Telephone Inquiries Research Articles

A cross-sectional study to assess the adverse events following immunization with CoviShield vaccine at a private medical college in South India

Background: The World Health Organization had proclaimed the outbreak of the novel coronavirus (COVID-19) as a worldwide pandemic on March 11, 2020. Immunization against the disease was the need of the hour to curtail the spread of COVID-19 pandemic. Two vaccines manufactured in India were approved for emergency use authorization initially. They are ChAdox1CoV-19 vaccine – CoviShield and Covaxin. Aims and objectives: This study aimed at assessing the occurrence of adverse effects following immunization (AEFI) among individuals who received the CoviShield vaccine. The objective of this research was to evaluate the type of AEFI among vaccinated beneficiaries and to determine the factors contributing to the development of AEFI. Materials and Methods: A cross-sectional study was done at a teaching hospital in Kerala. All beneficiaries who were administered CoviShield vaccine during the study period, that is, from January 2021 to June 2022 were incorporated in the study. Data regarding AEFI were collected from all vaccinated individuals by direct or telephonic enquiry. Results: The incidence rate of AEFI is 4.5/1000 doses (111/24925 doses). The reporting of AEFI was high among age group of 20–30 years and commonly seen in males (97.3%). The most common AEFI reported with CoviShield vaccine was fever (63%), myalgia (51%), and headache (40%). AEFI was seen commonly after administration of first dose (94%). Only 7 cases (6.3%) of serious AEFI were reported which included death, autoimmune encephalitis, Bell’s palsy, hypotension, and hypersensitivity reactions. There was no significant association between age and type of AEFI (P > 0.05) and dose of vaccine and type of AEFI (P > 0.05). Conclusion: The immunization with CoviShield vaccine is safe among adults (>18 years) with lesser incidence of serious adverse effects. Higher incidence of AEFI is witnessed after administration of first dose and it was commonly seen in males.

Effectiveness and Safety of an Intravenous Immune Globulin (IVIG) Preparation in Post-exposure Prophylaxis (PEP) Against Measles in Infants.

Background: Administration of measles virus (MV)-specific IgG as post-exposure prophylaxis (PEP) is known to effectively prevent measles. Since the introduction of active immunization against measles, the levels of MV-specific IgG antibodies in the population have dropped. Therefore, the concentration of MV-specific antibodies in immunoglobulin products derived from human plasma donors has declined as the proportion of vaccinated donors has increased. Literature on the effectiveness of PEP with current available immunoglobulins is limited. Here we examine the effectiveness of 400 mg/kg intravenous immunoglobulin (IVIG) (IgVena®, Kendrion) as PEP in infants during a measles outbreak in Austria, 2019.Methods: After exposure to a highly contagious measles patient, identified infants were evaluated for eligibility for IVIG PEP. Infants were tested for measles maternal antibodies, if the result was expected to be available within 72 h after exposure. IVIG was administered to eligible infants with negative maternal IgG antibody levels (n = 11), infants with protective levels but result beyond 72 h (n = 2) and infants not tested for maternal IgG antibodies (n = 52). Telephone enquiries were made asking for measles infection. Effectiveness was calculated using exact logistic regression. Samples of four out of seven used IVIG batches were tested for MV-neutralizing antibody capacity.Results: In 63 (96.9%) of 65 infants PEP with IVIG was administered. The parents of two infants declined IVIG PEP. None of the infants with IVIG PEP got measles or symptoms suggestive for measles, but both infants who did not receive PEP were infected. Effectiveness of IVIG PEP was calculated to be 99.3% (CI 95%: 88.7–100%). No serious adverse event of IVIG treatment was observed. The investigation on MV-neutralizing antibody capacity showed a geometric mean titer ranging from 10.0 to 12.7 IU/ml, resulting in a 1.57–2.26-fold higher concentration than postulated as minimum level for immunity.Conclusions: Our findings suggest that the used IVIG preparation provided an at least non-inferior protection rate compared to IVIG preparations derived from donors before the global introduction of standard active immunization against measles.

