The lockdown and its consequences—Perspectives and needs of people at increased risk of severe illness from COVID-19

Summary Background There is a lack of knowledge on how people at increased risk of severe illness from Coronavirus disease 2019 (COVID-19) experienced the infection control measures. This study aimed to explore their perspectives and needs during the coronavirus outbreak. Methods A qualitative longitudinal interview study was conducted in Austria during lockdown due to COVID-19 containment and afterwards. People older than 65 years of age and/or affected by a chronic medical condition participated in individual telephone interviews at two time points. Thematic analysis was used to analyze the data and saturation was defined as no new emerging concepts in at least 10 subsequent interviews. Results Thematic saturation was reached when 33 individuals (75.8% female, mean age ± standard deviation [SD] 73.7±10.9 years) were included. A total of 44 lower level concepts were extracted and summarized into 6 higher level concepts. They included (i) a general positive attitude toward COVID-19 measures, (ii) challenges of being isolated from the community, (iii) deterioration of health status, (iv) difficulties with measures due to their health condition, (v) lack of physical contact and (vi) lack of information versus overload. Participants suggested environmental adaptations for strengthening resilience in people at increased risk of severe illness from COVID-19. Conclusion Strategies and interventions are needed to support people at risk under pandemic conditions. Their perceptions and needs should be addressed to reduce the potential deterioration of health conditions and ensure well-being even during prolonged periods of crisis.

Changes in Behaviors and Attitudes in Response to COVID-19 Pandemic and Vaccination in Healthcare Workers and University Students in Italy

The objectives of the cross-sectional study were to measure how behaviors and attitudes about preventive measures toward COVID-19 changed over time among Italian vaccinated healthcare workers and university students, and the associated characteristics. The study was carried out between February and March 2021 in the city of Naples, Campania region, Southern Italy. The perceived personal risk of being infected by SARS-CoV-2 after the vaccination was significantly higher among males, in those having a higher perceived personal risk of being infected by SARS-CoV-2 before the vaccination, and in those who were more concerned about the efficacy of the vaccination. The fear of getting the disease as reason to have the COVID-19 vaccination was reported more frequently in younger participants, in those with at least one chronic medical condition, in those with a higher concern about the severity of COVID-19, in those with a higher level of trust in the information received, and in those who acquired information from scientific journals. Overall, 21.3% were willing to engage the three main public health measures (wearing a mask, careful hand washing, physical distancing) after receiving the second dose of the vaccination compared to the behavior before the pandemic began. This willingness was predicted by a higher level of trust in the information received and by a lower self-rated health status. Only 0.1% of participants were willing to engage all three measures after receiving the second dose of the vaccination compared to the behavior before receiving the first dose. These findings are useful in order to develop information strategies regarding vaccine safety and efficacy and the importance of public health measures against COVID-19.

1346. The Risk of Readmission after RSV Hospitalization Among Children Younger than 5 Years

Background Respiratory Syncytial Virus (RSV) is one of the most common causes of childhood lower respiratory tract infection (LRTI) leading to hospitalization worldwide. Readmissions following viral LRTI hospitalization are common, however rates, timing and causes of readmission following RSV LRTI hospitalization are understudied. We evaluated readmissions occurring during 1-year post-discharge of RSV hospitalization. Methods We prospectively identified children < 5 years of age hospitalized with laboratory-confirmed RSV LRTI at Primary Children’s and Riverton hospitals in Salt Lake City, Utah during the 2019-2020 RSV season. An electronic alert system identified all-cause readmission between November 2019 and April 2021. Discharge diagnoses of readmissions were reviewed by two pediatricians. We calculated the incidence rate of all-cause and respiratory-related readmission. Results A total of 297 children had laboratory-confirmed RSV LRTI hospitalizations during the 2019-2020 RSV season, with 24% admitted to the intensive care unit (ICU) during index RSV hospitalization and 24% having a chronic medical condition. During the 1-year follow-up period, 59 readmissions occurred among 47 patients (Table 1). The incidence rate of all-cause and respiratory-related readmission was 19.9 (95%CI 15.5-24.9) and 13.1 (95%CI 9.5-17.5) per 100 patients, respectively. Median age of readmitted patients was 11 months (interquartile range 5.9-11 months). Median number of readmissions was 1 (range: 1-4), with initial readmissions occurring within 28 days (median) of index admission; most (74%) due to a respiratory-related illness. Second and 3rd admissions were less common and occurred at 67 (median) and 160 (median) days respectively. During all readmissions, 19% of children required ICU admission and 25% had chronic medical conditions. Conclusion All cause and respiratory readmission after Initial hospitalization with RSV LRTI commonly occurred among children < 5 years. These data support the need for RSV vaccines and immunoprophylaxis to prevent RSV hospitalization. A further study with a control group is needed to determine the role of RSV in readmission. Disclosures Yoonyoung Choi, PhD, MS, RPh, Merck (Employee) Lyn Finelli, DrPH, MS, Merck (Employee)

