Week Of April Research Articles

Well-being and COVID-19-related worries of German children and adolescents: A longitudinal study from pre-COVID to the end of lockdown in Spring 2020.

BackgroundThere is concern that pandemic measures put a strain on the health and well‐being of children. We investigated the effects of the COVID‐19 pandemic, the lockdown, and social distancing on the well‐being, media use, and emotions of children and adolescents between 9 and 18 years.MethodsWe used linear and proportional odds logistic regression correcting for age, sex, and socioeconomic status (SES) and to compare media use, peers/social support, physical, and psychological well‐being between 2019 (pre‐COVID baseline) and two time points shortly after the start of the lockdown (last week of March and April 2020, respectively) in 391 9–19‐year‐old healthy children and adolescents of the LIFE Child cohort. COVID‐19‐related feelings and their relationship to age, sex, and SES were assessed at two time points during lockdown.ResultsWe found significantly lower scores in physical and psychological well‐being during lockdown compared to baseline. The effect was significantly stronger in children with medium/low SES. Perceived social support scores were also significantly lower during the lockdown. The percentage of children who had no contact with their peers (in‐person or online) increased from 3% pre‐COVID to 14% and 13% in April and March 2020, respectively. About 80% of the children missed in‐person contacts with friends. Most of the children worried more about the health of their families than their own. Sixty percent worried about the international situation at least moderately, whereas only 20% were afraid of COVID‐19 itself. The percentage of children who believed it would never be as before COVID‐19 rose from 7.4% at the beginning lockdown end of March to 16.2% a month later. In contrast, all other COVID‐19‐related worries, showed a (nonsignificant) decline during the same period.ConclusionOur study supports the notion that pandemic measures have to be balanced against adverse public health effects. Especially vulnerable groups have to be protected.

Estimation of COVID-19 under-ascertainment in Kano, Nigeria during the early phase of the epidemics

This study aims to estimate the number of COVID-19 cases under- ascertained (η), and the basic reproduction number (R0) during the early stage of epidemic in Kano, Nigeria. We adopt a simple exponential growth model to capture the patterns of COVID-19 early epidemic curve in Kano. The R0 is estimated at 2.7 (95%CI: 2.5, 3.0). We find that the number of COVID-19 cases under-ascertained likely occurred during the fourth week of April 2020, and should be considered for future epidemiological investigations and mitigation plan.

2020 trends in dental office visits during the COVID-19 pandemic

BackgroundCOVID-19 has created barriers to the delivery of health care services, including dental care. This study sought to quantify the change in dental visits in 2020 compared with 2019. MethodsThis retrospective, observational study examined the percentage change in weekly visits to dental offices by state (inclusive of the District of Columbia), nationally, and by county-level COVID-19 incidence using geographic information from the mobile applications of 45 million smartphones during 2019 and 2020. ResultsFrom March through August 2020, weekly visits to dental offices were 33% lower, on average, than in 2019. Weekly visits were 34% lower, on average, in counties with the highest COVID-19 rates. The greatest decline was observed during the week of April 12, 2020, when there were 66% fewer weekly visits to dental offices. The 5 states (inclusive of the District of Columbia) with the greatest declines in weekly visits from 2019 through 2020, ranging from declines of 38% through 53%, were California, Connecticut, District of Columbia, Massachusetts, and New Jersey. ConclusionsWeekly visits to US dental offices declined drastically during the early phases of the COVID-19 pandemic. Although rates of weekly visits rebounded substantially by June 2020, rates remain about 20% lower than the prior year as of August 2020. These findings highlight the economic challenges faced by dentists owing to the pandemic. Practical ImplicationsStates exhibited widespread variation in rates of declining visits during the pandemic, suggesting that dental practices may need to consider different approaches to reopening and encouraging patients to return depending on location.

