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Niemenoja O, Ämmälä AJ, Riihijärvi S, Lillrank P, Bono P, Taimela S. The impact of COVID-19 on healthcare booking and cancellation patterns: time series analysis of private healthcare service utilisation in Finland. BMC Health Serv Res 2024; 24:483. [PMID: 38637794 PMCID: PMC11027366 DOI: 10.1186/s12913-024-10987-0] [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: 10/13/2023] [Accepted: 04/12/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND COVID-19 has had wide-reaching effects on healthcare services beyond the direct treatment of the pandemic. Most current studies have reported changes in realised service usage, but the dynamics of how patients engage with healthcare services are less well understood. We analysed the effects of COVID-19 on healthcare bookings and cancellations for various service channels between January 2020 and July 2021. METHODS Our data includes 7.3 million bookings, 11.0 million available appointments, and 405.1 thousand cancellations by 900.6 thousand individual patients between the ages of 18 and 65 years. The data were collected from electronic health record data, including laboratory and imaging services as well as inpatient stays, between January 2017 and July 2021. The patients were Finnish private and occupational healthcare customers in the capital region of Finland. We fitted an autoregressive moving average (ARIMA) model on data between 2017 and 2019 to predict the expected numbers of bookings, available appointments, and cancellations, which were compared to observed time series data between 2020 and 2021. RESULTS Utilisation of physical, in-person primary care physician appointments decreased by up to 50% during the first 18 months of the pandemic. At the same time, digital care channels experienced a rapid, multi-fold increase in service usage. Simultaneously, the number of bookings for laboratory and imaging services decreased by 50% below the pre-pandemic projections. The number of specialist and hospital service bookings remained at the predicted level during the study period. Cancellations for most health services increased sharply by up to three times the pre-COVID levels during the first weeks of the pandemic but returned to the pre-pandemic levels for the rest of the study period. CONCLUSIONS The reduction in in-person appointments and the increase in the utilisation of digital services was likely a contributing factor in the decrease of the utilisation of diagnostic and imaging services throughout the study period. Utilisation of specialist care and hospital services were not affected. Cancellations contributed to the changes in service utilisation only during the first weeks of the pandemic.
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Affiliation(s)
- Oskar Niemenoja
- Terveystalo Plc, Helsinki, Finland.
- Aalto University, Espoo, Finland.
| | | | | | | | - Petri Bono
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Simo Taimela
- Terveystalo Plc, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
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Burton E, Quinn R, Crosbie-Staunton K, Deasy C, Masterson S, O'Donnell C, Merwick Á, Willis D, Kearney PM, Mc Carthy VJC, Buckley CM. Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study. BMJ Open 2024; 14:e078168. [PMID: 38508613 PMCID: PMC10961584 DOI: 10.1136/bmjopen-2023-078168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES Time is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions were introduced in Ireland in response to the pandemic, which resulted in major societal changes. However, current research on the effects of the COVID-19 pandemic on prehospital care for stroke/TIA is limited to early COVID-19 waves. Thus, we aimed to investigate the effect of the COVID-19 pandemic on ambulance time intervals and suspected stroke/TIA call volume for adults with suspected stroke and TIA in Ireland, from 2018 to 2021. DESIGN We conducted a secondary data analysis with a quasi-experimental design. SETTING We used data from the National Ambulance Service in Ireland. We defined the COVID-19 period as '1 March 2020-31 December 2021' and the pre-COVID-19 period '1 January 2018-29 February 2020'. PRIMARY AND SECONDARY OUTCOME MEASURES We compared five ambulance time intervals: 'allocation performance', 'mobilisation performance', 'response time', 'on scene time' and 'conveyance time' between the two periods using descriptive and regression analyses. We also compared call volume for suspected stroke/TIA between the pre-COVID-19 and COVID-19 periods using interrupted time series analysis. PARTICIPANTS We included all suspected stroke/TIA cases ≥18 years who called the National Ambulance Service from 2018 to 2021. RESULTS 40 004 cases were included: 19 826 in the pre-COVID-19 period and 19 731 in the COVID-19 period. All ambulance time intervals increased during the pandemic period compared with pre-COVID-19 (p<0.001). Call volume increased during the COVID-19-period compared with the pre-COVID-19 period (p<0.001). CONCLUSIONS A 'shock' like a pandemic has a negative impact on the prehospital phase of care for time-sensitive conditions like stroke/TIA. System evaluation and public awareness campaigns are required to ensure maintenance of prehospital stroke pathways amidst future healthcare crises. Thus, this research is relevant to routine and extraordinary prehospital service planning.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork, Ireland
| | - Rory Quinn
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | | | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Siobhan Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- Discipline of General Practice, University of Galway, Galway, Ireland
| | - Cathal O'Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Áine Merwick
- Neurology Department, Cork University Hospital, Cork, Ireland
| | - David Willis
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Kanegusuku H, da Silva GO, Braghieri HA, de Carvalho JF, Costa RM, Cucato GG, Wolosker N, Ritti-Dias RM, Correia MA. Health and lifestyle parameters in peripheral artery disease at two periods of the COVID-19 pandemic: comparison between men and women. EINSTEIN-SAO PAULO 2024; 22:eAO0345. [PMID: 38451689 PMCID: PMC10948092 DOI: 10.31744/einstein_journal/2024ao0345] [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: 09/30/2022] [Accepted: 06/12/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE This study analyzed the impact of sex on self-reported health and lifestyle parameters in peripheral artery disease patients at two periods of the COVID-19 pandemic. METHODS In this longitudinal study, 99 patients with peripheral artery disease (53 men and 46 women) were evaluated during two periods of the COVID-19 pandemic ( i.e ., at onset: May to August 2020, and on follow-up: May to August 2021). Patients were interviewed via telephone, and information regarding lifestyle and health parameters was obtained. RESULTS At the onset of the COVID-19 pandemic, health and habit parameters were similar between women and men, with 63.0% and 45.3% indicating frequent fatigue, 73.9% and 84.9% reporting increased sitting time, and 23.9% and 39.6% practicing physical activity, respectively. At follow-up, difficulties in physical mobility (women: from 26.1% to 73.9%, p<0.001; men: from 39.6% to 71.7%, p=0.001) and the frequency of hospitalization for reasons other than COVID-19 increased similarly in women and men (women: from 4.3% to 21.7%, p=0.013; men: from 9.4% to 24.5%, p=0.038). The other parameters were similar between the periods. CONCLUSION Self-reported physical mobility difficulties and hospitalization frequency increased in women and men with peripheral artery disease. BACKGROUND ▪ Sitting time increased in 73.9% of women and 84.9% of men at the onset of the pandemic. BACKGROUND ▪ Physical activity was practiced by 23.9% of women and 39.6% of men at the onset of the pandemic. BACKGROUND ▪ The prevalence of both women and men reporting physical mobility difficulties increased at follow-up. BACKGROUND ▪ Hospitalization rates for reasons unrelated to COVID-19 have increased in both women and. BACKGROUND While women experience more consequences related to peripheral artery disease than men, such as worse functional capacity and higher morbidity, there was a similar increase in physical mobility difficulty and frequency of hospitalization for reasons other than COVID-19 one year after the onset of the pandemic.
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Affiliation(s)
- Hélcio Kanegusuku
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | - Renan Massena Costa
- Universidade Nove de JulhoSão PauloSPBrazilUniversidade Nove de Julho, São Paulo, SP, Brazil.
| | - Gabriel Grizzo Cucato
- Northumbria UniversityNewcastle upon TyneEnglandNorthumbria University, Newcastle upon Tyne, England.
| | - Nelson Wolosker
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinFaculdade Israelita de Ciências da Saúde Albert EinsteinSão PauloSPBrazilFaculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | - Marilia Almeida Correia
- Universidade Nove de JulhoSão PauloSPBrazilUniversidade Nove de Julho, São Paulo, SP, Brazil.
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V Carvalho AS, Broekema B, Brito Fernandes Ó, Klazinga N, Kringos D. Acute care pathway assessed through performance indicators during the COVID-19 pandemic in OECD countries (2020-2021): a scoping review. BMC Emerg Med 2024; 24:19. [PMID: 38273229 PMCID: PMC10811879 DOI: 10.1186/s12873-024-00938-7] [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: 03/14/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic severely impacted care for non-COVID patients. Performance indicators to monitor acute care, timely reported and internationally accepted, lacked during the pandemic in OECD countries. This study aims to summarize the performance indicators available in the literature to monitor changes in the quality of acute care in OECD countries during the first year and a half of the pandemic (2020-July 2021) and to assess their trends. METHODS Scoping review. Search in Embase and MEDLINE (07-07-2022). Acute care performance indicators and indicators related to acute general surgery were collected and collated following a care pathway approach. Indicators assessing identical clinical measures were grouped under a common indicator title. The trends from each group of indicators were collated (increase/decrease/stable). RESULTS A total of 152 studies were included. 2354 indicators regarding general acute care and 301 indicators related to acute general surgery were included. Indicators focusing on pre-hospital services reported a decreasing trend in the volume of patients: from 225 indicators, 110 (49%) reported a decrease. An increasing trend in pre-hospital treatment times was reported by most of the indicators (n = 41;70%) and a decreasing trend in survival rates of out-of-hospital cardiac arrest (n = 61;75%). Concerning care provided in the emergency department, most of the indicators (n = 752;71%) showed a decreasing trend in admissions across all levels of urgency. Concerning the mortality rate after admission, most of the indicators (n = 23;53%) reported an increasing trend. The subset of indicators assessing acute general surgery showed a decreasing trend in the volume of patients (n = 50;49%), stability in clinical severity at admission (n = 36;53%), and in the volume of surgeries (n = 14;47%). Most of the indicators (n = 28;65%) reported no change in treatment approach and stable mortality rate (n = 11,69%). CONCLUSION This review signals relevant disruptions across the acute care pathway. A subset of general surgery performance indicators showed stability in most of the phases of the care pathway. These results highlight the relevance of assessing this care pathway more regularly and systematically across different clinical entities to monitor disruptions and to improve the resilience of emergency services during a crisis.
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Affiliation(s)
- Ana Sofia V Carvalho
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Bente Broekema
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Pediatrics, Dijklander Hospital, Location Hoorn, Maelsonstraat 3, Hoorn, 1624 NP, The Netherlands
| | - Óscar Brito Fernandes
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Niek Klazinga
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Dionne Kringos
- Amsterdam UMC Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Baek JY, Seo SH, Cho S, Park JB, Keam B, Yoo SH, Shin A. Emergency department visits of newly diagnosed cardiovascular disease patients in Korea during the COVID-19 pandemic. Sci Rep 2024; 14:397. [PMID: 38172246 PMCID: PMC10764744 DOI: 10.1038/s41598-023-50709-w] [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: 09/13/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
This study aimed to examine the impact of the COVID-19 pandemic on the emergency department (ED) visits of cardiovascular disease (CVD) patients. The customized data of the National Health Insurance Service (NHIS) from 2017 to 2020 were analyzed. CVD patients were defined by the code 'V192' based on the NHIS coverage benefit expansion policy. The number of ED visits of CVD patients, as well as executed procedures in 2020 (during the pandemic), were compared to the corresponding average numbers in 2018 and 2019 (prepandemic). Stratification by age group, residential area and hospital location was performed. The number of ED visits of newly diagnosed CVD patients decreased by 2.1% nationwide in 2020 (2018-2019: 97,041; 2020: 95,038) and decreased the most (by 14.1%) in March (2018-2019: 8539; 2020: 7334). However, the number of executed procedures increased by 1.1% nationwide in 2020 (2018-2019: 74,696; 2020: 75,520), while it decreased by 11.9% in April (2018-2019: 6603; 2020: 5819). The most notable decreases in the number of newly diagnosed CVD patients (31.7%) and procedures (29.2%) in March 2020 were observed in the Daegu·Gyeongbuk area. CVD patients living in the epicenter of the COVID-19 pandemic may experience difficulty accessing healthcare facilities and receiving proper treatment.
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Affiliation(s)
- Ji Yoon Baek
- Cancer Research Institute, Seoul National University, Seoul, South Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | - Seung Hee Seo
- Cancer Research Institute, Seoul National University, Seoul, South Korea
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea
| | - Sooyoung Cho
- Medical Research Center, Genomic Medicine Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
- Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, South Korea
| | - Aesun Shin
- Cancer Research Institute, Seoul National University, Seoul, South Korea.
- Interdisciplinary Program in Cancer Biology Major, Seoul National University College of Medicine, Seoul, South Korea.
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, South Korea.
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehak-ro, Seoul, Jongno-gu, 03080, Republic of Korea.
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Kurt BF, Güven O, Selçuk H. The Effect of the COVID-19 Pandemic on Emergency Department (ED) Admissions in the Only Hospital of City Center ED. Cureus 2023; 15:e44527. [PMID: 37790053 PMCID: PMC10544729 DOI: 10.7759/cureus.44527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
AIM This study aimed to examine the effect of the pandemic on emergency service visits, together with the pre- and post-pandemic period data. MATERIAL AND METHODS The charts of patients who applied to the emergency department between 2019 and 2021 were included in the study. We analysed patients' charts from the pre-pandemic period (January 1, 2019-February 29, 2020), the pandemic period (March 1, 2020-June 30, 2021; from the date of detection of the first COVID-19 case to the date of the second dose of the vaccine), and normalisation period (July 1, 2021-December 31, 2021; the date from the completion of vaccination to the end of the year). Demographic characteristics, triage codes, diagnoses, hospitalisation or referral status, population ratio, admission rate, and mortality were examined in these data. RESULTS In total, 529,706 patient charts were examined. When the pre-pandemic period (15,983.29±1,493.19) was compared with the pandemic period (11,342.94±2,350.15), it was observed that there was a decrease in the number of visit period. In the post-pandemic period, patients coming to the hospital decreased following vaccination. It was determined that there were more visits (20742.17±967.61) compared to the pre-pandemic period. CONCLUSION The data demonstrate that, during the pandemic period, visits decreased in general, and the rate of critical patients increased gradually. Accordingly, there are unnecessary visits and inappropriate use of emergency services.