Real-Time CDC Consultation during the COVID-19 Pandemic-United States, March-July, 2020.

Context: In response to the COVID-19 pandemic, the Centers for Disease Prevention and Control (CDC) clinicians provided real-time telephone consultation to healthcare providers, public health practitioners, and health department personnel. Objective: To describe the demographic and public health characteristics of inquiries, trends, and correlation of inquiries with national COVID-19 case reports. We summarize the results of real-time CDC clinician consultation service provided during 11 March to 31 July 2020 to understand the impact and utility of this service by CDC for the COVID-19 pandemic emergency response and for future outbreak responses. Design: Clinicians documented inquiries received including information about the call source, population for which guidance was sought, and a detailed description of the inquiry and resolution. Descriptive analyses were conducted, with a focus on characteristics of callers as well as public health and clinical content of inquiries. Setting: Real-time telephone consultations with CDC Clinicians in Atlanta, GA. Participants: Health care providers and public health professionals who called CDC with COVID-19 related inquiries from throughout the United States. Main Outcome Measures: Characteristics of inquiries including topic of inquiry, inquiry population, resolution, and demographic information. Results: A total of 3154 COVID-19 related telephone inquiries were answered in real-time. More than half (62.0%) of inquiries came from frontline healthcare providers and clinical sites, followed by 14.1% from state and local health departments. The majority of inquiries focused on issues involving healthcare workers (27.7%) and interpretation or application of CDC’s COVID-19 guidance (44%). Conclusion: The COVID-19 pandemic resulted in a substantial number of inquiries to CDC, with the large majority originating from the frontline clinical and public health workforce. Analysis of inquiries suggests that the ongoing focus on refining COVID-19 guidance documents is warranted, which facilitates bidirectional feedback between the public, medical professionals, and public health authorities.

Analysis of Home Factors leading to the Development of Allergic Rhinitis in Children in Guangzhou, Southern China

Objective: To analyse home factors leading to the development of Allergic Rhinitis (hereafter referred to as "AR") in children in Guangzhou, Southern China. Methods: We selected children with a history of AR who attended the Otolaryngology Clinic of Guangzhou Women and Children's Medical Center from January 2020 to August 2020 to complete the "Home Environment Questionnaire for Children with Allergic Rhinitis" using an internet survey as well as telephone enquiries. We selected children who developed AR episodes during these 8 months as the case group and children who did not develop AR episodes as the control group to analyse independent influencing factors of home living environment leading to the development of AR in Children in Guangzhou. Results: We completed a total of 667 questionnaires from parents of children with AR, and 644 questionnaires were validly returned, with a valid return rate of 96.55%. There were 317 cases in the case group and 327 cases in the control group. Keeping pets, parents' smoking habits, bedroom orientation, living floor, frequency of plush toy cleaning, frequency of air conditioner cleaning, and frequency of bedding cleaning are all independent influencing factors of home environment leading to the development of AR in Children in Guangzhou (OR=3.618, 3.815, 7.576, 1.035, 4.030, 7.838, 5.971, P<0.05). Conclusions: A number of factors, inclusive of keeping pets, are all factors of home living environment leading to the development of AR in Children in Guangzhou, some of which require effective intervention, with particular attention to mites removal.

Carbon monoxide exposures reported to the UK National Poisons Information Service: a 4-year study.

