Search

The normative role of the World Health Organization (WHO) involves creating evidence-based, principled guidelines to guide its Member States in making well-informed public health decisions. While these guidelines often need to be adapted to ensure contextual relevance, foster better implementation and adherence, adapting existing guidelines is more efficient than creating new ones. Here we describe the adaptation of the WHO coronavirus disease 2019 (COVID-19) living guideline on pharmacological interventions for the Caribbean using the grading of recommendations, assessment, development and evaluation (GRADE)-ADOLOPMENT method. The Caribbean Public Health Agency and the Pan American Health Organization led the effort, assembling a diverse panel of 16 experts from seven Caribbean countries and territories. The adaptation process, involving 15 steps, was guided by an experienced methodologist and included selecting relevant clinical questions and prioritizing them based on regional needs. The panel evaluated the latest WHO guidelines and integrated additional local data. They adjusted the direction and strength of several recommendations to better fit the Caribbean context, considering local values and preferences, resources, accessibility, feasibility and impact on health equity. Ultimately, we changed the direction of two recommendations and the strength of five, tailoring them to regional realities. This effort highlights the importance of adapting global guidelines to local settings, improving their applicability and effectiveness. The adaptation process also serves as a valuable opportunity for skill transfer and capacity-building in guideline development. Continued research is needed to assess the impact of these adaptations on health-care outcomes in the Caribbean. [phrase omitted] Le role normatif de l'Organisation mondiale de la sante (OMS) consiste a elaborer des lignes directrices fondees sur des donnees scientifiques et sur des principes afin d'aider ses Etats membres a prendre des decisions eclairees en matiere de sante publique. Bien qu'elles necessitent souvent des adaptations pour garantir leur pertinence par rapport a des contextes precis et pour favoriser une meilleure mise en oeuvre et adhesion, il est plus efficace d'adapter les lignes directrices existantes que d'en creer de nouvelles. La presente publication decrit l'adaptation de la ligne directrice evolutive de l'OMS sur les interventions pharmacologiques dans le cadre de la maladie a coronavirus (COVID-19) pour les Caraibes en appliquant la methodologie GRADE (classement des recommandations, de l'appreciation, du developpement et de l'evaluation)-ADOLOPMENT. LAgence de sante publique des Caraibes et l'Organisation panamericaine de la Sante ont dirige les travaux en reunissant un groupe diversifie de 16 experts issus de sept pays et territoires des Caraibes. Le processus d'adaptation, comptant 15 etapes et encadre par un methodologiste experimente, a consiste a selectionner des questions cliniques pertinentes et a les classer par ordre de priorite selon les besoins regionaux. Ce groupe a evalue les dernieres lignes directrices de l'OMS et a integre des donnees locales supplementaires. Il a ensuite ajuste l'orientation et le poids de plusieurs recommandations afin de mieux les adapter au contexte des Caraibes, en tenant compte des valeurs et des preferences locales, des ressources, de l'accessibilite, de la faisabilite et de l'impact sur l'equite en matiere de sante. En fin de compte, l'orientation de deux recommandations et le poids de cinq autres ont ete modifies, en les adaptant aux realites regionales. Cet effort souligne l'importance d'adapter des lignes directrices mondiales aux contextes locaux, afin d'en ameliorer l'applicabilite et l'efficacite. Le processus d'adaptation represente egalement une occasion precieuse de transfert de competences et de renforcement des capacites en matiere d'elaboration de lignes directrices. Des recherches continues s'imposent pour evaluer l'impact de ces adaptations sur les resultats des soins de sante dans les Caraibes. [phrase omitted] La funcion normativa de la Organizacion Mundial de la Salud (OMS) consiste en elaborar directrices basadas en pruebas y principios para orientar a sus Estados Miembros en la toma de decisiones de salud publica bien fundamentadas. Aunque con frecuencia es necesario adaptar estas directrices para garantizar su pertinencia contextual y fomentar una mejor implementacion y observancia, la adaptacion de directrices existentes es mas eficiente que la creacion de otras nuevas. Aqui describimos la adaptacion de la directriz vigente de la OMS sobre la enfermedad por coronavirus (COVID-19) relativa a las intervenciones farmacologicas para el Caribe utilizando el metodo de clasificacion de valoracion, elaboracion y evaluacion de las recomendaciones (GRADE)ADOLOPMENT. La Agencia de Salud Publica del Caribe y la Organizacion Panamericana de la Salud lideraron la iniciativa, que reunio a un variado grupo de 16 expertos de siete paises y territorios caribenos. El proceso de adaptacion, que comprendio 15 pasos y fue guiado por un metodologo experimentado, Incluyo la seleccion de preguntas clinicas pertinentes y su priorizacion en funcion de las necesidades regionales. El grupo evaluo las ultimas directrices de la OMS e integro datos locales adicionales. Ajustaron la orientacion y la fuerza de varias recomendaciones para adaptarlas mejor al contexto caribeno, teniendo en cuenta los valores y preferencias locales, los recursos, la accesibilidad, la viabilidad y el impacto en la equidad sanitaria. Finalmente, cambiamos la orientacion de dos recomendaciones y la fuerza de cinco para adaptarlas a las realidades regionales. Esta iniciativa destaca la importancia de adaptar las directrices mundiales a los contextos locales, lo que mejora su aplicabilidad y eficacia. El proceso de adaptacion tambien constituye una valiosa oportunidad para la transferencia de conocimientos y el desarrollo de capacidades en la elaboracion de directrices. Es necesario seguir investigando para evaluar el impacto de estas adaptaciones en los resultados de la atencion sanitaria en el Caribe., Introduction Although the coronavirus disease 2019 (COVID-19) pandemic was a global catastrophe, its impact was not felt equally around the world. Despite being home to only 8% of the world's [...]

