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Ferro S, Riganti A. The hidden toll of the pandemic on nonrespiratory patients. Health Policy 2024; 143:105035. [PMID: 38461618 DOI: 10.1016/j.healthpol.2024.105035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Abstract
While many empirical studies have focused on the health consequences of COVID-19 for infected individuals, little attention has been given to its consequences for patients with nonrespiratory medical conditions. In this study, we apply machine learning and regression analysis techniques to complete-coverage administrative records of inpatient hospitalizations in Italy in 2012-2021 to investigate how the outbreak has impacted on the treatment of nonrespiratory patients in one of the countries most acutely affected by the pandemic. A comparison of hospital- and population-level excess deaths suggests that 53.7% of COVID-19 deaths occurred outside of hospitals. We interpret this as evidence of limited hospital resources, and we show that a higher number of hospital beds per capita is associated with a greater proportion of in-hospital deaths. We also document a 22.6% decrease in hospitalizations of nonrespiratory patients, more pronounced for patients in less severe conditions, and a conditional decrease of 0.5 days in the average length of stay for nonrespiratory patients. We attribute these changes to fear of infection and hospital resource limitations, and we show that the drop in admissions is more pronounced in areas that were more impacted by COVID-19 and had fewer hospital beds per capita. Our findings suggested that the pandemic's direct impact on infected individuals is just a fraction of the broader health losses in the population.
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Affiliation(s)
- Simone Ferro
- Department of Economics, Management and Quantitative Methods, University of Milan, Italy
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Ojewale LY, Mukumbang FC. Access to healthcare services for people with non-communicable diseases during the COVID-19 pandemic in Ibadan, Nigeria: a qualitative study. BMC Health Serv Res 2023; 23:1231. [PMID: 37946244 PMCID: PMC10636991 DOI: 10.1186/s12913-023-10278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Desirable outcomes for people with non-communicable diseases (NCDs) are achieved when they access routine monitoring and care services. Expectedly, the COVID-19 pandemic severely impacted access to healthcare services, leading to poor health outcomes among people with NCDs. We aimed to [1] explore the delays in accessing healthcare services and [2] understand alternative actions adopted by people with NCDs to overcome these delays. METHODS We conducted an exploratory qualitative research guided by the "Three Delays" model to unpack the barriers to healthcare access for people living with NCDs in Ibadan, Nigeria. The "Three Delays" model conceptualizes the reasons for negative/adverse healthcare outcomes related to the patient's decision-making to seek healthcare, reaching an appropriate healthcare facility, and receiving adequate care at the healthcare facility. Twenty-five (25) people with NCDs were purposively selected from the University College Hospital's medical outpatient department to participate in in-depth interviews. Interview recordings were transcribed verbatim and analyzed using a deductive-inductive hybrid thematic analysis. RESULTS At the level of individual decision-making, delays were related to fear of contracting COVID-19 in the hospital (considered a hotspot of the COVID-19 pandemic). Regarding reaching an appropriate healthcare facility, delays were mainly attributed to the intra- and inter-city lockdowns, limiting the movements of persons. For those who successfully arrived at the healthcare facilities, delays were related to the unavailability of healthcare professionals, prioritization of COVID-19 patients, and mandatory adherence to COVID-19 protocols, including COVID-19 testing. To overcome the delays mentioned above, people with NCDs resorted to (i) using private healthcare facilities, which were more costly, (ii) using virtual consultation through mobile phone Apps and (iii) self-management, usually by repeating previously prescribed prescriptions to obtain medication. CONCLUSION Pandemic conditions provide unique challenges to people with chronic illnesses. Recognizing the need for continuous access to monitoring and care services under such conditions remains critical. Alternative health service provision approaches should be considered in pandemic situations, including remote healthcare services such as Mobile health apps (mHealth) that can help manage and prevent NCDs.