Unintentional carbon monoxide (CO) poisoning poses a public health challenge. The UK National Poisons Information Service (NPIS) provides advice to healthcare professionals via the online database, TOXBASE®, and a 24-hour telephone line. Our aim was to analyse all CO-related enquiries to the NPIS. We analysed enquiries regarding unintentional CO exposure (1st July 2015-30th June 2019). Information on patient demographics, CO source and location, clinical features and poisoning severity was collected from telephone enquiries and TOXBASE accesses. 2970 unintentional non-fire-related CO exposures were reported. Exposures occurred commonly in the home (60%) with faulty boilers frequently implicated (27.4%). Although five fatalities were reported, 68.7% of patients experienced no or minor symptoms only (headache most frequently reported). Despite being the gold standard measurement, blood carboxyhaemoglobin concentration was only recorded in 25.6% patients, with no statistically significant correlation with severity. Unintentional CO exposures in the UK commonly occur in domestic settings and although are generally of low severity, fatalities continue to occur. Carboxyhaemoglobin measurement is important to confirm exposure but further work is required to assess its validity as a prognostic indicator in CO exposure. Public health policy should continue to focus on raising awareness of the dangers of CO.

Engaging People with Energy Efficiency: A Randomised Controlled Trial Testing the Effects of Thermal Imaging Visuals in a Letter Communication

The study tested the effect of adding visualisations to a communication to engage householders with an energy efficiency programme. External wall insulation is an appropriate way of insulating homes, yet take-up is low. Householders may be unaware of the heat loss from uninsulated walls. In earlier research, seeing thermal images prompted the uptake of simple energy efficiency actions amongst householders. Thermal images were added to a standard letter to visualise heat transfer from a home before and after external wall insulation had been installed. A randomised controlled trial tested three types of letter (standard, standard plus thermal image showing problem, standard plus thermal images showing problem and solution) in 5483 UK households. The target outcome was the rate of telephone enquiries after exposure to the letters. Enquiry rates were low (1.6%) and did not differ between letter type. We discuss the null effect in relation to the target action (external wall insulation), the manner of presentation of the visuals (mass communication, letter through the door) and the ingredients of a persuasive intervention. Findings suggest that taking a key ingredient from an intervention and applying it in a different context may result in the loss of its impact.

Abstract PS7-85: Population based survival of breast cancer in Greater Mumbai, India

Abstract Introduction: Population based survival provides a measure of the efficacy of cancer control in a defined geographical area. The Mumbai Cancer Registry (MCR), India’s oldest population based cancer registry (PBCR), was established by the Indian Cancer Society (ICS) in 1963. It covers 603 sq. km. of Greater Mumbai with a population of 146, 51,584 (2015) and over half a century it has consistently provided cancer statistics from its coverage area. Breast cancer is the commonest cancer in women in Mumbai constituting 30% of all female cancers, and is now the most common cancer in women in India (1, 62,468 in 2018), constituting 27.66% of all female cancers. There have been few reports on breast cancer survival from India, and in this study, we report the survival rate of women diagnosed with breast cancer in Greater Mumbai during the years 2009-13. Patients and Methods: Breast cancer cases registered during the years 2009-13 with the MCR were followed for outcome till 31 Dec 2018. Social investigators visited hospitals, nursing homes, clinics, hospices and laboratory centers for documenting cancer cases. Mortality data was collected from the Vital Statistics Division of the Municipal Corporation. Data and was verified and duplicate cases were deleted. Follow up was conducted with repeated scrutiny of medical records, death certificates issued by the Municipal Corporation, postal and telephone enquiries, house visits and linkage with electoral database. Observed survival was calculated by the Kaplan Meir (1958) method. Expected survival was calculated using the national life-table of India for (Maharashtra) based on Census of India, 2011. Using observed and expected survival, relative survival was calculated by Ederer (1961) method using STATA 12.0. The survival rate was compared to that from other regions of India and with developed countries. Results: Of the 9707 breast cancer cases registered during the period 2009-13, 8031 (83%) cases were included in this study. 1676 (17%) cases were excluded as 469 (5%) had only Death Certificate Information and 1207 (12%) were lost to follow up. The median follow up was 5.1 years (range 8 months - 9 years). The median age was 55 years (range 18 -96 years) with 2725(34%) ≤ 50 years and 5306 (66%) > 50 years. The overall observed survival rates at 1, 3, 5 years were 82.5%, 72.8% and 67.0% respectively and the corresponding figures for relative survival were 83.5%, 75.4%, and 70.9%. Increasing age had an inverse relationship with breast cancer survival. The highest 5-year relative survival was shown by ≤29 age group (74%) and lowest by >70 age group (60%). Those with localised disease at diagnosis had a higher 5-year relative survival rate (84%) compared to 79.7% for direct extension and 20.8% for distant metastasis. The clinical extent of disease and education were significant risk factors affecting survival (p < 0.001). Conclusion:The 5-year population-based survival of patients treated in Greater Mumbai during the period 2009-2013, is 70%. This compares favourably with previously reported 5-year survival from Mumbai (51-55.7%) and other Indian registry data (33-55%), but is inferior to that reported in the developed world (84-88 %). The association of survival with educational status and stage at diagnosis highlights the importance of awareness and early detection. Enhanced awareness and detection coupled with easy access to adequate and affordable treatment could help improve breast cancer outcomes. Citation Format: Vinay Deshmane, Shravani Koyande, Shweta Jadhav. Population based survival of breast cancer in Greater Mumbai, India [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-85.