The Impact of Anxiety on Perceptions During the Lockdown of COVID-19

The world faced a new way of organizing everyday life in many countries during 2019. Lockdowns applied in many societies. People adopted a “new way” of living which now is called “the new normal”. The tense days spent under the virus threat made people experience changes in their daily lives, plus it forced them into behaving differently than before when the fear of any pandemic was almost nonexistent. This research was conducted during the days of lockdown and it indicates the feelings people experienced during the conditions of lockdown, in particular: on the magnitude of anxiety they felt, how anxiety may have affected perceptions and behaviors related to economy; furthermore, on the perceptions of economic crisis. Also gender differences were tested regarding the above. An online survey was conducted in Albania from March 22nd to April 4th, 2020, during the lockdown period of COVID-19. Since the 9th of March 2020, the Albanian government started issuing the anti-COVID-19 measures that were toughened later in the following weeks of March and April. The education institutions were closed and other public and private services were limited. The government issued a strict curfew allowing people to go out in limited hours, in some days up to one hour. Some weekends the curfew lasted for 24-48 hours in isolation where citizens were prohibited to walk outside of their homes. Transportation was limited to the employee shuttles and distribution transportation services only. Private cars were not allowed for many weeks. Physical stores were closed; only those selling food could open for limited hours. 1205 respondents participated in this online survey, from which 1061 valid questionnaires were analyzed, in a sample of 66.2% female and 33.8% male, providing data regarding their feelings during quarantine, their decisions related to future spending and how they perceived the future economic situation. The aim is to investigate the relation between anxiety and economic crises perceptions, the levels of anxiety and decision-makings on future spending and if there is any variance affected by gender, in order to have an outcome on the assumption that anxiety feelings may affect peoples’ behavior as consumers. The results of this research show that there are differences between male and female groups on the levels of anxiety experienced during the lockdown and on the level of perception of future economic crisis, but there is no difference between gender groups regarding the decision in reducing future spending. Another finding from this research is that people experiencing high levels of anxiety, were more likely to lessen their future expenses. Also, there is a significant relationship between anxiety and the level of perception on the fear of future economic crisis in the country. People with high levels of anxiety, perceive a higher level of crisis. There is a significant relationship between anxiety and decision-making of reducing the future spending. People with high levels of anxiety, have higher levels of reduction of future spending. The decreasing of future spending is related more to the perception of future economic crisis than to feelings of anxiety.

EFFECTIVENESS OF TEXT MESSAGES TO TECHNOLOGY DISSEMINATION: A THEMATIC ANALYSIS

This study was conducted at Philippine Rice Research Institute located at Barangay Maligaya, Science City of Munoz, Nueva Ecija, and sought to determine the total number of text messages received by the PhilRice Text Center during the month of April in 2016. It also aimed to sort the text messages received according to categories/theme, the number of text messages per category/theme the frequency of the text messages from the regular texters, and the effectiveness of information on harvest and post-harvest based on the feedback obtained from the text messages. Results of the study show that the 4th week of April received the highest total number of text messages. On the most active regions in texting the Text Center, Region III, and Region XIII determined as the most active. On categories and themes, most of the text messages were on pest management, replies from senders, problems encountered, and plenty of seed availability and other seed-related concerns. . On the number of text per category/theme, the majority of the senders asked about seeds during the month of April. Senders asked if what seed varieties could be planted in the rainy season On the frequency of the texts of a regular texter, the data show that out of 2,691 texters all over the country, only 12 texters were determined as regular texters.

Decline in Receipt of Vaccines by Medicare Beneficiaries During the COVID-19 Pandemic - United States, 2020.