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Affiliation(s)
- Bedriye Feyza Kurt
- Emergency Department, Kırklareli Training and Research Hospital, Kırklareli, TUR
| | - Oya Güven
- Emergency Department, Kırklareli Training and Research Hospital, Kırklareli, TUR
| | - Hakan Selçuk
- Emergency Department, Kırklareli Training and Research Hospital, Kırklareli, TUR
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Candela V, Proietti R, Polizzotti G, Rionero M, Gumina S. Three Years of COVID-19 on Orthopaedic Trauma; Are We Going Back to Normality? MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1464. [PMID: 37629754 PMCID: PMC10456244 DOI: 10.3390/medicina59081464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023]
Abstract
Background and Objective: On March 2020, our country became a protected area due to the COVID-19 pandemic. The consequences of COVID-19 on trauma surgery were great. We aimed to evaluate the activity of the Trauma Centre of a highly populated suburban area over 30 days starting from the first day of restrictions, to compare it with the same period of 2019 and 2022 and to evaluate whether a progressive return to normality has taken place. Materials and Methods: All patients older than 18 years managed in our Trauma Unit between 8 March 2020 and 8 April 2020 (the first COVID-19 period) were compared to the same period of 2019 (a COVID-19 free period) and 2022 (the second COVID-19 period). Clinical records were examined. Five categories of diagnoses and six mechanisms of injury were distinguished. Results: There were 1351 patients [M:719-F:632; mean age (SD):49.9 (18.7)], 451 [M:228-F:223; mean age (SD):55.9 (18.4)] and 894 [M:423-F:471;mean age (SD):54.1 (16.7)] in the COVID-19 free and in the first and second COVID-19 periods, respectively (p < 0.05). In 2020, the most significant decrease was registered for sprains/subluxations (80%); contusions decrease by 77% while fractures decrease only by 37%. The lowest reduction was found for dislocations (26%). In 2022, dislocations decreased by only 16% and both fractures and sprains decreased by about 30% with respect to the pre-pandemic period. Patients with minor trauma (contusions) were half compared to 2019. Accidental falls remain the most frequent mechanism of injury. The incidence of proximal femur, proximal humerus and distal radius fractures remained almost unchanged during both pre-pandemic and pandemic periods. Conclusions: COVID-19 has markedly altered orthopaedic trauma. Injuries related to sports and high energy trauma/traffic accidents drastically reduced in 2020; however, we are slowly going back to normality: the same injuries increased in 2022 due to the progressive easing of restrictions. Elderly fractures related to accidental falls remained unchanged.
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Affiliation(s)
- Vittorio Candela
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
| | - Riccardo Proietti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Giuseppe Polizzotti
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Marco Rionero
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
| | - Stefano Gumina
- Department of Anatomical, Histological, Forensic Medicine and Orthopaedics Sciences, Sapienza University of Rome, 00185 Rome, Italy; (R.P.); (G.P.); (M.R.); (S.G.)
- Istituto Chirurgico Ortopedico traumatologico (ICOT), 04100 Latina, Italy
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Jäntti S, Ponkilainen V, Kuitunen I, Uimonen MM, Huttunen T, Mattila VM. Intensive care unit admissions with and without COVID-19 in Finland from 2017 to 2021: a retrospective register-based study. BMC Anesthesiol 2023; 23:251. [PMID: 37488508 PMCID: PMC10367372 DOI: 10.1186/s12871-023-02207-9] [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: 10/10/2022] [Accepted: 07/14/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND After the COVID-19 pandemic started, critical care resources were expanded in Finland to manage a possible surge in patients requiring intensive care. The aim of this study was to evaluate the incidence of overall ICU admissions, patient diagnoses, characteristics, and length of stay during the pandemic. METHODS This retrospective hospital register-based study was conducted in two large and one mid-size Finnish public hospitals. The required data were collected from ICU patient information systems and all adult patients were included. Monthly and yearly incidences with 95% confidence intervals (CI) were counted per 100 000 persons-years by Poisson exact method and compared by incidence rate ratios (IRR). RESULTS A total of 4407 admissions to ICUs for any cause occurred during 2020. In 2021, this figure was 4931. During the reference years (2017-2019), the mean number of admissions to ICU was 4781. In 2020 and 2021, the proportion of patients requiring intensive care due to COVID-19 was only 3%. The incidence of all-cause ICU admissions decreased during the lockdown in 2020 when compared to the reference years. Before the start of the lockdown in February 2020, the IRR of all-cause ICU admissions was 1.02 (CI: 0.89 to 1.18). During the lockdown period, however, the IRR of all-cause ICU admissions decreased to 0.78 (CI: 0.67 to 0.90) in March. When the lockdown ended, the incidence rebounded to the same level as before the lockdown. However, in 2021, the incidence of ICU admissions remained at the same level when compared to the reference years. The most prominent changes occurred in the incidence of diseases of the nervous system, which includes epilepsy and seizures and transient cerebral ischemic attacks, in diseases of the respiratory system, and neoplasms. CONCLUSIONS According to the findings of this study, the incidence of all-cause ICU admissions decreased after the lockdown was implemented in 2020. Furthermore, the percentage of patients requiring intensive care due to COVID-19 in Finland was only 3% in 2020 and 2021. These findings may serve to help in the planning and allocating of ICU resources during future pandemics.
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Affiliation(s)
- Saara Jäntti
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, Tampere, 33520, Finland.
| | - Ville Ponkilainen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Ilari Kuitunen
- Mikkeli Central Hospital, Porrassalmenkatu 35-37, Mikkeli, 50100, Finland
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, Kuopio, 70211, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Hospital Nova, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Tuomas Huttunen
- Department of Cardiothoracic Anesthesia, Tampere Heart Hospital, Teiskontie 35, Tampere, 33521, Finland
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Kauppi Campus, Arvo Ylpön katu 34, Tampere, 33520, Finland
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, Tampere, PL2000, 33521, Finland
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Duncan A, Herrera CN, Okobi M, Nandi S, Oblath R. Locked down or locked out? Trends in psychiatric emergency services utilization during the COVID-19 pandemic. J Health Serv Res Policy 2023; 28:80-88. [PMID: 36475326 PMCID: PMC9732494 DOI: 10.1177/13558196221135119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To estimate changes in Boston Emergency Services Team (BEST) psychiatric emergency services (PES) encounter volume (total and by care team) and inpatient disposition during the first 8 months of the COVID-19 pandemic. METHODS Data on 30,657 PES encounters was extracted from the four-county, BEST reporting system. The study period consisted of the first 34 weeks of 2019 and 2020. This period corresponded to the first five stages of Massachusetts's COVID-19 public health restrictions: pre-lockdown, lockdown, Phase I, II and III reopenings. Descriptive and regression analyses were performed to estimate changes in encounter volume by care team and disposition. RESULTS Compared to the same period in 2019, covariate-adjusted, weekly PES encounters decreased by 39% (β = -0.40, 95% Confidence Interval (CI) = [-0.51, -0.28], p < 0.00) during the lockdown. PES volume remained significantly lower during Phase I reopening compared to the previous year but returned to 2019 levels during Phase II. The covariate-adjusted proportion of weekly encounters that led to inpatient admission significantly increased by 16% (CI = [0.11, 0.21], p < 0.00) for mobile crisis teams (MCTs) and significantly declined by 13% (CI = [-0.19, -0.07], p < 0.00) for BEST-designated emergency departments during the lockdown period compared to the prior year. CONCLUSIONS The overall drop in PES utilization and the rise in inpatient admissions for MCT encounters suggests that during the early phases of the pandemic, patients delayed psychiatric care until they had a psychiatric crisis. Public health messaging about the lockdowns and absent equivalent messaging about the availability of telehealth services may have made patients more reluctant to seek psychiatric care.
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Affiliation(s)
- Alison Duncan
- Director, Psychiatric Emergency Services, Boston Medical Center, Massachusetts, USA
- Assistant Professor, Boston Univeristy Chobanian and Avedisian School of Medicine, Massachusetts, USA
| | - Carolina-Nicole Herrera
- Doctoral Candidate, Department of Health Law, Policy, and Management, Boston University School of Public Health, Massachusetts, USA
| | - Margaret Okobi
- Medical Student, Harvard School of Medicine, Boston, Massachusetts, USA
- Candidate, Masters of Public Health, TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Shurobhi Nandi
- Undergraduate, Northeastern University, Boston, Massachusetts, USA
| | - Rachel Oblath
- Postdoctoral Associate, Department of Psychiatry, Boston Medical Center, Massachusetts, USA
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Jiménez-García Á, Pérez-Romero G, Hueso-Montoro C, García-Caro MP, Castro-Rosales L, Montoya-Juárez R. [COVID-19 pandemic impact on primary care emergency services activity: Comparative study between 2019 and 2020 periods]. Aten Primaria 2023; 55:102600. [PMID: 36921391 PMCID: PMC9974358 DOI: 10.1016/j.aprim.2023.102600] [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: 01/17/2023] [Revised: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/05/2023] Open
Abstract
OBJECTIVE To compare the care provided by primary care emergency services during the COVID19 lockdown (March-June 2020) and the same period in 2019. DESIGN Retrospective descriptive study. SETTING Basic Health Area of Granada. POPULATION 10.790 emergency reports, 3.319 in 2020 and 7.471 in 2019. OUTCOMES Age, sex, service, shifts, referrals, priority levels, care times, previous processes, and reasons for consultation. T-Student and Chi Square were used for continuous and categorical variables. Effect size (Cohen's d) and OR along with 95% CI were calculated. RESULTS The patients attended by primary care emergency services decreased in 2020 compared to 2019, but the percentage of Priority V cases (p<0.01), home discharges (p=0.01) and hospital transfers (p<0.01) increased, and referrals to family doctors (p<0.01) decreased. In 2020, the percentage of emergencies at night (p<0.01) and in low-income neighborhoods (p<0.01) increased. Waiting time for classification decreased (p<0.01), but total care time increased in 2020 (p<0.01). The patients seen in 2020 were older (p<.001), and with a greater number of previous processes (p<0.01), highlighting patients with anxiety, depression, or somatization (p<0.01) and diabetes (p=0.041). Consultations related to various symptoms of COVID19, mental health problems and chronic pathologies increased. CONCLUSIONS Primary care emergency services offer additional advantages in situations such as the COVID19 pandemic, as they allow channeling part of the health demand.
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Affiliation(s)
- Ángela Jiménez-García
- Servicio de Urgencias de Atención Primaria del Distrito Sanitario Granada Metropolitano, Granada, España; Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, España
| | - Genoveva Pérez-Romero
- Servicio de Urgencias de Atención Primaria del Distrito Sanitario Granada Metropolitano, Granada, España; Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, España
| | - César Hueso-Montoro
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, España; Departamento de Enfermería, Universidad de Jaén, Jaén, España; Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC) de la Universidad de Granada, Granada, España.
| | - María Paz García-Caro
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, España; Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC) de la Universidad de Granada, Granada, España; Departamento de Enfermería, Universidad de Granada, Granada, España
| | - Luís Castro-Rosales
- Servicio de Estadística del Distrito Sanitario Granada Metropolitano, Granada, España
| | - Rafael Montoya-Juárez
- Instituto de Investigación Biosanitaria de Granada (ibs.Granada), Granada, España; Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC) de la Universidad de Granada, Granada, España; Departamento de Enfermería, Universidad de Granada, Granada, España
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11
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Kuitunen I, Uimonen MM, Ponkilainen VT, Mattila VM. Primary care visits due to mental health problems and use of psychotropic medication during the COVID-19 pandemic in Finnish adolescents and young adults. Child Adolesc Psychiatry Ment Health 2023; 17:35. [PMID: 36895042 PMCID: PMC9998142 DOI: 10.1186/s13034-023-00584-0] [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: 11/22/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023] Open
Abstract
BACKGROUND Social restrictions due to COVID-19 have impacted the everyday life of adolescents and young adults, with increased levels of stress and anxiety being reported. Therefore, we report primary care visits due to mental health problems and the use of psychotropic medication in Finland. METHODS We conducted a nationwide register-based study and included primary care visits with mental health problems (F*-class ICD-10 diagnosis) for patients aged 15-24 years. We calculated incidence for visits and used incidence rate ratios (IRR) for comparisons. Psychotropic medication purchases for patients aged 13-24 years were included. Annual psychotropic medication user prevalence per 1000 was calculated and prevalence rate ratios (PRR) with 95% confidence intervals (CI) were used for comparisons. The years 2020 and 2021 were compared to the pre-pandemic reference year 2019. RESULTS A total of 396534 visits to primary care due to mental health problems were included. Annual visit incidences per 1000 were 151.7 in 2019, 193.6 in 2020, and 306.7 in 2021, indicating a 28% (IRR 1.28, CI 1.27-1.29) increase from 2019 to 2020 and a 102% (IRR 2.02, CI:2.01-2.04) increase from 2019 to 2021. Highest reported increases in 2020 were sleeping disorders (IRR 1.79, CI 1.72-1.87) and anxiety disorders (IRR 1.39, CI 1.37-1.42). Prevalence of antidepressant use increased by 25% (PRR 1.25, CI 1.23-1.26) in 2021. An increase was also seen in the use of antipsychotics (+ 19%, PRR 1.19. CI 1.16-1.21). CONCLUSIONS The COVID-19 pandemic increased the need for mental health services and medication among Finnish adolescents and young adults. Our health care system needs the capacity to manage the increased number of visits, and we must be better prepared for future crises.