Government institutions, entrepreneurship education and entrepreneurship education programmes in Malaysia

PurposeThis study aims to examine the status of entrepreneurship education (EE) in Malaysia and entrepreneurship education programmes (EEPs) offered by Malaysian public and private higher education institutions (HEIs), against the backdrop of macro-level context of Malaysian government institutions related to entrepreneurship.Design/methodology/approachThis study replicates and extends the research by Maritz et al. (2015, 2019). The study expands a nascent archetype regarding an iterative and systematic open-ended emergent enquiry, together with data collection from Malaysian HEIs.FindingsThe findings suggest significant emergence of EE (programmes and research) in Malaysia, despite EEPs being sparsely distributed across HEIs in the bottom half of Table 1. The top ten HEIs (12% of all HEIs in Table 1) accounted for 35% of all EEPs. This study highlights the significant influence of Malaysian government institutions related to entrepreneurship on EE and EEPs.Research limitations/implicationsThe findings are subject to the availability and accuracy of information and documents available on official websites of HEIs. This limitation has been mitigated with telephone and email inquiries and other sources of information.Practical implicationsThe findings provide critical grounding and inferences on the status of EE and EEPs in Malaysia for researchers, practitioners, HEIs, governments and other stakeholders.Originality/valueThis study is first of its kind on emergent enquiry into the status of EE in Malaysia and EEPs offered by 19 public HEIs and 67 private HEIs in Malaysia. Moreover, this study links macro-level context of the Malaysian government institutions related to entrepreneurship with micro-level context of EE and EEPs.

Factors that infertile couples from mainland China may take into consideration for cross-border reproductive care – A cross-sectional questionnaire study

ObjectiveCross-border reproductive care (CBRC) has become popular in the world, including mainland China. We designed a questionnaire and aimed to determine the main factors that infertile couples from mainland China may consider for CBRC. Materials and methodsIn this cross-sectional questionnaire-based study, we retrospectively analyzed the data from questionnaires collected at the Reproductive Center of Beijing BaoDao Obstetrics and Gynecology Hospital from January 2018 to June 2018. The questionnaire contained 38 items that belonged to six different categories (environment and equipment, service quality, patient safety, medical quality, information acquisition channel and overseas medical services). The item scores for each factor were calculated and then weighted using principal component analysis. ResultsA total of 297 infertile couples were identified. Most of the infertile women were aged 31–35 years, were married 1–3 years, and had a bachelor's degree. In the weighted factor analysis, “clean outpatient clinic and medical equipment” had the highest weight in the dimension of environment and equipment. The item with the highest weight in the dimension of service quality was “wait time for examination”. In the dimension of patient safety, “health education on medication and surgery by counselors” had the highest weight. The item with the highest weight in the dimension of medical quality was “fee charged for ART treatment”. The items with the three highest weights in the dimension of information acquisition channel were “other (seminar, exhibition, dissertation …)”, “introduction from friends and relatives”, and “telephone inquiry”. In the dimension of overseas medical services, the two items with the highest weights were “cultural similarities” and “language similarities”. ConclusionFor CBRC, infertile couples from mainland China may take following significant factors into consideration: a high success rate and inexpensive treatment, cultural and linguistic familiarity, high-quality service and short wait time.