On March 13, 2020, the United States declared a national emergency concerning the novel coronavirus disease 2019 (COVID-19) outbreak (1). In response, many state and local governments issued shelter-in-place or stay-at-home orders, restricting nonessential activities outside residents' homes (2). CDC initially issued guidance recommending postponing routine adult vaccinations, which was later revised to recommend continuing to administer routine adult vaccines (3). In addition, factors such as disrupted operations of health care facilities and safety concerns regarding exposure to SARS-CoV-2, the virus that causes COVID-19, resulted in delay or avoidance of routine medical care (4), likely further affecting delivery of routine adult vaccinations. Medicare enrollment and claims data of Parts A (hospital insurance), B (medical insurance), and D (prescription drug insurance) were examined to assess the change in receipt of routine adult vaccines during the pandemic. Weekly receipt of four vaccines (13-valent pneumococcal conjugate vaccine [PCV13], 23-valent pneumococcal polysaccharide vaccine [PPSV23], tetanus-diphtheria or tetanus-diphtheria-acellular pertussis vaccine [Td/Tdap], and recombinant zoster vaccine [RZV]) by Medicare beneficiaries aged ≥65 years during January 5-July 18, 2020, was compared with that during January 6-July 20, 2019, for the total study sample and by race and ethnicity. Overall, weekly administration rates of the four examined vaccines declined by up to 89% after the national emergency declaration in mid-March (1) compared with those during the corresponding period in 2019. During the first week following the national emergency declaration, the weekly vaccination rates were 25%-62% lower than those during the corresponding week in 2019. After reaching their nadirs of 70%-89% below 2019 rates in the second to third week of April 2020, weekly vaccination rates gradually began to recover through mid-July, but by the last study week were still lower than were those during the corresponding period in 2019, with the exception of PPSV23. Vaccination declined sharply for all vaccines studied, overall and across all racial and ethnic groups. While the pandemic continues, vaccination providers should emphasize to patients the importance of continuing to receive routine vaccinations and provide reassurance by explaining the procedures in place to ensure patient safety (3).

Gestión de la actividad quirúrgica electiva de un hospital terciario durante la pandemia por SARS-CoV-2

IntroductionDuring the SARS-CoV-2 pandemic, elective surgical activity was reduced to a minimum. As both the number of cases and the hospitalization needs for this pathology decreased, we thought it appropriate to progressively recover scheduled surgical activity. This work describes how, even with the current alarm state, we were able to practically normalize this activity in a few weeks. MethodsTwo weeks before the intervention, the patients included in the waiting lists were contacted by telephone. After checking their health status and expressing their desire to undergo surgery, they were provided with recommendations to decrease the risk of coronavirus infection. Likewise, an exclusive circuit was established to carry out, 48 hours before the intervention, the detection of SARS-CoV-2 by means of exudates nasopharyngeal PCR. The results were evaluated by each surgical service and the anesthesiology service. In addition, asymptomatic Surgical Area professionals could undergo weekly screening for the early detection of coronavirus according to the recommendations of Occupational Health. ResultsIn the midst of a pandemic, scheduled surgical activity was reduced by 85%. From the week of April 13, the operating rooms available were recovered, which allowed practically all surgical activity to be recovered the week of May 25. ConclusionsThe creation of circuits and procedures to streamline surgical activity, still in full force of the state of alarm, has allowed us, in a few weeks, to recover almost all of it.

Spatio-temporal characterization of landscape fire in relation to anthropogenic activity and climatic variability over the Western Himalaya, India

ABSTRACT The frequent occurrence of a forest fire can be detrimental to the functioning of ecologically fragile regions such as the Western Himalaya. This study assesses the spatio-temporal variability and trends of fire occurrence in forests, shrubland, and grassland in relation to anthropogenic activities and climate oscillations over Uttarakhand and Himachal Pradesh; the most fire-affected states in the Western Himalaya. The Pre-monsoon (March to June) temporal distribution of fire occurrence is bimodal with the first and second fire peaks occurring in the last week of April and late May/early June, respectively. The length of fire season was found to have reduced by ~ 10 days in 2010s compared to 2000s with the increasing burned area concentration over a shorter period (~110 days). The Mann-Kendall Tau (τ) and Sen’s-slope suggested an increasing trend (τ = 0.3, Sen’s slope = 46.78 km2 year−1, p = 0.02) of burn area over Uttarakhand where most fire activity occurs. The Getis-Ords (Gi*) statistic was derived by using Fire Radiative Power (FRP) data to infer the spatial distribution of hot and cold clusters which were found to be greatest (Gi* = 1–10) in evergreen needleleaf forest which also accounted for a marginally higher mean per-pixel FRP than other land cover types. Analyses of the role of climatic variables on fire activity revealed moderate positive and negative correspondence between the burned area and average maximum-temperature (R = 0.57, p = 0.01) and total precipitation (R = – 0.53, p = 0.02), respectively. Assessment of the variation of fire activity with global climatic oscillation indices found the Niño-3.4 index to have the strongest, albeit modest, relationship (R = 0.51) with burned area anomalies. This study highlights the increase in fire intensity in the fragile forests of the Western Himalayan region and the requirement for further research into the role of climate and anthropogenic activities on fire occurrence in order to best preserve regional biodiversity and develop an effective forest management strategy.

