关键词： COVID-19   abortion, induced   family planning services   Reproductive Rights   Reproductive Health Services   Sexual Health   CITY  

摘要： Background We describe clients in Mexico City's public abortion programme, Interrupci & oacute;n Legal de Embarazo (ILE), during the COVID-19 pandemic and test whether the pandemic exacerbated inequities in *** We conducted a cohort study of all abortions in the ILE programme from 1 January 2019 to 30 June 2022. We compared patients from within and outside the Mexico City Metropolitan area (ZMVM) by pandemic stage (pre-, acute-, mid- and late-COVID periods) and assessed changes in client characteristics (adolescent age, education, weeks' gestation) by place of residence (ZMVM vs outside the ZMVM) using linear probability models clustered on *** We included 45 031 abortions. The proportion of abortions to women who travelled from outside the ZMVM decreased from 6.5% pre-COVID to 4.4%-4.8% in in the acute, mid- and late-COVID periods. The adjusted probability of being an adolescent who travelled from outside the ZMVM dropped between pre-COVID (14.4%, 95% CI 12.7% to 16.1%) and mid-COVID (9.3%, 95% CI 7.9% to 10.7%). The proportion of abortions to women with a high school education stayed fairly flat among those travelling, while it rose among those residing in the ZMVM. The adjusted probability of presenting at 11 gestational weeks or greater was higher among women residing in the ZMVM in the pre-pandemic period; this flipped during all pandemic stages, with a higher probability of presenting at 11 weeks or greater among those who travelled from outside the *** The COVID-19 pandemic exacerbated existing disparities in who can access ILE services. To reduce inequities in access to essential health services, public sector abortion services should be made available in all Mexican states.

关键词： Clinical status   hazard ratio   mortality   odds ratio   time to recovery   totality of evidence  

摘要： Background The current endpoints for therapeutic trials of hospitalized COVID-19 patients capture only part of the clinical course of a patient and have limited statistical power and robustness. Methods We specify proportional odds models for repeated measures of clinical status, with a common odds ratio of lower severity over time. We also specify the proportional hazards model for time to each level of improvement or deterioration of clinical status, with a common hazard ratio for overall treatment benefit. We apply these methods to Adaptive COVID-19 Treatment Trials. Results For remdesivir versus placebo, the common odds ratio was 1.48 (95% confidence interval (CI) = 1.23-1.79; p < 0.001), and the common hazard ratio was 1.27 (95% CI = 1.09-1.47; p = 0.002). For baricitinib plus remdesivir versus remdesivir alone, the common odds ratio was 1.32 (95% CI = 1.10-1.57; p = 0.002), and the common hazard ratio was 1.30 (95% CI = 1.13-1.49; p < 0.001). For interferon beta-1a plus remdesivir versus remdesivir alone, the common odds ratio was 0.95 (95% CI = 0.79-1.14; p = 0.56), and the common hazard ratio was 0.98 (95% CI = 0.85-1.12; p = 0.74). Conclusions The proposed methods comprehensively characterize the treatment effects on the entire clinical course of a hospitalized COVID-19 patient.

关键词： COVID-19   Mortality prediction   SOFA score   SOFA SCORE   ACUTE PHYSIOLOGY  

摘要： Objective: To determine the accuracy and reliability of the sequential organ failure assessment (SOFA) score in predicting the risk of mortality in ICU-admitted COVID-19 patients. Study Design: Cross-sectional study. Place and Duration of the Study: COVID Intensive Care Unit (ICU), The Aga Khan University Hospital, Karachi, from January to June 2022. Methodology: A total of 62 patients with a positive RT-PCR for COVID-19, admitted into the intensive care unit (ICU), were included in this descriptive cross-sectional study. Written informed consent was obtained after explaining the risks and benefits of the study to the patients / next of kin. SOFA score at the time of admission and 48 hours after admission was calculated. The outcome variable, i.e., mortality, was assessed in association with the SOFA score. Results: The study had a predominantly male population of 54.8% (n = 34). The SOFA score >7 at admission and 48 hours after admission was observed in 46.8% (n = 29) patients. Among 62 COVID-19 patients, the majority were found to have a severe nature of the disease, i.e., 69.4% (n = 43), followed by moderate / mild cases 30.6% (n = 19). Depending on the requirement of the patient, 74.2% (n = 46) were invasively ventilated while 77.4% (n = 48) were on non-invasive ventilation. Overall the mortality rate of the present study was 43.5% (n = 27). The scores both at the time of admission and 48 hours after admission for the survivors had a significant difference (p = 0.001) with the non-survivors. Conclusion: The SOFA score on admission and 48 hours after had a significant positive association with the severity of COVID-19 infection and its risk of mortality.

