cross-sectional electronic survey of health and non-health care professionals (5 May - 5 June 2020) in six languages, with respondents recruited via email, social media and website posting. Participants were asked to score inhibitors (-10 to 0) or facilitators (0 to +10) impacting country response to COVID-19 from the following domains – Political, Economic, Sociological, Technological, Ecological, Legislative, and wider Industry (the PESTELI framework). Participants were then asked to explain their responses using free text. Descriptive and thematic analysis was followed by triangulation with the literature and expert validation to develop the assessment tool, which was then compared with four existing pandemic planning frameworks.Results928 respondents from 66 countries (57% health care professionals) participated. Political and economic influences were consistently perceived as powerful negative forces and technology as a facilitator across high- and low-income countries. The 103-item tool developed for guiding rapid situational assessment for pandemic planning is comprehensive when compared to existing tools and highlights the interconnectedness of the 7 domains.ConclusionsThe tool developed and proposed addresses the problems associated with decision making in disciplinary silos and offers a means to refine future use of epidemic modelling.

Predictors for Recurrent 30-Day Unplanned Readmissions in Patients with Hematologic Malignancies

BackgroundNewly diagnosed hospitalized patients (pts) with hematologic malignancies (HM) frequently have high symptom burden, often need prolonged courses of highly myelosuppressive chemotherapy and consequent protracted transfusion support- factors that predispose these pts to unplanned readmissions (UR). Given the paucity of data on risk factors associated with repeated UR in HM pts, we first analyzed the baseline characteristics of pts with one or more 30-day UR and then evaluated factors that predicted for additional 30-day UR following the first 30-day UR event.MethodsAdult (≥ 18 years) HM pts treated at Cleveland Clinic between January 2011-February 2016 were included in the study. Thirty-day UR was defined as hospitalization within 30 days of index admission for any reason other than planned chemotherapy. A readmission event served as an index admission for the subsequent readmission. Bone marrow transplant pts were excluded. HM included acute leukemias, myelodysplastic syndromes (MDS) and aggressive lymphomas (Diffuse Large B-Cell Lymphoma, Burkitt's). Demographics (age, race, sex, highest education attained, median income, payer status), clinical characteristics (HM type, symptoms at index admission/readmission, disease status, body mass index at discharge, absolute neutrophil count (ANC) at discharge/readmission, and discharge on intravenous antibiotics or narcotics), hospitalization (reason for readmission, length of stay (LOS) at index admission/readmission), and discharge characteristics (discharged to and readmitted from) were collected. Data were analyzed using Fisher's exact test chi-square tests, and t-tests for univariable analyses; and logistic regression for multivariable analyses. Recursive partitioning was used to find cut points for continuous factors.ResultsA total of 259 thirty-day UR were observed in 157 pts - 107 had a single 30-day UR, while 50 (32%) had > 2 UR. The majority of pts were males (59%), with a median age of 66 years (yrs, interquartile range (IQR) 48-75). Acute myeloid leukemia was the most common HM diagnosis (44%) and 50% had relapsed or refractory disease. Pt median income was $51,700 and 86% (IQR, 80-90%) had greater than a high school education, using census tract based data (Table 1). By payer source, 49% of pts were covered by Medicare, 12% by Medicaid, and 36% by private insurance. Discharges following UR were to: home (50%), home with home health (32%), nursing facility (15%) and hospice (3%). Of the discharges after UR, 10% were discharged on intravenous antibiotics, 44% on opioids and 48% on psychotropic drugs. Neutropenic fever with or without a confirmed source was the primary diagnosis (61%) for 30-day UR and 59% had symptoms at presentation. Median ANC at discharge from an UR was 870/mL (IQR 190-3570) and was 940/mL (IQR, 100-3700) at the time of readmission. The median LOS during 30-day UR was 5 days (IQR 3-10) and the median interval from prior discharge to readmission was 11 days (IQR 5-19). The majority of 30-day UR originated from outpatient clinic, emergency department, or pt's home (46%) followed by a non-health care facility (27%) and outside hospital transfers (22%). Table 1 shows univariable analysis of factors significantly associated with 30-day UR. In multivariate analysis, factors that independently predicted for subsequent 30-day UR included pts with the following characteristics - ANC <2000/mL at last discharge (OR 7.5, P=.0002), constitutional symptoms (fevers/chills/sweats/severe fatigue at index admission presentation) (OR 5.84, P=.002), gastrointestinal symptoms (OR 5.11, P=.009), if pt was transferred from an outside facility (OR 3.26, P=.005), febrile neutropenia as reason for index admission (OR 3.18, P=.0001), relapsed/refractory disease (OR 2.94, P=.009), and higher education (OR 2.08, P=.01).ConclusionOur findings suggest directing UR reduction strategies to optimize symptom control (constitutional and gastrointestinal) prior to discharge and design specific measures for the cohort with relapsed/refractory disease who might further benefit with individualized care from a multidisciplinary care team, and closer ambulatory follow up. Increased risk of additional 30-day UR with education may reflect better understanding of care complexities resulting in a lower threshold for seeking care with a change in medical condition, or possibly a surrogate for better health care access. [Display omitted] DisclosuresGerds:Incyte: Consultancy; CTI BioPharma: Consultancy. Advani:Takeda/ Millenium: Research Funding; Pfizer: Consultancy. Sekeres:Celgene: Membership on an entity's Board of Directors or advisory committees.