Problem At the beginning of the coronavirus disease 2019 (COVID-19) pandemic, reliable, globally applicable recommendations for safe and continuous school operations were lacking. Approach In October 2020, the German Association of Scientific Medical Societies' task force for COVID-19 guidelines and public health researchers at Ludwig-Maximilians-Universitat Munchen initiated the rapid development of a living evidence- and consensus-based guideline to reduce severe acute respiratory syndrome coronavirus 2 transmission in schools. To facilitate transparent, structured and comprehensive decision-making with a whole-of-society perspective, they applied the WHO- INTEGRATE evidence-to-decision framework. This framework supported a broad, multisectoral composition of the guideline panel. The panel used newly synthesized evidence on nine school measures. Participating medical societies or the guideline secretariat completed evidence- to-decision tables. They also drafted recommendations for the guideline panel, who discussed and revised them during moderated consensus conferences. Local setting In Germany, each state is responsible for organizing schooling. The German Association of Scientific Medical Societies coordinates development of evidence- and consensus-based guidelines. Relevant changes The first version of the guideline was published in February 2021, and the guideline dissemination created much media attention. Of the 16 state education ministries, almost all knew about the guideline, nine recognized it as a relevant source of information and five used it to check existing directives. Lessons learnt The WHO-INTEGRATE framework facilitated a comprehensive assessment of school measures from the start of guideline development, considering the broad societal impact of the measures. Using the framework in rapid mode was feasible, but it fell short of its potential. [phrase omitted] Probleme Au debut de la pandemie de maladie a coronavirus 2019 (COVID-19), il n'existait pas de recommandations fiables et applicables a l'echelle mondiale pour assurer le fonctionnement des ecoles sans interruption et en toute securite. Approche En octobre 2020, le groupe de travail de l'Association allemande des societes scientifiques et medicales charge d'emettre des lignes directrices sur la COVID-19, en collaboration avec des chercheurs en sante publique de l'Universite Louis-et-Maximilien de Munich, a lance le developpement rapide d'une orientation evolutive fondee sur le consensus et sur des preuves, afin de limiter la transmission du coronavirus 2 du syndrome respiratoire aigu severe dans les ecoles. Pour favoriser un processus decisionnel transparent, structure et exhaustif adoptant la perspective de la societe dans son ensemble, il a applique le cadre WHO-INTEGRATE, un outil privilegiant une prise de decision fondee sur des donnees probantes. Ce cadre a permis de composer un vaste panel multisectoriel qui, a la lumiere d'une synthese recente d'elements factuels, a examine neuf mesures scolaires. De leur cote, les societes medicales participantes ou le Secretariat des directives ont complete des tableaux de prises de decision fondees sur des donnees probantes. Ils ont egalement formule des recommandations a l'attention du panel, qui en a discute et les a revisees lors de conferences de concertation moderees. Environnement local En Allemagne, l'education releve de la responsabilite des Etats federes. C'est l'Association allemande des societes scientifiques et medicales qui coordonne l'elaboration de lignes directrices fondees sur le consensus et sur des preuves. Changements significatifs La premiere version de l'orientation a ete publiee en fevrier 2021 et sa diffusion a engendre une forte couverture mediatique. Parmi les 16 Ministeres de l'Education des Etats federes, presque tous en connaissaient l'existence, neuf d'entre eux la consideraient comme une source d'information pertinente et cinq l'utilisaient pour verifier les directives existantes. Lecons tirees Vu l'Impact majeur de ces mesures sur la societe, le cadre WHO-INTEGRATE a contribue a une evaluation globale des mesures scolaires des le debut de l'elaboration de l'orientation. Ce cadre a pu etre rapidement mis en oeuvre, mais n'a pas atteint son plein potentiel. [phrase omitted] Situacion Al principio de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19), no existian recomendaciones fiables y aplicables a escala mundial para el funcionamiento seguro y continuo de las escuelas. Enfoque En octubre de 2020, el grupo de trabajo encargado de las directrices sobre la COVID-19 de la Asociacion alemana de sociedades cientificas medicas e investigadores de salud publica de la Ludwig-Maximilians- Universitat Munchen iniciaron el desarrollo rapido de una directriz activa basada en la evidencia y el consenso para reducir la transmision del sindrome respiratorio agudo grave por coronavirus 2 en las escuelas. Para facilitar una toma de decisiones transparente, estructurada y exhaustiva con una perspectiva de toda la sociedad, aplicaron el marco WHO-INTEGRATE, una herramienta para la toma de decisiones basada en evidencias. Este marco propicio una composicion amplia y multisectorial del panel de directrices. El panel utilizo pruebas recientemente sintetizadas sobre nueve medidas escolares. Las sociedades medicas participantes o la secretaria de la directriz completaron las tablas de evidencia para la toma de decisiones. Tambien redactaron recomendaciones para el panel de directrices, que las debatio y reviso durante conferencias de consenso moderadas. Marco regional En Alemania, cada estado es responsable de organizar la escolarizacion. La Asociacion alemana de sociedades cientificas medicas coordina la elaboracion de directrices basadas en la evidencia y el consenso. Cambios importantes La primera version de la directriz se publico en febrero de 2021 y su difusion suscito una gran atencion mediatica. De los 16 ministerios de educacion estatales, casi todos conocian la directriz, nueve la reconocieron como fuente de informacion pertinente y cinco la utilizaron para verificar las directrices existentes. Lecciones aprendidas El marco WHO-INTEGRATE permitio una evaluacion exhaustiva de las medidas escolares desde el inicio de la elaboracion de las directrices, y tuvo en cuenta el amplio impacto social de las medidas. Utilizar el marco en modo rapido fue factible, pero no alcanzo su potencial., Introduction Public health and social measures played a pivotal role in containing the coronavirus disease 2019 (COVID-19) pandemic. Most governments closed schools during the early months of the pandemic. (1) [...]

Problem By 31 December 2021, only 5.5% (861 879/15 670 530) of the Somali population had been fully vaccinated against coronavirus disease 2019 (COVID-19). Approach To rapidly increase COVID-19 vaccine coverage in 2022, the health ministry and its partners (World Health Organization and United Nations Children&apos;s Fund) adopted a more responsive strategy. This strategy included careful microplanning, better targeting of populations and providing people-centred vaccination services close to their homes. These services were combined with childhood vaccination and basic health-care provision using the existing polio network and community health workers. Additionally, a digital tool for recording COVID-19 vaccination data and a mobile phone-based electronic registration system were introduced. Local setting Somalia, a fragile and conflict-affected state, faced challenges when implementing COVID-19 vaccination, including inexperience in managing mass adult vaccination, inadequate infrastructure and health workforce. Furthermore, insecurity in some areas and severe drought resulted in large-scale displacement of people. Relevant changes The implementation of a more context-specific strategy helped Somalia reach substantially more people with COVID-19 vaccination and 42.1% coverage by 31 December 2022. Additionally, 84 600 zero- dose children received their first childhood vaccine during the integrated campaigns. The increased coverage has led to public health benefits that outweigh the investment in the COVID-19 vaccination campaigns. Lessons learnt Successful roll-out of adult vaccination is achievable even in a fragile and conflict-affected setting through implementation of a tailored contextualized approach. Key factors include good microplanning, use of digital tools, better population-targeting, bundling vaccines together and delivering vaccination services close to people&apos;s homes. Probleme Au 31 decembre 2021, seulement 5,5% (861 879/15 670 530) des Somaliens etaient totalement vaccines contre la maladie a coronavirus 2019 (COVID-19). Approche Afin d&apos;accroitre rapidement la couverture vaccinale contre la COVID-19 en 2022, le Ministere de la Sante et ses partenaires (l&apos;Organisation mondiale de la Sante et le Fonds des Nations Unies pour l&apos;enfance) ont adopte une strategie plus reactive. Celle-ci comprenait une microplanification minutieuse, un meilleur ciblage des populations et la fourniture de services de vaccination centres sur les personnes, a proximite de leur domicile. Ces services etaient combines a une vaccination des enfants et a des soins de base, grace au reseau actuel de lutte contre la polio et des agents de sante communautaires. En outre, un outil numerique d&apos;acquisition des donnees relatives a la vaccination contre la COVID-19 ainsi qu&apos;un systeme d&apos;enregistrement electronique via telephone mobile ont ete deployes. Environnement local La Somalie, un Etat fragile et en conflit, a ete confrontee a des difficultes de mise en reuvre de la vaccination contre la COVID-19, notamment en raison de son manque d&apos;experience dans la gestion de campagnes de vaccination massive des adultes, de ses infrastructures inadaptees et d&apos;une penurie de soignants. De plus, l&apos;insecurite qui regne dans certaines regions et la secheresse extreme ont entraine des deplacements a grande echelle. Changements significatifs L&apos;instauration d&apos;une strategie mieux adaptee au contexte a aide la Somalie a vacciner nettement plus de gens contre la COVID-19, et a atteindre 42,1% de couverture vaccinale au 31 decembre 2022. Par ailleurs, 84 600 enfants <> ont recu leur premier vaccin pediatrique durant les campagnes combinees. L&apos;amelioration de la couverture vaccinale a engendre de nombreux benefices pour la sante publique, depassant l&apos;investissement dans les campagnes de vaccination contre la COVID-19. Lecons tirees En definissant une approche contextualisee et sur mesure, il est possible de proceder a la vaccination des adultes, meme dans une region fragile et en conflit. Parmi les facteurs cles figurent une bonne microplanification, le recours aux outils numeriques, un meilleur ciblage des populations, le regroupement des vaccins et la mise a disposition de services de vaccination non loin des habitations. Situacion A 31 de diciembre de 2021, solo el 5,5% (861 879/15 670 530) de la poblacion somali habia sido completamente vacunada contra la enfermedad por coronavirus de 2019 (COVID-19). Enfoque Para aumentar rapidamente la cobertura de la vacuna contra la COVID-19 en 2022, el Ministerio de Sanidad y sus asociados (la Organizacion Mundial de la Salud y el Fondo de las Naciones Unidas para la Infancia) adoptaron una estrategia mas receptiva. Esta estrategia incluia una cuidadosa microplanificacion, una mejor seleccion de las poblaciones y la prestacion de servicios de vacunacion centrados en las personas y cercanos a sus hogares. Los servicios se combinaron con la vacunacion infantil y la prestacion de atencion sanitaria basica mediante la red antipoliomielitica existente y los agentes de salud comunitarios. Ademas, se introdujeron una herramienta digital para registrar los datos de vacunacion contra la COVID-19 y un sistema de registro electronico por telefono movil. Marco regional Somalia, un estado fragil y afectado por conflictos, atraveso dificultades a la hora de implementar la vacunacion contra la COVID-19, como la inexperiencia en la gestion de la vacunacion masiva de adultos, la falta de infraestructuras y de personal sanitario. Asimismo, la inseguridad en algunas regiones y la grave sequia provocaron desplazamientos de poblacion a gran escala. Cambios importantes La implementacion de una estrategia mas adaptada al contexto ayudo a Somalia a llegar a un numero mucho mayor de personas con la vacunacion contra la COVID-19 y a una cobertura del 42,1% a 31 de diciembre de 2022. Ademas, 84 600 ninos con dosis cero recibieron su primera vacuna infantil durante las campanas integradas. El aumento de la cobertura ha propiciado beneficios para la salud publica que superan la inversion en las campanas de vacunacion contra la COVID-19. Lecciones aprendidas El despliegue exitoso de la vacunacion de adultos es posible incluso en un entorno fragil y afectado por conflictos mediante la implementacion de un enfoque contextualizado y adaptado. Los factores clave consisten en una buena microplanificacion, el uso de herramientas digitales, una mejor orientacion de la poblacion, la agrupacion de vacunas y la prestacion de servicios de vacunacion cerca de los hogares., Introduction Somalia received its first 300 000 doses of coronavirus disease 2019 (COVID-19) vaccines from the COVID-19 Vaccines Global Access (COVAX) initiative on 15 March 2021, (1) and the first [...]