COVID-19, Intimate Partner Violence, and Communication Ecologies

The purpose of this research is to identify important predictors, related to the ongoing COVID-19 pandemic, of intimate partner violence (IPV) and to provide insight into communication ecologies that can address IPV in disaster contexts. This study uses a cross-sectional design, with purposive snowball sampling, for primary survey data collected over 10 weeks starting the first week in April 2020. A total of 374 adults participated in the study. Logistic binary regression was used to identify key predictors among sociodemographic characteristics, stress related to COVID-19, and perceived stress of group membership for those who reported IPV experiences. A t test was used to statistically differentiate between IPV-reporters and non-IPV reporters based on perceived stress measured by the Perceived Stress Scale. Results indicated that respondents who reported renting, lost income due to COVID-19, and increased nutritional stress were all more likely to belong to the IPV-reporters group. These findings provide insight into additional stressors related to the ongoing pandemic, such as stress due to income loss, nutritional stress, and renting, and their likelihood of increasing IPV victimization. Taken together, these results indicate that additional communication resources are needed for those affected by IPV. Additional findings and implications are further discussed.

Cross-sectional observational study of epidemiology of COVID-19 and clinical outcomes of hospitalised patients in North West London during March and April 2020

ObjectiveThe aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London.DesignObservational cohort study.SettingLondon North...

Estimated time for supply and drainage of water for rice planting in freshwater swampland

Information about the timing of supply and drainage to the land is important. This aims to minimize crop failure and increase swamp rice productivity. The highest water requirement occurs in the first week of October, namely 1.21 mm day−1, while the lowest water requirement occurs in January III to April week III. In the dry conditions, runoff that occurs 0.04 to 5.71 mm day−1 is estimated to occur on January 1 to May 10 and November 22 to December 31. While the land will require water from 0.06 to 6.31 mm day−1 on May 11 to November 21. In a normal conditions, runoff will occur 0.05 to 12.89 mm day−1, estimated on January 1 to June 13 and October 26 to December 31, and requires a water supply of 0.04 to 4.20 mm day−1 on June 14 to October 25. Meanwhile, in the rainy conditions there will be a runoff of 0.05 to 16.72 mm day−1, estimated to occur on January 1 to July 9 and September 29 to December 31. As well as land will require water of 0.02 to 1.30 mm day−1, is expected to occur on 10 July to 28 September.

Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer.

Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer. To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies. We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer. Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms. We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms. None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.

Impact of the COVID-19 pandemic on hospitalizations for acute coronary syndromes: a multinational study.

Background: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. Conclusions: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

Excess Cerebrovascular Mortality in the United States During the COVID-19 Pandemic.

The magnitude and drivers of excess cerebrovascular-specific mortality during the coronavirus disease 2019 (COVID-19) pandemic are unknown. We aim to quantify excess stroke-related deaths and characterize its association with social distancing behavior and COVID-19-related vascular pathology. United States and state-level excess cerebrovascular deaths from January to May 2020 were quantified using National Center for Health Statistic data and Poisson regression models. Excess cerebrovascular deaths were analyzed as a function of time-varying stroke-related emergency medical service (EMS) calls and cumulative COVID-19 deaths using linear regression. A state-level regression analysis was performed to determine the association between excess cerebrovascular deaths and time spent in residences, measured by Google Community Mobility Reports, during the height of the pandemic after the first COVID-19 death (February 29). Forty states and New York City were included. Excess cerebrovascular mortality occurred nationally from the weeks ending March 28 to May 2, 2020, up to a 7.8% increase above expected levels during the week of April 18. Decreased stroke-related EMS calls were associated with excess stroke deaths one (70 deaths per 1000 fewer EMS calls [95% CI, 20-118]) and 2 weeks (85 deaths per 1000 fewer EMS calls [95% CI, 37-133]) later. Twenty-three states and New York City experienced excess cerebrovascular mortality during the pandemic height. A 10% increase in time spent at home was associated with a 4.3% increase in stroke deaths (incidence rate ratio, 1.043 [95% CI, 1.001-1.085]) after adjusting for COVID-19 deaths. Excess US cerebrovascular deaths during the COVID-19 pandemic were observed and associated with decreases in stroke-related EMS calls nationally and mobility at the state level. Public health measures are needed to identify and counter the reticence to seeking medical care for acute stroke during the COVID-19 pandemic.