End-of-Life Planning: Normalizing the Process

ABSTRACT End-of-life (EOL) planning occurs across the United States at a frequency of below 50%, suggesting a new approach to encourage action is in order, especially as COVID-19 and other potentially lethal conditions emerge. Utilizing data from a multi-year survey of 2,614 adults in Nebraska, this study examined demographic factors related to completion of EOL planning documents, and identified people with whom EOL wishes could, and had been discussed. Logistic regression estimates indicated more reliance on non-health care providers for EOL discussions. This shift with whom people would discuss EOL wishes may afford others an opportunity to encourage EOL discussions.

Partisan Differences in Twitter Language Among US Legislators During the COVID-19 Pandemic: Cross-sectional Study

BackgroundAs policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems.ObjectiveWe examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared.MethodsWe used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation.ResultsWe found that health care–related themes in Democratic legislators’ tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators’ discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care–related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23).ConclusionsDivergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis.

Does the advice requested by carers of people who live with dementia reflect the level of commissioned post-diagnostic support? A retrospective evaluation of calls to the Me2U dementia day centre 24-hour advice line

AimsThe aim was to examine the reasons for advice requests by carers of people who live with dementia (PLWD) that attend the Me2u dementia day centre in order to identify key explanatory themes. We hypothesised that requests were related mainly to coordinating care and clinical issues due to limited post-diagnostic support (PDS) in our area.BackgroundThe Me2u dementia day centre (Merseyside) cares for PLWD and also supports carers. As part of the service, a 24-hour advice line is included for PLWD and their carers who attend the centre. Locally, there is limited PDS and most carers navigate the health and social care system alone mirroring the findings by the National Collaborating Centre for Mental Health (NCCMH).MethodWe undertook a retrospective evaluation of 244 advice calls, from 64 carers, between 01/06/2019 and 31/12/2019. We analysed time of call, type of advice, type of dementia, age and whether the advice was for the PLWD or for the carer.ResultOf the 244 calls, the most common time to call was between 09.00 - 14.00 (n = 168; (68.8%) peak 09.00 - 10.00 (n = 38). Average age of the person about whom the advice was sought was 79.08 years. 91.4% of the advice calls related to PLWD (most common dementia Alzheimer's) and 8.6% to the carer only. The mean number of calls per person was 3.8 (range 1–24).Advice data were grouped into 9 broad themes namely, related to symptoms/behaviour (32.79%, n = 80), request for Me2u to coordinate care (20.08%, n = 49), general advice (14.75%, n = 36), personal care (9.42%, n = 23), carer only advice (8.60%, n = 21), social issues (6.14%, n = 15), social care (4.50%, n = 11), safeguarding (2.46%, n = 6), non-health and social care issue (1.23%, n = 3).ConclusionReasons for limited/poor PDS given by the NCCMH are; absence of named coordinators of care, over-reliance on families and carers to manage and facilitate appointments, poor recognition and management of comorbidities. This data show that 52.87% of calls were for clinical advice and coordination of care reflecting NCCMH findings. The interventions post-call reduced the impact on providers of urgent care.These findings provide support for the provision of a [24-hour] advice line as a routine part of post-diagnostic support services, especially in areas that have limited or poor PDS. Commissioners of PDS services in areas that have limited or poor PDS should make this a priority to prevent unplanned admissions to hospital and carer breakdown.

