Regular Health Care Research Articles

Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020.

We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic.

Abstract 069: Missed Opportunities For The Control Of Hypertension In Premenopausal Women In The US

Background: Cardiovascular disease (CVD) is the number one killer in US women, and hypertension the most common modifiable risk factor. Though women have had better control of hypertension than men, control rates have declined over the past decade. We quantify US population estimates of missed opportunities for hypertension control in premenopausal women with access to regular healthcare. Methods: We used National Health and Nutrition Examination Survey (2011-2018) to identify US women aged 35-54 years with no prior CVD. Within this sample we identified the population prevalence of respondents with hypertension (SBP ≥ 140mmHg or DBP ≥ 90mmHg), a usual healthcare provider, attending at least two visits per year, awareness (ever been told you have hypertension), treatment (prescribed and taking hypertension medication) and control (SBP &lt; 140mmHg) of blood pressure. We derived hypertension control cascades for this population comparing 2011-2014 and 2015-2018. Results: The prevalence of hypertension in women age 35-54 years with no prior CVD was 6.4M in 2011-2014 and rose to 8.5M in 2015-2018. The prevalence at each stage and the missed opportunities to intervene are presented in the hypertension control cascade (Figure 1). In 2015-2018 only two thirds of this population had access to regular healthcare. Among the women with hypertension in regular care, the greatest missed opportunity occurred in those who are unaware of their hypertension (25%), followed by those untreated (11%) and uncontrolled (6%). Conclusion: The number of premenopausal women with hypertension in the US increased by 25% from the start to the finish of the prior decade. Although most of these 2.1 million women are cared for by healthcare professionals, considerable gaps exist in awareness, treatment, and control of their hypertension, gaps that have not improved substantially over the decade. Improvements in hypertension prevention, access to care, and delivery of guideline-concordant care for premenopausal women should be a priority.

Abstract P032: Initiating Hypertension Treatment To Prevent Incident Cardiovascular Disease: A Population Estimate Using The Cardiovascular Disease Policy Model

Background: Hypertension is a leading preventable cause of CHD, stroke, and heart failure (HF). WHO hypertension guidelines recommend initiating first dose medication in hypertensive adults with access to healthcare, yet many US adults with a usual source of care are not receiving treatment. We estimate the population impact of initiating hypertensive therapy in untreated US adults with uncontrolled blood pressure (BP) and access to usual healthcare on incident CVD. Methods: We used the CVD Policy Model, a dynamic state-transition model of CVD risk factors, events, and outcomes to simulate the impact over 10 years of treating uncontrolled BP in our target population of US adults 35-94 years of age with no prior CVD, baseline systolic BP ≥140mmHg, and no current hypertensive medication use, estimated from National Health and Nutrition Examination Survey years 2015-2018. We initiated first dose medication in the target population reporting access to a usual source of healthcare and at least two visits per year. We used the Law, Morris and Wald equation to estimate the systolic BP effect size for a standard first dose of medication. Results: Initiating hypertension medications in those with currently untreated but with regular healthcare access would prevent 214,000 incident CVD events in the US, a quarter of which (52,000) are incident heart failure (Table 1). First dose treatment (and maintenance) would be expected to reduce incident CHD by 9.1%, HF by 6.1%, ischemic stroke by 8.1%, and hemorrhagic stroke by 11.3% over the decade, compared to no treatment. Treatment of hypertension would have the greatest relative benefit in the prevention on incident CVD events in those younger than 65, compared with those over 65 years of age. Conclusion: In the US population with regular access to healthcare, initiating first dose medications for hypertension in those with elevated blood pressure but currently untreated would reduce incident CVD in both sexes and all age groups, with particular benefit for prevention in those less than 65 years of age.

Abstract P4-12-06: A patient experience model of diagnosis of pregnancy associated breast cancer (PABC)

