Articles: pandemics.
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Wien. Klin. Wochenschr. · May 2023
Community engaged research to measure the impact of COVID-19 on vulnerable community member's well-being and health : A mixed methods approach.
The COVID-19 pandemic has exacerbated existing income inequality and health disparities in the United States (US). The objective of this study was to conduct timely, community-engaged research to understand the disproportionate impact of the COVID-19 pandemic on historically under-resourced communities with the goal of improving health equity. The initiative focused on priorities identified by Community Health Needs Assessments (CHNA) conducted every 3 years per Federal funding requirements. These were access to healthcare, maternal/child health, obesity/food insecurity/physical activity, and mental health/addiction. ⋯ Healthcare systems may use the methodology outlined in this paper to conduct responsive community engagement during periods of instability and/or crisis and to address health equity issues. The results can inform sustainable approaches to collaborate with communities to build resilience and prepare for future crises.
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Wien. Klin. Wochenschr. · May 2023
Recovery and stress of control center dispatchers in the first waves of the SARS-CoV-2 pandemic.
Control center dispatchers (CCDs) are exposed to high levels of work-related mental stress, which are exacerbated by the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The aim of this study was to comparatively analyze the recovery and stress state of CCDs during the first and second waves of the SARS-CoV‑2 pandemic. A total of 490 CCDs (n = 440, t1 and n = 50, t2) with a mean age of 42.26 ± 8.79 years participated directly at the end of the first wave from June to August 2020 (t1) and during the second wave between January and February 2021 (t2) of the SARS-CoV‑2 pandemic. ⋯ The SARS-CoV‑2 pandemic illustrates that the stress experience increased from the first to the second waves, and the recovery of CCDs decreased. These data provide a directional trend as the pandemic is ongoing, and stress and strain situations in control centers may continue to worsen. Immediate health promotion and prevention measures are essential.
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We present the case of a young woman admitted for diabetic ketoacidosis with persistent, asymptomatic lactic acid (LA) elevation during the evolving COVID-19 pandemic. Cognitive biases in interpreting an elevated LA in this patient's care resulted in an extensive infectious workup instead of the low-cost and potentially diagnostic provision of empiric thiamine. We discuss clinical patterns and etiologies of LA elevation and the role of thiamine deficiency. We also address cognitive biases potentially affecting the interpretation of elevated lactate levels and provide guidance for clinicians to determine appropriate patients for empiric thiamine administration.
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Observational Study
The effect of COVID-19 in a university hospital neurosurgery clinic comparison to pre-pandemic period: a retrospective study with 6 months of data.
The coronavirus disease 2019 (COVID-19) pandemic affected all countries' health systems and people's lifestyles. In this study, we aimed to investigate its effects in a university hospital neurosurgery clinic. ⋯ The pandemic and restrictions affected negatively the health system and people's access to healthcare. Our retrospective observational study aimed to evaluate these effects and take lessons for the next similar situations. People's access to health care should be considered when lockdown restrictions.
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Observational Study
Challenges in Estimating the Effectiveness of COVID-19 Vaccination Using Observational Data.
The COVID-19 vaccines were developed and rigorously evaluated in randomized trials during 2020. However, important questions, such as the magnitude and duration of protection, their effectiveness against new virus variants, and the effectiveness of booster vaccination, could not be answered by randomized trials and have therefore been addressed in observational studies. Analyses of observational data can be biased because of confounding and because of inadequate design that does not consider the evolution of the pandemic over time and the rapid uptake of vaccination. ⋯ The nature of the confounding depends on the analysis strategy: Estimating "per-protocol" effects (accounting for vaccination of initially unvaccinated persons after baseline) may require adjustment for both baseline and "time-varying" confounders. These issues are illustrated by using observational data from 2 780 931 persons in the United Kingdom aged 70 years or older to estimate the effect of a first dose of a COVID-19 vaccine. Addressing the issues discussed in this article should help authors of observational studies provide robust evidence to guide clinical and policy decisions.