Exploring the Role of Item Scenario Features on Situational Judgment Test Response Selections

Objective. To explore pharmacists' and pharmacy students' perceptions regarding the significance of changing the features of test item scenario (eg, switching from a health care to a non-health care context) on their situational judgment test (SJT) responses.Methods. Fifteen Doctor of Pharmacy students and 15 pharmacists completed a 12-item SJT intended to measure empathy. The test included six scenarios in a health care context and six scenarios in a non-health care context; participants had to rank potential response options in order of appropriateness and no two items could be of equal rank. Qualitative data were collected individually from participants using think-aloud and cognitive interview techniques. During the cognitive interview, participants were asked how they selected their final responses for each item and whether they would have changed their answer if features of the scenario were switched (eg, changed to a non-health care context if the original item was in a health care context). Interviews were transcribed and a thematic analysis was conducted to identify the features of the scenario for each item that were perceived to impact response selections.Results. Participants stated that they would have changed their responses on average 51.3% of the time (range 20%-100%) if the features of the scenario for an item were changed. Qualitative analysis identified four pertinent scenario features that may influence response selections, which included information about the examinee, the actors in the scenario, the relationship between examinee and actors, and details about the situation. There was no discernible pattern linking scenario features to the component of empathy being measured or participant type.Conclusion. Results from this study suggest that the features of the scenario described in an SJT item could influence response selections. These features should be considered in the SJT design process and require further research to determine the extent of their impact on SJT performance.

Comparison of prevalence and risk factors of somatization between Chinese health care workers and non-health care workers during COVID-19 outbreak

BackgroundThis study aimed to compare prevalence and risk factors of somatization (SOM) between health care workers and non-health care workers during COVID-19 outbreak in China.MethodsFrom 14 February to 29 March 2020, an online survey was performed in both 605 health care workers and 1151 non-health care workers. Based on the somatization dimension score of the Symptom Checklist-90, participants were divided into non-SOM group and SOM group.ResultsHealth care workers had higher prevalence rate of SOM (p < 0.001) than non-health care workers, with an OR of 1.70 (95% CI, 1.22–2.36, p = 0.002). Multiple logistic regression analysis revealed that in non-health care workers, the risk factors of SOM included other ethnicities, insomnia, and suicide, while in health care workers, the risk factors included working 6–8 h per day, and working ≥10 h per day during COVID-19 outbreak.ConclusionsOur research suggests that both non-health care workers and health care workers have a relatively high prevalence of somatization. However, the related factors for somatization in both groups are significantly different, showing that medical service-related factors are associated with somatization in health care workers, while demographic and clinical factors are associated with somatization in non-health care workers.

Intention to receive a COVID-19 vaccine: results from a population-based survey in Canada

BackgroundThe success of any COVID-19 vaccine program ultimately depends on high vaccine uptake. This study determined overall intention to receive a COVID-19 vaccine and identified factors that predict intentions to be vaccinated against COVID-19 in Canada, specifically in key priority groups identified by the American Committee on Immunization Practice (ACIP) and the National Advisory Committee on Immunization (NACI) for early immunization.MethodsIndividuals from research cohorts from the general population of British Columbia aged 25–69 were invited complete an online survey based on validated scales and theoretical frameworks to explore intention to receive a COVID-19 vaccine. Two multivariable logistic regression models were conducted to determine factors associated with intention to receive the COVID-19 vaccine.ResultsOf 4948 respondents, 79.8% intended to receive a COVID-19 vaccine. In multivariable modeling, respondents who intended to receive the vaccine had higher vaccine attitudinal scores (p < 0.001), reported greater influence of direct social norms (p = 0.001), and indirect social norms, including their family physician (p = 0.024), and Provincial Health Officer (p = 0.011). Older individuals (> 60 years) were more likely to intend to receive the vaccine, while females (95%CI 0.57,0.93), those with less than high school education (95%CI 0.5,0.76), those who self-identified as non-white (95%CI 0.60,0.92), self-identified as Indigenous (95%CI 0.36,0.84) and essential non-health care workers (95%CI 0.59,0.86) had lower adjusted odds of intending to receive a COVID-19 vaccine.ConclusionsTo optimize vaccine coverage, public health should focus on key messages around vaccine safety and benefit, and leverage trusted practitioners for messaging. As certain key populations identified by NACI and ACIP for early immunization report a lower intention to vaccinate, there is a need for in-depth education and support for these communities to ensure optimal uptake.