Objective To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on protests by health workers. Methods We conducted an interrupted time series analysis of data from 159 countries for 2 years before and after the World Health Organization classified COVID-19 as a pandemic in March 2020, thus between 2018 and 2022. We produced models examining two main outcomes: (i) the total weekly number of health worker protests globally; and (ii) the number of countries with one or more health worker protests in a given week. Findings In total, there were 18 322 health worker protests in 133 countries between 2018 and 2022. The number of weekly health worker protests globally increased by 47% (30.1/63.5), an increase of 30.1 protests per week (95% confidence interval, CI: 11.7-48.6) at the onset of the COVID-19 pandemic. Furthermore, the number of countries experiencing such protests in a given week increased by 24% (5.7/24.1) following the declaration of the pandemic (an increase of 5.7 countries; 95% CI: 3.5-7.8). Conclusion The pandemic increased the overall level of health worker protests globally as well as the number of countries experiencing such protests. These protests highlight discontent in the health workforce. Given the ongoing global health workforce crisis, understanding and addressing the drivers of health worker discontent is important for global health policy and security. Objectif Evaluer l&apos;impact de la pandemie de maladie a coronavirus 2019 (COVID-19) sur les manifestations du personnel de sante. Methodes Nous avons effectue une analyse de serie chronologique interrompue de donnees issues de 159 pays deux ans avant et deux ans apres la classification, par l&apos;Organisation mondiale de la Sante, de la COVID-19 dans la categorie des pandemies en mars 2020, donc entre 2018 et 2022. Nous avons ensuite elabore des modeles pour deux elements principaux: (i) le nombre total de manifestations organisees chaque semaine par le personnel de sante; ainsi que (ii) le nombre de pays ou le personnel de sante a manifeste au moins une fois au cours d&apos;une semaine donnee. Resultats Le personnel de sante a participe a un total de 18 322 manifestations dans 133 pays entre 2018 et 2022. Le nombre de manifestations hebdomadaires a augmente de 47% (30,1/63,5) a l&apos;echelle planetaire, l&apos;equivalent de 30,1 manifestations supplementaires par semaine (intervalle de confiance de 95%, IC: 11,7-48,6) au moment de l&apos;apparition de la pandemie de COVID-19. En outre, le nombre de pays touches par ces manifestations au cours d&apos;une semaine donnee a augmente de 24% (5,7/24,1) lorsque l&apos;etat de pandemie a ete declare (ce qui represente une hausse de 5,7 pays; IC de 95%: 3,5-7,8). Conclusion La pandemie a entrame une recrudescence des manifestations organisees par le personnel de sante dans le monde, ainsi que du nombre de pays confrontes a de telles manifestations, ce qui illustre le mecontentement qui regne au sein du secteur. Etant donne la crise que connait actuellement le personnel de sante partout dans le monde, s&apos;interesser et s&apos;attaquer aux facteurs de mecontentement des soignants est essentiel pour la securite et la politique en matiere de sante mondiale. Objetivo Evaluar el Impacto de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19) en las protestas del personal sanitario. Metodos Se realizo un analisis de series temporales interrumpidas de datos de 159 paises durante dos anos antes y despues de que la Organizacion Mundial de la Salud clasificara la COVID-19 como pandemia en marzo de 2020, es decir, entre 2018 y 2022. Se elaboraron modelos para examinar dos resultados principales: (i) el numero total semanal de protestas del personal sanitario en todo el mundo; y (ii) el numero de paises con una o mas protestas del personal sanitario en una semana determinada. Resultados En total, hubo 18 322 protestas de personal sanitario en 133 paises entre 2018 y 2022. El numero de protestas semanales del personal sanitario en todo el mundo aumento un 47% (30,1/63,5), lo que supone un aumento de 30,1 protestas por semana (intervalo de confianza del 95%, IC: 11,7-48,6) al inicio de la pandemia de la COVID-19. Ademas, el numero de paises que experimentaron este tipo de protestas en una semana determinada aumento un 24% (5,7/24,1) tras la declaracion de la pandemia (un aumento de 5,7 paises; IC del 95%: 3,5-7,8). Conclusion La pandemia aumento el nivel general de protestas del personal sanitario en todo el mundo, asi como el numero de paises que las experimentaron. Estas protestas ponen de manifiesto el descontento del personal sanitario. Dada la actual crisis mundial del personal sanitario, comprender y abordar los factores que impulsan el descontento del personal sanitario es importante para la politica y la seguridad sanitarias a nivel mundial., Introduction Protests, that is organized public demonstrations of grievances, by health workers have gained increasing attention in recent years. Health workforce crises are occurring around the world in both high- [...]

It has been hypothesized that air pollution can increase an individual&apos;s susceptibility to COVID-19. Our study sought to investigate if short-term exposure to a high average level of Air Quality Index (AQI), ozone ([O.sub.3]), particulate matter (P[M.sub.2.5], P[M.sub.10]), sulfur dioxide (S[O.sub.2]), carbon monoxide (CO), and nitrogen dioxide (N[O.sub.2]) are risk factors for death from COVID-19. We conducted an unmatched case-control study to compare the risk of mortality among reported COVID-19 cases within metropolitan statistical areas in Indiana from March 31, 2020, to December 31, 2020 (N = 53,459). Air pollution concentration data at the county level were retrieved from the U.S. Environmental Protection Agency. Pollutant concentrations for the 90 days before disease development were averaged. Data were analyzed using stepwise logistic regression accounting for median air temperature, race, ethnicity, and preexisting conditions as confounders. At the population level, individuals who were exposed to a greater average of P[M.sub.2.5] in the 90 days before the development of COVID-19 had an increased risk of death: OR = 2.16, 95% confidence interval (CI) [1.12, 18.57]. Individuals with chronic lung disease had an increased risk of death in relation to P[M.sub.10]: OR = 2.72, 95% CI [1.15, 6.43]. Short-term exposure to particulate matter may serve as a risk factor for COVID-19 mortality. Keywords: COVID-19, air pollution, Indiana, particulate matter, Introduction In 2020, the third leading cause of death in Indiana was COVID-19 (Centers for Disease Control and Prevention, 2024). Since 2020, preliminary studies have demonstrated a relationship between COVID-19 [...]

INTRODUCTION In the fast-paced world of manufacturing, it is critical to research and understand the vital, and often expensive, ways in which employee benefits impact turnover and retention, two of [...], This study explores the efficacy of tuition reimbursement programs in addressing turnover and retention concerns, leveraging comprehensive data spanning pre- and post-COVID-19 pandemic periods. Through extensive survey data collected from manufacturing businesses in Middle Tennessee, encompassing four years and 1,247 responses, this study evaluates the impact of tuition reimbursement programs on turnover rates and perceptions through comparisons between organizations who provide tuition reimbursement benefits and those who do not. The findings suggest that organizations offering tuition reimbursement achieve lower turnover rates and perceive turnover as less of a challenge compared to their counterparts lacking such programs. Moreover, even with the upheaval wrought by the CO VID-19 pandemic, these trends persisted, despite the overall inflation of turnover that began post-pandemic. In conclusion, this study advocates for the strategic integration of tuition reimbursement programs as a potentially powerful tool for mitigating turnover challenges and nurturing employee retention.