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Ponce SA, Wilkerson M, Le R, Nápoles AM, Strassle PD. Inability to get needed health care during the COVID-19 pandemic among a nationally representative, diverse population of U.S. adults with and without chronic conditions. BMC Public Health 2023; 23:1868. [PMID: 37752511 PMCID: PMC10523792 DOI: 10.1186/s12889-023-16746-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Delays in health care have been observed in the U.S. during the COVID-19 pandemic; however, the prevalence of inability to get needed care and potential disparities in health care access have yet to be assessed. METHODS We conducted a nationally representative, online survey of 5,500 American Indian/Alaska Native, Asian, Black/African American, Latino (English- and Spanish-speaking), Native Hawaiian/Pacific Islander, White, and multiracial adults between 12/2020-2/2021 (baseline) and 8/16/2021-9/9/2021 (6-month follow-up). Participants were asked "Since the start of the pandemic, was there any time when you did not get medical care that you needed?" Those who responded "Yes" were asked about the type of care and the reason for not receiving care. Poisson regression was used to estimate the association between sociodemographics and inability to receive needed care; all analyses were stratified by chronic condition status. Chronic conditions included: chronic obstructive pulmonary disease (COPD), heart conditions, type 2 diabetes, chronic kidney disease or on dialysis, sickle cell disease, cancer, and immunocompromised state (weakened immune system). RESULTS Overall, 20.0% of participants at baseline and 22.7% at follow-up reported not getting needed care. The most common reasons for being unable to get needed care included fear of COVID-19 (baseline: 44.1%; follow-up: 47.2%) and doctors canceled appointment (baseline: 25.3%; follow-up: 14.1%). Routine care (baseline: 59.9%; follow-up: 62.6%) and chronic care management (baseline: 31.5%; follow-up: 30.1%) were the most often reported types of delayed care. Fair/poor self-reported physical health was significantly associated with being unable to get needed care despite chronic condition status (≥ 1 chronic condition: aPR = 1.36, 95%CI = 1.04-1.78); no chronic conditions: aPR = 1.52, 95% CI = 1.28-1.80). The likelihood of inability to get needed care differed in some instances by race/ethnicity, age, and insurance status. For example, uninsured adults were more likely to not get needed care (≥ 1 chronic condition: aPR = 1.76, 95%CI = 1.17-2.66); no chronic conditions: aPR = 1.25, 95% CI = 1.00-1.56). CONCLUSIONS Overall, about one fifth of participants reported being unable to receive needed care at baseline and follow-up. Delays in receiving needed medical care may exacerbate existing conditions and perpetuate existing health disparities among vulnerable populations who were more likely to have not received needed health care during the pandemic.
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Affiliation(s)
- Stephanie A Ponce
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Miciah Wilkerson
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Randy Le
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Anna María Nápoles
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Paula D Strassle
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA.
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Hwang J, Kim WH, Heo J. An association between individual's risk perceptions and delayed or foregone healthcare services during the COVID-19 pandemic in Korea. BMC Health Serv Res 2023; 23:850. [PMID: 37568127 PMCID: PMC10422804 DOI: 10.1186/s12913-023-09807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/11/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Existing evidence highlights that the COVID-19 pandemic is associated with a large reduction in healthcare utilization for routine and less-urgent services around the world including Korea. During the COVID-19 pandemic, delayed and foregone healthcare are driven by various factors, and risk perception, a complex psychological construct, is one of them. The aim of this study was to examine how COVID-19 risk perceptions influence delayed and foregone care during the pandemic in Korea. METHODS The Koreans' Happiness Survey (KHS) 2020 was used to analyze responses from 13,491 individuals over 19 years of age residing in Korea. To assess delayed and foregone care, self-reported delayed or foregone care after the COVID-19 outbreak was used. COVID-19 risk perceptions were analyzed in terms of fear and severity of the pandemic based on responses from the participants. Logistic regression models, stratified by gender, were used to examine the relationship between COVID-19 risk perception and delayed/foregone healthcare. RESULTS Among the total 13,491 individuals included in the study, 4.0% (n = 541) reported delayed and foregone care in 2020. The results showed that higher level of fear of COVID-19 was associated with an increased likelihood of reporting delayed and foregone care in Korean adults (OR = 1.36, 95% CI = 1.08-1.73). The gender-stratified model revealed that greater fear of COVID-19 was associated with higher odds of delayed and foregone healthcare (OR = 1.71, 95%CI = 1.23-2.39) among women while the perceived severity did not have any association. However, the perceived severity was associated with a higher likelihood of delayed and foregone care in men (OR = 1.17, 95%CI = 1.04-1.32), but no association was found between fear of COVID-19 and delayed and foregone healthcare in men. CONCLUSIONS To ensure the timely use of any needed healthcare services, it is worth considering establishing policy interventions to mitigate unnecessary fear and worries about COVID-19. This can be achieved by providing accurate information on the virus, protective measures, and treatment.
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Affiliation(s)
- Jongnam Hwang
- Division of Social Welfare & Health Administration, Wonkwang University, Iksan, Korea
| | - Woong-Han Kim
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jongho Heo
- JW LEE Center for Global Medicine, Seoul National University College of Medicine, Seoul, Korea.
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea.
- National Assembly Futures Institute, Seoul, Korea.