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Affiliation(s)
- Ilari Kuitunen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland. .,Department of Pediatrics, Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland.
| | | | | | - Ville M Mattila
- Faculty of Medicine and Health Technologies, Tampere University, Tampere, Finland.,Tampere University Hospital, Tampere, Finland
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12
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Sweeny AL, Keijzers G, Marshall A, Hall EJ, Ranse J, Zhang P, Grant G, Huang YL, Palipana D, Teng YD, Gerhardy B, Greenslade JH, Jones P, Crilly JL. Emergency department presentations during the COVID-19 pandemic in Queensland (to June 2021): interrupted time series analysis. Med J Aust 2023; 218:120-125. [PMID: 36567660 PMCID: PMC9880727 DOI: 10.5694/mja2.51819] [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: 06/20/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To assess emergency department (ED) presentation numbers in Queensland during the coronavirus disease 2019 (COVID-19) pandemic to mid-2021, a period of relatively low COVID-19 case numbers. DESIGN Interrupted time series analysis. SETTING All 105 Queensland public hospital EDs. MAIN OUTCOME MEASURES Numbers of ED presentations during the COVID-19 lockdown period (11 March 2020 - 30 June 2020) and the period of easing restrictions (1 July 2020 - 30 June 2021), compared with pre-pandemic period (1 January 2018 - 10 March 2020), overall (daily numbers) and by Australasian Triage Scale (ATS; daily numbers) and selected diagnostic categories (cardiac, respiratory, mental health, injury-related conditions) and conditions (stroke, sepsis) (weekly numbers). RESULTS During the lockdown period, the mean number of ED presentations was 19.4% lower (95% confidence interval, -20.9% to -17.9%) than during the pre-pandemic period (predicted mean number: 5935; actual number: 4786 presentations). The magnitudes of the decline and the time to return to predicted levels varied by ATS category and diagnostic group; changes in presentation numbers were least marked for ATS 1 and 2 (most urgent) presentations, and for presentations with cardiac conditions or stroke. Numbers remained below predicted levels during the 12-month post-lockdown period for ATS 5 (least urgent) presentations and presentations with mental health problems, respiratory conditions, or sepsis. CONCLUSIONS The COVID-19 pandemic and related public restrictions were associated with profound changes in health care use. Pandemic plans should include advice about continuing to seek care for serious health conditions and health emergencies, and support alternative sources of care for less urgent health care needs.
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Affiliation(s)
- Amy L Sweeny
- Griffith University, Gold Coast, QLD.,Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - Gerben Keijzers
- Gold Coast Hospital and Health Service, Gold Coast, QLD.,Bond University, Gold Coast, QLD
| | - Andrea Marshall
- Gold Coast Hospital and Health Service, Gold Coast, QLD.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| | - Emma J Hall
- Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - Jamie Ranse
- Gold Coast Hospital and Health Service, Gold Coast, QLD.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| | - Ping Zhang
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| | - Gary Grant
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
| | - Ya-Ling Huang
- Gold Coast Hospital and Health Service, Gold Coast, QLD.,Southern Cross University Faculty of Health, Gold Coast, QLD
| | - Dinesh Palipana
- Griffith University, Gold Coast, QLD.,Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - Yang D Teng
- Harvard Medical School, Boston, MA, United States of America
| | | | - Jaimi H Greenslade
- Royal Brisbane and Women's Hospital, Brisbane, QLD.,Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD
| | - Philip Jones
- Gold Coast Hospital and Health Service, Gold Coast, QLD
| | - Julia L Crilly
- Gold Coast Hospital and Health Service, Gold Coast, QLD.,Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD
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13
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First and second wave dynamics of emergency department utilization during the COVID-19 pandemic: A retrospective study in 3 hospitals in The Netherlands. PLoS One 2023; 18:e0279105. [PMID: 36795702 PMCID: PMC9934309 DOI: 10.1371/journal.pone.0279105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/30/2022] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE During certain phases of the COVID-19 pandemic, a decrease was observed in emergency department (ED) utilization. Although this phenomenon has been thoroughly characterized for the first wave (FW), second wave (SW) studies are limited. We examined the changes in ED utilization between the FW and SW, compared to 2019 reference periods. STUDY DESIGN AND METHODS We performed a retrospective analysis of ED utilization in 3 Dutch hospitals in 2020. The FW and SW (March-June and September-December, respectively) were compared to the reference periods in 2019. ED visits were labeled as (non-)COVID-suspected. RESULTS During the FW and SW ED visits decreased by 20.3% and 15.3%, respectively, when compared to reference periods in 2019. During both waves high urgency visits significantly increased with 3.1% and 2.1%, and admission rates (ARs) increased with 5.0% and 10.4%. Trauma related visits decreased by 5.2% and 3.4%. During the SW we observed less COVID-related visits compared to the FW (4,407 vs 3,102 patients). COVID-related visits were significantly more often in higher need of urgent care and ARs were at least 24.0% higher compared to non-COVID visits. CONCLUSION During both COVID-19 waves, ED visits were significantly reduced. ED patients were more often triaged as high urgent, the ED length of stay was longer and ARs were increased compared to the reference period in 2019, reflecting a high burden on ED resources. During the FW, the reduction in ED visits was most pronounced. Here, ARs were also higher and patient were more often triaged as high urgency. These findings stress the need to gain better insight into the motives of patients to delay or avoid emergency care during pandemics, as well as to better prepare EDs for future outbreaks.
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14
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Kim J, Rao N, Collins A, Eboh T, Chugh J, Sheladia S, Naguib TH. Retrospective Study of Psychiatric Hospitalizations in a West Texas Mental Health Treatment Facility during the COVID-19 Pandemic. South Med J 2023; 116:170-175. [PMID: 36724531 PMCID: PMC9897119 DOI: 10.14423/smj.0000000000001514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The association between the coronavirus disease (COVID-19) pandemic and adverse mental health outcomes has been well documented; however, little is known about its impact in rural areas of the United States. This study aims to characterize and compare inpatient psychiatric admissions in West Texas before and during the initial months of the COVID-19 pandemic. METHODS A retrospective study was conducted using the electronic health records of 1392 inpatient psychiatric admissions from period A (March 13, 2019-July 3, 2019) to period B (March 13, 2020-July 3, 2020). RESULTS During period B, there was a significant increase in the length of stay (P < 0.01) compared with period A. The pandemic was associated with an increased history of psychiatric medication use (P < 0.01), substance use (P ≤ 0.01), and suicide risk at the time of admission (P < 0.01). Significant differences were found in employment status (P < 0.01), living situation (P < 0.01), and ethnicity (P = 0.03). CONCLUSIONS Rural communities in West Texas experienced a decrease in psychiatric hospitalizations during the beginning of the COVID-19 pandemic, followed by an increase as lockdown restrictions began to lift; this warrants further investigation into healthcare service utilization during the pandemic.
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Affiliation(s)
- Jimin Kim
- From the Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Nikita Rao
- the School of Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Alex Collins
- the School of Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Tochi Eboh
- the School of Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Julie Chugh
- the School of Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Shyam Sheladia
- the School of Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Tarek H. Naguib
- the Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo
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15
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Abstract
BACKGROUND To study pediatric acute otitis media (AOM) burden fluctuations before and during the first two COVID years, which were characterized by measures to reduce the spread of airborne diseases. We used urinary tract infection (UTI) as a comparison infection. METHODS This was a cross-sectional study encompassing three pre-COVID years (March 1, 2017-February 29, 2020) and the first two COVID years (March 1, 2020-February 28, 2021, and March 1, 2021-February 28, 2022). Records were retrieved from the Clalit Health Services database, Israel's largest healthcare maintenance organization. Children 0-15 years with AOM and UTI episodes were categorized according to age (1>, 1-4, 5-15 years). We collected demographics, seasonality, AOM complications, antibiotic prescriptions, and recent COVID-19 infections. The average AOM/UTI rates of the three pre-COVID years vs. two COVID years were used to calculate the incidence rate ratios (IRRs). RESULTS We identified 1,102,826 AOM and 121,263 UTI episodes. The median age at AOM diagnosis was 2.0 years (IQR, 1.1-4.1). Male predominance, age at presentation, and the dominant age group of 1-4 years did not change during the COVID years. While UTI episode rates decreased during the COVID years (IRR 0.76, 95% CI, 0.68-0.84, P < 0.001), the reduction in AOM episode rates was >2-fold (IRR 0.46, 95% CI, 0.34-0.63, P < 0.001). The largest decrease was observed among children 1-4 years old during the first COVID year (β=-1,938 AOM episodes/100,00 children, 95% CI, -2,038 to -1,912, P < 0.001). Recent COVID-19 infection was associated with low AOM morbidity (IRR 0.05, 95% CI 0.05-0.05, P < 0.001). CONCLUSIONS AOM burden substantially decreased during the first COVID year but almost reached pre-pandemic levels during the second year.
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16
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Vuilleumier S, Spichiger T, Dénéréaz S, Fiorentino A. Not only COVID-19 disease impacts ambulance emergency demands but also lockdowns and quarantines. BMC Emerg Med 2023; 23:4. [PMID: 36635638 PMCID: PMC9836922 DOI: 10.1186/s12873-023-00772-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/02/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The pandemic has impacted both patients infected by the SARS-CoV-2 virus and patients who seek emergency assistance due to other health issues. Changes in emergency demands are expected to have occurred during the pandemic, the objective of this investigation is to characterize the changes in ambulance emergency demands during the first year of the COVID-19 pandemic in the Vaud State of Switzerland. The goal of this research is to identify the collateral effects of the COVID-19 pandemic on emergency demands. To do so, this study quantifies the differences in health issues, level of severity, and patients' sociodemographic characteristics (age, location, gender) prior to and during the outbreak. METHOD This is a retrospective, descriptive and comparative statistical analysis of all ambulance emergency missions from 2018 to 2020 (n = 107,150) in the State of Vaud in Switzerland. Variables analyzed were the number of ambulance missions, patient age and gender, health issues, severity (NACA scores), number of non-transports, mission times and locations. Variables were compared between prepandemic and pandemic situations across years and months. Comparative analysis used bivariate analysis, χ2 test, Student's t test, and Mann‒Whitney U test. RESULTS The pandemic has had two major impacts on the population's emergency demands. The first appears to be due to COVID-19, with an increase in respiratory distress cases that doubled in November 2020. The second relates to the implementation of lockdown and quarantine measures for the population and the closures of restaurants and bars. These might explain the decrease in both the number of traumas and intoxications, reaching more than 25% and 28%, respectively. An increase in prehospital emergency demands by the older population, which accounted for 53% of all demands in 2020, is measured. CONCLUSION Collateral effects occurred during 2020 and were not only due to the pandemic but also due to protective measures deployed relative to the population. This work suggests that more targeted reflections and interventions concerning the most vulnerable group, the population of people 65 and older, should be of high priority. Gaining generalizable knowledge from the COVID-19 pandemic in prehospital settings is critical for the management of future pandemics or other unexpected disasters.
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Affiliation(s)
- Séverine Vuilleumier
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
| | - Thierry Spichiger
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Sandrine Dénéréaz
- grid.507562.3ES ASUR, Vocational Training College for Registered Paramedics and Emergency Care, Le Mont- sur-Lausanne, CH-1052 Switzerland
| | - Assunta Fiorentino
- La Source School of Nursing, University of Applied Sciences and Art Western Switzerland (HES-SO), Lausanne, CH-1004 Switzerland
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17
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Kinaan W, Soares P, Rocha JV, Boto P, Santana R, Lopes S. The Pandemic-Related Factors Associated with Emergency Department Visits in Portugal throughout Two Years of the Pandemic: A Retrospective Population-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1207. [PMID: 36673960 PMCID: PMC9858921 DOI: 10.3390/ijerph20021207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The COVID-19 pandemic has affected the use of emergency departments (ED) worldwide. This study identifies the pandemic-related factors associated with the number of ED visits in mainland Portugal and each of its regions. We collected data on ED visits from March 2020 to March 2022. Data on incidence, vaccination, mobility, containment index, and Google search volume were retrieved from open online sources at different time points. We fitted a quasi-Poisson generalized linear regression model, and each variable was modeled separately and adjusted for time and month. There was a positive ED trend throughout the two years of the pandemic in mainland Portugal and each of its regions. In the mainland, during months with high workplace mobility, there were 10.5% more ED visits compared to months with average mobility. ED visits decreased in months with low mobility for retail and recreation, groceries and pharmacies, and transit compared to months of medium mobility. Portugal saw a reduction in ED utilization during the pandemic period, but with a positive trend from March 2020 to March 2022. The change in the population's behavior of seeking the ED throughout the pandemic might be associated with mobility, incidence, and pandemic fatigue.