Due to COVID-19 prevention measures, schools in Quebec were closed in 2020 and 2021, reducing instructional time compared to previous years. This study compares the reading performance of Grade 4 students on ministerial tests before (June 2019, n = 13,669) and after (June 2021, n = 10,880) school closures while quantifying variations based on students' individual and socio-economic characteristics. Results reveal a significant decrease of 8.4 percentage points between 2019 (mean = 77.7%) and 2021 (mean = 69.27%) and an increase of 10.8% in the failure rate (17.1% in 2019 versus 27.9% in 2021). Students in the bottom 10% of the distribution experienced marked declines in performance (-18 percentage points), while students in the top 10% of the distribution did not exhibit any decline. This study contributes to the understanding of the impact of school closures on children's reading competencies and underscores the critical importance of in-person instruction, particularly for students with learning difficulties. Keywords: COVID-19, school closures, student learning outcomes, educational impact, reading performance, Quebec En raison des mesures de prevention pour contrer la propagation de la COVID-19, les ecoles du Quebec ont ete fermees en 2020 et 2021, reduisant ainsi le temps d'enseignement par rapport aux annees precedentes. Cette etude visait a comparer les performances a l'epreuve ministerielle de lecture des eleves de 4e annee avant (mai 2019, n = 13 669) et apres (mai 2021, n = 10880) ces fermetures scolaires, tout en quantifiant les variations de performance en fonction des caracteristiques individuelles et socioeconomiques des eleves. Les resultats revelent une diminution significative de 8,4 points de pourcentage entre 2019 (M= 77,7 %) et 2021 (M= 69,27 %), ainsi qu'une augmentation de 10,8 points de pourcentage du taux d'echec (17,1 % en 2019 vs 27,9 % en 2021). Les resultats des eleves dans les 10 % inferieurs de la distribution de performance ont subi des baisses marquees (18 points de pourcentage), tandis que les resultats des eleves des 10 % superieurs n'ont pas diminue. Cette etude contribue a la comprehension des repercussions de la pandemie sur les competences en lecture des eleves et souligne l'importance de l'enseignement en personne, en particulier pour les eleves en difficulte d'apprentissage. Mots-cles: COVID-19, fermetures d'ecoles, performances des eleves, impact educatif, competences en lecture, Quebec, Introduction Les mesures de prevention pour contrer la propagation de la COVID-19 ont entraine la fermeture complete des ecoles du Quebec de 40 (en region) a 75 (a Montreal) jours [...]

Building upon empirical research, this study examines the socio-economic impact of the Covid-19 pandemic on Syrian refugees in Turkey by analyzing its implications on employment, livelihood opportunities, and social cohesion. More specifically, it focuses on the experiences of Syrian refugees to examine the ways in which they exert their agency to cope with the structural constraints when faced with 'multiple crises' in host countries, intersecting with the dynamics of a 'normalized refugee crisis'. Our findings from fieldwork conducted in the top six refugee-hosting cities reveal that loss of jobs, limited access to decent work, increased dependency on external financial assistance, and social exclusion have been some of the most acute effects of the pandemic on refugees. Meanwhile, the perceived effects that refugees have on the host community's welfare trigger problems that impede social cohesion. All in all, the study intends to highlight the far-reaching effects of the pandemic beyond its direct health implications by addressing the structural vulnerability of refugees and the importance of providing an enabling environment for socio-economic self-reliance. Keywords: Syrian refugees, Turkey, Covid-19, migration management, refugee politics, Introduction In recent years, the substantial increase in Turkey's refugee population has affected the country's political economy in multiple ways by exerting significant pressure on public resources, labor force dynamics, [...]

The usual challenges of conducting primary care research, including randomized trials, have been exacerbated, and new ones identified, during the COVID-19 pandemic. HOMER (Home versus Office for Medication Enhanced Recovery; subsequently, Comparing Home, Office, and Telehealth Induction for Medication Enhanced Recovery) is a pragmatic, comparative-effectiveness research trial that aims to answer a key question from patients and clinicians: What is the best setting in which to start treatment with buprenorphine for opioid use disorder for this patient at this time? In this article, we describe the difficult journey to find the answer. The HOMER study began as a randomized trial comparing treatment outcomes in patients starting treatment with buprenorphine via induction at home (unobserved) vs in the office (observed, synchronous). The study aimed to enroll 1,000 participants from 100 diverse primary care practices associated with the State Networks of Colorado Ambulatory Practices and Partners and the American Academy of Family Physicians National Research Network. The research team faced unexpected challenges related to the COVID-19 pandemic and dramatic changes in the opioid epidemic. These challenges required changes to the study design, protocol, recruitment intensity, and funding conversations, as well as patience. As this is a participatory research study, we sought, documented, and responded to practice and patient requests for adaptations. Changes included adding a third study arm using telehealth induction (observed via telephone or video, synchronous) and switching to a comprehensive cohort design to answer meaningful patient-centered research questions. Using a narrative approach based on the Greek myth of Homer, we describe here the challenges and adaptations that have provided the opportunity for HOMER to thrive and find the way home. These clinical trial strategies may apply to other studies faced with similar cultural and extreme circumstances. Key words: opioid use disorder; buprenorphine; primary care; practice-based research; vulnerable populations; participatory research; clinical trials as topic; health services; COVID-19; pandemics, https://doi.org/10.1370/afm.3149 'Passage home? Never. Surely, you're plotting something else, goddess, urging me--in a raft--to cross the ocean's mighty gulfs. So vast, so full of danger not even the deep-sea ships [...]

BACKGROUND For many patients with post-COVID-19 condition (long COVID), primary care is the first point of interaction with the health care system. In principle, primary care is well situated to manage long COVID. Beyond expressions of disempowerment, however, the patient's perspective regarding the quality of long COVID care is lacking. Therefore, this study aimed to analyze the expectations and experiences of primary care patients seeking treatment for long COVID. METHODS A phenomenological approach guided this analysis. Using purposive sampling, we conducted semistructured interviews with English-speaking, adult primary care patients describing symptoms of long COVID. We deidentified and transcribed the recorded interviews. Transcripts were analyzed using inductive qualitative content analysis. RESULTS This article reports results from 19 interviews (53% female, mean age = 54 years). Patients expected their primary care practitioners (PCPs) to be knowledgeable about long COVID, attentive to their individual condition, and to engage in collaborative processes for treatment. Patients described 2 areas of experiences. First, interactions with clinicians were perceived as positive when clinicians were honest and validating, and negative when patients felt dismissed or discouraged. Second, patients described challenges navigating the fragmented US health care system when coordinating care, treatment and testing, and payment. CONCLUSION Primary care patients' experiences seeking care for long COVID are incongruent with their expectations. Patients must overcome barriers at each level of the health care system and are frustrated by the constant challenges. PCPs and other health care professionals might increase congruence with expectations and experiences through listening, validating, and advocating for patients with long COVID. Key words: primary care issues; long COVID; COVID-19; qualitative methods; patient perspective, https://doi.org/10.1370/afm.3145 Annals Early Access article BACKGROUND Post-COVID-19 conditions (PCC), or 'long COVID,' is an imminent public health emergency. Long COVID has already contributed to an estimated 3,500 American deaths, resulted [...]

From the very beginning, the COVID-19 crisis management could have hardly been considered rational. Many governments had prepared plans for dealing with exactly this kind of pandemic after the 9/11 [...]