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Machado JP, Costa BCP, Sudré MRS, Santos IGMD, Veiga EV. Implications of the COVID-19 pandemic in monitoring health and cardiovascular diseases: survey study. Rev Esc Enferm USP 2023; 57:e20220112. [PMID: 37366180 DOI: 10.1590/1980-220x-reeusp-2022-0112en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 04/14/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To analyze the implications of COVID-19 in the monitoring of health and cardiovascular diseases in health services. METHOD This is a descriptive, cross-sectional, survey-type study with 798 adults, selected by snowball on social networks, between June and July 2020. Data were collected in an electronic form validated for this study. RESULTS There was a negative impact on monitoring health and cardiovascular diseases with missed appointments and elective exams. Symptoms such as chest pain and hypertensive crisis were neglected due to fear of contagion, lack of knowledge or structural lack of services, in addition to impaired monitoring of chronic conditions. CONCLUSION The severity of results is noted considering the COVID-19 progression and the risk of complications. It is necessary to organize flows and structures compatible with each care profile, in health services, to guarantee care and promote diagnosis and control of chronic conditions in the set of actions to contain pandemics. It is crucial to prioritize primary care in health follow-ups during pandemic periods, as this has a direct impact on the progression of critical conditions at other levels of care.
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Affiliation(s)
| | - Bárbara Caroliny Pereira Costa
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Enfermagem Fundamental, Ribeirão Preto, SP, Brazil
| | - Mayara Rocha Siqueira Sudré
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Enfermagem Fundamental, Ribeirão Preto, SP, Brazil
| | - Isabela Gomes Musa Dos Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Programa de Enfermagem Fundamental, Ribeirão Preto, SP, Brazil
| | - Eugenia Velludo Veiga
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Departamento de Enfermagem Geral e Especializada, Ribeirão Preto, SP, Brazil
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Haridas K, Edelman D. Changes in glycemic control and body weight over the course of the COVID 19 pandemic in an outpatient setting. J Diabetes Metab Disord 2023; 22:847-850. [PMID: 37250368 PMCID: PMC10116108 DOI: 10.1007/s40200-023-01212-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/13/2023] [Indexed: 05/31/2023]
Abstract
Objective The COVID-19 pandemic altered health outcomes in populations through a host of downstream social, economic, and psychological changes, especially among those with chronic non-communicable diseases (NCDs). Some studies reveal worsened glycemic control and weight gain, while others indicate improved glycemic control and weight loss. Thus, evidence demonstrates conflicting results in this context. We aimed to conduct a study to explore changes in these metrics in an outpatient setting providing for an underserved population. Methods We conducted a single-site observational study at a Federally Qualified Health Center (FQHC) in New York City to compare glycemic control and body weight, measured by Hemoglobin A1c (HbA1c) and body mass index (BMI) respectively, before and after the onset of the COVID-19 pandemic. Results After the pandemic, there was a 103% increase in the annual change in average HbA1c from the years prior to the pandemic versus from early 2020 to 2021 (p < 0.005). Mean BMI increased during the pandemic, although this was not statistically significant. The slope for the change in BMI over five years prior to the pandemic is -0.09, while the slope of change in BMI before and after the onset of COVID-19 is 0.31. The difference between the two slopes is 0.48 (p = 0.37). Discussion/Conclusion Our study reveals that the COVID-19 pandemic could have contributed to a worsening in the status of metabolic disorders due to decreased physical activity, worsened dietary habits, psychosocial stressors, and reduced access to healthcare, emphasizing the need for enhanced medical, pharmaceutical and emotional support. Concurrently, many individuals adopted healthier practices through dietary and activity modifications, with a resulting improvement in cardio-metabolic parameters.
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Affiliation(s)
- Keerthana Haridas
- Icahn School of Medicine at Mount Sinai Morningside –West, New York, NY 10019 USA
| | - Deborah Edelman
- General Internal Medicine, Icahn School of Medicine at Mount Sinai Morningside –West, New York, NY 1001 USA
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Padovani A, Falato S, Pegoraro V. Extemporaneous combination of donepezil and memantine to treat dementia in Alzheimer disease: evidence from Italian real-world data. Curr Med Res Opin 2023; 39:567-577. [PMID: 36803101 DOI: 10.1080/03007995.2023.2182530] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Providing evidence on donepezil and memantine administration as extemporaneous combination (DM-EXT) to treat Alzheimer Disease (AD) in Italy, and describing demographic and clinical features of AD patients prescribed DM-EXT. METHODS Retrospective observational study using IQVIA Italian LifeLink Treatment Dynamics (LRx) and Longitudinal Patient Database (LPD). Prevalent users of DM-EXT were identified on the databases (cohorts DMpLRx and DMpLPD) including patients with donepezil and memantine overlapping prescriptions during the selection period (DMpLRx: "July 2018-June 2021"; DMpLPD: "July 2012-June 2021"). Demographic and clinical profiles of patients were provided. Starting from cohort DMpLPD, new users of DM-EXT were selected to calculate treatment adherence. Three additional cohorts of prevalent users of DM-EXT were identified on IQVIA LRx over subsequent 12-month periods, from July 2018 to June 2021, to get national-level yearly estimates accounting for database representativeness. RESULTS Cohorts DMpLRx and DMpLPD included 9862 and 708 patients, respectively. For both cohorts, two-third of patients were female, and more than half were aged 80+. Concomitant conditions and co-treatments prevalence was very high; most frequent comorbidities included psychiatric and cardiovascular diseases. An intermediate-to-high adherence was observed in 57% of DM-EXT new users. National-level yearly estimates showed an increasing trend (+4%) in DM-EXT prescription, which led to estimate about 10,000 patients being treated during the period "July 2020-June 2021". CONCLUSIONS Prescription of DM-EXT is a common practice in Italy. Because the administration of fixed-dose (FDCs) instead of extemporaneous combinations improves treatment adherence, the introduction of an FDC containing donepezil and memantine might enhance AD patients' management and reduce caregiver burden.
