Impact of COVID‐19 on access to healthcare in low‐ and middle‐income countries: Current evidence and future recommendations

The COVID‐19 pandemic continues to be a major public health threat globally and low‐ and middle‐income countries (LMICs) are not an exception. The impact of the COVID‐19 pandemic is far‐reaching on many areas including but not limited to global health security, economic and healthcare delivery with a potential impact on access to healthcare in LMICs. We evaluate the impact of the COVID‐19 pandemic on access to healthcare in LMICs, as well as plausible strategies that can be put in place to ensure that the delivery of healthcare is not halted. In order to mitigate the devastating effect of the COVID‐19 pandemic on the already weak health systems in LMICs, it is much necessary to reinforce and scale up interventions and proactive measures that will ensure that access to healthcare is not disrupted even in course of the pandemic.     

Telemedicine is an important aspect of healthcare services amid COVID‐19 outbreak: Its barriers in Bangladesh and strategies to overcome

The current pandemic of coronavirus disease 19 (COVID‐19) has been a global concern since early 2020, where the number of COVID‐19 cases is also on a rapid surge in Bangladesh with the report of a total of 276,549 cases after the detection of the first three cases in this country on 8 March 2020. The COVID‐19 pandemic has made a seismic shift in the healthcare delivery system, where physician offices have accelerated digital health solutions at record speed, putting telemedicine (i.e., telehealth) at centre stage. Amid the severely contagious COVID‐19, telemedicine has moved from being an optional service to an essential one. As the developing country, there are some barriers to get evenly distributed advantages of this approach due to the digital divides and disparities. In this commentary, we have described the importance of telemedicine service amid the outbreak of COVID‐19 in Bangladesh, the barriers and challenges that the country is facing to implement this approach and the strategies to overcome these barriers in this developing country.     

Delaying the COVID‐19 epidemic in Australia: evaluating the effectiveness of international travel bans

Objective: Following the outbreak of novel Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2), and the disease named COVID‐19, in Wuhan, China in late 2019, countries have implemented different interventions such as travel bans to slow the spread of this novel virus. This brief report evaluates the effect of travel bans imposed to prevent COVID‐19 importation in the Australian context. Methods: We developed a stochastic meta‐population model to capture the global dynamics and spread of COVID‐19. By adjusting our model to capture the travel bans imposed globally and in Australia, the predicted COVID‐19 cases imported to Australia were evaluated in comparison to observed imported cases. Results: Our modelling results closely aligned with observed cases in Australia and elsewhere. We observed a 79% reduction in COVID‐19 importation and a delay of the COVID‐19 outbreak in Australia by approximately one month. Further projection of COVID‐19 to May 2020 showed spread patterns depending on the basic reproduction number. Conclusion: Imposing the travel ban was effective in delaying widespread transmission of COVID‐19. However, strengthening of the domestic control measures is needed to prevent Australia from becoming another epicentre. Implications for public health: This report has shown the importance of border closure to pandemic control.     

Inpatient violence in a psychiatric hospital in the middle of the pandemic: clinical and community health aspects

Healthcare workers are at a high risk of violence all over the world. The hostility toward nurses, physicians, and hospital staff has reached the point that it can be considered a public health problem. In this paper, we focus on the harassment, aggression, and violence that many healthcare workers have encountered while treating unstable psychiatric patients in the middle of the COVID-19 pandemic. We present a case with a history of violence toward mental health workers, review psychopathological and clinical aspects, and discuss how both the COVID-19 pandemic and current challenges in psychiatric hospital settings increase the frequency and severity of these attacks and how this affects the team on inpatient psychiatric units. We used the CARE guidelines to provide the most accurate and transparent information about the patient and relevant psychosocial aspects. We also pooled more than 20 unique sources to cover all aspects of violent behaviors in all psychiatric settings for all age groups. We concluded that a lack of nursing staff, the mental burden imposed by difficult patients, and poor communication between team members are some of the factors contributing to patient violence. An incomplete understanding of the problem creates barriers to change on both personal and systematic levels. Constant violence and abuse against healthcare workers cause stress, decreased productivity, and work dissatisfaction. To improve the safety of healthcare professionals, especially in inpatient psychiatric settings, several system-based changes should be implemented.     

Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID‐19) in Australia and New Zealand

Coronavirus disease 2019 (COVID‐19) results from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The clinical features and subsequent medical treatment, combined with the impact of a global pandemic, require specific nutritional therapy in hospitalised adults. This document aims to provide Australian and New Zealand clinicians with guidance on managing critically and acutely unwell adult patients hospitalised with COVID‐19. These recommendations were developed using expert consensus, incorporating the documented clinical signs and metabolic processes associated with COVID‐19, the literature from other respiratory illnesses, in particular acute respiratory distress syndrome, and published guidelines for medical management of COVID‐19 and general nutrition and intensive care. Patients hospitalised with COVID‐19 are likely to have preexisting comorbidities, and the ensuing inflammatory response may result in increased metabolic demands, protein catabolism, and poor glycaemic control. Common medical interventions, including deep sedation, early mechanical ventilation, fluid restriction, and management in the prone position, may exacerbate gastrointestinal dysfunction and affect nutritional intake. Nutrition care should be tailored to pandemic capacity, with early gastric feeding commenced using an algorithm to provide nutrition for the first 5–7 days in lower‐nutritional‐risk patients and individualised care for high‐nutritional‐risk patients where capacity allows. Indirect calorimetry should be avoided owing to potential aerosol exposure and therefore infection risk to healthcare providers. Use of a volume‐controlled, higher‐protein enteral formula and gastric residual volume monitoring should be initiated. Careful monitoring, particularly after intensive care unit stay, is required to ensure appropriate nutrition delivery to prevent muscle deconditioning and aid recovery. The infectious nature of SARS‐CoV‐2 and the expected high volume of patient admissions will require contingency planning to optimise staffing resources including upskilling, ensure adequate nutrition supplies, facilitate remote consultations, and optimise food service management. These guidelines provide recommendations on how to manage the aforementioned aspects when providing nutrition support to patients during the SARS‐CoV‐2 pandemic.     

新冠疫情背景下实习后期护生职业认同现状调查

目的 分析新冠疫情背景下实习后期护生的职业认同现状及其影响因素.方法 采用护生职业认同量表和焦虑自评量表,于2020年2—3月借助问卷星平台对河南省6所院校的实习后期护生进行调查.结果 本次调查的实习后期护生职业认同总分为(66.34±12.88)分.多元线性回归分析结果显示:年龄、新冠发生后对护理职业的喜欢程度、新冠...     

Clinical Nutrition Research and the COVID‐19 Pandemic: A Scoping Review of the ASPEN COVID‐19 Task Force on Nutrition Research

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID‐19) Nutrition Task Force was to examine nutrition research applicable to the COVID‐19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID‐19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO‐T) questions. The aggregated data were analyzed by clinical stage: pre–COVID‐19, acute COVID‐19, and chronic/post–COVID‐19. Research gaps were discovered for all PICO‐T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre–COVID‐19); cardiometabolic‐based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID‐19); registered dietitian nutritionist counseling (chronic/post–COVID‐19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO‐T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre–COVID‐19); enteral nutrition, protein‐energy requirements, and glycemic control with nutrition (acute COVID‐19); and home enteral and parenteral nutrition support (chronic/post–COVID‐19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID‐19.     