The COVID-19 pandemic created many challenges for K-12 schools during the 2020-2021 school year (e.g, establishing social distancing measures, decisions regarding testing protocols, and transition from in-person to distance learning). Changes in teaching and learning modalities, from in-person to remote learning options, quickly became a reality for many students [an estimated 95%, according to Engzell et al. (2021)]. With an increase in distance learning came changes in students' structured and unstructured physical activity participation. The impact of these changes is unknown and justifies research investigating the effect modality shifts held on students' participation in physical activity and any associated outcomes. A mixed-methods survey was administered to examine changes in K-12 students' learning modality, participation in physical activity, and associated outcomes. Changes in learning modality from in-person to online were most frequently indicated (90%). Respondents stated both challenges and success stories associated with students' participation in physical activities resulting from modality shifts (e.g, decreased social engagements, decreased exposure to structured and facilitated physical education, and increased outdoor play). Positive outcomes were most prevalent in children engaging in moderate PA. However, 85% of respondents indicated a decrease in their child's physical activity participation. Our findings justify further investigation of the immediate and long-term impact of school modality shifts on students' engagement in physical activities., Introduction Throughout the 2020-2021 school year, the United States K-12 education system faced a breadth of challenges in providing students with an effective learning experience as a result of the [...]

To monitor COVID-19 epidemic spread, the World Health Organization tracked worldwide incidence by relying on notification data of laboratory-confirmed cases (1). In Germany, public health and social measures (PHSM), such [...]

Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection that usually affects immunocompromised patients, most commonly those with HIV infection (1). PJP in immunocompetent persons is extremely rare (2), particularly among [...]

Mass gatherings include a diverse range of events such as sporting competitions, religious ceremonies, entertainment activities, political rallies and cultural celebrations, which have important implications for population well-being. However, if not managed properly, these events can amplify health risks including those related to communicable diseases, and place undue strain on health systems in host countries and potentially in attendees' home countries, upon their return. The coronavirus disease 2019 (COVID-19) pandemic has provided a unique opportunity to evaluate the risk factors associated with mass gatherings and the effectiveness of applying mitigation measures during infectious disease emergencies. The pandemic has also allowed event organizers and health officials to identify best practices for mass gathering planning in host countries. To guide decisions about whether to hold, postpone, modify or cancel a mass gathering during the COVID-19 pandemic, the World Health Organization and its partners developed normative guidance and derivative tools promoting a risk-based approach to mass gathering planning. This approach involves three steps to guide decision-making around mass gatherings: risk evaluation, risk mitigation and risk communication. The approach was applied in the planning and execution of several mass gathering events, including the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games. Lessons identified from these large-scale international events offer insights into the planning and implementation of mass gathering events during a pandemic, and the broader impacts of such events on society. These lessons may also further inform and refine planning for future mass gatherings. Les rassemblements de masse designent un large eventail d'evenements tels que des competitions sportives, ceremonies religieuses, activites de divertissement, manifestations politiques et fetes culturelles. Tous ont un impact considerable sur le bien-etre de la population. Toutefois, s'ils ne sont pas geres correctement, ils peuvent augmenter les risques sanitaires, notamment concernant les maladies transmissibles, et exercer une pression excessive sur les systemes de sante des pays hotes, voire sur ceux des pays d'origine des participants apres leur retour. La pandemie de maladie a coronavirus 2019 (COVID-19) a offert une occasion unique d'evaluer les facteurs de risque associes aux rassemblements de masse, ainsi que l'efficacite des mesures visant a limiter la propagation dans des situations d'urgence liees a des maladies infectieuses. Cette pandemie a egalement permis aux organisateurs d'evenements et responsables de sante d'identifier les bonnes pratiques a appliquer dans les pays hotes pendant les rassemblements de masse. Afin de guider les decisions relatives au maintien, au report, a la modification ou a l'annulation d'un rassemblement de masse durant la pandemie de COVID-19, l'Organisation mondiale de la Sante et ses partenaires ont mis au point des orientations normatives et des outils derives favorisant une approche tenant compte des risques au moment de la planification. Cette approche comprend trois etapes contribuant a la prise de decision: l'evaluation, la reduction et la communication des risques. Elle a ete deployee lors de la planification et de l'execution de nombreux rassemblements de masse, comme les Jeux olympiques et paralympiques de Tokyo 2020 et Beijing 2022. Les lecons tirees de ces evenements internationaux a grande echelle fournissent des informations sur leur organisation et leur mise en oeuvre en cas de pandemie, ainsi que les impacts de tels evenements sur la societe. Elles sont en outre susceptibles de faciliter et d'ameliorer la planification des futurs rassemblements de masse. Las concentraciones masivas Incluyen una gran variedad de eventos, como competiciones deportivas, ceremonias religiosas, actividades de entretenimiento, mitines politicos y celebraciones culturales, que tienen importantes implicaciones para el bienestar de la poblacion. Sin embargo, si no se gestionan adecuadamente, estos eventos pueden amplificar los riesgos para la salud, incluidos los relacionados con las enfermedades transmisibles, y suponer una carga excesiva para los sistemas sanitarios de los paises anfitriones y, potencialmente, de los paises de origen de los participantes a su regreso. La pandemia de la enfermedad por coronavirus de 2019 (COVID-19) ha brindado una oportunidad unica para evaluar los factores de riesgo asociados a las concentraciones masivas y la eficacia de aplicar medidas de mitigacion durante las emergencias por enfermedades infecciosas. La pandemia tambien ha permitido a los organizadores de eventos y a las autoridades sanitarias identificar las mejores practicas para la planificacion de concentraciones masivas en los paises anfitriones. Para orientar las decisiones sobre la celebracion, el aplazamiento, la modificacion o la cancelacion de una concentracion masiva durante la pandemia de la COVID-19, la Organizacion Mundial de la Salud y sus asociados elaboraron orientaciones normativas y herramientas derivadas que promueven un enfoque de la planificacion de concentraciones masivas basado en los riesgos. Este enfoque consta de tres pasos para orientar la toma de decisiones en torno a las concentraciones masivas: la evaluacion, la mitigacion y la comunicacion de riesgos. El enfoque se aplico en la planificacion y ejecucion de varias concentraciones masivas, incluidos los Juegos Olimpicos y Paralimpicos de Tokio 2020 y Pekin 2022. Las conclusiones extraidas de estos eventos internacionales a gran escala permiten comprender mejor la planificacion y ejecucion de concentraciones masivas durante una pandemia, asi como las repercusiones mas generales de estos eventos en la sociedad. Estas lecciones tambien pueden informar y perfeccionar la planificacion de futuras concentraciones masivas., Introduction Mass gatherings are characterized by the concentration of people at a specific location for a specific purpose over a set period. Such gatherings encompass a diverse range of events, [...]

PURPOSE COVID-19 is a condition that can lead to other chronic conditions. These conditions are frequently diagnosed in the primary care setting. We used a novel primary care registry to quantify the burden of post-COVID conditions among adult patients with a COVID-19 diagnosis across the United States. METHODS We used the American Family Cohort, a national primary care registry, to identify study patients. After propensity score matching, we assessed the prevalence of 17 condition categories individually and cumulatively, comparing patients having COVID-19 in 2020-2021 with (1) historical control patients having influenza-like illness in 2018 and (2) contemporaneous control patients seen for wellness or preventive visits in 2020- 2021. RESULTS We identified 28,215 patients with a COVID-19 diagnosis and 235,953 historical control patients with influenza-like illness. The COVID-19 group had higher prevalences of breathing difficulties (4.2% vs 1.9%), type 2 diabetes (12.0% vs 10.2%), fatigue (3.9% vs 2.2%), and sleep disturbances (3.5% vs 2.4%). There were no differences, however, in the postdiagnosis monthly trend in cumulative morbidity between the COVID-19 patients (trend = 0.026; 95% CI, 0.025-0.027) and the patients with influenza- like illness (trend = 0.026; 95% CI, 0.023-0.027). Relative to contemporaneous wellness control patients, COVID-19 patients had higher prevalences of breathing difficulties and type 2 diabetes. CONCLUSIONS Our findings show a moderate burden of post-COVID conditions in primary care, including breathing difficulties, fatigue, and sleep disturbances. Based on clinical registry data, the prevalence of post-COVID conditions in primary care practices is lower than that reported in subspecialty and hospital settings. Key words: long COVID; post-COVID conditions; post-infectious disorders; primary health care; family practice; chronic illness; morbidity https://doi.org/10.1370/afm.3131, INTRODUCTION The direct and immediate impact of COVID-19 on the health of the US population has been of generational significance, and the secondary wave of persistent symptoms and new conditions [...]