Abstract Breast cancer is the most prevalent malignancy in pregnancy. Pregnancy-associated breast cancer (PABC), defined here as cancer detected during pregnancy or in the first year after miscarriage or delivery, accounts for nearly 7% of breast cancers in women under 45 years of age. This rate nearly doubles among women under 35. While there is increasing attention to the pathology of PABC, little is known about the pathways to diagnosis, how these young women navigate these pathways, and the barriers resulting in delays. Methods We conducted a qualitative study of young breast cancer survivors (YBCS) under age 45 to explore their paths to diagnosis. We administered a 52-item online survey to a convenience sample of YBCS (n=163), including open-ended questions about diagnosis experience and multiple-choice and short answer questions on demographics and disease status. This analysis focuses on the subset of women diagnosed with PABC (n=26). Data were analyzed using qualitative methods of content analysis. Results Our analysis generated a patient-experience model of YBCS diagnosis comprised of four phases: discovery, exploration, investigation, and confirmation. In discovery, women with PABC often delayed seeking care, attributing breast changes to pregnancy or breastfeeding and waiting to explore symptoms until their next scheduled clinic appointment. Participants also reported delays following discovery due to availability of newborn/child-care or insurance issues. In exploration, women with PABC frequently relied on their regular healthcare provider to assess their symptoms. They reported that providers often expressed confidence that symptoms were due to pregnancy or breastfeeding and did not recommend further investigation until symptoms worsened. Women with PABC generally demonstrated trust in providers’ assessments of symptoms, with limited evidence to suggest that respondents requested more aggressive or timely evaluation. In investigation, women with PABC reported that when symptoms progressed, the pace of the diagnostic process shifted, moving quickly with few delays or barriers, and rapid scheduling for diagnostic testing and follow-up managed by the healthcare provider. This rapid pace continued through confirmation, when respondents noted prompt, short intervals between diagnostics and intensive activities in preparation for treatment. Women with PABC also noted they often received referrals for mental health support as part of the diagnosis process. While participants reported frequent reliance on their partner, mother, and mother-in-law for support, they often experienced isolation due to the time and effort required to care for a newborn during preparation for breast cancer treatment. Conclusions This patient-experience model of pregnancy associated breast cancer diagnosis in young women documents the timing and nature of delays, including the phases where delays occur most frequently, and can help inform the development and evaluation of targeted interventions to improve timely care. Delays experienced in the discovery and exploration phases are often due to the attribution of symptoms to pregnancy or breastfeeding by both patients and possibly their healthcare providers. The intensity and pace of the diagnostic process shifts notably when symptoms progress, with healthcare providers taking an active role to ensure rapid diagnosis and treatment planning. The model identifies opportunities for health care systems to address barriers and facilitators to the diagnostic process for PABC and improve quality of care across all phases. A detailed understanding of the PABC patient experience identifies opportunities to reduce barriers to care, facilitate timely diagnosis, and provide a roadmap to support the unique needs of young women undergoing an evaluation for breast cancer while pregnant or postpartum. Citation Format: Tamara Hamlish, Sarah Strom, Pamela Ganschow. A patient experience model of diagnosis of pregnancy associated breast cancer (PABC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-06.

Insight into the content of and experiences with follow-up conversations with bereaved parents in paediatrics: A systematic review.

AimA follow‐up conversation with bereaved parents is a relatively well‐established intervention in paediatric clinical practice. Yet, the content and value of these conversations remain unclear. This review aims to provide insight into the content of follow‐up conversations between bereaved parents and regular healthcare professionals (HCPs) in paediatrics and how parents and HCPs experience these conversations.MethodsSystematic literature review using the methods PALETTE and PRISMA. The search was conducted in PubMed and CINAHL on 3 February 2021. The results were extracted and integrated using thematic analysis.ResultsTen articles were included. This review revealed that follow‐up conversations are built around three key elements: (1) gaining information, (2) receiving emotional support and (3) facilitating parents to provide feedback. In addition, this review showed that the vast majority of parents and HCPs experienced follow‐up conversations as meaningful and beneficial for several reasons.ConclusionAn understanding of what parents and HCPs value in follow‐up conversations aids HCPs in conducting follow‐up conversations and improves care for bereaved parents by enhancing the HCPs' understanding of parental needs.

Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study.

BackgroundElectronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients’ use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level.ObjectiveThe aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3.MethodsData from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders’ personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method.ResultsThe overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (β=.12, 95% CI 0.02-0.22; P=.02).ConclusionsThis study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.

Changes in cardiovascular mortality in Chile during the COVID-19 pandemic

ObjectivesThe COVID-19 pandemic has impacted regular cardiovascular healthcare access and delivery. Service utilisation has declined, and excess cardiovascular mortality has been reported in several countries. We aim to estimate excess...