Longitudinal Tracking of Vape Shop Compliance With State Business Regulations Within Southern California Ethnic Neighborhoods During the COVID-19 Pandemic.

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020-June 10, 2020), extending from the mandated closure of nonessential businesses (Stage 1; Assessments 1-3) to the reopening of nonessential sectors (Stage 2; Assessments 4-6), to evaluate business operations (open and closure statuses). The proportion of vape shops found to be noncompliant with the Governor's executive order (i.e., open) during Stage 1 gradually increased from 54 (61.4%) at Assessment 1 (week of April 1, 2020) to 58 (65.9%) at Assessment 3 (week of April 29, 2020). Moreover, vape shops located in Hispanic/Latino and Korean/Asian communities (vs. those in non-Hispanic White and African American communities) were more likely to stay open both during and after the shutdown at Assessments 1 and 6. More specifically, vape shops located in Hispanic/Latino communities were significantly more likely to offer walk-in service during Assessment 1 (during the shutdown), and vape shops in Hispanic/Latino and Korean/Asian were significantly more likely to offer walk-in service during Assessment 6 (after the re-opening). This study demonstrates high rates of noncompliance with shutdown orders among vape shops located in ethnic communities, thus suggesting higher contextual risk factors of COVID-19 exposure among certain ethnic communities.

COVID-19 and the public response: Knowledge, attitude and practice of the public in mitigating the pandemic in Addis Ababa, Ethiopia.

The COVID-19 pandemic is impacting the global community in many ways. Combating the COVID-19 pandemic requires a coordinated effort through engaging public and service providers in preventive measures. The government of Ethiopia had already announced prevention guidelines for the public. However, there is a scarcity of evidence-based data on the public knowledge, attitude, and practice (KAP) and response of the service providers regarding COVID-19. This study aimed to assess the public KAP and service providers' preparedness towards the pandemic in Addis Ababa, Ethiopia. A community-based cross-sectional study was conducted in Addis Ababa, Ethiopia, from late March to the first week of April 2020. Participants were conveniently sampled from 10 different city sites. Data collection was performed using a self-administered questionnaire and observational assessment using a checklist. All statistical analysis was performed using SPSS version Descriptive statistics, correlation coefficient and chi-square tests were performed. A total of 839 public participants and 420 service providers enrolled in the study. The mean age was 30.30 (range = 18-72) years. The majority of the respondents (58.6%) had moderate knowledge about COVID-19, whereas 37.2% had good knowledge. Moreover, 60.7% and 59.8% of the participants had a positive attitude towards preventive measures and good practice to mitigate the pandemic, respectively. There was a moderate positive correlation between knowledge and attitude, whereas the correlations between knowledge and practice and attitude and practice were weak. With regard to service providers' preparedness, 70% have made hand-washing facilities available. A large majority of the respondents (84.4%) were using government-owned media followed by social media (46.0%) as a main source of information. The public in Addis Ababa had moderate knowledge, an optimistic attitude and descent practice. The information flow from government and social media seemed successful seeing the majority of the respondents identifying preventive measures, signs and symptoms and transmission route of SARS-CoV-2. Knowledge and attitude was not associated with practice, thus, additional innovative strategies for practice changes are needed. Two thirds of the service provider made available hand washing facilities which seems a first positive step. However, periodic evaluation of the public KAP and assessment of service providers' preparedness is mandatory to combat the pandemic effectively.