Introduction Ancestral spike-based COVID-19 vaccines have reduced effectiveness in preventing symptomatic Omicron variant infections due to progressive neutralizing antibody escape (1). As such, COVID-19 vaccines have been serially updated to [...], BACKGROUND. There is uncertainty about the timing of booster vaccination against COVID-19 in highly vaccinated populations during the present endemic phase of COVID-19. Studies focused on primary vaccination have previously suggested improved immunity with a longer interval between the first and second vaccine doses. METHODS. We conducted a randomized, controlled trial (November 2022-August 2023) and assigned 52 fully vaccinated adults to an immediate or a 3-month delayed bivalent Spikevax mRNA booster vaccine. Follow-up visits were completed for 48 participants (n = 24 per arm), with collection of saliva and plasma samples following each visit. RESULTS. The rise in neutralizing antibody responses to ancestral and Omicron strains were almost identical between the immediate and delayed vaccination arms. Analyses of plasma and salivary antibody responses (IgG, IgA), plasma antibody-dependent phagocytic activity, and the decay kinetics of antibody responses were similar between the 2 arms. Symptomatic and asymptomatic SARS-CoV-2 infections occurred in 49% (21 of 49) participants over the median 11.5 months of follow-up and were also similar between the 2 arms. CONCLUSIONS. Our data suggest that there was no benefit in delaying COVID-19 mRNA booster vaccination in preimmune populations during the present endemic phase of COVID-19. TRIAL REGISTRATION. Australian New Zealand Clinical Trials Registry number 12622000411741 (https://anzctr.org.au/Trial/ Registration/TrialReview.aspx?ACTRN=12622000411741). FUNDING. National Health and Medical Research Council, Australia (program grant App1149990) and Medical Research Future Fund (App2005544).

The world experienced an unprecedented health shock (COVID-19) which caught everyone by surprise, and destabilized many sectors, especially the agri-food sector. This unpleasant situation caused upset in the food production and distribution chain, and continues to threaten the attainment of Sustainable Development Goal 2 which underscores zero hunger in society. Many people in South Africa were disproportionately affected with severe consequences on their livelihood activities, food security status, health status, and general welfare conditions; and as a result, social relief intervention was put in place or expanded. This study examined the factors influencing rural households' food security status among the recipients of social relief grants in rural areas of South Africa. The study used a secondary dataset from Wave 5 of National Income Dynamics Study - Coronavirus Rapid Mobile Survey (NIDS-CRAM). The research applied descriptive statistics to describe the respondents' socio-economic characteristics, and pattern of income flow. Food Insecurity Access Scale was employed to investigate the respondents' food security status, while multinomial logistic regression was used to explore the determinants of food security. The results showed that the majority of the respondents were black (99%), female-headed (54.15%), dwelling in flats (74.01%), with secondary education (88.6%), and heavily dependent on government grants (58.61%). Also, most households were food secure (71.69%) during the pandemic. Moreover, households headed by men were more food secure (62.84%) compared to the ones headed by the female counterparts (37.08). Multinomial regression estimates revealed that formal education (p Key words: Covid-19, social grant, rural households, food security, South Africa, INTRODUCTION Covid-19 health shock was pivotal in exacerbating food shortages and general welfare distress, especially in the global south countries [1]. The pandemic undermined the drive by the United Nations [...]

Background: The effect of the COVID-19 pandemic on the diagnosis and management of lung cancer in Canada is not fully understood. We sought to quantify the provincial volume of diagnostic imaging, thoracic surgeon referrals, time to surgery after referral, and pathologic staging for curative surgery in the context of the pandemic, as well as explore the effect of a pooled patient model, which was implemented to prioritize surgeries for lung cancer and mitigate the effects of the pandemic. Methods: We conducted a retrospective cohort study of patients who underwent diagnostic imaging in Nova Scotia and were subsequently referred to a thoracic surgeon at the province&apos;s only tertiary care centre for surgical management of their primary lung cancer before (Mar. 1, 2019, to Feb. 29, 2020) and during (Mar. 1, 2020, to Feb. 28, 2021) the COVID-19 pandemic. We conducted a survey to capture the patient and surgeon experience with a pooled patient model of managing surgical oncology cases. Results: Compared with the pre-COVID-19 period, the overall volume of chest radiography and chest computed tomography decreased by 30.9% (p < 0.001) and 18.7% (p = 0.002), respectively, in the COVID-19 period. Thoracic surgeon referrals, operative approach, extent of resection, length of hospital stay, and pathologic staging did not significantly differ. Time from referral to surgery was significantly shorter during the COVID-19 period (mean 196.8 d v. 157.9 d, p = 0.04). A pooled patient approach contributed to positive patient satisfaction. Conclusion: The COVID-19 pandemic was associated with reductions in rates of diagnostic imaging and referrals to thoracic surgeons for management of pulmonary cancer. A pooled patient model was used to mitigate the effects of the pandemic on lung cancer management and was positively received by patients. An extended study period is needed to determine the full effect of this redistribution of resources. Contexte : L&apos;effet de la pand mie de COVID-19 sur le diagnostic et la prise en charge du cancer du poumon au Canada n&apos;est pas enti rement compris. Nous avons voulu conna tre le volume provincial d&apos; preuves d&apos;imagerie diagnostique et de demandes de consultation en chirurgie thoracique, de m me que l&apos;intervalle entre les consultations et les chirurgies et le stade de la maladie justiciable d&apos;une chirurgie vis e curative dans le contexte de la pand mie, en plus d&apos;explorer l&apos;effet d&apos;un mod le de cas group s pour tablir l&apos;ordre de priorit des chirurgies pour le cancer du poumon et att nuer les effets de la pand mie. M thodes : Nous avons proc d une tude de cohorte r trospective aupr s des personnes ayant subi des preuves d&apos;imagerie diagnostiques en Nouvelle- cosse et adress es en chirurgie thoracique dans le seul tablissement de soins tertiaires de la province pour une prise en charge chirurgicale de leur n oplasie pulmonaire primitive avant (du 1er mars 2019 au 29 f vrier 2020) et durant (du 1er mars 2020 au 28 f vrier 2021) la pand mie de COVID-19. Nous avons r alis un sondage sur l&apos;exp rience des malades et des chirurgiennes et chirurgiens dans le cadre d&apos;un mod le de cas group s pour la prise en charge chirurgicale en oncologie. R sultats : Comparativement la p riode pr -COVID-19, le volume global des radiographies pulmonaires et des tomodensitom tries thoraciques a diminu de 30,9% (p < 0,001) et de 18,7% (p = 0,002), respectivement, durant la p riode de COVID-19. Les consultations en chirurgie thoracique, l&apos;approche chirurgicale, l&apos;ampleur de la r section, la dur e du s jour hospitalier et la stadification de la maladie n&apos;ont pas diff r significativement. L&apos;intervalle entre les consultations et les chirurgies a t significativement plus bref durant la p riode de COVID-19 (moyenne 196,8 j c. 157,9 j, p = 0,04). Le mod le de priorisation des cas group s a contribu favorablement la satisfaction des malades. Conclusion : La pand mie de COVID-19 a t associ e une r duction des taux d&apos; preuves d&apos;imagerie diagnostique et de demandes de consultation en chirurgie thoracique pour la prise en charge du cancer du poumon. Un mod le de priorisation de cas group s a servi att nuer les effets de la pand mie sur la prise en charge du cancer du poumon et a t accueilli favorablement par les malades. Un volet de prolongation est n cessaire pour mesurer tout l&apos;effet de cette redistribution des ressources., Lung cancer is the leading global cause of cancer-related deaths among both males and females. (1) In Canada, lung cancer has the highest cancer mortality; Nova Scotia has one of [...]