Professional Commitment,Satisfaction and Quality of Life of Nurses During the COVID-19 Pandemic in Konya,Turkey

BackgroundThe COVID-19 pandemic has negatively affected nurses. The aim of this study was to assess professional commitment, satisfaction and quality of professional life of nurses during the COVID-19 pandemic in Konya city, Turkey.Methods and MaterialCross-sectional study was conducted through online survey in March 2021 in Konya province of Turkey. Current working nurses from 30 public health facilities participated in the study. Standard questionnaire was used, the questionnaire has four components, the first part of questionnaire for characteristics of the participants, the second part was Nursing Professional Commitment Scale, the third part was regarding Professional Satisfaction Scale and the fourth part was related to Employees'' Quality of Life Scale.ResultsTotal 407 nurses participated in the study, only 24% of the participants were male, 76% of them were married and 78% of them were undergraduate degree holders. About two-third (68%) of the nurses worked in COVID 19 treatment Unit serving/treatıng COVID 19 patients durıng this period. Some nurses (37%) have considered leaving their job during the Pandemic. Average scores of total nursing professional commitment 2.63±0.48. The nurses'' working quality of life level was above average of total satisfaction. Comparing the age groups of the participants with the scale and sub-dimensions, a difference was found only with the Compassion fatigue sub-dimension (p<0.05). There is a positive relationship between total nursing professional commitment, compassion satisfaction and professional satisfaction.ConclusionCOVID-19 pandemic negatively affected nurses'' professional commitment, professional satisfaction and quality of their professional life.     

Syndemic aspects between COVID-19 pandemic and social inequalities

Although the coronavirus disease 2019 (COVID-19) pandemic has reached all over the world population, it has demonstrated a heterogeneous impact on different populations. The most vulnerable communities which coexist daily with the social inequalities like low access to hygiene and personal protection products, crowded residences, and higher levels of chronic diseases have a higher risk of contact and the spread of infection, beyond unfavorable clinical outcomes. The elevation of the risk of infection exposure can be related to gender due to the presence of a larger contingent of women in essential services, as well as frontline and cleaning professionals who regardless of gender have the greatest exposure to the virus. Such exposures can contribute to the development of fear of contaminating themselves or their family members associated also with the work stress, both of which are related to the emergence of mental disturbances in these populations. Furthermore, conditions of unsanitary living and low socioeconomic status, populations at war, pre-existing social barriers, and ethnicity have contributed to more impact of the pandemic both in the exposure to the virus and access to health services, COVID-19 management, and management of other pathologies. At the same time, factors such as the closing of non-essential services, the loss of jobs, and the increase in household spending aggravated the social vulnerabilities and impacted the family economy. Lastly, the COVID-19 pandemic contributed still more to the impact on women's health since it propitiated a favorable environment for increasing domestic violence rates, through the segregation of women from social life, and increasing the time of the victims with their aggressors.     

Professional background and the comprehension of family-centredness of rehabilitation for children with cerebral palsy

Background Children with cerebral palsy have difficulties in several areas of functioning, and they need long‐lasting rehabilitation with a clear focus on the individual's needs. Finnish guidelines emphasize family‐centred service. The values of family‐centred service are widely known, but how the principles of family‐centred service are adopted in clinical practice is not well documented. The objective of this study was to analyse the family‐centred behaviour of professionals working with children and adolescents with cerebral palsy. Methods A translated version of the Measure of Processes of Care for Service Providers (MPOC‐SP) questionnaire was used to evaluate the family‐centred service. The questionnaire was sent to all the professionals in the multidisciplinary rehabilitation teams at all the hospitals and governmental special schools treating children and adolescents with cerebral palsy in Finland (n= 327). Furthermore, 438 physiotherapy service providers working in the children's home region were invited to participate. Results A total of 201 multidisciplinary team members and 311 physiotherapy service providers completed the questionnaire. Both the team members and the service providers generally rated their family‐centred behaviour positively. There was statistically significant difference in how the team members in the multidisciplinary teams self‐assessed their family‐centred service. Physiotherapists working in multidisciplinary teams rated their family‐centred service higher than physiotherapy service providers. The professional's apprehension of family‐centred service increased with work experience. Conclusions Professional background and professional context seem to affect the apprehension of family‐centred service. Also work experience and being part of a multidisciplinary team have an influence on how the professionals embrace the family‐centred service delivered. The MPOC‐SP can be used to identify areas for improvement.     