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Affiliation(s)
- Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Serena Falato
- RWS Department, IQVIA Solutions Italy S.r.l, Milan, Italy
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Ryder M, Guerin S, Forde R, Lowe G, Jaarsma T, O'Neill M, Halley C, Connolly M. The perceived effects of COVID-19 while living with a chronic illness. J Nurs Scholarsh 2023; 55:154-162. [PMID: 36281970 PMCID: PMC9874398 DOI: 10.1111/jnu.12835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION A diagnosis of chronic illness posed a serious threat to people during the recent COVID-19 pandemic. People with chronic illnesses were faced with increased mortality and reduced access to healthcare. Self-care is the process of maintaining health and managing a chronic illness. Nurses working in specialist services provide healthcare education to people with chronic illnesses. Access to these nurses was decreased during periods of the COVID-19 virus escalation due to the reconfiguration of services and redeployment of nurses. The purpose of the research was to learn from the experiences of people with a chronic illnesses in self-care behaviors and accessing altered healthcare services to inform future practices. DESIGN A population survey design. METHODS A mixed methods survey was designed, combining validated questionnaires and scales with open-ended questions. A convenience sample was utilized via using social media platforms. Data analysis included descriptive and inferential statistics. Content analysis was used to analyze open-ended responses. RESULTS There were 147 responses, with approximately half reporting no changes in face-to-face healthcare contact, 41% reporting decreased contacts and 12% increased contacts. Non-face-to-face contacts were reduced by almost 9%, did not change by almost 60%, while 33% indicated an increase. Participants reported mixed perceptions in contact with healthcare providers during restrictions. In the Patient Assessment of Chronic Illness Care and the Self-Care of Chronic Illness scales, participants scored statistically lower scores than in previous studies. Participants indicated that public health restrictions negatively impacted their confidence, created challenges with re-engaging and that access to care was more difficult. CONCLUSION This research highlights the importance of providing continued support to people with chronic illness irrespective of other challenges to healthcare services. A structured approach to virtual self-care education is required. CLINICAL RELEVANCE This research concluded that the experience of access to one healthcare professional as opposed to diverse multidisciplinary input was similar for a number of chronic illnesses groups of people during the COVID-19 pandemic. There was an altered dynamic of virtual contacts with healthcare providers and a lack of confidence interpreting what monitoring was required by people with a chronic illnesses due to a lack of preparedness for virtual healthcare delivery.
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Affiliation(s)
- Mary Ryder
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
| | - Suzanne Guerin
- School of PsychologyUniversity College DublinDublinIreland
| | - Rita Forde
- Nursing, Midwifery and Palliative CareKings College LondonLondonUK
| | - Grainne Lowe
- Institute of Health and WellbeingFederation University AustraliaMelbourneAustralia
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden,Julius CenterUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - Madeline O'Neill
- School of Nursing, Midwifery & Health Systems, University College DublinRegistered Advanced Nurse PractitionerOur Lady's Hospice and Care Services, Harold's CrossDublin 8Ireland
| | | | - Michael Connolly
- School of Nursing, Midwifery & Health Systems University College Dublin and Our Lady's Hospice & Care ServicesDublinIreland
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Comparison of Clinical Features, Complete Blood Count Parameters, and Outcomes between Two Distinct Waves of COVID-19: A Monocentric Report from Italy. Healthcare (Basel) 2022; 10:healthcare10122427. [PMID: 36553950 PMCID: PMC9778399 DOI: 10.3390/healthcare10122427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since the beginning of the SARS-CoV-2 pandemic, the ability to predict the trajectory of the disease has represented a major challenge for clinicians. There is recent evidence that complete blood cell count (CBC)-derived inflammation indexes have predictive value in COVID-19. We aimed to describe any changes in the clinical features, CBC-derived ratios, and outcomes of patients admitted to our hospital across two temporally distinct waves. METHODS We retrospectively assessed and compared the clinical characteristics and blood cell count values of patients hospitalized during the second and fourth waves of COVID-19, and explored any outcome differences in terms of the level of respiratory support required and transfer to intensive care. RESULTS We observed that fourth-wave patients were older, less male-predominant, and carried more comorbidities compared to the second-wave patients but, nevertheless, experienced more favorable outcomes. A strong internal correlation was documented for both waves between outcomes and CBC-derived ratios, with the fourth-wave cases displaying lower admission values of the neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), platelet-to-lymphocyte ratio (PLR), and systemic inflammation index (SII). No significant differences were found for lymphocyte-to-monocyte ratio (LMR), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). CONCLUSIONS We observed that both admission values of CBC-derived indexes and adverse respiratory outcomes decreased from the second to the fourth wave of COVID-19. These data represent a contribution to the existing knowledge on the role of CBC-derived indexes as a potential tool to help clinicians to quickly differentiate in-hospital patients at increased risk of serious illness and death.