BACKGROUND The efficacy, effectiveness, and safety of the approved nirmatrelvir/ritonavir regimen for treatment of laboratory-confirmed mild/moderately severe COVID-19 remains unclear. METHODS We systematically identified randomized controlled trials (RCTs) and realworld studies (RWS; observational studies) of the efficacy/effectiveness and/or safety of the approved nirmatrelvir/ritonavir regimen for COVID-19. We pooled appropriate data (adjusted estimates for RWS) using an inverse variance, random-effects model. We calculated statistical heterogeneity using the [I.sup.2] statistic. Results are presented as relative risk (RR) with associated 95% CI. We further assessed risk of bias/study quality and conducted trial sequential analysis of the evidence from RCTs. RESULTS We included 4 RCTs (4,070 persons) and 16 RWS (1,925,047 persons) of adults (aged [greater than or equal to] 18 years). One and 3 RCTs were of low and unclear risk of bias, respectively. The RWS were of good quality. Nirmatrelvir/ritonavir significantly decreased COVID- 19 hospitalization compared with placebo/no treatment (RR = 0.17; 95% CI, 0.10-0.31; [I.sup.2] = 77.2%; 2 RCTs, 3,542 persons), but there was no significant difference for decrease of worsening severity (RR = 0.82; 95% CI, 0.66-1.01; [I.sup.2] = 47.5%; 3 RCTs, 1,824 persons), viral clearance (RR = 1.19; 95% CI, 0.93-1.51; [I.sup.2] = 82%; 2 RCTs, 528 persons), adverse events (RR = 1.41; 95% CI, 0.92-2.14; [I.sup.2] = 70.6%; 4 RCTs, 4,070 persons), serious adverse events (RR = 0.82; 95% CI, 0.41-1.62; [I.sup.2] = 0%; 3 RCTs, 3,806 persons), and all-cause mortality (RR = 0.27; 95% CI, 0.04-1.70; [I.sup.2] = 49.9%; 3 RCTs, 3,806 persons), although trial sequential analysis suggested that the current total sample sizes for these outcomes were not large enough for conclusions to be drawn. Real-world studies also showed significantly decreased COVID-19 hospitalization (RR = 0.48; 95% CI, 0.37-0.60; [I.sup.2] = 95.0%; 11 RWS, 1,421,398 persons) and all-cause mortality (RR = 0.24; 95% CI, 0.14-0.34; [I.sup.2] = 65%; 7 RWS, 286,131 persons) for nirmatrelvir/ritonavir compared with no treatment. CONCLUSIONS Nirmatrelvir/ritonavir appears to be promising for preventing hospitalization and potentially decreasing all-cause mortality for persons with mild/moderately severe COVID-19, but the evidence is weak. More studies are needed. Key words: nirmatrelvir/ritonavir; Paxlovid; laboratory-confirmed COVID-19; systematic review; quantitative methods: meta-analysis; trial sequential analysis; efficacy/effectiveness; safety https://doi.org/10.1370/afm.3120, INTRODUCTION The virus responsible for the COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), remains in circulation. It mutates and keeps infecting large proportions of populations, with attributable substantial [...]

PURPOSE The COVID-19 pandemic not only exacerbated existing disparities in health care in general but likely worsened disparities in access to primary care. Our objective was to quantify the nationwide decrease in primary care visits and increase in telehealth utilization during the pandemic and explore whether certain groups of patients were disproportionately affected. METHODS We used a geographically diverse primary care electronic health record data set to examine the following 3 outcomes: (1) change in total visit volume, (2) change in in-person visit volume, and (3) the telehealth conversion ratio defined as the number of pandemic telehealth visits divided by the total number of prepandemic visits. We assessed whether these outcomes were associated with patient characteristics including age, gender, race, ethnicity, comorbidities, rurality, and area-level social deprivation. RESULTS Our primary sample included 1,652,871 patients from 408 practices. During the pandemic we observed decreases of 7% and 17% in total and in-person visit volume and a 10% telehealth conversion ratio. The greatest decreases in visit volume were observed among pediatric patients (-24%), Asian patients (-11%), and those with more comorbidities (-9%). Telehealth usage was greatest among Hispanic or Latino patients (17%) and those living in urban areas (12%). CONCLUSIONS Decreases in primary care visit volume were partially offset by increasing telehealth use for all patients during the COVID-19 pandemic, but the magnitude of these changes varied significantly across all patient characteristics. These variations have implications not only for the long-term consequences of the COVID-19 pandemic, but also for planners seeking to ready the primary care delivery system for any future systematic disruptions. Key words: COVID-19; access to primary care; telemedicine; primary health care https://doi.org/10.1370/afm.3134, INTRODUCTION Primary care is the largest platform for health care delivery in the United States, (1) and an adequate supply of primary care physicians is associated with positive and more [...]

PURPOSE Relationship continuity of care has declined across English primary health care, with cross-sectional and longitudinal variations between general practices predicted by population and service factors. We aimed to describe cross-sectional and longitudinal variations across the COVID-19 pandemic and determine whether practice factors predicted the variations. METHODS We conducted a longitudinal, ecological study of English general practices during 2018-2022 with continuity data, excluding practices with fewer than 750 patients or National Health Service (NHS) payments exceeding 500 [pounds sterling] per patient. Variables were derived from published data. The continuity measure was the product of weighted responses to 2 General Practice Patient Survey questions. In a multilevel mixed-effects model, the fixed effects were 11 variables&apos; interactions with time: baseline continuity, NHS region, deprivation, location, percentage White ethnicity, list size, general practitioner and nurse numbers, contract type, NHS payments per patient, and percentage of patients seen on the same day as booking. The random effects were practices. RESULTS Main analyses were based on 6,010 practices (out of 7,190 active practices). During 2018-2022, mean continuity in these practices declined (from 29.3% to 19.0%) and the coefficient of variation across practices increased (from 48.1% to 63.6%). Both slopes were steepest between 2021 and 2022. Practices having more general practitioners and higher percentages of patients seen the same day had slower declines. Practices having higher baseline continuity, located in certain non-London regions, and having higher percentages of White patients had faster declines. The remaining variables were not predictors. CONCLUSIONS Variables potentially associated with greater appointment availability predicted slower declines in continuity, with worsening declines and relative variability immediately after the COVID-19 lockdown, possibly reflecting surges in demand. To achieve better levels of continuity for those seeking it, practices can increase appointment availability within appointment systems that prioritize continuity. Key words: primary health care; continuity of patient care; physician-patient relationship; health workforce; delivery of health care; office visits; COVID-19; allied health personnel; telemedicine; organizational change https://doi.org/10.1370/afm.3128 Annals Early Access article, INTRODUCTION Continuity in primary (community-based) health care can be understood in different ways. (13) We aimed to study therapeutic longitudinal (relationship) continuity of care (LCoC), defined as the repeated contact [...]

This study describes the vulnerability of poor women when confronted with the shock of a social disaster in the form of the COVID-19 pandemic. Despite increasing vulnerabilities, poor women managed the uncertain situation by utilizing their survival skills. This study was conducted in the middle of 2020 in 22 districts of East Java Province with 457 married women from low-income families serving as respondents. Data were descriptively analyzed and presented in the form of diagrams and narratives. According to the findings of this study, women's vulnerability in dealing with the COVID-19 pandemic is caused by a decrease in family income and an imbalance in the domestic roles of men and women at home. Using resilience theory, this study explores how women's adaptability can help them survive in an uncertain situation. However, it was inappropriate for the government to leave these women in a subsistence economic situation; the government did not adequately support poor women through targeted and equitable social assistance programs. Following this social disaster, the role of well-targeted social assistance needs to be addressed to promote gender equality and contribute to the 2030 goals of the MDGs, which include poverty alleviation and the eradication of inequality. Keywords: Vulnerability, Poor women, Poverty, Resilience, Adaptation, Social disaster, COVID-19, Indonesia, Introduction Several studies conducted before the COVID-19 pandemic era revealed that women were quite capable of carrying out their roles in both the domestic and public sectors (Kusumawati, 2012; Ismanto [...]

Domestic violence is a serious social problem, and the number of domestic violence cases are increasing each year in Indonesia. This study aims to explore marital discord and types and triggers of domestic violence experienced by career women who worked from home during the COVID-19 pandemic (2020-2021). In this qualitative research, the researchers interviewed professional working women who experienced domestic violence perpetrated by their husbands in East Java. This study shows that marital discord escalated into domestic violence due to complications experienced when they were staying at home because of the lockdown. Daily engagement between husbands and wives had an impact on the rise in frequency and intensity of violence. Economic problems caused by the COVID-19 pandemic worsened the occurrence of violence. In a family with an unemployed husband, the nature and forms of violence varied, including physical, economic, verbal, and psychological violence, all of which add to women's suffering. Therefore, social support mechanisms from families and communities as well as policy strategies are necessary to address domestic violence. Keywords: Career women, Domestic violence, COVID-19, Marital discord, Family, Indonesia, Introduction Domestic violence is a serious problem continuing in the 21st century. In Indonesia, the number of domestic violence cases is increasing each year. The data from the National Commission [...]