Inequalities in access to healthcare by local policy model among newly arrived refugees: evidence from population-based studies in two German states

BackgroundAccess to healthcare is restricted for newly arriving asylum seekers and refugees (ASR) in many receiving countries, which may lead to inequalities in health. In Germany, regular access and full entitlement to healthcare (equivalent to statutory health insurance, SHI) is only granted after a waiting time of 18 months. During this time of restricted entitlements, local authorities implement different access models to regulate asylum seekers’ access to healthcare: the electronic health card (EHC) or the healthcare voucher (HV). This paper examines inequalities in access to healthcare by comparing healthcare utilization by ASR under the terms of different local models (i.e., regular access equivalent to SHI, EHC, and HV).MethodsWe used data from three population-based, cross-sectional surveys among newly arrived ASR (N=863) and analyzed six outcome measures: specialist and general practitioner (GP) utilization, unmet needs for specialist and GP services, emergency department use and avoidable hospitalization. Using logistic regression, we calculated odds ratios (OR) and 95% confidence intervals for all outcome measures, while considering need by adjusting for socio-demographic characteristics and health-related covariates.ResultsCompared to ASR with regular access, ASR under the HV model showed lower needs-adjusted odds of specialist utilization (OR=0.41 [0.24-0.66]) while ASR under the EHC model did not differ from ASR with regular access in any of the outcomes. The comparison between EHC and HV model showed higher odds for specialist utilization under the EHC model as compared to the HV model (OR=2.39 [1.03-5.52]). GP and emergency department utilization, unmet needs and avoidable hospitalization did not show significant differences in any of the fully adjusted models.ConclusionASR using the HV are disadvantaged in their access to healthcare compared to ASR having either an EHC or regular access. Given equal need, they use specialist services less. The identified inequalities constitute inequities in access to healthcare that could be reduced by policy change from HV to the EHC model during the initial 18 months waiting time, or by granting ASR regular healthcare access upon arrival. Potential patterns of differences in GP utilization, unmet needs, emergency department use and avoidable hospitalization between the models deserve further exploration in future studies.

Factors Associated with Oral Cancerous and Precancerous Lesions in an Underserved Community: A Cross-Sectional Study.

Street-involved people with limited access to regular healthcare have an increased risk of developing oral cancer and a lower survival rate. The objective of this study was to measure the prevalence of oral cancerous/precancerous lesions and determine their associated risk factors in a high-risk, underserved population. In this cross-sectional study, English-speaking adults aged 18 years and older living in a marginalized community in Edmonton were recruited from four non-profit charitable organizations. Data were collected through visual oral examinations and a questionnaire. Descriptive statistics, chi-squared tests, and logistic regressions were applied. In total, 322 participants with a mean (SD) age of 49.3 (13.5) years completed the study. Among them, 71.1% were male, 48.1% were aboriginal, and 88.2% were single. The prevalence of oral cancerous lesions was 2.4%, which was higher than the recorded prevalence in Canada (0.014–1.42: 10,000) and in Alberta (0.011–1.13: 10,000). The clinical examinations indicated that 176 (54.7%) participants had clinical inflammatory changes in their oral mucosa. There was a significant association between clinical inflammatory oral lesions and oral cancerous/precancerous lesions (p < 0.001). Simple logistic regression showed that the risk of the presence of oral cancerous/precancerous lesions was two times higher in participants living in a shelter or on the street than in those living alone (OR = 2.06; 95% CI: 1.15–3.82; p-value: 0.021). In the multiple logistic regression analysis, the risk of oral cancerous/precancerous lesions was 1.68 times higher in participants living in a shelter or on the street vs. living alone after accounting for multiple predictors (OR = 1.67; 95% CI: 1.19–2.37; p-value: 0.022). The results demonstrated a high prevalence of cancerous/precancerous lesions among the study participants, which was significantly associated with clinical inflammatory oral lesions. The evidence supports the need for developing oral cancer screening and oral health promotion strategies in underserved communities.