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Pelullo CP, Tortoriello P, Angelillo S, Licata F, Napolitano F, Di Giuseppe G. Assessment of Perceived Health Status and Access to Health Service during the COVID-19 Pandemic: Cross-Sectional Survey in Italy. Vaccines (Basel) 2022; 10:vaccines10122051. [PMID: 36560461 PMCID: PMC9783022 DOI: 10.3390/vaccines10122051] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
(1) Background: The aims of this survey were to assess the perceived health status and to evaluate the use of healthcare services during the pandemic period. (2) Methods: This cross-sectional survey was conducted from May to October 2021 in the Campania and Calabria regions, Southern Italy. The sample was selected among 655 subjects attending vaccination or primary care physician clinics. (3) Results: More than half (57.2%) of the respondents were female, the mean age was 49 years (range 19-97), and 61.3% had at least one chronic disease. Among the respondents, 56.3% declared that they had accessed healthcare at least once during the pandemic and, among all respondents who did not access healthcare, 23.2% gave reasons related to the COVID-19 pandemic. The two scores obtained from the Short-Form-12 Health Survey (SF-12), physical health summary (PCS) and mental health summary (MCS), had a means of 48.4 and 45.9, respectively. Among the respondents, 2.3% of respondents considered their health poor, 43.1% good and 6.4% excellent. (4) Conclusions: Our results suggest the need to ensure, in similar health emergency situations, a quick response from the National Health System so that ordinary medical assistance activities can be guaranteed in full safety, avoiding the risk of missed access or lack of assistance.
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Affiliation(s)
- Concetta Paola Pelullo
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, 80133 Naples, Italy
| | - Pamela Tortoriello
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Silvia Angelillo
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy
| | - Francesca Licata
- Department of Health Sciences, University of Catanzaro “Magna Græcia”, 88100 Catanzaro, Italy
| | - Francesco Napolitano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Gabriella Di Giuseppe
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Correspondence: ; Tel.: +39-081-5667708
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Fouda A, Moy N. Health System Shock Frameworks Between Theory, Application, and Assessment Comment on "The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic". Int J Health Policy Manag 2022; 12:7373. [PMID: 36300253 PMCID: PMC10125167 DOI: 10.34172/ijhpm.2022.7373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/07/2022] [Indexed: 04/26/2023] Open
Abstract
The COVID-19 System Shock Framework (CSSF) tested the resilience of service providers throughout the coronavirus disease 2019 (COVID-19) pandemic in Australia. In this commentary, we tackle the topic of the CSSF applicability in less mature health systems and propose elements or dimensions that could be added to provide comprehensive response to future shocks. We acknowledge the fact that information systems, telehealth, and standard operation procedures constitute important pillars of system shock frameworks. However, there are doubts on the applicability of such pillars in middle- and low-income countries where the infrastructure is weaker compared to high-income countries and the digital divide is wider. Moreover, while it provided a paramount solution to deliver health services during the pandemic, the negative impact of telehealth should be addressed. In addition, we propose that CSSF should consider focusing on the continuity of the other medical conditions, which may have been affected due to the mitigation policies. Finally, we propose adding a dimension on the evaluation of CSSF to provide quantifiable and comparable assessment with other providers or systems.