A study to correlate the compliance of health care professional to infection control protocols with selected maternal outcome in labor room of a Tertiary care Hospital in Bangalore

Prevention of infection and control is an integral component of nursing care delivery in any setting to reduce risks for morbidity and mortality in patients and care givers at all levels. A descriptive correlational research design was conducted in the labor room of Obstetric ward of SJMCH, Bangalore. A total of 42 parturient mothers and 62 HCP were the samples. A non participatory observation was done on compliance of infection control protocol (HH, PPE, BMW) using checklist by the investigator. These mothers were observed for puerperal infection on 1st, 2nd and 3rd day for pyrexia, REEDA scale for Episiotomy wound (only 3rd day) and Follow up on Mothers was done by telephonic enquiry on 10th day for the assessment of infection. The finding of the study showed that compliance to infection control protocols: HH (41.67%), PPE (90.32%) and BMW is (98%) respectively. The incidence of episiotomy wound infection on 3rd day is 9.5% and on 10th day (follow up) there is no evidence of infection. The study finding showed that health care professional were not fully complied to the infection control protocols. Although there was mild redness and edema of episiotomy wound and no incidence of puerperal infection identified among mothers. There was no association found between professonal variables and compliance to infection control protocols.

Telephone consults at the Infectious Disease Outpatient Clinic during the early period of the COVID-19 epidemic.

Once novel coronavirus disease 2019 (COVID-19) emerged in Wuhan, China in December 2019 and the first case in Japan was reported the following month, telephone inquiries to the Infectious Disease Outpatient Clinic increased. During the first wave of the epidemic, before medical measures for this emerging infectious disease were in place, the Outpatient Clinic received a significant amount of inquiries, reflecting the prevailing social turmoil. During the second wave, inquiries did not increase because a proper system of medical care was in place in hospitals and communities. Therefore, in the early stages of an emerging infectious disease, relevant information needs to be quickly consolidated and it needs to be linked to measures that are appropriate to the situation.

Neuropathic Pain after Adolescent Idiopathic Scoliosis Correction Surgery.

Study DesignProspective study.PurposeTo investigate the prevalence and the associated risk factors of chronic neuropathic pain symptoms using painDETECT questionnaire in adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal fusion (PSF) surgery.Overview of LiteraturePost-lumbar surgery syndrome is a disease entity that describes neuropathic pain following spinal surgery. However, few studies have investigated the prevalence and risk factors for neuropathic pain in pediatric population undergoing corrective spinal surgery.MethodsForty AIS patients were recruited. Demographic, preoperative, and postoperative data were recorded. The magnitude and characteristics of postoperative pain were assessed using the painDETECT questionnaire through telephone enquiries at intervals of 2, 6, 12, and 24 weeks. Statistical analyses were followed by Pearson correlation test to determine the relationship between pain scores at 6, 12, and 24 weeks with the risk factors.ResultsBased on the painDETECT questionnaire, 90% of the patients had nociceptive pain, and 10% had a possible neuropathic pain component at 2 weeks postoperatively as per a mean painDETECT score of 7.1±4.5. Assessments at 6, 12, and 24 weeks showed that no patients had neuropathic pain with painDETECT scores of 4.4±3.2, 2.9±2.9, and 1.5±2.0, respectively. There was a significant correlation between total postoperative morphine use during 48 hours after the surgery and a tendency to develop neuropathic pain (p=0.022).ConclusionsChronic neuropathic pain was uncommon in AIS patients who had undergone PSF surgery. Higher opioid consumption will increase the possibility of developing chronic neuropathic pain.