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Affiliation(s)
- Walaa Kinaan
- NOVA National School of Public Health, NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Patrícia Soares
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Paulo Boto
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
| | - Sílvia Lopes
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), NOVA University Lisbon, 1600-560 Lisboa, Portugal
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18
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Kabadayi Sahin E, Usul E. Prehospital Emergency Service Use for Substance-Related Issues before and during COVID-19. Emerg Med Int 2023; 2023:8886832. [PMID: 37101767 PMCID: PMC10125766 DOI: 10.1155/2023/8886832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/06/2023] [Accepted: 04/02/2023] [Indexed: 04/28/2023] Open
Abstract
Objective The COVID-19 pandemic disrupted the healthcare system and disproportionally affected individuals with substance use. This study aimed to evaluate the prehospital emergency medical service (EMS) use for substance-related health issues during the COVID-19 pandemic period and compare the changes with the pre-COVID-19 period. Methods The prehospital EMS calls due to substance-related problems in overall Turkiye were analyzed retrospectively. The applications were categorized into the pre-COVID-19 period (May 11, 2019, to March 11, 2020) and the COVID-19 period (March 11, 2020, to January 4, 2021). These two periods were compared to if there were any changes in sociodemographic features of the applicants, the reason for EMS calls, and the dispatch results of the calls. Results There were 6,191 calls in the pre-COVID-19 period and 4,758 calls in the COVID-19 period. According to the age groups, the number of applications of 18 years and under decreased, while the application of people 65 years and over increased during the COVID-19 period (p < 0.001). Considering the reasons for the EMS application, there was an increase in the calls due to suicide and transfers during the COVID-19 period. Besides, the EMS applications for court-ordered treatment decreased in the COVID-19 period (p < 0.001). There was no statistically significant difference in terms of dispatch results (p = 0.081). Conclusions This study shows that the elderly group is at higher risk for substance-related medical problems. Suicide is an important risk among individuals with substance use. The increase in demand for ambulance transfer services can place a significant burden on prehospital emergency care. There is a need for measures to provide emergency and transport services, especially for the elderly and suicide attempts during any future case of emergency.
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Affiliation(s)
- Esra Kabadayi Sahin
- Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine, Ankara, Turkey
| | - Eren Usul
- Department of Emergency Medicine, Ankara Etlik City Hospital, Ankara, Turkey
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19
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Muacevic A, Adler JR, Alageel MK, Alwatban SM, Aldusari R, Aldeeb M, Alsomali S. The Effect of the COVID-19 Lockdown on the Frequency of Acute Poisoning Presentation to Adult and Pediatric Emergency Departments. Cureus 2023; 15:e33581. [PMID: 36636518 PMCID: PMC9830523 DOI: 10.7759/cureus.33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 01/11/2023] Open
Abstract
Background The coronavirus type 2 that causes severe acute respiratory syndrome (SARS-CoV-2) was detected in December 2019 in Wuhan, China. A worldwide emergency response has been initiated because of the fast rise in the number of cases and fatalities during the early stages of the pandemic when vaccinations and efficient medical care were unavailable. Misinformation spread quickly in the early phases of the pandemic, leading to the inappropriate use of medications, chemicals, and traditional remedies for their claimed preventive or therapeutic purposes. Thus, our aim is to identify the impact of the coronavirus disease 2019 (COVID-19) lockdown on the patterns of intoxicated patients presenting to King Abdulaziz Medical City's adult and pediatric emergency departments. Methods A retrospective cohort study was conducted in the adult emergency department at King Abdulaziz Medical City and the pediatric emergency department at King Abdullah Specialized Children's Hospital in Riyadh, Saudi Arabia. All patients presented with poisoning as a chief complaint between March 23 to June 21 in 2019 (pre-lockdown), 2020 (the lockdown), and 2021 (post-lockdown) were included. Cases of registered poisoning complaints were reviewed and assessed with respect to patient demographics, the causative agent/substance responsible for the poisoning, management of poisoning, and particular outcomes on the approved data collection form by the research team. The data were entered and analyzed by using SPSS v26 (IBM Corp, Armonk, NY). The descriptive statistics are presented as frequency and percentage for the categorical data variables and mean and standard deviation for the numerical data. The data were further analyzed by using cross-tabulation (chi-square test), for the data that are both the predictor and the outcome was categorical. A p-value of < 0.05 was considered significant for all statistical tests. Results Out of 318 patients identified, 164 were adults and 154 were pediatric patients. The mean age of adult and pediatric patients was 33.3±15.5 years and 4±3.6 years, respectively. The majority of patients (115; 70.1%) were males in the adult group and females (90; 58.4%) in the pediatric. The majority of self-harm cases were accidental among both adults and pediatrics, 109 (66.5%) and 144 (93.5%), respectively. The disposition from the emergency department was discharged for 113 (68.7%) adult patients and 134 (87.0%) pediatric patients. The number of cases presented to ER with poisoning cases during the lockdown decreased. This was further tested inferentially, but no significant association was seen among study variables, i.e., p > 0.05. Conclusion The lockdown and pandemic had a significant impact on the rate and patterns of ED visits. The establishment and operation of Drug and Poison Information Centers (DPIC) across the Kingdom, in addition to increasing awareness through campaigns addressing drug and substance safety, is recommended.
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Frontera WR, Latimer MR, de Jesús K, Pabón A, González J, Conde JG. Effect of the COVID-19 Pandemic on Musculoskeletal Care in the Emergency Room. Disaster Med Public Health Prep 2022; 17:e310. [PMID: 36471913 PMCID: PMC9947031 DOI: 10.1017/dmp.2022.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Study the effect of the coronavirus disease (COVID-19) pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. METHODS Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM codes were used to assign the primary diagnosis. Joinpoint regression was applied to a time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. RESULTS Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2% for all-cause and 35.8% for MSK encounters. Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. CONCLUSION The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restrictions and a change in patients behaviors. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.
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Affiliation(s)
- Walter R. Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
- Corresponding author: Walter R. Frontera,
| | - Marcos R. Latimer
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Kevin de Jesús
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Angel Pabón
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Juan González
- Department of Emergency Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - José G. Conde
- Department of Biomedical Sciences Program, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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21
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Muacevic A, Adler JR, Alghamdi AA, Alghazzawi N, Bakhsh A, Alharbi T. The Effect of COVID-19 Lockdown on Cerebrovascular Accidents, Acute Coronary Syndrome, and Diabetic Ketoacidosis Visits the Emergency Department: A Retrospective Study. Cureus 2022; 14:e33154. [PMID: 36601185 PMCID: PMC9803928 DOI: 10.7759/cureus.33154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 01/02/2023] Open
Abstract
Objective This study aims to assess the effect of the COVID-19 lockdown on acute coronary syndrome (ACS), cerebrovascular accident (CVA), and diabetic ketoacidosis (DKA) visits the emergency department (ED). Methods We compared two groups of patients attending King Abdulaziz University Hospital (KAUH) ED diagnosed with one of the following ACS, CVA, or DKA; patients presenting from 21 December 2019 to 23 March 2020 and patients presenting from 23 March 2020 to 21 June 2020, representing COVID-19 pre-lockdown and during-lockdown period, respectively. The variables we analyzed were age, nationality (Saudi/non-Saudi), and gender. Results Our total sample size was 285 patient visits, ACS (n=130), CVA (n=98), and DKA (n=57). Results showed a statistically significant relationship between the number of patients with ACS and the period of visitation to ED (45.24% reduction, p-value <0.001), while CVA (18.5% reduction, p-value 0.312) and DKA (16% reduction, p-value 0.508) showed no statistically significant relationship. Conclusion A lockdown may be necessary to control a pandemic. However, it may carry potential collateral damage, such as a decrease and delay in the presentation of life-threatening conditions, which may lead to worsening outcomes. A clinical presentation of these conditions should warrant comprehensive evaluation by healthcare workers regardless of an ongoing pandemic while implementing infection control guidelines.
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22
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Wang J, Yin D, Li G, Wang T, Zhang Y, Gan H, Sun J. Impacts of COVID-19 Prevention and Control Measures on Asthma-Related Hospital and Outpatient Visits in Yichang, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13572. [PMID: 36294152 PMCID: PMC9603737 DOI: 10.3390/ijerph192013572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 06/16/2023]
Abstract
This article investigates the impact of COVID-19 lockdown and regular epidemic prevention and control after lifting lockdown on asthma-related hospital and outpatient visits in Yichang. Data on the general outpatient department (GOPD), emergency department (ED) and intensive care unit (ICU) visits for asthma from 15 November 2019 to 21 May 2020 and the corresponding from 2018 to 2019 were collected from eight tertiary hospitals in municipal districts. The controlled interrupted time series (CITS) analysis was used to investigate the level and long-term trend changes of weekly asthma visits during lockdown and regular epidemic prevention and control, and stratified by type of visits and age. A total of 9347 asthma-related hospital and outpatient visits were analyzed. The CITS showed that after the implementation of lockdown, the weekly visits of asthma patients immediately decreased by 127.32 (p = 0.002), and the level of GOPD and ED/ICU visits immediately decreased significantly. After implementation of regular prevention, the level and trend of overall weekly visits changed insignificantly compared with the lockdown period. The weekly visits of GOPD adults immediately increased by 51.46 (p < 0.001), and the trend of ED/ICU adults decreased by 5.06 (p = 0.003) visits per week compared with lockdown period. The COVID-19 lockdown in Yichang was related to the decrease in hospital and outpatient visits for asthma. After the implementation of subsequent regular prevention and control measure, only the GOPD visits of adults increased compared with lockdown period.
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Affiliation(s)
- Jinyi Wang
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Dapeng Yin
- Hainan Center for Disease Control and Prevention, Haikou 570110, China
| | - Guoxing Li
- Department of Occupational and Environmental Health Sciences, School of Public Health, Peking University, Beijing 100191, China
| | - Tianqi Wang
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Yanli Zhang
- Institute for Scientific Information, Yichang Center for Disease Control and Prevention, Yichang 443000, China
| | - Hui Gan
- The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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23
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Bord S, Tur-Sinai A, Basis F. High Non-COVID-19 in-Hospital Deaths during the First Lockdown in Israel Compared with the Second and Third Lockdowns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13134. [PMID: 36293711 PMCID: PMC9602693 DOI: 10.3390/ijerph192013134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/02/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
During the first lockdown in Israel, citizens were instructed to visit community clinics only for urgent cases. However, they were not informed that emergency departments (EDs) were safe. Reports from the National Ambulance Services showed a 22% increase in at-home deaths during the lockdown. Perhaps, the reason is because some critically ill patients postponed referrals and came "at the last minute". After the first lockdown, the Ministry of Health (MOH) declared that hospital EDs were safe. The objective of the study was to examine the rates of admission from EDs to hospital wards, and non-COVID-19 in-hospital deaths during the first lockdown in Israel, compared with the second and third lockdowns. From the business intelligence software of the Rambam Medical Center in Israel, we collected data about the rates of admission to the ED, the non-COVID-19 in-hospital deaths during the three lockdowns, during the same periods in the previous three years, and the main five causes of non-COVID-19 deaths. Data comparison was done using multiple chi-square tests. ED admission numbers were significantly higher during the first lockdown than during the second (χ2 (1, n = 36,245) = 24.774, p = 0.00001) and third lockdowns (χ2 (1, n = 36,547) = 8.7808, p = 0.0030). We found a significantly higher number of non-COVID-19 in-hospital deaths vs. discharges during the first lockdown than in the second and third lockdowns (χ2 (2, n = 26,268) = 7.794, p = 0.0203) The number of deaths due to respiratory diseases was significantly higher during the first lockdown than in the second lockdown (χ2 (1, n = 572) = 8.8185, p = 0.0029) and in the third lockdown (χ2 (1, n = 624) = 9.0381, p = 0.0026), and deaths from infectious diseases were higher during the first lockdown than during both the second and third lockdowns (χ2 (1, n = 566) = 5.9479, p = 0.0147, and χ2 (1, n = 624) = 9.5978, p = 0.0019), respectively. The onset of CVA and CVD are abrupt, while respiratory and infectious diseases may have an insidious pattern; this may have led patients to postpone referrals to hospitals to the "last minute" during the first lockdown, perhaps due to fears of contracting COVID-19, and as a result of vague instructions. Citizens and policymakers must be made aware of this point during future pandemics.
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Affiliation(s)
- Shiran Bord
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
| | - Aviad Tur-Sinai
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
- School of Nursing, University of Rochester Medical Center, Rochester, NY 14642-8404, USA
| | - Fuad Basis
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Yezreel Valley 1930600, Israel
- Rambam Health Care Campus, Haifa 3109601, Israel
- Faculty of Medicine, Technion Israel Institute of Technology, Haifa 3200003, Israel
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Zaboli A, Brigo F, Sibilio S, Fanni Canelles M, Rella E, Magnarelli G, Pfeifer N, Turcato G. The impact of COVID-19 pandemic on the urgency of patients admitted to the emergency department. Int Emerg Nurs 2022; 65:101229. [PMCID: PMC9550667 DOI: 10.1016/j.ienj.2022.101229] [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: 02/02/2022] [Revised: 06/30/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022]
Abstract
Background Methods Results Conclusion
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Affiliation(s)
- Arian Zaboli
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy,Corresponding author at: Emergency Department, Hospital of Merano, Via Rossini 5, 39012 Merano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Serena Sibilio
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | - Eleonora Rella
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | | | - Norbert Pfeifer
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Gianni Turcato
- Emergency Department, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
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25
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Obed D, Salim M, Ammo T, Gildt MM, Krezdorn N, Vogt PM, Dastagir K. The effect of the COVID-19 pandemic lockdown measures on plastic, reconstructive and hand surgery emergency presentations – A comparative retrospective study in a regional referral center in Germany. Ann Med Surg (Lond) 2022; 82:104650. [PMID: 36124314 PMCID: PMC9476368 DOI: 10.1016/j.amsu.2022.104650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/02/2022] Open
Abstract
Background Methods Results Conclusions The COVID-19 lockdown caused a shift in surgical emergency case presentations. Increasing domestic and decreasing recreational and work injuries were noted. Middle-aged females were at high risk to sustain injuries during lockdown. Hand injuries showed consistent severity and hospital admission rates. Resource allocation remains crucial in future pandemic waves.