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Affiliation(s)
- Ayman Fouda
- Center for Social & Health Innovation, MCI | The Entrepreneurial School, Innsbruck, Austria
| | - Naomi Moy
- School of Economics & Finance, Faculty of Business & Law, Queensland University of Technology, Brisbane, QLD, Australia
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Rezaei G, Zeraatgari R, SadeghzadehMaharluie M, Nasseri A. The role of the management accounting system of Iranian healthcare organizations in the management and control of the COVID-19 pandemic. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2108744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- GholamReza Rezaei
- Department of Accounting, Faculty of Management and Economics, University of Sistan and Baluchestan, Zahedan, Iran
| | - Ramin Zeraatgari
- Department of Accounting, Faculty of Management and Economics, University of Sistan and Baluchestan, Zahedan, Iran
| | | | - Ahmad Nasseri
- Department of Accounting, Faculty of Management and Economics, University of Sistan and Baluchestan, Zahedan, Iran
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Bruno S, Nachira L, Villani L, Beccia V, Di Pilla A, Pascucci D, Quaranta G, Carducci B, Spadea A, Damiani G, Lanzone A, Federico B, Laurenti P. Knowledge and beliefs about vaccination in pregnant women before and during the COVID-19 pandemic. Front Public Health 2022; 10:903557. [PMID: 35991061 PMCID: PMC9386522 DOI: 10.3389/fpubh.2022.903557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/11/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Vaccine hesitancy threatens the health of populations and challenges Public Health professionals. Strategies to reduce it aim to improve people's risk perception about vaccine-preventable diseases, fill knowledge gaps about vaccines and increase trust in healthcare providers. During pregnancy, educational interventions can provide a proper knowledge about safety and efficacy of maternal and childhood vaccinations. Fighting hesitancy and clarifying doubts is fundamental during the COVID-19 pandemic, which may have affected people's knowledge and beliefs toward vaccination. This study aimed at assessing if the advent of the pandemic was associated with changes in pregnant women's knowledge and beliefs toward vaccination, and trust in healthcare services. Methods A repeated cross-sectional study was conducted through self-reported questionnaires in a Roman teaching hospital, where educational classes about vaccinations are routinely held as part of a birthing preparation course. Data were collected on a sample of pregnant women before and during the pandemic. Free-of-charge flu vaccinations were offered to all course participants and adherence to flu vaccination was assessed. Results The proportion of pregnant women reporting that vaccines have mild side effects and that are sufficiently tested increased from 78.6 to 92.0% (p = 0.001) and from 79.4 to 93.2% (p = 0.001), respectively. There was a reduction from 33.0 to 23.3% (p = 0.065) in the proportion of those declaring that healthcare workers (HCWs) give information only on the benefits and not on the risks of vaccines, and a reduction from 27.3 to 12.1% (p = 0.001) in those reporting that vaccines are an imposition and not a free choice of mothers. Trust in National Health Service (NHS) operators slightly decreased. Among participants, the monthly flu vaccination adherence ranged from 50.0% in November to 29.2% January for 2019–20 flu season, and from 56.3% in September to 14.5% in January for 2020–21 flu season, showing a higher vaccination acceptance in the earlier months of 2020-21 flu season. Conclusions The pandemic may have positively affected pregnant women's knowledge and opinions about vaccinations and trust in HCWs, despite a possible negative impact on their perceptions about NHS operators. This should inspire Public Health professionals to rethink their role as health communicators.
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Affiliation(s)
- Stefania Bruno
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lorenza Nachira
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Lorenza Nachira
| | - Leonardo Villani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Viria Beccia
- Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea Di Pilla
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Clinical Governance, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Domenico Pascucci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gianluigi Quaranta
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Brigida Carducci
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Gianfranco Damiani
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Lanzone
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Bruno Federico
- Department of Human Sciences, Society and Health, University of Cassino and Southern Lazio, Cassino, Frosinone, Italy
| | - Patrizia Laurenti
- Women, Children and Public Health Sciences Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Lo Moro G, Scaioli G, Bert F, Zacchero AL, Minutiello E, Siliquini R. Exploring the Relationship between COVID-19 Vaccine Refusal and Belief in Fake News and Conspiracy Theories: A Nationwide Cross-Sectional Study in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159350. [PMID: 35954711 PMCID: PMC9368531 DOI: 10.3390/ijerph19159350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has been accompanied by an infodemic, which includes fake news (FNs) and conspiracy theories (CTs), and which may worsen vaccine refusal (VR), thus hindering the control of the transmission. This study primarily aimed to assess COVID-19 VR in Italy and its relationship with belief in FNs/CTs. Secondarily, it explored the conviction in FNs and CTs and associated variables. An online cross-sectional study was conducted in Italy (2021). The primary outcome was VR and secondary outcomes were FN misclassification score (0% to 100%: higher score means higher misclassification) and CT belief score (1 to 5: higher score means higher agreement). There were 1517 participants; 12.3% showed VR. The median FN and CT scores were: 46.7% (IQR = 40–56.7%) and 2.8 (IQR = 2.2–3.4). Age, education, FN, and CT scores had significant associations with VR. Education, economic situation, health and e-health literacy showed significant relationships with secondary outcomes. Study/work background had a significant association only with the FN score. FN and CT scores were associated. This work estimated a VR lower than before the first COVID-19 vaccine approval. The relationship between VR and FN/CT belief represents a new scenario, suggesting the need for planning effective strategies to tackle FNs and CTs to implement successful vaccination campaigns.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
| | - Giacomo Scaioli
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
| | - Fabrizio Bert
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
- Correspondence: ; Tel.: +39-0116705816
| | - Andrea Lorenzo Zacchero
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
| | - Ettore Minutiello
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, University of Turin, 10126 Turin, Italy; (G.L.M.); (G.S.); (A.L.Z.); (E.M.); (R.S.)