PENGARUH KEBIASAAN MEROKOK DAN POLA MAKAN PASIEN TERHADAP KEJADIAN HIPERTENSI PADA PASIEN RAWAT JALAN DI POLIKLINIK RUMAH SAKIT PATAR ASIH LUBUK PAKAM TAHUN 2021

Hypertension or high blood pressure, sometimes also called arterial hypertension, is a chronic medical condition where the blood pressure in the arteries increases. The purpose of this study was to determine the effect of smoking habits and patient diet on the incidence of hypertension in outpatients at the hospital polyclinic Patar Asih Lubuk Pakam in 2020. The research method used a quantitative research design with a quasi experimental type. This research is a pre-experimental design using pre-test and final test. (the one group, pretest and post test design). The results obtained based on the analysis of the Paired T-test obtained p-value = 0.000 <a = 0.05, so the research hypothesis is accepted, so it can be concluded that there is an effect of smoking on the incidence of hypertension in outpatients at Patar Hospital. Asih Year 2020. Conclusion: Smoking habits before the incidence of hypertension, namely "not done" as many as 9 people (30.0%), smoking habits after the incidence of hypertension namely "not done" as many as 22 people (73.3%). Suggestion: It is hoped that this research can add input for further researchers to add research variables.

Burnout and Sense of Coherence in Dentistry Students of Karachi

OBJECTIVE: This study aimed to assess burnout and sense of coherence levels in dentistry students of Karachi. METHODOLOGY: A cross-sectional study involving 361 students from four renowned dental colleges in Karachi was carried out. The students were distributed a questionnaire derived from the Mayo Clinic Well-being Index (WBI) and a modified 13-item Antonovsky's Sense of Coherence Scale (SOC scale). They were stratified on the basis of gender, age, professional year, institution, relationship status, history of chronic medical condition and history of chronic psychiatric condition. Scores for the WBI and SOC scale were calculated. For the WBI, a score of >4 was a sign that an individual was at risk of developing burnout or other severe outcomes. A high or low total score on the SOC scale demonstrated whether the individual was able to cope with his environment or not. MS Excel and SPSS version 23 were used for data compilation and statistical analysis. Descriptive statistics were calculated. Chi-square test of independence was applied to gauge any association between the strata and outcome variables. After determination of statistical difference, Mann Whitney-U Test and Kruskal Wallis Test were applied to compare the means where a significant association was found. A p-value of 0.05 or less was considered significant. RESULTS: The mean WBI score was found to be 4.07. Around 64% respondents were at-risk of burnout (score > 4). A greater percentage of females was at risk (66%) as compared to males (50%). Third professional students were found to be the most affected (77% with WBI score > 4 and 9% in the low coherence category). The mean SOC score was found to be 36.39 (moderate levels of coherence). Overall, around 4-9% of each professional year students exhibited a low sense of coherence. Age, relationship status, institution and a history of chronic medical and/or psychiatric condition were not found to have a significant association with the outcome variables (p>0.05). CONCLUSION: A significant number of dentistry students are at risk of burn-out and suffer from a low sense of coherence. The risk factors need to be evaluated and solutions need to be found to create a healthy and conducive environment for the growth and learning of the students. More research needs to be focused on gathering data related to the well-being of dentistry students. KEYWORDS: Burnout, sense of coherence, well-being index, dentistry.

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

Background: Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California. Methods: This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models. Results: Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health. Conclusion: This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.

“The immediate effect of neutral spinal compress on heart rate variability in hypertensive individuals”

Objectives Hypertension (HTN) is considered as chronic medical condition. Because of the increased complications associated with the conventional medicine, the effects of naturopathic modalities were emphasized to prevent and minimize those adverse effects. This study was done to assess the immediate effect of neutral spinal compress on heart rate variability and blood pressure and thereby to substantiate the clinical understanding of its effect in hypertensive individuals. Methods Hundred hypertensive individuals were recruited for the study. Subjects were assessed for Blood Pressure (BP) and Heart Rate Variability (HRV) before and immediately after the intervention of 20 min. Results Result shows significant reduction in mean Heart Rate (HR) (p<0.001), Low Frequency (LF) (p<0.001), Low Frequency/High Frequency (LF/HF) (p<0.001), Systolic blood pressure (SBP) (p<0.001) and Diastolic blood pressure (DBP) (p<0.001) and significant increase in mean R-R interval (Mean RR) (p<0.001) and High frequency (HF) (p<0.001) components of Heart Rate Variability after neutral spinal compress intervention. Conclusions The results of the study reported that full neutral spinal compress reduces the sympathetic tone and shifts the Sympatho-vagal balance in favor of parasympathetic dominance and hence it can be concluded that neutral spinal compress can be effectively used in the management of hypertension. Trial registration Clinical Trial Registry- India (CTRI); CTRI Reg. No- CTRI/2020/01/022639.