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Pöyhiä R, Ohvanainen A, Rapo-Pylkkö S, Niemi-Murola L. Influences of COVID-19 pandemic on hospital-at-home functions in Finland - a questionnaire survey. Scand J Prim Health Care 2022; 40:379-384. [PMID: 36325735 PMCID: PMC9848305 DOI: 10.1080/02813432.2022.2139475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To investigate functions of Finnish hospital-at-home (HAH) during the first year of COVID19-pandemic 2020 compared with the previous year 2019. DESIGN Retrospective questionnaire survey. SETTING Finnish HAHs from Northern, Eastern, Southern, Western and Central parts of Finland participated in a questionnaire web-based questionnaire survey. The numbers of patients, activities and staff in 2019 and 2020, participation in the care of COVID19 patients, availability of protective clothing, attitudes of patients towards home care and development of new practices in the corona era were asked using both predefined and free questions. SUBJECTS questionnaire was sent to the nurses and physicians in charge of the HAHs (N = 13), 77% responded. The HAHs provided services to a total of 1,196,783 inhabitants in their municipalities. RESULTS There were no significant changes in the numbers of patients, staff or activities between the years 2019 and 2020. Although nurses did viral tests, COVID19 patients were cared only in 40% of HAHs. Protective clothing was well available. New instructions for infection management were created. CONCLUSIONS The COVID-19 pandemic did not largely influence the functions of the examined Finnish HAHs in 2020. Most activities and patients' characteristics remained unchanged from 2019. The role of HAHs should be further developed in Scandinavian countries, particularly during pandemics.Key PointsHospital-at-home (HAH) is a cost-effective model to provide hospital-like services.Data about the role of HAHs during COVID19 pandemics is lacking in the Nordic countries.This study shows that, the large Finnish municipal HAHs have been not influenced by pandemics.
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Affiliation(s)
- Reino Pöyhiä
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
- Palliative Medicine, Department of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Palliative Center, The South Savo Social and Health Care Authority, Mikkeli, Finland
- CONTACT Reino Pöyhiä Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
| | - Antti Ohvanainen
- Palliative Center, Joint Municipal Authority for North Karelia Social and Health Service, Siun sote, Joensuu, Finland
| | | | - Leila Niemi-Murola
- Department of Anaesthesia and Intensive Care, University of Helsinki, Helsinki, Finland
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Flament J, Clarembeau F, Hayden C, Scius N, Regnier M, Thonon H. Do Non-COVID-19 Patients' Behaviour Towards Emergency Changed During the COVID-19 Outbreak? A Severity-Based Approach. Open Access Emerg Med 2022; 14:473-479. [PMID: 36039178 PMCID: PMC9419907 DOI: 10.2147/oaem.s368254] [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: 04/07/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Objective During the COVID-19 pandemic, the number of patients presenting to the emergency department (ED) declined. The main goal of this study was to compare and describe the non-COVID-19 patient’s disease severity presentation during the pandemic with its pre-pandemic severity. Methods We conducted a retrospective observational study. We selected two samples of visits: one during the first COVID-19 wave of 2020 (pandemic period, PP) and the other during the same months of 2019 (control period, CP). The primary endpoints were the comparison of severity and distribution of the Emergency Severity Index (ESI). Secondary endpoints were comparisons of specific patient characteristics (age, sex, length of the symptoms before the visits, spontaneous visits or not, return home or not). Results The mean ESI of the visits during the PP (3.19) was statistically significantly lower (P = 0.001) than it was in the CP (3.43). These changes were more pronounced during the months of March (3.03 versus 3.33, P = 0.037) and April (2.96 versus 3.48, P < 0.001). The change in ESI was mainly due to an increase in the proportion of visits by patients with an ESI score of 3 (42% versus 28%, P < 0.001). There were no differences in the characteristics of patients except a decline in patients whose symptoms had a duration of more than 30 days (2% during PP versus 4% during CP, P = 0.03). Conclusion The COVID-19 pandemic caused a change in the pattern of non-COVID-19 visits, with proportionally more severe presentations based on the ESI. To our knowledge, this is the first description of changes in behaviour in ED visits by specifically non-COVID-19 patients.
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Affiliation(s)
| | | | | | - Nathan Scius
- Emergency Department, CHU UCL Namur, Yvoir, Belgium
| | | | - Henri Thonon
- Emergency Department, CHU UCL Namur, Yvoir, Belgium
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Farakla I, Lagousi T, Miligkos M, Nicolaides N, Vasilakis IA, Mpinou M, Dolianiti M, Katechaki E, Taliou A, Spoulou V, Kanaka-Gantenbein C. Stress hyperglycemia, Diabetes mellitus and COVID-19 infection: The impact on newly diagnosed type 1 diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:818945. [PMID: 36992762 PMCID: PMC10012074 DOI: 10.3389/fcdhc.2022.818945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/29/2022] [Indexed: 11/13/2022]
Abstract
Several recent studies have documented an increased incidence of newly diagnosed type 1 Diabetes (T1D) cases in children and adolescents during the COVID-19 pandemic and a more severe presentation at diabetes onset. In this descriptive study, we present the experience of the Diabetes Centre of the Division of Endocrinology, Diabetes, and Metabolism of the First Department of Pediatrics of the National and Kapodistrian University of Athens Medical School at “Aghia Sophia” Children’s Hospital in Athens, Greece, concerning new cases of T1D diagnosis during the COVID-19 pandemic (March 2020- December 2021). Patients who had already been diagnosed with T1D and needed hospitalization due to poor control during the pandemic have been excluded from this study. Eighty- three children and adolescents with a mean age of 8,5 ± 4.02 years were admitted to the hospital due to newly diagnosed T1D during this 22 months’ period in comparison to 34 new cases in the previous year. All patients admitted during the pandemic with a new diagnosis of T1D, presented in their majority with DKA (Ph: 7.2) representing an increase of new severe cases in comparison to previous years (Ph 7.2 versus 7.3, p value: 0.021, in the previous year), [p-value: 0.027]. 49 cases presented with DKA, of which 24 were characterized moderate and 14 severe DKA (28.9% and 16,9%, respectively), while 5 patients newly diagnosed, needed to be admitted to the ICU to recover from severe acidosis. Whether a previous COVID- 19 infection could have been the triggering factor is not supported by the SARS-Cov2 specific antibodies analysis in our cohort of patients. As far as HbA1c is concerned there was no statistically significant difference between the pre COVID-19 year and the years of the pandemic (11.6% versus 11.9%, p- value: 0.461). Triglycerides values were significantly higher in patients with new onset T1D during COVID-19 years compared to those before the pandemic (p value= 0.032). Additionally, there is a statistically significant correlation between Ph and Triglycerides for the whole period 2020-2021 (p-value<0.001), while this correlation is not significant for the year 2019. More large- scale studies are required to confirm these observations.
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Affiliation(s)
- Ioanna Farakla
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Theano Lagousi
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Michael Miligkos
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Nicolas C. Nicolaides
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Ioannis-Anargyros Vasilakis
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Maria Mpinou
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Maria Dolianiti
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Elina Katechaki
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Anilia Taliou
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Vasiliki Spoulou
- Immunobiology Research Laboratory and Infectious Diseases Department “MAKKA”, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, “Aghia Sophia” Children’s Hospital, Athens, Greece
- *Correspondence: Christina Kanaka-Gantenbein,
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Marom T, Schwarz Y, Gluck O, Ginzburg G, Tamir SO. Trends in Pediatric Acute Otitis Media Burden During the First COVID-19 Year. Otol Neurotol 2022; 43:e760-e766. [PMID: 35878638 DOI: 10.1097/mao.0000000000003581] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the changes in acute otitis media (AOM) pediatric emergency department (PED) visits and pediatric admission before and during the first coronavirus disease 2019 (COVID-19) year. STUDY DESIGN Retrospective case review. SETTING Secondary care center. PATIENTS Children younger than 18 years with all-cause and AOM-related PED visits and pediatric admissions for 3 years (March 1, 2018-January 28, 2021) were identified. Children were categorized according to age (0-2, 2-6, and 6-18 yr) and their date of presentation: pre-COVID-19 (yearly average of visits/admissions during the 2 prepandemic years: March 1, 2018-February 28, 2019 and March 1, 2019-February 29, 2020) or COVID-19 year (visits/admissions between March 1, 2020-February 28, 2021). INTERVENTION Pre- and post-COVID-19 emergence, alternating lockdowns, kindergarten and school closures, and increased hygiene measures. MAIN OUTCOME MEASURE Post- versus pre-COVID-19 AOM PED visit and pediatric admission incidence rate ratios (IRRs), using a generalized estimating equation model with a negative binomial regression calculation, while controlling for monthly fluctuations. RESULTS Annual AOM visits/admissions during the pre-COVID-19 and COVID-19 years were 517 and 192 and 256 and 94, respectively (p < 0.05 for both). For children aged 0 to 2 years, AOM visits/admissions significantly decreased during the first COVID-19 year, compared with the pre-COVID years (β = -1.11 [IRR, 0.33; 95% confidence interval [CI], 0.26-0.42; p < 0.005] and β = -1.12 [IRR, 0.33; 95% CI, 0.25-0.42; p < 0.005]). Relatively to all-cause of children aged 0 to 2 years, AOM visits/admissions decreased during the first COVID-19 year versus the pre-COVID-19 years (β = -2.14 [IRR, 0.12; 95% CI, 0.08-0.17; p < 0.005] and β = -1.36 [IRR, 0.26; 95% CI, 0.23-0.29; p < 0.005]) and had monthly fluctuations coinciding with the lockdown/relaxation measures. For children aged 2 to 6 years, the reduction in AOM admissions was significant (β = -1.70, IRR, 0.18; 95% CI, 0.09-0.37; p < 0.005). No significant differences were observed for children aged 6 to 18 years because of the small sample size. CONCLUSION Pediatric AOM burden substantially decreased during the first COVID-19 year.
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Affiliation(s)
| | | | | | - Gabriel Ginzburg
- Faculty of Medicine, Hebrew University in Jerusalem, Jerusalem, Israel
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30
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Möttönen J, Kuitunen I, Uimonen M, Mattila VM, Paloneva J, Ponkilainen V. Effect of national COVID-19 lockdown on the incidence of muscle, tendon and ligament injuries and related surgical procedures in the working-aged Finnish population. Arch Orthop Trauma Surg 2022; 143:2539-2545. [PMID: 35780198 PMCID: PMC10110679 DOI: 10.1007/s00402-022-04521-2] [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: 01/03/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The effect of lockdown on the incidence of fractures and severe injuries has been widely studied, whereas studies regarding muscle, tendon, and ligament injuries have not received as much attention. The aim of the study was to investigate the effect of the lockdown and later regional regulations due to the COVID pandemic on the incidence of muscle, tendon, and ligament injuries and related surgical procedures. MATERIALS AND METHODS This study focuses on the working-age population in the catchment areas of three major Finnish hospitals. Patients were divided into three age groups 18-34, 35-50 and 51-65 years of age. Suitable injuries were retrieved from the data using appropriate ICD-10 codes and procedure codes. The monthly incidence rate ratio (IRR), with 95% confidence intervals (CI), were compared between the year 2020 and the reference years 2017-2019. RESULTS Upper and lower extremity injury ED visits decreased by 15.7 and 8.2%. For upper extremity injuries, a decrease in incidence was observed for all three age groups in March (IRR 0.52, CI 0.33-0.80), (IRR 0.53, CI 0.31-0.91), (IRR 0.60, CI 0.38-0.95), respectively. An increase in 18-34 years of age group was detected in June (IRR 1.49, CI 1.05-2.13). Lower extremity injuries decreased in 18-34 years of age group in March (IRR 0.62, CI 0.43-0.90) and April (IRR 0.60, CI 0.42-0.87). A decrease on the incidence of surgeries was observed in April for the 35-50 (IRR 0.53, CI 0.29-0.97) and 51-65 years of age groups (IRR 0.58, CI 0.34-0.98). CONCLUSIONS The nationwide lockdown in spring 2020 led to a notable decrease in the incidence of emergency department visits and the surgical treatment of muscle, tendon, and ligament injuries in Finland.