- AOU City of Health and Science of Turin, 10126 Turin, Italy
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15
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Carta MG, Sancassiani F, Melis P, Aviles-Gonzales CI, Urban A, Minerba L, D'Oca S, Atzeni M, Velluzzi F, Ferreli C, Serrentino R, Coghe F, Cossu G. The perception of professionals and users of the quality of care and respect for human rights in four outpatient care facilities of an Italian hospital during the Covid-19 pandemic. J Public Health Res 2022; 11:22799036221119026. [PMID: 36172597 PMCID: PMC9511322 DOI: 10.1177/22799036221119026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background: During the Covid-19 pandemic, delays in providing medical services, dissatisfaction, criticism toward health workers (HW) and the risk of burnout of HW in Italy have been documented. No studies have contrasted the point of view of HW and users on the quality of care and respect for human rights in health facilities. Objective: To compare the perception of users of their satisfaction with the care provided with the perception of HW of their satisfaction with work as well as the perception of the respect of HW “s and users” human rights. Methods: The “Well-Being at work and respect for human rights questionnaire” (WWRR) was administered on a sample of users (142) and HW (154) in four outpatient health care facilities of a hospital in Sardinia, Italy. Results: Users showed higher scores than HW on their satisfaction with the care received (p < 0.0001), the perception of respect for their human rights (p < 0.0001), and availability of resources for care (p < 0.0001). The HW scores were higher than 50% of the maximum in all items, but a relatively low score was reported on the HW’s satisfaction of the resources and the respect for their rights. Conclusion: The satisfaction for care and respect for human rights in the outpatient health services was higher than expected. The relatively low score by the HWs in relation to the satisfaction with the resources and perception of respect for their human rights could be a wake-up call. The study does not involve emergency rooms, wards, or Covid units.
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Affiliation(s)
- Mauro G Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Paola Melis
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Cesar I Aviles-Gonzales
- Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.,Popular Universidad del Cesar, Valledupar, Colombia
| | - Antonio Urban
- Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Luigi Minerba
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Silvia D'Oca
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Michela Atzeni
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Fernanda Velluzzi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Caterina Ferreli
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy
| | - Roberta Serrentino
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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16
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AYDIN YILDIRIM T, GEBEŞOĞLU N. Kronik Hastalığı Olan Bireylerde Covid 19 Korkusu ve Sağlık Hizmetlerini Kullanma Durumlarının Değerlendirilmesi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.996416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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17
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Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Is the pandemic leading to a crisis of trust? Insights from an Italian nationwide study. Public Health 2021; 202:32-34. [PMID: 34879320 DOI: 10.1016/j.puhe.2021.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Along with mistrust toward politics and journalism, the pandemic is amplifying mistrust in healthcare. To explore trust in key professionals among the Italian population, we focused on perceived change in trust during the pandemic. STUDY DESIGN Nationwide online cross-sectional survey (called COCOS). METHODS COCOS was conducted in Italy in two periods: the end of the first lockdown (T1: April-May 2020) and the end of 2020 (T2: November-December 2020). Descriptive analyses and multivariable logistic regressions were performed (sample size = 2673). RESULTS Trust in healthcare workers (HCWs) was reduced in 1.5% of participants (T1) and 2.8% (T2). Trust in scientists/researchers was reduced in 5.8% (T1) and 7.6% (T2). Trust in politicians was reduced in 37.6% (T1) and 52.3% (T2). Trust in journalists was reduced in 41.7% (T1) and 48.3% (T2). Considering multivariable models, participants of the second period, participants who were HCWs, participants with anxiety symptoms, and those experiencing economic struggle due to the pandemic had a higher likelihood of having a reduced trust. The period had the strongest association with reduced trust. CONCLUSIONS We argue that a central role might be played by the pandemic fatigue. We suggest leading figures should be more aware of the relationship between communication and trust. The pandemic is a real-world experiment in reshaping mediated communication and, although social media play an important role, other approaches might be successful. As a notable part of the population is trusting politicians and media less and less, Italian key professionals should implement initiatives to reinvigorate public support.