Time Required for Planned and Unplanned Episodes of Care in Primary Total Joint Arthroplasty: Has Anything Changed With a Growth in Outpatient Arthroplasty?

BackgroundThis study sought to determine the total amount of time committed to planned and unplanned episodes of care related to primary, unilateral total joint arthroplasty (TJA), relative to a growth in outpatient TJA. MethodsAll primary, unilateral TJA procedures performed over a 7-year period by a single surgeon at a single institution were retrospectively reviewed. Time dedicated to planned work was calculated over each episode of care, from surgery scheduling to 90 days postoperatively. All telephone inquiries and readmissions involving the surgeon’s direct input, over the episode of care, constituted time dedicated to unplanned work. ResultsBetween 2012 and 2018, as the proportion of outpatient TJAs increased, the average planned episode-of-care time per patient decreased from 412 minutes to 361 minutes. Despite a 108% increase in the total number of outpatient TJAs between 2017 and 2018 (51/432 (11.8%) to 106/555 (19.1%); P = .002), neither the average number of unplanned telephone inquiries (4.6 ± 3.8 vs 4.2 ± 3.7; P = .124), nor the mean time per patient required to respond to calls (23.1 ± 19.4 vs 21.2 ± 18 minutes, P = .135) differed. Between 2017 and 2018, the average total episode-of-care time per patient decreased from 403 minutes (376 planned + 27 unplanned) to 387 minutes (361 planned + 26 unplanned). ConclusionDespite an increase in outpatient TJA, the average time required for planned and unplanned patient care remained relatively constant. The growth of outpatient TJA nationally should not trigger a change in Centers for Medicare and Medicaid Services benchmarks.

Prévalence, diagnostic et médication de l’hyperactivité/TDAH en France

Resume Contexte La prevalence de l’hyperactivite/TDAH fait l’objet d’intenses debats au niveau international. En France, la seule etude disponible pointe un taux de prevalence du TDAH de 3,5 a 5,6 % des enfants âges de 6 a 12 ans. Les auteurs estiment egalement que 3,48 % des 6–12 ans sont traites par psychostimulant. Notre article s’appuie sur les donnees de l’Assurance Maladie pour discuter ces resultats. Methode Il est possible de proceder a une etude rigoureuse du taux diagnostic et du niveau de prescription du methylphenidate en France en analysant les donnees de l’Assurance Maladie. Dans cette perspective, nous avons utilise les informations extraites de la base du Systeme National d’Information Inter-Regime de l’Assurance Maladie (SNIIRAM) presentees en 2017 dans un rapport de l’Agence Nationale de Securite du Medicament et des produits de sante (ANSM). Resultats Les donnees de l’Assurance maladie permettent d’etablir une estimation de la prevalence du TDAH de 0,3 % en France. Discussion Ce resultat appelle des investigations plus approfondies dans la base du SNIIRAM. Il questionne les raisons du faible taux de medication du TDAH en France en comparaison d’autres pays occidentaux. Il interroge les biais methodologiques et les conflits d’interets susceptibles d’orienter les etudes de prevalence du TDAH en France et au niveau international.

A Study on the Enactment of Planning and Management Guidelines of ‘Shared Public Support Private Rental Housing’ for the Young People

The purpose of this study is to the guideline for “Shared Public Support Private Rental Housing” for the young under the Special Act on Private Rental Housing. It commences with case analyses and expert views on domestic and international rental housing systems. The analysis examined current laws and systems in Korea and shared housing systems in Japan (share houses), the UK(houses of multiple occupancy, HMO), and Australia (rooming/boarding houses). Following a literature review, web searches, and telephone inquiry, 6 social housing cases in Korea, were identified for analysis. For international cases, we identify 11 cases in Japan, 2 cases in the UK, and 1 case in Australia was conducted mainly through large-scale corporations share houses. As a result, for planning and facility guidelines, 16 items were selected, which included the appropriate number of occupants, room size, space planning standards, fixtures and furnishings, emergency evacuation, common areas and facilities, and parking lot. For operation guidelines, 7 items were selected, which included the selection, and composition of residents, disputes and management of residents, housing services, living regulations, and administrative expenses. A consolidated of 30 items is finally presented to provided model standards appropriate for young people’s shared housing.