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Affiliation(s)
- Julius Möttönen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.
| | - Ilari Kuitunen
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Mikkeli Central Hospital, Porrassalmenkatu 35-37, 50100, Mikkeli, Finland
| | - Mikko Uimonen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville M Mattila
- Department of Orthopaedics and Traumatology, Tampere University Hospital, Teiskontie 35, PL2000, 33521, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,COXA Hospital for Joint Replacement, Biokatu 6, 33520, Tampere, Finland
| | - Juha Paloneva
- School of Medicine, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland.,Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
| | - Ville Ponkilainen
- Department of Surgery, Hospital Nova of Central Finland, Keskussairaalantie 19, 40620, Jyväskylä, Finland
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31
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Mittermaier P, Oxley PJ, Mian RA, Prince JM, Lee AT, Murabit A, Ratanshi I, Bone J. The 1 Year Effect of COVID-19 on Plastic Surgery Trauma at a Level One Trauma Centre: A Retrospective Review. Plast Surg (Oakv) 2022. [PMCID: PMC9247628 DOI: 10.1177/22925503221109074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Since the onset of the COVID-19 pandemic, Canada has
seen significant societal and health changes leading to the closures of many
businesses and shifts in the daily activities of many Canadians. Despite these
changes and a sharp drop in the number of patients attending emergency
departments across British Columbia (BC), little change was noted in the use of
protected plastic surgery trauma time at a level one trauma centre surveyed in
BC. The purpose of this study was to analyze and compare the changes in plastic
surgery-related trauma cases before and after the onset of the COVID-19
pandemic, both in etiology and case description. Methods: A
retrospective medical chart review was performed, evaluating all of the
participating surgeon's trauma slates in the year before and after April 1,
2020. Patient demographics, etiology, injury location, diagnosis, and surgical
timing were all recorded and analyzed using an interrupted time-series
statistical model. Results: No significant difference was observed
in any of the recorded categories across the 2 time periods. Slight increases
were noted in workplace injuries, assaults, and home-related machinery injuries.
Conclusion: The lack of significant change in workplace
injuries likely stemmed from the high number of factories and industrial plants
present in our health region, as these jobs lacked the ability to work from
home. The results of this study show that the demand for trauma-related plastic
surgery care is independent of an overall decrease in hospital admissions and
therefore should be planned and budgeted for accordingly.
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Affiliation(s)
| | - Paul J. Oxley
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Rizwan A. Mian
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Jennifer M. Prince
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Adrian T. Lee
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Amera Murabit
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Imran Ratanshi
- Division of Plastic Surgery, University of British Columbia, Surrey, BC, Canada
| | - Jeffrey Bone
- BC Children’s’ Hospital Research Institute, Vancouver, BC, Canada
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Hayashi K, Tanaka T, Sakawa A, Ebara T, Tanaka H, Nakamura H. Effects of self-quarantine during the COVID-19 pandemic on patients with lumbar spinal stenosis: A case-control study. Medicine (Baltimore) 2022; 101:e29388. [PMID: 35713443 PMCID: PMC9276399 DOI: 10.1097/md.0000000000029388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 04/12/2022] [Indexed: 11/27/2022] Open
Abstract
Prospective case-control studyThis study aimed to investigate the effect of self-quarantine on the changes in low back symptoms and activities of daily living (ADL) due to low physical activity because of the COVID-19 pandemic in patients with lumbar spinal stenosis (LSS).The frequency and intensity of low back and leg pain have reportedly increased in healthy subjects because of self-quarantine.Patients with LSS who self-quarantined from baseline (SQ group) were matched to controls who did not self-quarantine (non-SQ group), based on age, sex, medication, ADL, and the numeric rating scale score for low back symptoms. The change in low back symptoms, ADL, and health-related quality of life between baseline and follow-up were compared between the groups.The SQ and non-SQ group included 80 and 60 patients, respectively. Compared with the baseline, the numeric rating scale score for low back pain at follow-up in the SQ group significantly improved (P = .004, median; 1 point), but not in the non-SQ group. No significant difference was found regarding changes in leg pain or numbness. Low back pain improvement did not lead to ADL improvement. The short form 12 evaluation revealed the role/social component score in the SQ group to be significantly lower than that in the non-SQ group; no difference was found for the physical or mental components at follow-up.Self-quarantine with conservative treatment effected short-term low back pain improvement in patients with LSS. However, no improvement in ADL was found. Self-quarantine had an unfavorable impact for health-related quality of life. The effect of self-quarantine can influence the treatment results of LSS.
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Affiliation(s)
- Kazunori Hayashi
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toru Tanaka
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Akira Sakawa
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Tsuneyuki Ebara
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Hidekazu Tanaka
- Department of Orthopedic Surgery, Osaka City Juso Hospital, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Bucaj J, Mechili EA, Galanis P, Mersini B, Nika S, Hoxhaj I, Likaj S, Patelarou AE, Patelarou E. Decreased Hospital Visits and Increased Mortality Rate in Emergency Department during the COVID-19 Pandemic: Evidence from Albania. Acta Med Litu 2022; 29:58-68. [PMID: 36061927 PMCID: PMC9428650 DOI: 10.15388/amed.2022.29.1.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 12/23/2022] Open
Abstract
Objective: To investigate the hospital visits and mortality rate during the COVID-19 in emergency department of Vlora regional hospital in Albania and to compare with the three previous years (2017–2019). Methods: Secondary data of patients that visited emergency department of Vlora Regional hospital Albania (largest hospital in the south of the country), since January 1, 2017 till December 31, 2020. This is a retrospective study. We used the hard copy of the patients’ health register records. The data extraction was conducted during March 2021 till June 2021. Eligible were all patients admitted and recorded in the registry of the emergency department. The causes of admission were categorized in 14 different disease categories. All registered patients admitted to the Vlora regional hospital were included in the study. Results: Study population included 44,917 patients during 2017–2020. Mean age of patients was 51.5 years, while 53.6% were females. The highest number of patients was in 2017 (n=12,407) and the lowest in 2020 (n=9,266). Increase of patients presented with cardiovascular, psychiatric and renal/urinary tract was observed in 2020 in comparison to 2019. Patients decreased over time with an average annual percent decrease of 7% (p-value=0.22). Joinpoint analysis revealed that mortality rate increased over time with an average annual percent increase of 34.3% (95% confidence interval=42.7% to 214.8%, p-value=0.27). Conclusions: The number of patients visiting emergency department decreased while mortality rate increased. Educating and raising awareness of patient to seek medical assistance should be a key objective of health policy makers and health personnel.
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Effects of COVID-19 lockdown strategies on emergency medical services. Am J Emerg Med 2022; 60:40-44. [PMID: 35905600 PMCID: PMC9186951 DOI: 10.1016/j.ajem.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction The aim of this study is to evaluate the change in the number of EMS cases by comparing the lockdown period, the non-lockdown period, and the pre-pandemic period. Methods In our study, 3 periods of EMS cases were compared to evaluate the effect of lockdown. The first period (Period A) included in the study was the lockdown period (01-12-2020 and 31–01–2021. The second period (period B) is the period between 01 and 10-2020 and 30–11–2020, where there was no lockdown despite the pandemic. The third period (period C) in the study is the period between 01 and 12-2019 and 31–01–2020 before the pandemic. Results A total of 120,989 cases in 3 periods were included in the study. It was determined that the highest number of patients were in period C (42,703, 35.3%), while the least was in period A (39,054, 32.2%). On the other hand, it was found that the number of calls was highest in period A (246,200, 35.1%), while the least was in period C (212,267, 30.2%). Response times were longer in the pandemic period than in the pre-pandemic period. Mean talk time were longer during the pandemic period. The most frequent diagnosis in period A (21.6%) and B (42.2%) was COVID-19. The second most frequent disease group in these two periods was cardiovascular diseases. Conclusion While the number of EMS cases decreased during the pandemic period, it decreased even more during the lockdown period. However, the number of calls increased significantly during the lockdown period, and the response times and talk times increased accordingly.
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de Jesús K, Guasp WR, Fontánez R, Ramírez H, Conde JG, González J, Frontera WR. Musculoskeletal Conditions in Older Men and Women: An Emergency Room Study. PUERTO RICO HEALTH SCIENCES JOURNAL 2022; 41:56-62. [PMID: 35704522 PMCID: PMC9228770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To study the utilization of emergency room (ER) services for health complaints of the musculoskeletal (MSK) system in older men and women. METHODS Data from all medical encounters at the ER of a teaching hospital for calendar years 2016-2020 were extracted from an electronic database. MSK encounters were defined as those with ICD 10-CM M and S codes in the primary diagnosis field of the database. Frequency distributions were calculated by year, sex, and age group for MSK and all encounters. The most frequent codes used by sex and age groups were assessed. RESULTS The number of unique patients with medical encounters at the ER during the five-year period was 94,346. There was a total of 220,153 encounters (median:1 encounter per patient; interquartile range:1-3). A 33.2% reduction in the number of encounters occurred in 2020 compared to 2019. The total number of unique patients in the 60 yr. and older group was 24,412 (25.9% of all unique patients). The total number of encounters in the group 60 yr. and older was 56,294 (25.6% of all encounters). Women accounted for 31,488 (56%) encounters in this age group. A total of 12,744 encounters (22.6%) in older adults involved the MSK system and this proportion decreased with increasing age. The most common MSK conditions included low back pain, pain in joints, and femoral fractures. CONCLUSION Older adults with MSK health conditions represent a substantial portion of ER patients. Many MSK health conditions could be evaluated and treated in other health care settings.
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Affiliation(s)
- Kevin de Jesús
- Department of Physical Medicine, Rehabilitation & Sports Medicine, University of Puerto Rico School of Medicine
| | - William Ramos Guasp
- Department of Physical Medicine, Rehabilitation & Sports Medicine, University of Puerto Rico School of Medicine
| | - Richard Fontánez
- Department of Physical Medicine, Rehabilitation & Sports Medicine, University of Puerto Rico School of Medicine
| | - Humberto Ramírez
- Department of Physical Medicine, Rehabilitation & Sports Medicine, University of Puerto Rico School of Medicine
| | - José G. Conde
- Biomedical Sciences Program, University of Puerto Rico School of Medicine
| | - Juan González
- Department of Emergency Medicine, University of Puerto Rico School of Medicine
| | - Walter R. Frontera
- Department of Physical Medicine, Rehabilitation & Sports Medicine, University of Puerto Rico School of Medicine
- Department of Physiology and Biophysics, University of Puerto Rico School of Medicine
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Ageron FX, Hugli O, Dami F, Caillet-Bois D, Pittet V, Eckert P, Beysard N, Carron PN. Lessons from COVID-19 syndromic surveillance through emergency department activity: a prospective time series study from western Switzerland. BMJ Open 2022; 12:e054504. [PMID: 35523491 PMCID: PMC9082728 DOI: 10.1136/bmjopen-2021-054504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We aimed to assess if emergency department (ED) syndromic surveillance during the first and second waves of the COVID-19 outbreak could have improved our surveillance system. DESIGN AND SETTINGS We did an observational study using aggregated data from the ED of a university hospital and public health authorities in western Switzerland. PARTICIPANTS All patients admitted to the ED were included. PRIMARY OUTCOME MEASURE The main outcome was intensive care unit (ICU) occupancy. We used time series methods for ED syndromic surveillance (influenza-like syndrome, droplet isolation) and usual indicators from public health authorities (new cases, proportion of positive tests in the population). RESULTS Based on 37 319 ED visits during the COVID-19 outbreak, 1421 ED visits (3.8%) were positive for SARS-CoV-2. Patients with influenza-like syndrome or droplet isolation in the ED showed a similar correlation to ICU occupancy as confirmed cases in the general population, with a time lag of approximately 13 days (0.73, 95% CI 0.64 to 0.80; 0.79, 95% CI 0.71 to 0.86; and 0.76, 95% CI 0.67 to 0.83, respectively). The proportion of positive tests in the population showed the best correlation with ICU occupancy (0.95, 95% CI 0.85 to 0.96). CONCLUSION ED syndromic surveillance is an effective tool to detect and monitor a COVID-19 outbreak and to predict hospital resource needs. It would have allowed to anticipate ICU occupancy by 13 days, including significant aberration detection at the beginning of the second wave.