Innovations in COVID-19 testing: the road from pandemic response to control

Innovations in COVID-19 testing: the road from pandemic response to control

A Study on Assessment of Knowledge and To Create Awareness Regarding COVID-19 Infection and Its Preventive Measures among Health Care Students and Non-Health Care Students

Background: The World Health Organization (WHO) declared covid-19 as a pandemic on 11th march 2020. Since no treatment is available, following preventive measures is only the effective way to stop the spread of covid-19. This study aimed to assess knowledge regarding covid-19 and its preventive measures and to create awareness about covid-19 among healthcare students and non-healthcare students. Methods: An online cross sectional study was conducted in 2 months i.e., from 1st Aug. 2020 to 30th Sept. 2020 among healthcare students and non-health care students. To determine the scoring of questionnaire, mean of knowledge scores and standard deviation were calculated. Results: A total of 766 students were participated in this study. The age of participants ranged from 18 to 23. Males were 496 and females were 270. Health care students were 423 and 343 students are non-health care students. Overall knowledge about covid-19 infection was good among 480 students, average among 183 students and was poor among 103 students. The mean knowledge score of healthcare students (8.41) is higher than non-health care students (6.11) towards covid-19 infection and its preventive measures. Conclusion: This study reveals that majority of the students were knowledgeable about covid-19 infection and its preventive measures. The mean knowledge score of healthcare students (8.41) is higher than non-health care students (6.11) indicating that the health care students have more knowledge. Though the overall knowledge on covid-19 was good enough among health care students and non-health care students, still there is a need for education to increase knowledge especially among non-health care students. Keywords: SARS-COV 2 virus, Covid-19 infection, health care students, non-healthcare students, knowledge, awareness, India.

Bias in a blink: Shedding light on implicit attitudes toward patients with a cleft lip

Previous studies have shown that patients with cleft lip and/or palate may be stigmatized in society. The objective of this study was to use an implicit association test to evaluate the subconscious biases of non-health care providers and orthodontists against patients with a repaired cleft lip (CL). Respondents participated in an implicit association test. Pictures of patients with CL and controls were shown to participants, along with terms representing positive and negative attributes. Participants were prompted to match pictures to the attributes. The software algorithm detected whether the participants were more likely to associate CL with positive or negative terms than controls. Demographic information was collected to measure the association between some sociodemographic factors and implicit biases. Of 130 valid participants, 52 were orthodontists and 78 were non-health care providers. The entire sample displayed a significant implicit bias against CL (P<0.001). Overall, orthodontists tended to exhibit slightly higher levels of implicit biases against CL than non-health care providers, but the difference was not significant when controlling for sociodemographic factors (P=0.34). Females showed significantly lower implicit biases against CL than males (P=0.046). Spearman correlations showed that older people and those who reported a more conservative political affiliation tended to show slightly higher levels of implicit biases against CL (P<0.007). Orthodontists and non-health care providers showed moderate but significant levels of implicit biases against patients with clefts. Males, older age groups, and patients with a more conservative political affiliation tended to exhibit slightly higher levels of biases than females, younger people, and those with a more liberal political affiliation.

Protocol for a mixed methods process evaluation of the LinkMM randomised controlled trial "Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas".

Background Multimorbidity, defined as two or more chronic conditions is increasing in prevalence and is associated with increased health care use, fragmented care and poorer health outcomes. Link workers are non-health or social care professionals who support people to connect with resources in their community to improve their well-being, a process commonly referred to as social prescribing. The use of link workers in primary care may be an effective intervention in helping those with long-term conditions manage their illness and improve health and well-being, but the evidence base in limited. The LinkMM study is a randomised controlled trial of the effectiveness of link workers based in primary care, providing social prescribing and health and social care coordination for people with multimorbidity. The aim of the LinkMM process evaluation is to investigate the implementation of the link worker intervention, mechanisms of impact and influence of the specific context on these, as per the Medical Research Council framework, using quantitative and qualitative methods. Methods Quantitative data will be gathered from a number of sources including researcher logbooks, participant baseline questionnaires, client management database, and will be analysed using descriptive statistics. Semi structured interviews with participants will investigate their experiences of the intervention. Interviews with link workers, practices and community stakeholders will explore how the intervention was implemented and barriers and facilitators to this. Thematic analysis of interview transcripts will be conducted. Discussion The process evaluation of the LinkMM trial will provide important information allowing a more in-depth understanding of how the intervention worked and lessons for future wider scale implementation.