P528 Feasibility, satisfaction and machine learning analysis of factors influencing IBD patients’ trust in the mobile application Care4today IBD

Abstract Background The use of telemedicine for the management of patients with Inflammatory Bowel Disease (IBD) has developed quickly over the past few years. In our tertiary referral Centre for IBD we have provided our patients an asynchronous telemedicine service, the App Care4today® IBD (Bepatient, Paris, France). Its main function is the remote monitoring of patients’ symptoms and disease activity (abdominal pain and bowel movements). In addition, it evaluates the quality of life through the EQ-5D-5L questionnaire, it provides information on topics to implement patient education (e.g., smoking), and it allows patients to insert reminders for the therapy. Decision trees (DT) and random forests (RF) are two machine learning (ML) techniques which have been increasingly utilized in the last few years due to their ability to uncover non-linear relationships between covariates and outputs. Methods The aims of our study were to evaluate the app use, satisfaction and trust of IBD patients, and to identify the possible determinants influencing its trust through a ML analysis. From April 26th to May 21st 2021, we have consecutively proposed to all IBD patients (familiar with smartphones and mobile Apps) on biological therapy to download Care4today® IBD. Ease of use, patients’ satisfaction and trust were assessed through a 5 points Likert scale questionnaire adapted on the SUTAQ (Service User Technology Acceptability Questionnaire). ML tools, DT and RF, were used to identify the determinants of patients’ trust. Results Out of 135 enrolled patients (among 151 patients), 87 (64.4%) used the app. Among the patients who compiled the questionnaire (39/87, 44.8%), 92.4% trusted to use the App, 94.9% showed confidence in the monitoring system. On contrast, disagreement (92.4% giving a score &amp;lt;3/5) was expressed for the statement “the Apps can replace my regular health care”. The DT showed that the variable which has influenced the most patients’ trust is the conviction that the App is a tool useful for a better monitoring of their disease by physicians, since it represented the root of the tree which explains the final decision. The RF confirmed that this variable influenced the most patients’ trust with a 15% increase in mean squared error (IncMSE) and 7.10 IncNodePurity. Conclusion More than half of our patients actively used the Care4today IBD App, and more than four of every five of those who responded to the survey proved to be well disposed to its usage, showing a good level of confidence and trust in it. The knowledge of patients’ trust determinants (App utility is the most relevant) is the key point in order to implement the use of these new digital monitoring options, which may help to better manage the disease, through tight control and personalized medicine

P659 No decrease in number of new Inflammatory Bowel Disease diagnoses in children in the Netherlands during the Covid-19 pandemic: a nationwide retrospective cohort study

BackgroundThe COVID-19 pandemic has had a large impact on regular healthcare provision in the Netherlands. During the first wave, healthcare in children was strongly reduced due to safety regulations and reduced hospital capacity for non-COVID care. This, and fear of COVID-19 could have led to delayed inflammatory bowel disease (IBD) healthcare, and delayed or even missed diagnoses. This has already been demonstrated in adult IBD patients in the Netherlands1, but not yet in the paediatric population. This is of importance, as in children, diagnostic delay is associated with higher rates of strictures, fistulising complications, and growth delay2. Therefore, this study aims to determine the impact of COVID-19 on IBD-related procedures and new IBD diagnoses in children in the Netherlands.MethodsIn this nationwide retrospective cohort study, a search was conducted in the nationwide pseudonymized pathology registry of the Netherlands (PALGA), with complete national coverage. Using retrieval terms for ulcerative colitis, Crohn’s disease, IBD unclassified and corresponding synonyms, all IBD related pathology reports (resection specimens or intestinal biopsies) from January 2018 to December 2020 in children age 1–18 were selected. Patients with a recognized diagnosis of IBD were eligible for inclusion, which was scored independently by two authors based on all reports. All IBD-related procedures (endoscopies and intestinal resections) were identified. Monthly frequencies of procedures and new IBD diagnoses during the COVID-19 pandemic in the Netherlands (March 11, 2020 – December 31, 2020) were compared to the average monthly frequencies of 2018–2019.ResultsAfter exclusion of non-IBD related reports, 2161 IBD-related procedures were identified between January 2018 and December 2020. The average number of monthly IBD procedures in 2018–2019 was 59.8, whereas in 2020 this was 60.6 procedures per month, reflecting a 0.8% increase (Figure 1). In 2020, the number of new IBD diagnoses was 456, similar to the 458 new IBD diagnoses in 2018–2019. During the COVID-19 pandemic the weekly number of new diagnoses was 8.8, while between January 2018 and March 2020 this was 8.5 (Figure 2). A slight reduction in monthly IBD-related resections was observed (2.7 vs. 3.5).ConclusionDespite the reduction in regular healthcare in children in the Netherlands due to the COVID-19 pandemic, no reduction was observed in IBD-related endoscopies and surgeries during the pandemic in the Netherlands. This reassuring evidence demonstrates that pediatric IBD healthcare remained unchanged, thus not delaying diagnosis of new IBD patients or treatment of severe disease flares.