ASSESSMENT OF IMPACT OF COVID-19 CHALLENGES ON PSYCHOSOCIAL WELL-BEING OF NIGERIANS

Assessment of the impact of COVID-19 challenges on the psychosocial wellbeing of the Nigerian populace are the focus of this paper. There are diverse reasons for the essence of assessment of this pandemic; however, the major reason is to document it for future generations. This study, therefore, examined the challenges faced by the populace as a result of COVID-19 pandemic in the South-Western zone and Nigeria as a whole. The study was conducted using a volunteering sampling technique and 335 participants were used using telephone inquiry. Those who completed the interview were 203 (60.6%) males and the rest 132 (39.4%) were female respondents. The instrument has a reliability coefficient of 0.76. Some of the challenges or impacts of COVID-19 on Nigeria populace are hunger, lawlessness, arm robbery, economic crisis, political crisis, financial problem, and hike in the price of essential commodities, young adults resulting in abuse of drugs, raping, pool betting, and internet fraudsters. The spiritual houses like churches, mosques, and shrine were closed up, couples that have given up raising child still found themselves in it as a result of lockdown order and finally the loss of love ones due to CORONA Virus. Based on these findings it was concluded that COVID-19 among the citizenry had cost Nigerians a lot of havoc. Article visualizations:

Effect of the UK Psychoactive Substances Act 2016 on episodes of toxicity related to new psychoactive substances as reported to the National Poisons Information Service. A time series analysis

Background: There have been recent increases in use of new psychoactive substances (NPS) associated with acute health harms including hospital presentations due to toxicity and increasing numbers of deaths. In response, the UK Government enacted generic legislation on 26th May 2016 (the Psychoactive Substances Act) making it an offence to produce, possess with intent to supply, supply, import or export, or possess within a custodial setting a psychoactive substance. We studied the impact of this Act on monthly frequency of enquiries made by health professionals to the UK National Poisons Information Service (NPIS) about NPS. We also studied five commonly used ‘conventional’ drugs of misuse that had been controlled prior to January 2009.Method: Anonymised clinical enquiries to the NPIS and accesses to the poisons information database TOXBASE were reviewed retrospectively from January 2009 to December 2018 to ascertain the trends in reported toxicity for NPS, cocaine, heroin, cannabis, amphetamines and MDMA. Data were analysed using interrupted time series analysis with the date of the PSA used as an independent predictor.Results: Over the period of study there were 3,866 NPIS telephone enquiries and 79,271 TOXBASE user accesses made by UK health professionals concerning NPS. There were increases in monthly TOXBASE accesses (t = 7.408, P < 0.0001) and telephone enquiries (t = 4.74, P < 0.001) over the pre-specified period January 2009 to May 2016. Comparing the period after the PSA with that before, there were significant reductions in TOXBASE accesses (t = −3.327, P < 0.001) and telephone enquiries (t = −6.97, P < 0.001), although reductions started before May 2016. There were no significant changes for the five conventional drugs. There were significant reductions in telephone enquiries (t = −3.418, P < 0.001) and non-significant reductions in TOXBASE accesses (t = −1.713, P = 0.089) for NPS between June 2016 and December 2018. Increases in telephone enquiries for cocaine and reductions TOXBASE accesses for MDMA were also observed over that period.Conclusions: There have been significant recent reductions in NPIS enquiry activity relating to NPS; although these began before enactment of the PSA in May 2016.

The changing trend of teleconsultations during COVID-19 era at a tertiary facility in Tanzania.