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Affiliation(s)
| | - Olivier Hugli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Fabrice Dami
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - David Caillet-Bois
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Valerie Pittet
- Centre for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Philippe Eckert
- General Directorate, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Beysard
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
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Cozzi G, Blasutig F, De Nardi L, Giangreco M, Barbi E, Amaddeo A. The first winter of social distancing improved most of the health indexes in a paediatric emergency department. Acta Paediatr 2022; 111:1027-1033. [PMID: 35080037 PMCID: PMC9303403 DOI: 10.1111/apa.16271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/23/2022]
Abstract
Aim We compared visits to a tertiary level paediatric emergency department (PED) in Italy, during winter 2020–2021, when COVID‐19 social distancing measures were in place, with winter 2019–2020. Methods This was a retrospective analysis of an electronic database. We obtained the number of visits and the ages, main complaints, triage codes, discharge diagnoses and outcomes of patients who accessed the PED from the 1 October 2020 to 28 February 2021. These were compared to the same period in 2019–2021. Results Visits fell by 52%, from 10982 in 2019–2020 to 5317 in 2020–2021 (p < 0.0001). The reductions were 52% in neonates, 58% in infants, 53% in toddlers, 61% in preschool children, 48% in school children and 46% in adolescents. Non‐urgent and urgent triage codes declined. Respiratory and gastrointestinal infections fell by 72% and 71% respectively. Injuries declined by 42%, mainly among adolescents. Accidental intoxication, psychiatric symptoms and substance or alcohol abuse declined by 24%, 33% and 64%. Hospital admissions reduced by 8% and admissions to intensive care fell by 29%. Conclusion During the first winter of pandemic social distancing visits to an Italian PED fell by 52%, with higher reductions in younger children and infants, and hospital admissions fell by 8%.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Francesca Blasutig
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Laura De Nardi
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Manuela Giangreco
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Egidio Barbi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
- Department of Medicine University of Trieste Surgery and Health Sciences Trieste Italy
| | - Alessandro Amaddeo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
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Del Fiol FDS, Bergamaschi CDC, De Andrade IP, Lopes LC, Silva MT, Barberato-Filho S. Consumption Trends of Antibiotics in Brazil During the COVID-19 Pandemic. Front Pharmacol 2022; 13:844818. [PMID: 35387351 PMCID: PMC8978992 DOI: 10.3389/fphar.2022.844818] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/03/2022] [Indexed: 12/21/2022] Open
Abstract
Background: In 2019, a new type of coronavirus emerged and spread to the rest of the world. Numerous drugs were identified as possible treatments. Among the candidates for possible treatment was azithromycin alone or in combination with other drugs. As a result, many clinicians in Brazil have prescribed azithromycin in an attempt to combat or minimize the effects of COVID19. Aim: This study analyzed the sales data of the main antibiotics prescribed in Brazil to verify the change in consumption trends of these drugs during the COVID-19 pandemic. Methods: This is an interrupted time series that analyzed antimicrobial sales data between January 2014 and July 2021, publicly accessible information obtained from the Brazilian government's website. Monthly means of "defined daily doses of DDDs" (DDDs per 1,000 inhabitants per day) of antibiotics were compared by analysis of variance, followed by the Dunnett Multiple Comparisons Test. Monthly trend changes in antibiotic use were verified using Joinpoint regression. Results: Amoxicillin (31.97%), azithromycin (18.33%), and cefalexin (16.61%) were the most sold antibiotics in Brazil during the evaluation period. Azithromycin consumption rose from 1.40 DDDs in February 2020 to 3.53 DDDs in July 2020. Azithromycin sales showed a significant increase in the pandemic period [Monthly Percent Change (MPC) 5.83%, 95% 1.80; 10.00], whereas there was a fall in amoxicillin sales (MPC -9.00%, 95% CI -14.70; -2.90) and cefalexin [MPC-2.70%, 95% (CI -6.30; -1.10)] in this same period. Conclusion: The COVID-19 pandemic changed the pattern of antibiotic consumption in Brazil, with a decrease in the use of amoxicillin and cefalexin and an increase in the consumption of azithromycin.
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Grande M, Bjørnsen LP, Næss-Pleym LE, Laugsand LE, Grenne B. Observational study on chest pain during the Covid-19 pandemic: changes and characteristics of visits to a Norwegian emergency department during the lockdown. BMC Emerg Med 2022; 22:57. [PMID: 35366802 PMCID: PMC8976421 DOI: 10.1186/s12873-022-00612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Following the spread of the Covid-19 pandemic in 2020, reports emerged on decreasing emergency department (ED) visits in many countries. Patients experiencing chest pain was no exception. The aim of the current study was to describe how the Covid-19 pandemic and the subsequential lockdown impacted the chest pain population in a Norwegian ED. Methods All patients presenting to the ED with chest pain during the study period were included. Data were collected retrospectively from the time period January 6th to August 30th, 2020, and compared to the corresponding period in 2019, assessing variations in the number of ED visits, severity, gender, and age. Results Fewer patients with chest pain were seen in the ED following the national lockdown in Norway, compared to the corresponding 2019 period (week 13: 38% fewer; weeks 11–27: 16% fewer). By week 28, the rate normalized compared to 2019 levels. There was a relative increase in lower acuity patients among these patients, while fewer moderate acuity patients were seen. During the initial period following lockdown, the median age was lower compared to the corresponding 2019 period (58 years (IQR 25) vs 62 years (IQR 24), respectively). Admissions due to acute coronary syndromes (ACS) remained proportionally stable. Conclusions Succeeding the Covid-19 outbreak and the subsequent national lockdown in Norway, fewer chest pain patients presented to the ED. Paradoxically, the patients seemed to be less severely ill and were on average younger compared to 2019 data. However, the proportion of patients admitted with ACS was stable during this period. This could imply that some patients may have failed to seek medical advice despite experiencing a myocardial infarction.
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Balkrishna A, Singh K, Oberoi G, Singh P, Raj P, Varshney A. Psychological Impacts of COVID-19 in Dental Patients are Moderated and Mediated by Hospital-Infection-Control-Policy and Satisfaction-with-Life: A Prospective Observational Dental-COVID Study. Psychol Res Behav Manag 2022; 15:913-925. [PMID: 35463936 PMCID: PMC9020577 DOI: 10.2147/prbm.s351948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction COVID-19 pandemic has imposed nation-wide lock-downs which severely impacted day-to-day lifestyle and caused anxiety, stress and fear among patients taking medical care including dental treatments. These psychological behaviors have also been observed during the strategic relaxation of social restrictions (Unlock). However, potential effect of these psychological behavior in endodontic cases have not been probed. Here, it is of great interest to explore the magnitude and buffering effect of two important psychological resources: satisfaction-with-life, and confidence in hospital-infection-control-policy in relation with COVID-19 risk perception on psychological impact due to fear for COVID-19. Methods Patients visiting Dental Clinic & Research Center for endodontic procedures were randomly asked to fill survey questionnaire, and were later enrolled as per the study criteria. The study carried out in two phases: from 15 Sept 2020 to 15 Dec 2020 (restrained confinement; Unlock 1.0); and from 16 Dec 2020 to 12 Feb 2021 (mild confinement; Unlock 2.0) with total sample size of 136. We used data collection tools such as fear-of-COVID-19 scale (FCV-19), perceived-stress-scale (PSS), modified-dental-anxiety-scale (MDAS), satisfaction-with-life scale (SWLS), COVID-19 risk perception, and confidence in hospital-infection-control-policy for COVID-19. Results A double moderation and dual moderated mediation structured model were used to establish the correlation of various parameters using SPSS (version 25.0) software suite. Confidence in hospital-infection-control-policy and SWLS were negatively correlated with FCV-19, MDAS, and PSS. Risk perception of COVID-19 was found to positively associated with FCV-19, MDAS, and PSS. Discussion Patient’s confidence in hospital-infection-control-policy for COVID-19 and SWLS acted as independent moderator for FCV-19 and mental distress. FCV-19 and risk perception were found to be lower during mild confinement (Unlock 2.0), and were also the positive predictors of PSS; and negative predictors of SWLS. The higher SWLS correlated very well with lower COVID-19 risk perception, concerning PSS and MDAS.
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Affiliation(s)
- Acharya Balkrishna
- Clinical Research Division, Patanjali Research Institute, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
| | - Kuldeep Singh
- Dental Clinic & Research Center, Patanjali Bharatiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India
| | - Gurpreet Oberoi
- Dental Clinic & Research Center, Patanjali Bharatiya Ayurvigyan Evam Anusandhan Sansthan, Haridwar, Uttarakhand, India
| | - Pratima Singh
- Clinical Research Division, Patanjali Research Institute, Haridwar, Uttarakhand, India
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Preeti Raj
- Clinical Research Division, Patanjali Research Institute, Haridwar, Uttarakhand, India
| | - Anurag Varshney
- Clinical Research Division, Patanjali Research Institute, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
- Special Centre for Systems Medicine, Jawaharlal Nehru University, New Delhi, India
- Correspondence: Anurag Varshney, Email
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A un año de la pandemia en Argentina, características clínicas de pacientes con accidente cerebral agudo en una cohorte hospitalaria y sus implicancias. NEUROLOGÍA ARGENTINA 2022. [PMCID: PMC8612657 DOI: 10.1016/j.neuarg.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introducción Materiales y métodos Resultados Conclusión
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Akhtar N, Kamran S, Al-Jerdi S, Imam Y, Joseph S, Morgan D, Abokersh M, Uy RT, Shuaib A. Trends in stroke admissions before, during and post-peak of the COVID-19 pandemic: A one-year experience from the Qatar stroke database. PLoS One 2022; 17:e0255185. [PMID: 35324905 PMCID: PMC8947388 DOI: 10.1371/journal.pone.0255185] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/10/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Several reports document a decrease in the rates of stroke hospital admissions during the covid-19 pandemic. There is very little information whether the admission rates will change as the infection is controlled. We report on our rates of admissions before, during and following the peak of covid-19 infections in a prospective database from Qatar. METHODS AND RESULTS The stroke admissions in the six months prior to COVID-19 pandemic averaged 229/month. There was a decrease to 157/month in March-June during the peak of the pandemic. In the 6 months following the peak, as covid-19 numbers began to decrease, the average numbers increased back to 192/month. There was an increase in severe ischemic strokes and decreased in functional recovery. The decreased admissions were mainly driven by fewer stroke mimics. Patients presenting with ischemic stroke or cerebral hemorrhage remained unchanged. CONCLUSIONS Fewer stroke mimics presenting to the hospital can explain the fewer admissions and poor outcome at the height of the covid-19 pandemic. The continued decrease in the number of ischemic stroke and stroke mimic admissions following the pandemic peak requires more study.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Salman Al-Jerdi
- Weill Cornell Medical College- Qatar Foundation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abokersh
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - R. T. Uy
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neurology Division, Department of Medicine, University of Alberta, Edmonton, Canada
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ONAY ZR, MAVI D, AYHAN Y, CAN OKSAY S, BILGIN G, GIRIT S. Did Hospital Admissions Caused by Respiratory Infections and Asthma Decrease During the COVID-19 Pandemic? Medeni Med J 2022; 37:92-98. [PMID: 35306795 PMCID: PMC8939444 DOI: 10.4274/mmj.galenos.2022.02779] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/01/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Despite maximum isolation measures taken during the coronavirus disease-2019 (COVID-19) pandemic, the workload of health institutions has increased. Consequently, changes in the number of admissions in clinics and emergency departments by disease groups have been observed. We aimed to quantitatively investigate the changes in the frequency of respiratory infections and asthma in the pediatric population during the COVID-19 pandemic. Methods We analyzed electronic medical record data of patients who were admitted to the emergency department (ED), outpatient and inpatient clinics, and pediatric intensive care unit (PICU) because of influenza, upper and lower respiratory tract infections (URTI, LRTI), acute bronchiolitis, and asthma during the two-year period (one year pre-COVID period and first year of the pandemic). Results There were 96,648 admissions in the pre-COVID period and 15,848 during the pandemic. We observed a decline in ED admissions (-73%), outpatient clinic visits (-70%), hospitalizations (-41.5%), and PICU admissions (-42%). While the admission rates of patients with influenza [from 4.26% to 0.37% (p=0.0001)] and URTI [from 81.54% to 75.62% (p=0.0001)] decreased, the ratio of the number of admissions to the total number of admissions due to LRTI [from 8.22% to 10.01% (p=0.0001)], acute bronchiolitis [from 2.76% to 3.07% (p=0.027)], and asthma [from 5.96% to 14% (p=0.0001)] increased. Conclusions The decrease in viruses that cause acute bronchiolitis and asthma attacks lead to a reduction in admissions to ED of this patient group. The fact that parents preferred not to admit their child in ED during this period may have paved the way for the development of more severe LRTIs.
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Affiliation(s)
- Zeynep Reyhan ONAY
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Deniz MAVI
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Yetkin AYHAN
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Sinem CAN OKSAY
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Gulay BILGIN
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
| | - Saniye GIRIT
- Istanbul Medeniyet University Faculty of Medicine, Department of Pediatric Pulmonology, Istanbul, Turkey
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NYGREN H, KOPRA J, KRÖGER H, KUITUNEN I, MATTILA VM, PONKILAINEN V, RIKKONEN T, SUND R, SIROLA J. The effect of COVID-19 lockdown on the incidence of emergency department visits due to injuries and the most typical fractures in 4 Finnish hospitals. Acta Orthop 2022; 93:360-366. [PMID: 35257188 PMCID: PMC8902588 DOI: 10.2340/17453674.2022.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 lockdowns have affected personal mobility and behavior worldwide. This study compared the number of emergency department (ED) visits due to injuries and typical low-energy fractures in Finland during the COVID-19 lockdown period in spring 2020 to the reference period in 2019. PATIENTS AND METHODS The data was collected retrospectively from the electronic patient records of 4 hospitals covering 1/5 of the Finnish population. We included the patients who were admitted to a hospital ED due to any injury during the lockdown period (March 18-May 31, 2020) and the reference period (March 18-May 31, 2019). We compared the differences between the average daily ED admissions in the 2 years using the zero-inflated Poisson regression model. RESULTS The overall number of ED visits due to injuries decreased by 16% (mean 134/day vs. 113/day, 95% CI -18 to -13). The number of ED visits due to wrist fractures decreased among women aged over 50 years by 40% (CI -59 to -9). Among women, the number of ED visits due to ankle fractures decreased by 32% (CI -52 to -5). The number of ED visits due to fractures of the upper end of the humerus decreased by 52% (CI -71 to -22) among women. The number of ED visits due to hip fractures increased by 2% (CI -16 to 24). INTERPRETATION Restrictions in personal mobility decreased the number of ED visits due to injuries during the pandemic. The effect can mainly be seen as a decreased number of the most typical low-energy fractures among women. In contrast, lockdown restrictions had no effect on the number of hip fractures.