Impact of the COVID-19 Pandemic on Healthcare Activity in the Regional Hospitals of Andalusia (Spain).

(1) Background: The large global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overloaded the public health systems and reduced the regular healthcare activity, leading to a major health crisis. The main objective of this study was to carry out a comparative evaluation of the healthcare activities in the hospitals of Eastern Andalusia, Spain. (2) Methods: In this study, an observational, multicentered, and retrospective approach was adopted to compare the healthcare activities of the Poniente Hospital (PH) and the Alto Guadalquivir Health Agency (AGHA). Data was collected over a period of 24 months, i.e., from 1 January 2019 to 31 December 2020, and the variables evaluated were: patients seen in the hospital emergency service (HES), X-ray tests performed, patients cited in outpatient consultations, surgical interventions performed, and patients included in the waiting list. (3) Results: The analysis of the above-mentioned variables revealed a significant reduction in the number of patients registered in 2020 at HES as compared to that in 2019 for both PH (p = 0.002) and AGHA (p < 0.001). Moreover, the number of surgical interventions in 2020 was significantly reduced from that in 2019 for both PH (p = 0.001) and AGHA (p = 0.009). Moreover, for PH (p < 0.001), a significant reduction was observed in the waiting list admissions in 2020 compared to that in 2019; however, no significant difference in the waiting list admissions between the years 2020 and 2019 was observed for AGHA (p = 0.446). In 2020, the number of teleconsultations was significantly increased from that in 2019 for both PH (p < 0.001) and AGHA (p = 0.006). (4) Conclusion: The analysis carried out indicates that in 2020, compared to 2019, healthcare activity was significantly reduced in most of the parameters included in this study.

The Decision-Making Process for Palliative Sedation for Patients with Advanced Cancer-Analysis from a Systematic Review of Prospective Studies.

Simple SummaryThe involvement of patients in decision making about their healthcare plans is being emphasized, but little is known how the decision making on palliative sedation is conducted and who are involved in. The aim of this study is to understand how decisions about palliative sedation are taken. The results may help to understand the reality of this decision-making considering when and by whom the decision-making process is initiated, patient involvement, family involvement and healthcare involvement. This may contribute to identifying aspects that should be improved.Background. The involvement of patients in decision making about their healthcare plans is being emphasized. In the context of palliative sedation, it is unclear how these decisions are made and who are involved in. The aim of the study is to understand how this decision-making is taken. Method. Information from a systematic review on clinical aspects of palliative sedation prospective studies were included. PubMed, CINAHL, Cochrane, MEDLINE, and EMBASE were searched (January 2014–December 2019). Data extraction and analysis regarded: (a) When and by whom the decision-making process is initiated; (b) patient involvement; (c) family involvement and (d) healthcare involvement. Results. Data about decision making were reported in 8/10 included articles. Palliative sedation was reported in 1137 patients (only 16 of them were non-cancer). Palliative sedation was introduced by the palliative care team during the disease process, at admission, or when patients experienced refractory symptoms. Only two studies explicitly mentioned the involvement of patients in decision making. Co-decision between families and the regular health care professionals was usual, and the health care professionals involved had been working in palliative care services. Conclusion. Patient participation in decision making appeared to be compromised by limited physical or cognitive capacity and family participation is described. The possibility of palliative sedation should be discussed earlier in the disease process.

Factors Affecting Admission To Intensive Care Unit Of COVID-19 Patients In The Kingdom Of Bahrain

Objective: Coronavirus disease-2019 (COVID-19) is a newly emerging infectious disease that has become a global pandemic. This study aimed to identify the risk factors at presentation to predict intensive care unit (ICU) admissions. Materials &amp; Methods: This retrospective observational study recruited 188 confirmed laboratory COVID-19 patients who were hospitalized in Jidhafs Maternity Hospital (JMH) from 1st June to 5th July 2020. Univariate and multivariate analyses were used to Explore risk factors associated with the increased risk of ICU admission. Results: The study revealed that older age (&gt;60 years old) (16[38.1%], P=0.044), male gender (30 [40.0%], P=0.000) were significantly associated with the increased risk of ICU admissions. The most prevalent symptoms in admission were myalgia (13[40.6%], P=0.035), fever (39[34.2%], P=0.002) and cough (37[31.4%], P=0.032). In addition, raised serum level of alanine amino-transferase (ALAT) (34.7% vs. 20.7%, P=0.033), D-dimers (30.7% vs 12.2%, P=0.012), lactate dehydrogenase (LDH) (31.6% vs 0.0%, P=0.025) and ferritin (37.7% vs 16.7%, P=0.011) found to be important predictor of ICU admission. Conclusion: The finding indicates that older age, male gender, with increased alanine transferase (ALT), increased lactate dehydrogenase (LDH), high D-dimer and high ferritin was associated with an increased risk of ICU admissions. Identification of such factors will help to detect people who are more likely to develop severe COVID-19 disease and will help physicians to determine if patients need regular health care or ICU admission. Keywords: COVID-19, Emerging communicable diseases, Intensive care units, Physicians, Risk factors