The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews

BackgroundPolicymakers in many countries promote collaboration between health care organizations and other sectors as a route to improving population health. Local collaborations have been developed for decades. Yet little is known about the impact of cross-sector collaboration on health and health equity.MethodsWe carried out a systematic review of reviews to synthesize evidence on the health impacts of collaboration between local health care and non-health care organizations, and to understand the factors affecting how these partnerships functioned. We searched four databases and included 36 studies (reviews) in our review. We extracted data from these studies and used Nvivo 12 to help categorize the data. We assessed risk of bias in the studies using standardized tools. We used a narrative approach to synthesizing and reporting the data.ResultsThe 36 studies we reviewed included evidence on varying forms of collaboration in diverse contexts. Some studies included data on collaborations with broad population health goals, such as preventing disease and reducing health inequalities. Others focused on collaborations with a narrower focus, such as better integration between health care and social services. Overall, there is little convincing evidence to suggest that collaboration between local health care and non-health care organizations improves health outcomes. Evidence of impact on health services is mixed. And evidence of impact on resource use and spending are limited and mixed. Despite this, many studies report on factors associated with better or worse collaboration. We grouped these into five domains: motivation and purpose, relationships and cultures, resources and capabilities, governance and leadership, and external factors. But data linking factors in these domains to collaboration outcomes is sparse.ConclusionsIn theory, collaboration between local health care and non-health care organizations might contribute to better population health. But we know little about which kinds of collaborations work, for whom, and in what contexts. The benefits of collaboration may be hard to deliver, hard to measure, and overestimated by policymakers. Ultimately, local collaborations should be understood within their macro-level political and economic context, and as one component within a wider system of factors and interventions interacting to shape population health.

The development of a reliable and valid instrument to measure the osteoporosis-related knowledge: validation of the Hungarian version of Osteoporosis Knowledge Assessment Tool (OKAT)

BackgroundOsteoporosis is one of the most common chronic musculoskeletal diseases. Osteoporosis-related knowledge is an important contributor in to prevent osteoporosis. There is no validated reliable questionnaire to measure the knowledge in Hungary. The aim of the study was to validate the Osteoporosis Knowledge Assessment Tool (OKAT) Hungarian version.MethodsThe research was a randomized validation study of a new Hungarian language instrument. The questionnaire was administered to 557 randomly selected healthy women (age between 25 and 44 years) from December 2018 to July 2019 in Baranya county, Hungary. The reliability was examined by the Flesch reading ease and McNemar’s test. We examined item discrimination and item-total correlations, inter-item consistency (Cronbach’s alpha coefficient) and principal component factor analysis.ResultsSignificant differences (p < 0.001) were reported between total scores and the age categories. Significant (p < 0.001) correlation (r = 0.25) was found between the education level and the knowledge. Significantly (p < 0.001) higher knowledge were found in health care profession (14.53 ± 3.58) than the non-health care profession (9.99 ± 4.04). Participants with osteoporosis or fracture in family history had better knowledge (p < 0.001). Flesch reading ease was 44, the questionnaire had a Ferguson’s sigma of 0.94 and a Cronbach’s alpha of 0.81. There were no negative inter-item correlations psychometric properties of the OKAT, all items had more than 70% of correlations (p < 0.001).ConclusionsThe Hungarian version of the Osteoporosis Knowledge Assessment Tool is a reliable and objective questionnaire to measure women’s knowledge in Hungary.

61 Real-time Burn Outpatient Virtual Visits in the Home During the Era of COVID-19

IntroductionThe majority of burn injured patients travel long distances to receive burn care from regional burn centers, creating a burden on families and impairing outcomes. Recent federal policies in response to the COVID-19 pandemic have relaxed some of the barriers to virtual visits in the non-health care setting. We sought to review the experience of a comprehensive burn program in managing burn patients with a virtual platform.MethodsA clinical quality database was maintained to evaluate virtual videoconference and in-person clinic visits for a comprehensive adult and pediatric burn program during the COVID-19 pandemic (March 2020 to August 2020). Virtual visits utilized a telemedicine platform that employs real-time audio and video communication. Demographic, burn severity, and visit quality data were recorded. Zip code data was also collected and then used to calculate the following estimated savings for the patient and their family: total miles, travel hours, driving costs, and wages.ResultsA total of 145 patients were included in this study with 96 (66.2%) male and 49 (33.7%) female. 91 (62.8%) were pediatric patients with a mean age of 6.2 ± 0.5 years and 54 (37.2%) were adult patients with a mean age of 40.4 ± 2.5 years. There were 320 total burn outpatient follow-up visits with 199 pediatric visits (40 virtual and 159 in-person) and 121 adult visits (24 virtual and 97 in-person). The majority of patients (73.1%) were treated as in-person visits while 6.9% had purely virtual visits, and 20.0% of patients had both virtual and in-person visits. The following savings were associated with virtual visits: 8562.6 total miles (average 133.8 ± 42.4), $6789.29 total driving cost (average $106.08 ± 33.61), 161.5 total travel hours (average 2.5 ± 0.7), and $4758.42 total wages lost to travel (average $74.35 ± 21.43). Technical issues were only reported in 14% of total visits (2.5% of pediatric virtual visits and 33.3% of adult virtual visits).ConclusionsOutpatient virtual visits for burn care are a new frontier, driven by improvements in technology and reduced barriers to reimbursement. This study demonstrates that virtual visits are associated with major financial and temporal benefits for patients and their families. Technical issues remain an important barrier, particularly in the adult population. A clear understanding of this and other barriers may improve implementation of this new healthcare delivery paradigm.