The Ongoing Impact of COVID-19 on US Dermatology Practices

Background: COVID-19 is significantly impacting healthcare delivery worldwide. Chen et al anecdotally reported the impact on dermatology outpatient care at the outbreak epicenter in Wuhan, China, but nothing has yet been assessed for the US. The purpose of this study was to determine the magnitude of the ongoing impact of COVID-19 on US dermatology outpatient care. Methods: After pre-validation, 2 surveys comparing outpatient volumes and scheduling issues for the weeks of February 17th versus the week of March 16th, 2020 (Survey 1) and April 13th, 2020 (Survey 2) and for estimation of trends in the next several weeks was emailed to 9,891 US Dermatologists on 3/21(Survey 1) and 4/18(Survey 2)(Tables S1a &amp; S1b). Because of the importance of this information and the need for rapid dissemination, only data from the first 1,000 respondents (collected in the initial 36 hours) were included in each survey. In Survey 1, 30 responses were removed due to ineligible geography or errors in survey entry, leaving 970 for the analysis. Survey 2 consisted of 1,000 eligible respondents. Demographics (Table 1) representativeness with AAD membership was confirmed (Table S2). Statistical significance was calculated using chi-square, difference-of-proportions, and two-tailed independent t-tests. Results: COVID-19 impact was material (Table 2). From the 3rd week in February to the 3rd week in March to the 3rd week in April, the average number of patients seen fell from 149.4 to 63.4 to 28.2(p&lt;0.0001), practice days from 4.2 to 3.1 and then rose to 3.5(p&lt;0.0001) and biopsies from 19.8 to 7.7 to 3.5(p&lt;0.0001). Although by 3/16 there were only 24.5k cases nationally, the early-phase decrease in patient volume and office days suggests the magnitude of disease concern impact was greater than actual prevalence. Postponement of non-essential appointments increased from 35.5% to 79.4% to 95.6%(p&lt;0.00001). In Survey 1, 66.3% of respondents estimated a &gt;50% decrease in patient volume in the coming 2 weeks (18.9% completely closing practices) and, disturbingly, 47.2% of respondents in the 2nd survey estimated an additional 50%+ decrease in patient volume in the next 2 weeks. 54.6% (Survey 1) of postponed appointments were for &gt;4 weeks with an additional 25.4% not rescheduled. Discussion: A greater negative impact was found in US “hotspot” regions (36% (Survey 1) and 34% (Survey 2) of respondents-Figure S1) for week 3/16-20 for practice days (3.0 hotspots vs. 3.3 non-hotspots) and patients seen (56.2 in hotspots vs. 70.0 in non-hotspots); and for week 4/13-18 (3.4 in hotspots vs 3.5 in non-hotspots) and patients seen (25.3 in hotspots vs 29.7 in non-hotspots). No significant differing telemedicine usage (39.5% hotspots vs 37.2% non-hotspots) or practice closure (21.0% hotspots vs 17.6% non-hotspots) was found in Survey 1 (March); however, a significant difference in telemedicine usage (54.5% hotspots vs 45.5% non-hotspots) and practice closure (25.4% hotspots vs 16.4% non-hotspots, when compared to a typical April week) was found in Survey 2 (April). Mean estimated telemedicine visits overall for the next 2 weeks was 37.8% (Survey 1) and 45.9% (Survey 2). Academic/University/Institutional dermatologists were significantly more likely to use telemedicine (Survey 1=57.1%, Survey 2=68.6%) than private practitioners (Survey 1=35.5%, Survey 2=46.2%). Telemedicine usage was less likely for dermatologists with &gt;30 practice years (&gt;30=32.4% vs 40.0%) and this trend continued in April with only 37.2% of more experienced dermatologists using telemendine. However, telemedicine usage does not have an impact on the deferred/postponed biopsies that had already occurred during the March (mean=10.7) or April (mean=7.9) weeks as well as those predicted to be subsequently postponed. Limitations include that this study reflects a “snapshot” which could materially change given the dynamically evolving situation. Estimations could have led to recall bias and the 10.1% response rate could have introduced sampling and non-response bias. Those with lower work volumes could have been more likely to have time to respond, but this bias was minimized by weekend-only data collection. However, the large sample size and representative distribution mitigate selection bias and standard statistical testing demonstrated significance. Conclusion: Our findings demonstrate the significant early impact of COVID-19 on US dermatologic care and can help better understand national trends. With an estimated 49.9 million annual US dermatology office visits, the 50%+ decrease in predicted visits could be devastating. Beyond telemedicine, other innovative approaches will need to be developed and implemented to help delivery of essential dermatology care during this crisis.