This paper aims to fill a lacuna in existing literature by adopting a feminist and intersectional framework and analysis to examine the experience of racism of individual Chinese residing in the Greater Toronto Area (GTA), and to explicate how macro and meso-structural processes impact Chinese individuals and communities during COVID-19. We draw on data analysis from a Social Sciences and Humanities Research Council of Canada (SSHRC) funded research project, and focus our analysis of the experience of anti-Chinese racism before and during COVID on i) context of racialization and racism, i.e., geopolitics, Chinese culture and identity, and media representation; and ii) experiences of racialization and racism, in the form of stereotyping, microaggression, and verbal acts of racism. We demonstrate that anti-Chinese racism has persisted prior to COVID-19, however, the pandemic exacerbates precipitating racist ideologies, policies and practices, allowing them to manifest and proliferate. In particular, our paper elucidates how different forms of anti-Chinese racism interact with individuals' intersectionalities (i.e., race, class, gender, age, ability, English/French fluency, immigration/citizenship status, etc.) to further complicate how individuals are differentially targeted and how they experience racism differently. As well, our paper illuminates how individual interviewees utilize their agency to devise strategies to deal with anti-Asian racism. Keywords: Racism during COVID-19, anti-Chinese racism, anti-Asian racism, context of racialization and racism, experience of racialization and racism. Cet article vise a combler une lacune dans la litterature existante en adoptant un cadre et une analyse feministes et intersectionnels pour examiner l'experience du racisme des chinois residant dans la region du Grand Toronto (RGT), et pour expliquer comment les processus macro et mesostructurels ont eu un impact sur les individus et les communautes chinoises pendant la COVID 19. Nous nous appuyons sur l'analyse des donnees d'un projet de recherche finance par le Conseil de recherches en sciences humaines du Canada (CRSH) et nous centrons notre analyse de l'experience du racisme anti-chinois avant et pendant la COVID sur i) le contexte de la racialisation et du racisme, c'est-a-dire la geopolitique, la culture et l'identite chinoises, et la representation mediatique ; et ii) les experiences de la racialisation et du racisme, sous la forme de stereotypes, de micro-agressions et d'actes verbaux de racisme. Nous demontrons que le racisme anti-chinois a subsiste avant la COVID 19, mais que la pandemie exacerbe les ideologies, les politiques et les pratiques racistes qui l'ont precede, leur permettant de se manifester et de proliferer. Plus particulierement, notre article elucide la maniere dont les differentes formes de racisme anti-chinois interagissent avec l'intersectionnalite des individus (c'est-a-dire la race, la classe, le sexe, l'age, les capacites, la maitrise de l'anglais ou du francais, le statut d'immigrant ou de citoyen, etc. En outre, notre article met en lumiere la maniere dont les personnes interrogees utilisent leur pouvoir d'action pour elaborer des strategies de lutte contre le racisme anti-asiatique. Mots-cles: Racisme pendant la COVID 19, racisme anti-chinois, racisme anti-asiatique, contexte de racialisation et de racisme, experience de racialisation et de racisme., INTRODUCTION Concomitant with the onset of COVID-19, there has been a resurgence of anti-Chinese racism that follows similar patterns as previous pandemics such as SARS in 2003 and H1N1 in [...]

The study presented in this paper explored the relationship between corporate entrepreneurship and business model innovation of companies in Bosnia and Herzegovina (B&H) after the COVID-19 pandemic. In particular, the authors aimed to analyze how the individual dimensions of corporate entrepreneurship influence business model innovation by using the dynamic capabilities view. The study empirically analysed a sample of 100 companies using regression analysis. The findings revealed that each dimension of corporate entrepreneurship positively and significantly impacts business model innovation. Innovativeness, proactiveness, risk-taking, autonomy, and competitive aggressiveness positively affected the innovation of the business model. The results of this study confirm that entrepreneurial initiative is a good predictor of a company's ability to innovate business models. The implication for management is to deepen the understanding of how corporate entrepreneurship promotes and shapes an innovative business model. This increases companies' success and overall well-being in B&H after the COVID-19 pandemic. KEYWORDS: corporate entrepreneurship, business model innovation, innovativeness, proactiveness, risk-taking, autonomy, competitive aggressiveness, dynamic capabilities view., 1. INTRODUCTION The COVID-19 pandemic has damaged economies around the world, although the extent of the damage is difficult to assess. Economic development slowdown is evident in developed and developing [...]

This paper aims to examine how digitalization played a vital role in enabling women-led businesses to navigate the challenges of the pandemic and explore the strategies they implemented for this purpose. Many countries were unprepared to cope with such a catastrophic situation, leading to significant consequences across various sectors. Therefore, this study emphasizes the importance of digitizing business processes and provides insights into how businesses have adapted to this challenge. In addition, the paper includes a thorough analysis of studies conducted by various authors who have explored this topic. This research paper is a qualitative case study and draws on primary and secondary data sources. The primary data was obtained by distributing questionnaires to selected companies to gain insights into their working methods throughout the pandemic. From the information gathered, it is evident that digitalization became imperative during the pandemic. However, this transition came with challenges in adapting the workforce to remote working arrangements. It is worth noting that the companies examined in this study are run by women, a particularly affected demographic during the pandemic. In terms of government decisions, several business support packages were adopted. This paper argues that women-led businesses should receive more support to operate more freely, digitize their work processes, improve well-being, and increase both turnover and the number of their employees. KEYWORDS: digitalization; small and medium enterprises (SMEs); female entrepreneurship; COVID-19; Kosovo, 1. INTRODUCTION In March 2020, the World Health Organization declared the COVID-19 outbreak, attributed to the SARS-CoV-2 virus, a pandemic (Ducharme, 2020). The COVID-19 pandemic became a global challenge that [...]

COVID-19 has caused a significant global disease burden since it was first identified in December 2019; as of May 2024, [greater than or equal to]750 million cases had been confirmed, [...]

As of November 1, 2023, [approximately equal to]1 million COVID-19 deaths have been reported in the United States (1) including >15,000 among Minnesota residents (2). The literature suggests that for [...]

Globally, the COVID-19 pandemic resulted in >650 million infections and 6.5 million deaths during March 2020-December 2022 (2,2). Uganda recorded its first case of SARS-CoV-2 infection on March 21, 2020; [...]

The global COVID-19 pandemic, caused by SARSCoV-2, dramatically disrupted the lives of persons around the world, resulting in record numbers of cases and deaths (1). In the early stages of [...]

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis has been reported after severe acute respiratory disease coronavirus 2 (SARS-CoV-2) vaccination rarely. We report the second known case of anti-NMDAR encephalitis after receiving fourth dose of SARS-CoV-2 vaccine in a middle-aged male presenting with stroke-like symptoms, highlighting a rare potential neuroinflammatory complication of vaccination against SARS-CoV-2 that is currently being distributed worldwide. Despite the occurrence of such rare adverse events, the benefits of COVID-19 vaccination outweigh concerns over neurologic complications. Keywords: Autoimmune encephalitis, booster dose, SARS-CoV-2 vaccine, Author(s): Mohammad Sayadnasiri (corresponding author) [1]; Fereydoun Layeghi [2] Key Message: The SARS-CoV-2 vaccine has some rare neurological side effects that should be considered in patients, but the benefits of [...]

Mycoplasma pneumoniae is a major cause of respiratory tract infections, particularly in children and young adults. M. pneumoniae accounts for 10%-30%) of community-acquired pneumonia (1). Macrolides are the primary treatment, [...]

Arthropodborne viruses are distinguished by alternating transmission between arthropod vectors and vertebrates. Some of the most clinically relevant arboviruses (e.g., dengue, Zika, and yellow fever) belong to the genus Flavivirus. [...]