HYPERTENSION: AN AYURVEDIC PERSPECTIVE

Hypertension (HTN) is a major public health issue worldwide, because of its high prevalence and concomitant increase in the risk of disease. In the contemporary situation Hypertension is the most critical disease in the world. If we focus on the present situation then we can see that due to rapid globalization we are facing Hypertension. Due to rapid modernization, people are leading more stressful lives. As a result, hypertension is one of the wide- spread disorders which came across in practice. Ab. India is labelled as the global capital of hypertension. Nowa- days, not only lifestyle disorders are becoming more common, but they are also affecting younger populations. Hence, the population at risk shifts from 40+ to maybe 30+ or even younger. Hypertension results from a variety of reasons like stress, obesity, genetic factors, overuse of the salts in the diet and ageing etc. As we all know, Hy- pertension is called a silent killer because it rarely exhibits symptoms before it damages the heart, brain or kidney. Though a lot of potent antihypertensive drugs are available today in modern medicine, none of them is free from untoward effects. The principal focus of Ayurveda is on maintaining good health and adopting a healthy way of life. In Ayurveda, there is no description of such a single disease that can resemble hypertension. As per Ayurve- dic principles, in case of an unknown disease, the physician should try to understand the nature of the disease through Dosha, Dushya and Samprapti; then should initiate the treatment. So, it becomes our prime concern to understand hypertension thoroughly with an Ayurvedic perspective. Hypertension (HTN or HT), also known as High blood pressure or arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is persistently elevated. Hypertension is one of the major causes of cardiovascular morbidity and mortalityworldwide. It is a global health problem affecting people of different ethnicity and ages around the world. It is an asymptomatic medical condition in which systemic arterial blood pressure is elevated beyond the normal value. Keywords: High Blood Pressure, Lifestyle disorders, Silent killer.

Racial Disparity and Factors Associated with Internet Health Information-Seeking Among US Adults with Diabetes Mellitus (Preprint)

BACKGROUND Many patients with chronic medical conditions search the internet to obtain medical advice and health information to improve their health condition and quality of life. Diabetes is a common chronic disease that disproportionately affects different race/ethnic groups in the US. With the existing literature on the popularity of internet health information seeking in persons with a chronic medical condition, there is limited data among US adults with diabetes. OBJECTIVE This study aimed to examine factors associated with internet health information seeking in US adults with diabetes and whether there was a disparity in internet information-seeking stratified by race/ethnicity. METHODS We conducted a cross-section study using the Health Information National Trends Survey (HINTS) data from 2017 to 2020. We selected our study sample based on respondents' reports on whether they were told they had diabetes, and our primary outcome was internet health information seeking. We used two multivariable logistic regression models to examine the effects of sociodemographic factors and other covariates on internet health information-seeking in adults with diabetes. Jackknife replicate weights were used to provide bias-corrected variance estimates. RESULTS Our study sample includes a total of 2903 adults who self-reported they had diabetes. 60.0% were White (1744/2903), 44.9 % males (1336/2850), and 64% had some college or graduate education level (1812/2831). The prevalence of internet health information seeking in this population was 64.5% and the main factors associated with internet health information seeking include education level (Some college versus less than high school: OR = 1.42, 95% CI = [1.44, 1.88]; College graduate or higher versus less than high school: OR = 2.50, 95% CI = [1.79, 3.50] ), age (age group 65+ versus 18 to 44 years: OR = 0.46, 95% CI = [0.34, 0.63], and house income level (p<.001). Additionally, we found differences in the effects of predictors stratified by race. CONCLUSIONS This study suggests that internet health information-seeking is common among US adults with diabetes. Internet health information could influence the self-management and quality of life of adults with diabetes in many ways. CLINICALTRIAL Not Applicable.

Common factors in serious case reviews of child maltreatment where there is a medical cause of death: qualitative thematic analysis

AimTo identify the common factors in serious case reviews (SCRs) where a child has died of a medical cause.DesignQualitative thematic analysis.BackgroundSCRs take place when neglect or abuse results in children dying or being seriously harmed. Known key factors within SCRs include parental substance misuse, mental health problems and domestic abuse. To date, there has been no investigation of children who die of a medical cause where there are concerns about child maltreatment.Data sourcesA list of SCRs relating to deaths through medical causes was provided from previous coded studies and accessed from the National Society for the Prevention of Cruelty to Children National Case Review Repository. Twenty-three SCRs with a medical cause of death from 1 April 2009 to 31 March 2017 were sourced.Results20 children died of an acute condition and 12 of a chronic condition; 20 of the deaths were unexpected and maltreatment contributed to the deaths of 18 children. Most children were aged either <1 year or >16 years at the time of death. Many parents were caring for a child with additional vulnerabilities including behavioural issues (6/23), learning difficulties (6/23), mental health issues (5/23) or a chronic medical condition (12/23). Common parental experiences included domestic violence/abuse (13/23), drug/alcohol misuse (10/23), mental ill health or struggling to cope (7/23), criminal history (11/23) and caring for another vulnerable individual (8/23). Most children lived in a chaotic household characterised by missed medical appointments (18/23), poor school attendance (11/23), poor physical home environment (7/23) and disguised compliance (12/23). All 23 SCRs reported elements of abusive or neglectful parenting. In most, there was an evidence of cumulative harm, where multiple factors contributed to their premature death. At the time of death, 11 children were receiving social care support.ConclusionAlthough the underlying medical cause of the child’s death was often incurable, the maltreatment that often exacerbated the medical issue could have been prevented.