Understanding the influence of contextual factors and individual social capital on American public mask wearing in response to COVID–19

The COVID–19 pandemic poses unprecedented risks to the health and well-being of the entire population in the U.S. To control the pandemic, it is imperative for individuals to take precautionary behaviors (e.g., wearing a mask, keeping social distance, washing hands frequently, etc.). The factors that influence individual behavioral response thus warrants a close examination. Using survey data for respondents from 10 states merged with state-level data, our study represents a pioneering effort to reveal contextual and individual social capital factors that explain public mask wearing in response to COVID–19. Findings of logistic multilevel regression show that the COVID–19 death rate and political control of government at the state level along with one's social capital at the individual level altogether influence whether people decide to wear face masks. These findings contribute to the rapidly growing literature and have policy implications for mitigating the pandemic's devastating impact on the American public.     

God's Grace as Gift:

The probability of pastoral care givers encountering individuals and family members who have been touched by organ transplantation increases as transplantation moves out of the domain of the experimental and into the therapeutic. This article examines the issue of gift giving from the prespective of the recipient. Conflict can result from the recipient's need to reciprocate the gift of the donated organ. Pastoral counseling can provide an effective means for understanding this kind of gift by employing the concept of God's grace as gift.     

Violence against children during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has affected children’s risk of violence in their homes, communities and online, and has compromised the ability of child protection systems to promptly detect and respond to cases of violence. However, the need to strengthen violence prevention and response services has received insufficient attention in national and global pandemic response and mitigation strategies. In this paper, we summarize the growing body of evidence on the links between the pandemic and violence against children. Drawing on the World Health Organization’s INSPIRE framework to end violence against children, we illustrate how the pandemic is affecting prevention and response efforts. For each of the seven INSPIRE strategies we identify how responses to the pandemic have changed children’s risk of violence. We offer ideas for how governments, policy-makers, and international and civil society organizations can address violence in the context of a protracted COVID-19 crisis. We conclude by highlighting how the current pandemic offers opportunities to improve existing child protection systems to address violence against children. We suggest enhanced multisectoral coordination across the health, education, law enforcement, housing, child and social protection sectors. Actions need to prioritize the primary prevention of violence and promote the central role of children and adolescents in decision-making and programme design processes. Finally, we stress the continued need for better data and evidence to inform violence prevention and response strategies that can be effective during and beyond the COVID-19 pandemic.     

UK food and nutrition security during and after the COVID‐19 pandemic

The COVID‐19 pandemic is a major shock to society in terms of health and economy that is affecting both UK and global food and nutrition security. It is adding to the ‘perfect storm’ of threats to society from climate change, biodiversity loss and ecosystem degradation, at a time of considerable change, rising nationalism and breakdown in international collaboration. In the UK, the situation is further complicated due to Brexit. The UK COVID‐19 Food and Nutrition Security project, lasting one year, is funded by the Economic and Social Research Council and is assessing the ongoing impact of COVID‐19 on the four pillars of food and nutrition security: access, availability, utilisation and stability. It examines the food system, how it is responding, and potential knock on effects on the UK’s food and nutrition security, both in terms of the cascading risks from the pandemic and other threats. The study provides an opportunity to place the initial lessons being learnt from the on‐going responses to the pandemic in respect of food and nutrition security in the context of other long‐term challenges such as climate change and biodiversity loss.     