Atenção Primária à Saúde durante a pandemia de COVID-19 em Fortaleza, Brasil: fatores associados e padrão de uso por mães e crianças de até 18 meses de idade

To analyze the delay or failure to seek primary health care by the mother-child dyads during the COVID-19 pandemic, a practice that has a high potential to increase maternal and child morbidity and mortality. Data from three survey rounds of the Iracema-COVID cohort study, collected 6, 12, and 18 months after birth, showed the patterns of postpartum attendance to primary health care consultation of the mother-child dyad. Crude and adjusted multinomial logistic regressions with robust variance were used to assess factors associated with nonattendance. Among the 314 cohort mothers, 25% did not attend any primary health care consultation during the 18-months postpartum, while 30% of the mothers did all three. Regarding the child, 75% had regular primary health care consultations in all three survey rounds, while 4% did not attend any in their first 18 months of life. By the end of the first COVID-19 wave, the proportion of mother and child who attended the consultations had fallen by 23 and 18%, respectively. The main factors associated with nonattendance were mothers aged below 25 years, and mothers with more than one child. An important delay or nonattendance to primary health care consultation by the mother-child dyad was observed during the COVID-19 pandemic. Such practice, with a high potential to increase maternal and child morbidity and mortality, was particularly frequent among younger mothers and those with more than one child.

Abstract PO-106: Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients

Abstract Background: Non-Hispanic Black (NHB) patients are more likely to present with a later stage colon cancer and to die from the disease compared to their non-Hispanic White (NHW) counterparts. Despite a plethora of research regarding their effects on intermediate outcomes (e.g., patient satisfaction, behavioral outcomes), little is known about the role of clinical (i.e., patient-provider communication [PPC]) and non-clinical social support in survival. Objective: To describe clinical (PPC) and non-clinical social support among NHB and NHW urban colon cancer patients, and examine their associations with risk of colon cancer death. Method: Colon Cancer Patterns of Care in Chicago was a cross-sectional, multi-site study that examined disparities in colon cancer screening, diagnostic stage, and treatment. Patients were eligible if they were diagnosed with a first primary colon cancer, self-identified as NHB or NHW, and were between 30 and 79 years of age. Participants completed a 90-minute interview and consented to medical record abstraction. For these analyses we examined: 1) clinical support (PPC), treated as a categorical variable (low, moderate, or high), 2) non-clinical social support (no, yes), and 3) colon cancer death, ascertained via a National Death Index Plus search. We used multivariable Cox proportional hazard models to estimate hazard ratios (HRs) for associations of race, sex, PPC, and social support with colon cancer death. Adjusted models included the following covariates: age, marital status, education, income, insurance, comorbidities, body mass index, having a regular provider, healthcare utilization, and healthcare access. Results: The final sample of 407 colon cancer patients had (by design) a roughly equal distribution by race and gender. Overall, 26% of patients died due to colon cancer, and risk of death was highest for NHB males (33%) and lowest for NHW males (20%). NHB patients were more likely than NHW patients to report low PPC and no non-clinical social support. Low PPC was associated with a two-fold increased hazard of colon cancer death (HR=2.0, 95% CI: 1.06, 3.84), whereas non-clinical social support was not associated with risk of colon cancer death. The hazard of colon cancer death was two-fold (HR=2.05, 95% CI: 1.07, 3.71) greater for NHB males compared to NHW females. Conclusion: These findings suggest that clinical support – specifically PPC - can potentially decrease the risk of colon cancer death, especially among NHB male patients. Future research should determine optimal strategies for PPC improvement, including provider training in shared decision-making practices and high-quality informational support. Reducing survival disparities may thus require not only advances in diagnostics and treatment, but also in clinical support factors. Citation Format: Leslie R. Carnahan, Yamilé Molina, Karriem S. Watson, Susan Altfeld, Carol E. Ferrans, Garth E. Rauscher. Colon cancer death and associations with clinical and non-clinical support among non-Hispanic Black and White urban colon cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-106.