Busy Season and Proxy Recommendations

The short period of time, from the fourth week of April to the end of May, referred to as the proxy season, has about 333 proposals voted a day relative to 27 proposals voted per day outside the proxy season. The compressed workload results in 17.6% fewer negative recommendations from ISS during this busy period. The proxy season also entails busy voting schedules for institutional investors who in the aggregate, respond by increasing their reliance on ISS recommendations. Aggregate support for proposals with a negative recommendation from ISS is 10% lower during the busy period. Stock price reaction to outcomes in close votes show that successful negative recommendations during the busy period, that is when negative proposals fail, are not value enhancing. In sum, ISS recommendations during busy voting periods are less likely to be negative, have greater influence on voting, and are not value enhancing. The results inform the policy debate on the role and influence of proxy advisors.

Stress, Sources of Stress and Coping During the COVID-19 Lockdown

Background: Pandemics such as COVID-19 (with or without lockdown) can cause considerable stress to individuals, testing their coping resources. To contain the pandemic, there was a nationwide lockdown in India from March 25, 2020, severely limiting movement of the 1.3 billion population till the first relaxation came on April 21. This study was done in the 3rd week of April, just before relaxations were announced, to study the perceived stress, sources of stress, and coping strategies of adults during this core lockdown period in Kerala, India. Materials and Methods: We gathered data from 1073 adults using sociodemographic information, perceived stress scale, sources of stress checklist, and COVID-19 coping strategies scale. Correlation analyses, t-test, and one-way analysis of variance were employed for data analyses. Results: 65.7% of respondents scored high on the stress scale with 8.3% experiencing severe stress and 57.4% reporting moderate stress. Stress was negatively correlated with age, education level and income. Anxiety about the impact of the pandemic on the world and their own personal future were the main sources of stress. This was followed by financial worries, stress due to frustration of limited movement, and fear about contracting COVID. The five most common coping strategies used were increased hygiene, social distancing, increasing awareness about the disease, increased communication with family, and distraction through movies and books. Conclusion: During the core lock down period in April 2020 in India, there was high levels of stress among the people primarily due to the worry about the future impact of the pandemic as well due to the restrictions imposed.

Impact of COVID19 on Routine Immunization: A Cross-Sectional Study in Senegal

Introduction: The COVID 19 pandemic has prompted the world to implement drastic prevention methods based on limiting population movements that have an impact on public health policies such as vaccination. The objective of this work was to evaluate the impact of these prevention measures on routine vaccination in hospitals since the advent of the pandemic in Senegal. Methodology: This is a retrospective cross-sectional study carried out in August 2020 in the vaccination unit of the Abass NDAO hospital centre. We compared data from the vaccination unit during the period from March to August of the last three years (2018, 2019 and 2020). The parameter studied was the number of vaccine doses administered for the different periods according to the expanded programme of immunization. Results: For the vaccines administered in the sixth week in April, the number of doses was 36 in 2018, 29 in 2019 and 15 in 2020, i.e. a 50% drop compared to March. In July the number of doses administered was 40 in 2018, 35 in 2019 and 15 in 2020, a reduction of 42% compared to 2019. Conclusion: Measures to fight this pandemic should not make us forget routine vaccination, especially in our resource-constrained countries. It is essential to continue vaccination for children and to identify children who have missed vaccine doses for catch-up.