Trends in COVID-19 Testing and Positivity Rates from a Mobile Testing Program in the Phoenix Metropolitan Area

The coronavirus (COVID-19) pandemic continues to be a global concern, with over 150 million cases worldwide. Arizona, which was recently a hotspot for COVID-19, has over 860 thousand cases. Reviewing the COVID-19 trends over time is crucial in understanding the pandemic and evaluating the impact of mitigation techniques. This current study analyzes the trends in COVID-19 testing and positivity rates from a mobile testing program in the Phoenix metropolitan area between December 2020 and April 2021. Of the 32,234 tests performed there was a total of 3654 COVID positive cases, yielding an overall positivity rate of 11.3%. COVID-19 positivity rates were significantly higher in December (12.9%) and January (12.7%), compared to February (7.5%), March (4.9%), and April (6.7%), p?<?0.05. The peak of COVID-19 cases is likely attributable to the holiday season and family gatherings, followed by a steady decline, likely due to fewer gatherings and an increase in individuals receiving the COVID-19 vaccines. Continued public health measures, including vaccinations, are critical in reducing COVID-19 transmission.

     

Use of Continuous Glucose Monitoring to Assess Parenteral Nutrition–Induced Hyperglycemia in an Adult Patient With Severe COVID‐19

Many patients admitted to the intensive care unit (ICU) are acutely malnourished and often require aggressive and early nutrition support with parenteral nutrition (PN). However, PN‐induced hyperglycemia is a predictor of hospital mortality and is associated with increased length of stay. Elevated blood glucose in hospitalized patients with coronavirus disease 2019 (COVID‐19) is also associated with increased mortality. Real‐time continuous glucose monitoring (rtCGM) is primarily used in the outpatient setting, but there is rapidly growing interest in its applicability to help treat dysglycemia in critically ill patients, especially during the ongoing COVID‐19 pandemic. We assessed the use of rtCGM data (Dexcom G6) in a 58‐year‐old male admitted to the ICU for severe COVID‐19 infection, who developed PN‐induced hyperglycemia with markedly elevated total daily insulin requirements as high as 128 units. rtCGM was used to safely titrate insulin infusion and monitor glucose levels. No episodes of hypoglycemia were observed, despite an extremely aggressive insulin regimen. This case demonstrates the potential utility of rtCGM in the critical care setting and highlights its potential to help conserve personal protective equipment and minimize unnecessary staff exposure in the setting of COVID‐19.     

An Australian hospital's training program and referral pathway within a multi‐disciplinary health–justice partnership addressing family violence

Objective : An innovative health–justice partnership was established to deliver legal assistance to women experiencing family violence who attended an Australian hospital. This paper reports on a multifaceted response to build capacity and willingness of health professionals to identify signs of family violence and engage with referral pathways to on‐site legal assistance. Methods : A Realistic Evaluation analysed health professionals’ knowledge and attitudes towards identification, response and referral for family violence before and after training; and use of referral pathways. Results : Of 123 health professionals participating in training, 67 completed baseline and follow‐up surveys. Training improved health professionals’ self‐reported knowledge of, and confidence in, responding to family violence and understanding of lawyers’ roles in hospitals. Belief that patients should be referred to on‐site legal services increased. Training did not correspond to actual increased referrals to legal assistance. Conclusion : The program built capacity and willingness of health professionals to identify signs of, and respond to, family violence. Increase in referral rates to legal assistance was not shown. Potential improvements include better data capture and greater availability of legal services. Implications for public health : Strong hospital system supports and reliable recording of family violence referrals need to be in place before introducing such partnerships to other hospitals.     

Is elder abuse on the curriculum? The relative contribution of child abuse,domestic violence and elder abuse in social work,nursing and medicine qualifying curricula

In order to have a sufficiently high index of suspicion about elder abuse and neglect, child abuse and domestic violence, a knowledge base about the phenomena is clearly necessary. Education in the widest sense for health and social care professionals about elder abuse and neglect, child abuse and domestic violence is increasing with regular journal articles, media coverage and modular coverage now found on post basic training courses for health and social care professionals. However, it is suggested that the relative importance of a topic can be judged by its importance in the basic curricula of medical, nursing and social work qualifying courses. A survey of all medical schools and colleges, nursing colleges and university departments with qualifying studies in social work was conducted between April-September 1994. The aim was to ascertain the relative educational content in the curricula pertaining to elder abuse and neglect, child abuse, domestic violence, and generic family violence.