Introduction:the current COVID-19 pandemic has occasioned the increased adoption of telemedicine. This study reports the uptake and trend of a new teleconsultation service in a Tanzanian hospital.Methods:this is a retrospective observational study that profiled requests for teleconsultations and uptake of the service between April 1, 2020, and June 30, 2020.Results:two hundred and eighteen telephone inquiries were received over the 3 months. One hundred and sixteen (53.2%) individuals followed through with the teleconsultations. Paediatric (38.8%) and Internal medicine (32.8%) were the subspecialties with the highest number of teleconsultations. In a frame of 3 months, teleconsultation uptake was highest in May and lowest in June.Conclusion:there was a steady rise and a rapid fall in requests and uptake of teleconsultation services over the period under evaluation. Lack of insurance coverage for teleconsultations was a significant barrier. We propose a re-education and reiteration of the benefits of telemedicine to all stakeholders. This is important for the current era and beyond.

Airway clearance services (ACSs) in Australia for adults with chronic lung conditions: scoping review of publicly available web-based information

BackgroundConsumers frequently access the internet looking for health information. With the growing burden of chronic disease internationally, strategies are focussing on self-management interventions in community and ambulatory settings. The objective of this scoping review was to describe publicly available information on Australian airway clearance services.MethodsPublicly funded health services network webpages and Google were systematically searched between July and November 2018 using relevant keywords. We identified the number, location and currency of contact information of services; and described the services that were in operation and/or identifiable on the internet. Where specific airway clearance services were not identifiable via searching methods, webpages were navigated for associated physiotherapy services. All identified services were contacted via the listed phone or email to confirm web-based findings.ResultsSearching 131 publicly funded health service pages and 191 keyword hits identified four publicly funded airway clearance services (two of which were in operation when confirmed by direct contact) and six private services, all in metropolitan areas of capital cities. Webpages described who their services were for (9/10 services), how to gain referral (4/10) and types of airway clearance techniques available (5/10). A further 286 public physiotherapy services were identified, of which 24 (8%) included descriptors of service provision for respiratory patients on their webpage. In contrast, on direct telephone enquiry airway clearance intervention of some kind was confirmed as being available at 174/286 (61%) sites and unavailable at 69/286 (24%) sites.ConclusionsThis scoping review demonstrated inconsistencies between airway clearance service information available on the internet and the reported provision of services confirmed by direct phone contact. Services that are available need to make information visible to consumers on the internet and include details such as referral pathways, interventions and current contact details, to support people with airway clearance problems to access appropriate care in the community.

Impact of a Real-World Lifestyle Intervention in an Entire LatinAmerican City with More Than 50,000 People.

The aim of this study was to assess the impact of a real-world citywide intervention on physical activity and eating habits in a LatinAmerican city with more than 50,000 inhabitants. This was a plausibility assessment of a real-life intervention. A probabilistic sample (n = 1,424) from Jaguariuna (Sao Paulo, Brazil) was assessed before and after a 7-month intervention aimed at increasing physical activity levels and improving eating habits at a city level. Primary outcomes were physical activity, sedentary behavior, and eating habits assessed by a valid telephone inquiry. The secondary outcome was body weight. The proportion of individuals achieving therecommended intake of fruits and vegetables increased (18%; 95% CI: 2% to 36%; P = 0.031), whereas the number of individuals consuming soft drinks and exchanging main meals for snacks or junk food decreased (-35%; 95% CI: -45% to -22%; P < 0.001 and -16%; 95% CI: -29% to -1%; P = 0.037). The number of active individuals increased during leisure time (37%; 95% CI: 19% to 58%; P < 0.001), at work (17%; 95% CI: 4% to 32%; P = 0.009), and in the household (14%; 95% CI: 0% to 31%; P = 0.047). Body weight decreased among individuals with overweight or obesity. This intervention promoted pronounced lifestyle changes (i.e., increased physical activity and healthier food choices) in the entire city, providing scientific-based evidence on which to build effective public health policies in Latin America.