Compassion Fatigue among Nurses Assigned to COVID-19 Facilities: A Constructivist Grounded Theory.

The Coronavirus Disease (COVID-19) pandemic significantly disrupted regular health care services, mainly in the hospitals. Nurses soldiering on the battlefront of care of disaster response in the Philippines during the disease outbreak are at high risk of developing rapid-onset compassion fatigue. Notably, research is still needed to investigate the impact of compassion fatigue on various clinical areas and further develop a theory of compassion fatigue within the nursing context. The study explored the concept of compassion as experienced by nurses directly caring for COVID-19 patients. The study further explored the experiences of nurses on compassion fatigue. This study employed qualitative methodology, specifically the constructivist grounded theory. Thirty-four participants were included in the study. The narratives and voices of the nurses unfolded the following themes: (1) Acts of Compassion, (2) COVID-19 Pandemic: Nursing Challenges and Detours, (3) Nurses' Compassion Fatigue, (4) Narratives of Opportunities: Thriving at the outset of COVID-19. All four concepts are linked to the multidimensional concept of compassion fatigue. A substantive theory, "Remon's CF Theory in Nursing," is proposed based on the grounded experiences of nurses caring for COVID-19 patients related to compassion fatigue. Compassion Fatigue (CF) is a psycho-social phenomenon and occupational hazard affecting nurses directly caring for or in contact with COVID-19 patients. CF is a process that develops over time brought by prolonged enactment of compassion, the experience of empathic distress, and concurrence of organizational, contextual, and psychosocial factors. Nurses' CF can potentially affect safety and lead to poor nursing care, compromised work relations, and burnout. Nurse leaders' organizational and leadership commitment and support through up-to-date policies and continuous research on the topic are necessary to regain compassion among nurses. Likewise, reframing nurse compassion fatigue as an organizational and collective problem provides the larger perspective to further improve clinical practice and nurses' welfare. Nurse leaders, hospital and COVID-19 facility administrators must ensure specific policies and priorities that address issues causing and fueling nurse compassion fatigue, including frequency of exposure to traumatic events, lack of resources, and inadequate support system. The study further suggests conducting quantitative research to test the proposed theory and explore the relationship between organizational, psychosocial, and environmental context, compassion fatigue, and compassion-driven factors.

Scent-delivery devices as a digital healthcare tool for olfactory training: A pilot focus group study in Parkinson's disease patients

Parkinson's disease (PD) patients display a combination of motor and non-motor symptoms. The most common non-motor symptom is scent (olfactory) impairment, occurring at least four years prior to motor symptom onset. Recent and growing interest in digital healthcare technology used in PD has resulted in more technologies developed for motor rather than non-motor symptoms. Human–computer interaction (HCI), which uses computer technology to explore human activity and work, could be combined with digital healthcare technologies to better understand and support olfaction via scent training – leading to the development of a scent-delivery device (SDD). In this pilot study, three PD patients were invited to an online focus group to explore the association between PD and olfaction, understand HCI and sensory technologies and were demonstrated a new multichannel SDD with an associated mobile app. Participants had a preconceived link, a result of personal experience, between olfactory impairment and PD. Participants felt that healthcare professionals did not take olfactory dysfunction concerns seriously prior to PD diagnosis. Two were not comfortable with sharing scent loss experiences with others. Participants expected the multichannel SDD to be small, portable and easy-to-use, with customisable cartridges to deliver chosen scents and the mobile app to create a sense of community. None of the participants regularly performed scent training but would consider doing so if some scent function could be regained. Standardised digital SDDs for regular healthcare check-ups may facilitate improvement in olfactory senses in PD patients and potential earlier PD diagnosis, allowing earlier therapeutic and symptomatic PD management.

COVID-19 Delays Presentation and Management of Acute Coronary Syndrome

The COVID-19 pandemic started at the end of 2019 and remains carrying a health threat and significant economic consequences. Over the last two years, COVID-19 has been the main Public Health issue, and has impacted regular healthcare systems, with significant build-up of waiting lists and delay in optimum management of other serious medical conditions including heart diseases and cancer.

The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease.

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.