"Face mask dermatitis" due to compulsory facial masks during the SARS-CoV-2 pandemic: data from 550 health care and non-health care workers in Germany.

BackgroundDuring the COVID-19 pandemic, wearing face masks is mandatory not only for health care workers (HCWs) but also for the general population in many countries around the globe.ObjectivesThe aim of the study was to investigate the onset of adverse facial skin reactions due to compulsory face masks during the COVID-19 pandemic in HCWs and non-HCWs, and draw awareness of this new dermatological condition and its preventive measures.Materials & MethodsA questionnaire was distributed to 550 patients and HCWs from the Department of Dermatology and Allergy of the University Hospital Munich (LMU), Germany. Participants were surveyed regarding mask type, duration of usage and adverse facial skin reactions. Information on symptoms and the use of skin care products and topical drugs were retrieved.ResultsThe duration of wearing masks showed a significant impact on the prevalence of symptoms (p < 0.001). Type IV hypersensitivity was significantly more likely in participants with symptoms compared to those without symptoms (p = 0.001), whereas no increase in symptoms was observed in participants with atopic diathesis. HCWs used facial skin care products significantly more often than non-HCWs (p = 0.001).ConclusionPreventive and therapeutic measures should be established in order to avoid “face mask dermatitis”, especially for people with underlying risk factors.

COVID-19 Vaccination Acceptance Among Healthcare Workers and Nonhealthcare Workers in China: A Survey

Background: The coronavirus pneumonia is still spreading around the world. Much progress has been made in vaccine development, and vaccination will become an inevitable trend in the fight against this pandemic. However, the public acceptance of COVID-19 vaccination still remains uncertain. Methods: By calculating the sample size of random sampling, anonymous questionnaire was used in Wen Juan Xing survey platform. Multinomial logistic regression analyses were performed to identify the key sociodemographic, cognitive, and attitude associations with samples of healthcare workers and nonhealth care workers. Findings: A total of 2580 respondents have completed the questionnaire, including 1,329 healthcare workers and 1,251 nonhealthcare workers. This study showed that 76.98% of healthcare workers accepted the COVID-19 vaccine, 18.28% workers were hesitant, and 4.74% workers were resistant. Among the nonhealthcare workers, 56.19% workers received the COVID-19 vaccine, 37.57% workers were hesitant, and 6.24% workers were resistant. Among the healthcare workers, compared with vaccine recipients, vaccine-hesitant individuals were more likely to be female (AOR = 1.52, 95% CI: 1.12–2.07); vaccine-resistant individuals were more likely to live in the suburbs (AOR = 2.81, 95% CI: 1.44–3.99) with an income of 10,000 RMB or greater (AOR = 2.00, 95% CI: 1.03–3.90). Among the nonhealthcare workers, vaccine-hesitant individuals were more likely to be female (AOR = 1.66, 95% CI: 1.31–2.11); vaccine-resistant individuals were also more likely to be female (AOR =1.87, 95% CI: 1.16–3.02) and older than 65 years (AOR = 4.96, 95% CI: 1.40–7.62). There are great differences between healthcare workers and nonhealthcare workers in their cognition and attitude towards vaccines. Interpretation: Our study shows that healthcare workers are more willing to be vaccinated than nonhealthcare workers. Current vaccine safety issues continue to be a major factor affecting public acceptance, and to expand vaccine coverage in response to the COVID-19 pandemic, appropriate vaccination strategies and immunization programs are essential, especially for nonhealthcare workers.Funding: Medical and Technology Project of Zhejiang ProvinceDeclaration of Interest: None to declare. Ethical Approval: This study is a nation-wide cross-sectional study in China; the ethics committee ofAffiliated Hospital of Hangzhou Normal University approved all the procedures performed.