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Affiliation(s)
- M R Gualano
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - G Lo Moro
- Department of Public Health Sciences, University of Turin, Turin, Italy.
| | - G Voglino
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - F Bert
- Department of Public Health Sciences, University of Turin, Turin, Italy
| | - R Siliquini
- Department of Public Health Sciences, University of Turin, Turin, Italy
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18
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Santos VS, Vieira SCF, Barreto IDDC, de Gois-Santos VT, Celestino AO, Domingues C, Cuevas LE, Gurgel RQ. Effects of the COVID-19 pandemic on routine pediatric vaccination in Brazil. Expert Rev Vaccines 2021; 20:1661-1666. [PMID: 34612135 DOI: 10.1080/14760584.2021.1990045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND COVID-19 pandemic has disrupted health services, including vaccination demand. We describe the impact of the COVID-19 pandemic on routine pediatric vaccination in Brazil. METHODS We conducted a retrospective analysis of all vaccine doses provided to children aged 0-6 years from January 2019 to December 2020. We obtained data stratified by age group (0 to 2 years and >2 to 6 years) and Brazilian region. Difference-in-difference (DiD) analyses were performed to compare vaccine uptake in the pre-pandemic (January-February), stay-at-home (March-June), and reopening (July-December) periods. RESULTS The number of vaccine doses administered declined in the stay-at-home period. For children aged 0 to 2 years, the highest reductions were recorded in the North (-25.3%), Northeast (-16.8%) and Central-West (-10.2%) regions. For children aged >2 to 6 years, the highest decline was observed in the North (DiD = -27.2%) and South (DiD = -14.0%) regions. The number of vaccine doses administered in the reopening period has slightly increased in all regions. CONCLUSIONS Vaccination decreased during the COVID-19 pandemic. Although the number of doses recovered in part during the reopening phase, additional strategies, such as increased public awareness and vaccination booster campaigns are required.
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Affiliation(s)
- Victor Santana Santos
- Centre for Epidemiology and Public Health, Federal University of Alagoas, Arapiraca, Brazil.,Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Graduate Program in Health Sciences, Federal University of Alagoas, Maceió, Brazil
| | - Sarah Cristina Fontes Vieira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Pediatrics Subdivision, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
| | | | | | | | - Carla Domingues
- Epidemiologist, PhD in Tropical Medicine. Independent Researcher, Brasília, Brazil
| | - Luis Eduardo Cuevas
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ricardo Queiroz Gurgel
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Pediatrics Subdivision, Department of Medicine, Federal University of Sergipe, Aracaju, Brazil
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19
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Kalanj K, Marshall R, Karol K, Tiljak MK, Orešković S. The Impact of COVID-19 on Hospital Admissions in Croatia. Front Public Health 2021; 9:720948. [PMID: 34568262 PMCID: PMC8459902 DOI: 10.3389/fpubh.2021.720948] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 08/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 pandemic disrupted hospital care, as hospitals had to deal with a highly infectious virus, while at the same time continuing to fulfill the ongoing health service needs of their communities. This study examines the direct effects of COVID-19 on the delivery of inpatient care in Croatia. Materials and Methods: The research is a retrospective, comparative analysis of the hospital admission rate across all Diagnosis Related Group (DRG) classes before and during the pandemic. It is based on DRG data from all non-specialized acute hospitals in Croatia, which account for 96% of national inpatient activity. The study also used COVID-19 data from the Croatian Institute of Public Health (CIPH). Results: The results show a 21% decrease in the total number of admissions [incident rate ratio (IRR) 0.8, p < 0.0001] across the hospital network during the pandemic in 2020, with the greatest drop occurring in April, when admissions plunged by 51%. The decrease in activity occurred in non-elective DRG classes such as cancers, stroke, major chest procedures, heart failure, and renal failure. Coinciding with this reduction however, there was a 37% increase (IRR 1.39, p < 0.0001) in case activity across six COVID-19 related DRG classes. Conclusions: The reduction in hospital inpatient activity during 2020, can be attributed to a number of factors such as lock-downs and quarantining, reorganization of hospital operations, the rationing of the medical workforce, and the reluctance of people to seek hospital care. Further research is needed to examine the consequences of disruption to hospital care in Croatia. Our recommendation is to invest multidisciplinary effort in reviewing response procedures to emergencies such as COVID-19 with the aim of minimizing their impact on other, and equally important community health care needs.
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Affiliation(s)
- Karolina Kalanj
- Department of Medical Oncology, Clinic of Oncology, Clinical Hospital Center, Zagreb, Croatia
| | - Ric Marshall
- Epidemiologist and Independent Consultant in Health System Funding Models, Eaglehawk Neck, TAS, Australia
| | - Karl Karol
- Independent Consultant, Melbourne, VIC, Australia
| | - Mirjana Kujundžić Tiljak
- Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Stjepan Orešković
- Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
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