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Affiliation(s)
- Henri NYGREN
- University of Eastern Finland, School of Medicine, Kuopio
| | - Juho KOPRA
- University of Eastern Finland, School of Medicine, Kuopio
| | - Heikki KRÖGER
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
| | - Ilari KUITUNEN
- University of Eastern Finland, School of Medicine, Kuopio,Mikkeli Central Hospital, Mikkeli
| | - Ville M MATTILA
- Department of Orthopaedics, Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere
| | | | - Toni RIKKONEN
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Reijo SUND
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland, Kuopio
| | - Joonas SIROLA
- University of Eastern Finland, School of Medicine, Kuopio,Kuopio University Hospital, Kuopio
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Chang H, Kang MW, Paek SH. Impact of the COVID-19 pandemic on emergency department utilization patterns in South Korea: A retrospective observational study. Medicine (Baltimore) 2022; 101:e29009. [PMID: 35212313 PMCID: PMC8878873 DOI: 10.1097/md.0000000000029009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
The purpose of analyzing changes in the use of emergency departments (EDs) was to better understand how to use ED resources efficiently during infectious disease outbreaks.Our study was a retrospective observational study. We analyzed the patterns of visits of adult and pediatric patients to separate EDs during 2020 coronavirus disease 2019 (COVID-19) outbreak to know the changes in the ED utilization. We collected the patient's demographics and time of visit, patients' acuity level at triage, cause of visit, transportation used, disposition, symptom to visit time, length of stay, and top 10 most common complaints. We compared pediatric and adult EDs before and after COVID-19.The total number of patients who visited the EDs was 197,152 over 3 years. During the COVID-19 outbreak in 2020, the number of visits decreased significantly, especially the number of pediatric patients. The number of ED visits decreased in correlation with a surge in the number of confirmed COVID patients. The proportion of severe cases in pediatric emergency department (PED) visits increased, but there was no difference in adult emergency department. The number of hospitalized PED patients increased, and the number of hospitalized adult emergency department patients decreased. However, both types of ED patients increased in intensive care unit hospitalizations, proportion of deaths, and use of ambulances. The proportion of trauma patients in the PED increased significantly (P < .001). The time from symptom onset to ED visit time was reduced for patients. The ED length of stay increased in adults, and decreased for pediatric patients.COVID-19 brought about many changes to ED utilization. A greater reduction in ED utilization occurred in pediatric patients compared to adult patients. Our study showed changes in the number and characteristics of patients visiting the ED during the COVID-19 period compared to 2018 and 2019.
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Affiliation(s)
- Hyunglan Chang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Republic of Korea
| | - Min Woo Kang
- Department of Emergency Medicine, VHS Medical Center, Seoul, Republic of Korea
| | - So Hyun Paek
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Republic of Korea
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Sabbagh RS, Shah NS, Kanhere AP, Hoge CG, Thomson CG, Grawe BM. Effect of the COVID-19 Pandemic on Sports-Related Injuries Evaluated in US Emergency Departments. Orthop J Sports Med 2022; 10:23259671221075373. [PMID: 35224117 PMCID: PMC8873554 DOI: 10.1177/23259671221075373] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Organized athletics are undergoing a gradual resumption after a prolonged hiatus in 2020 because of the coronavirus disease 2019 (COVID-19) pandemic. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of the 2020 COVID-19 period on emergency department (ED) visits for sports-related injuries in the United States. It was hypothesized that such visits decreased in response to the pandemic conditions. Study Design: Descriptive epidemiology study. Methods: A selection of sports (baseball, basketball, softball, soccer, American football, weightlifting, track and field, martial arts, boxing, golf, personal fitness, cycling, tennis, and ice hockey) were classified as being an organized team, organized individual, or nonorganized sport. The National Electronic Injury Surveillance System database was then queried for ED visits for sports-related injuries between January 1, 2018, and December 31, 2020, and we compared weighted national injury estimates and injury characteristics from athletes presenting to EDs in 2018 and 2019 versus those from the 2020 COVID-19 pandemic period and between March 1 and May 31, 2020 (government-imposed lockdown period). Bivariate comparisons between variables were conducted using chi-square analysis, with strength of association assessed using odds ratios. Results: The 164,151 unweighted cases obtained from the query resulted in a weighted national estimate of 5,664,795 sports-related injuries during the study period. Overall, there was a 34.6% decrease in sports-related ED visits in 2020 compared with the yearly average between 2018 and 2019 (baseline). The number of ED visits in 2020 decreased by 53.9% versus baseline for injuries incurred by participation in an organized team sport and by 34.9% for injuries incurred by participation in an organized individual sport. The number of ED visits during the 2020 lockdown period decreased by 76.9% versus baseline for injuries incurred by participation in an organized team sport and by 65.8% for injuries incurred by participation in an organized individual sport. Injuries sustained while participating in a nonorganized sport remained relatively unaffected and decreased by only 8.1% in 2020. Conclusion: ED visits in the United States for injuries sustained while participating in an organized team or individual sport underwent a decrease after the beginning of the COVID-19 pandemic in 2020, especially during the lockdown period.
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Affiliation(s)
- Ramsey S. Sabbagh
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nihar S. Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Arun P. Kanhere
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Connor G. Hoge
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Cameron G. Thomson
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Brian M. Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Nam TM, Kim DH, Jang JH, Kim YZ, Kim KH, Kim SH. Impact of the Coronavirus Disease Pandemic on Patients with Head Injuries in South Korea. J Korean Neurosurg Soc 2022; 65:269-275. [PMID: 35108772 PMCID: PMC8918246 DOI: 10.3340/jkns.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/25/2021] [Indexed: 11/27/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic is affecting the characteristics of patients with head injuries. This study aimed to evaluate the effect of the COVID-19 pandemic on patients with head injuries at a regional emergency medical center in South Korea.
Methods From April 2019 to November 2020, 350 patients with head injuries were admitted to our hospital. The study period was divided into the pre-COVID-19 (n=169) and COVID-19 (n=181) eras (10 months each). Patients with severe head injuries requiring surgery (n=74) were categorized into those who underwent surgery (n=41) and those who refused surgery (n=33).
Results Head injuries in pediatric patients (<3 years) were more frequent in the COVID-19 era than in the pre-COVID-19 era (8.8% vs. 3.6%, p=0.048). More patients refused surgery in the COVID-19 era than in the pre-COVID-19 era (57.9% vs. 30.6%, p=0.021). Refusal of surgery was associated with old age (67.7±14.5 vs. 52.4±19.1, p<0.001), marital status (married, 84.8% vs. 61.0%, p=0.037), unemployment (42.4% vs. 68.3%, p=0.034), COVID-19 era (66.7% vs. 39.0%, p=0.021), and lower Glasgow coma scale scores (6.12±3.08 vs. 10.6±3.80, p<0.001). Multivariable logistic regression analysis revealed that refusal of surgery was independently associated with old age (adjusted odds ratio [OR], 1.084; 95% confidence interval [CI], 1.030–1.140; p=0.002), COVID-19 era (adjusted OR, 6.869; 95% CI, 1.624–29.054; p=0.009), and lower Glasgow coma scale scores (adjusted OR, 0.694; 95% CI, 0.568–0.848; p<0.001).
Conclusion We observed an increased prevalence of head injuries in pediatric patients (<3 years) during the COVID-19 pandemic. Additionally, among patients with severe head injuries requiring surgery, more patients refused to undergo surgery during the COVID-19 pandemic.
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Affiliation(s)
- Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Ishaque N, Butt AJ, Kamtchum-Tatuene J, Nomani AZ, Razzaq S, Fatima N, Vekhande C, Nair R, Akhtar N, Khan K, Saqqur M, Shuaib A. Trends in Stroke Presentations before and during the COVID-19 Pandemic: A Meta-Analysis. J Stroke 2022; 24:65-78. [PMID: 35135061 PMCID: PMC8829489 DOI: 10.5853/jos.2021.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/05/2021] [Indexed: 11/11/2022] Open
Abstract
Background and Purpose There are reports of decline in the rates of acute emergency presentations during coronavirus disease 2019 (COVID-19) pandemic including stroke. We performed a meta-analysis of the impact of COVID-19 pandemic on rates of stroke presentations and on rates of reperfusion therapy.Methods Following the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines, we systematically searched the literature for studies reporting changes in stroke presentations and treatment rates before and during the COVID-19 pandemic. Aggregated data were pooled using meta-analysis with random-effect models.Results We identified 37 observational studies (n=375,657). Pooled analysis showed decline in rates of all strokes (26.0%; 95% confidence interval [CI], 22.4 to 29.7) and its subtypes; ischemic (25.3%; 95% CI, 21.0 to 30.0), hemorrhagic (27.6%; 95% CI, 20.4 to 35.5), transient ischemic attacks (41.9%; 95% CI, 34.8 to 49.3), and stroke mimics (45.6%; 95% CI, 33.5 to 58.0) during months of pandemic compared with the pre-pandemic period. The decline was most evident for mild symptoms (40% mild vs. 25%–29% moderate/severe). Although rates of intravenous thrombolytic (IVT) and endovascular thrombectomy (EVT) decreased during pandemic, the likelihood of being treated with IVT and EVT did not differ between the two periods, both in primary and in comprehensive stroke centers (odds ratio [OR], 1.08; 95% CI, 0.94 to 1.24 and OR, 0.95; 95% CI, 0.83 to 1.09, respectively).Conclusions Rates of all strokes types decreased significantly during pandemic. It is of paramount importance that general population should be educated to seek medical care immediately for stroke-like symptoms during COVID-19 pandemic. Whether delay in initiation of secondary prevention would affect eventual stroke outcomes in the long run needs further study.
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Affiliation(s)
- Noman Ishaque
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Asif Javed Butt
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Joseph Kamtchum-Tatuene
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ali Zohair Nomani
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Red Deer Regional Hospital Center, Red Deer, AB, Canada
| | - Sarah Razzaq
- Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nida Fatima
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Chetan Vekhande
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Radhika Nair
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Naveed Akhtar
- Division of Neurology, Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Khurshid Khan
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Maher Saqqur
- Department of Neurology, Trillium Health Care, University of Toronto, Mississauga, ON, Canada
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Correspondence: Ashfaq Shuaib Division of Neurology, Department of Medicine, University of Alberta, Edmonton T6G 2G3, AB, Canada Tel: +1-780-248-1660 Fax: +1-780-248-1807 E-mail:
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Impact of the COVID-19 Pandemic on the Incidence and Characteristics of Patients with Psychiatric Illnesses Visiting Emergency Departments in Korea. J Clin Med 2022; 11:jcm11030488. [PMID: 35159940 PMCID: PMC8836502 DOI: 10.3390/jcm11030488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/11/2022] [Accepted: 01/18/2022] [Indexed: 12/23/2022] Open
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic has had wide-ranging effects on the mental health of the public. This study aimed to investigate the impact of the COVID-19 pandemic on the characteristics of psychiatric patients who visited emergency departments (ED) during this time. A cross-sectional study was conducted including patients visiting 402 nationwide EDs from 27 January 2020 to 29 June 2020 (22 weeks; during-COVID) and the corresponding period in 2019 (28 January 2019 to 30 June 2019, 22 weeks; before-COVID) to control for seasonal influences. Among the 6,210,613 patients who visited the ED, 88,520 (2.5%) patients who visited before the pandemic and 73,281 (2.7%) patients who visited during the pandemic had some kind of psychiatric illness. The incidence rates of psychiatric self-harm increased from 0.54 before the pandemic to 0.56 during the pandemic per 1,000,000 person-days (p = 0.04). Age- and sex-standardized rates of psychiatric illnesses per 100,000 ED visits increased during the pandemic (rate differences (95% CIs); 45.7 (20.1–71.4) for all psychiatric disorders and 42.2 (36.2–48.3) for psychiatric self-harm). The incidence of psychiatric self-harm and the proportion of psychiatric patients visiting EDs increased during the COVID-19 pandemic.
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Prabhakar Abhilash K, D'Silva R, Kola A, Vijay J, Jacob M, Selvaraj B, Joseph J. Impact of lockdown and unlocking on symptomatology and emergency department visits during the first wave of the COVID-19 pandemic. J Family Med Prim Care 2022; 11:976-981. [PMID: 35495828 PMCID: PMC9051679 DOI: 10.4103/jfmpc.jfmpc_1253_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background: The COVID-19 pandemic resulted in a complete nationwide lockdown on March 24, 2020. The months of April and May had stringent lockdown measures followed by a gradual loosening of restrictions in a graded manner. Methods: This observational study was performed in the emergency department (ED) of a tertiary hospital in south India triage Priority 1 and Priority 2 patients presented during the COVID-19 lockdown and unlock periods spanning from April 2020 to August 2020. The three different lockdown periods and the subsequent unlock periods were categorized as lockdown 1 (LD1), lockdown 2 (LD2), lockdown 3 (LD3), and unlock phase (UL), and a 7-day time period in each were taken for 7-day incidence analysis. Results: During the 5-month study period, a total of 1,954 patients were analyzed for the study that included 405, 440, 492, and 617 patients during the 7-day time periods in the LD1, LD2, LD3, and UL periods, respectively. The 7-day incidence of COVID-19 suspects increased significantly by 101.9% from LD1 to UL phases, whereas trauma cases increased by 52.9% in the same two time periods. Compared with LD1, in the UL phase, the 7-day ED admission and in-hospital mortality rates increased by 50.3% and 66.7%, respectively. Conclusion: The number of COVID-19 suspects saw a near-constant increase through the different phases of lockdown, culminating in the UL phase. The stringent lockdown measures resulted in a significant reduction in the incidence of trauma with a rebound increase in the UL phase.
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