关键词： Silent hypoxemia   Breathing control   Central pattern generator   Computational modeling   COVID-19   Polycythemia   Sensory feedback   PRE-BOTZINGER COMPLEX   HEMOGLOBIN CONCENTRATION   VENTILATORY RESPONSE   SUSTAINED HYPOXIA   GAS-EXCHANGE   DYSPNEA   MORTALITY   SEVERITY   ADULTS   PAIN  

摘要： Silent hypoxemia, or "happy hypoxia," is a puzzling phenomenon in which patients who have contracted COVID-19 exhibitvery low oxygen saturation (SaO(2)<80%) but do not experience discomfort in breathing. The mechanism by which thisblunted response to hypoxia occurs is unknown. We have previously shown that a computational model of the respiratoryneural network (Diekman et al. in J Neurophysiol 118(4):2194-2215, 2017) can be used to test hypotheses focused on changesin chemosensory inputs to the central pattern generator (CPG). We hypothesize that altered chemosensory function at thelevel of the carotid bodies and/or thenucleus tractus solitariiare responsible for the blunted response to hypoxia. Here, weuse our model to explore this hypothesis by altering the properties of the gain function representing oxygen sensing inputs tothe CPG. We then vary other parameters in the model and show that oxygen carrying capacity is the most salient factor forproducing silent hypoxemia. We call for clinicians to measure hematocrit as a clinical index of altered physiology in responseto COVID-19 infection.

关键词： Counterurbanisation   COVID-19 pandemic   Rural resurgence   Global north rural   Urban-rural relations   COVID-19   AREAS  

摘要： This review paper draws upon a wide range of diverse international sources to give a still relatively early assessment of the extent to which the COVID-19 pandemic stimulated a resurgence of counterurbanisation across much of the global North. Whilst it finds and argues that a 'resurgence' was apparent, it may not have been as strong or lasting as was suggested by media reports in particular. Indeed, numerous challenges to any such a resurgence are noted, drawn especially from recent reflections on the pandemic period. Nonetheless, any counterurban revival is seen as being significant more widely as it fits with a wider resurgent interest in 'all things rural' that pre-dated COVID-19 but was stimulated further by it. In contrast to the widely celebrated rural, the paper also notes how city life was often seen as unsatisfactory during the pandemic, not least because its usual underpinning by diverse everyday mobilities was strongly compromised. This condition stimulated, in particular, a turn to rural often more for pragmatic than idealistic reasons, such as for health and to have more freedom and space. Overall, the whole COVID-19 experience sits within a range of political questions about access to space centrally involving the rural.

关键词： favipiravir   kidney dysfunction   pharmacokinetics   COVID-19  

摘要： Objective: There is limited information on favipiravir pharmacokinetics in critically ill patients and no studies on pharmacokinetics in patients with moderate and severe kidney dysfunction. The aim was to determine favipiravir pharmacokinetics (oral, 1,600 mg, q12h on day 1, then 600 mg, q12h for 4 days) in critically ill COVID-19 patients with kidney dysfunction and to compare those with observations reported in healthy adults. Materials and methods: In a descriptive study, blood samples taken from patients meeting the relevant criteria (estimated glomerular filtration rate < 60 mL/ min) were collected and analyzed. Analysis of blood samples was done by high performance liquid chromatography (HPLC), and the maximal concentration (C-max), the time of maximal concentration (t(max)), half-life (T-1/2) and area under the curve (AUC(0-12h)) of favipiravir were calculated (WinNonlin) and compared to reported data in healthy subjects after first administration. Results: Based on analysis of samples collected in 7 patients, the C-max (29.99 vs. 64.5 g/mL) of favipiravir was decreased, T-1/2 (5.8 vs. 4.8 hours) longer, t max delayed, while total exposure was lower (AUC(0-12): 192.53 vs. 446.09 mu g/ mL) compared to reported data in healthy subjects after first administration. Exposure remained lower up to day 5. Conclusion: In patients with kidney dysfunction related to COVID-19, favipiravir did not reach the expected exposure. This may be due to poorer and delayed absorption, and subsequent altered disposition. Population pharmacokinetic and mechanistic studies are needed to better explore the relevant covariates and to determine the optimal dose in these patients, as this drug is likely of relevance for other indications.

关键词： Green entrepreneurial orientation   Green marketing orientation   SME's resilience   Innovation capabilities   Network ties  

摘要： The purpose of this study is to investigate the impact of green entrepreneurial orientations and green marketing orientations on the resilience of small and medium enterprises (SMEs) amidst the COVID-19 pandemic. Furthermore, it explores the mediating role of innovative capabilities and the moderating role of network ties between these relations. A quantitative research approach was used and data were collected from 450 managers and owners from different SMEs in China. By using a purposive sampling technique. Data was collected by using a structured questionnaire. After gathering the data, the proposed relationships were tested by analyzing it through structural equation modeling (SEM). The findings of the study showed that green entrepreneurial orientation and green marketing orientation have a significant impact on SMEs' resilience. Furthermore, innovative capabilities significantly mediate the relationship between green entrepreneurial orientation, green marketing orientation, and SMEs resilience. Additionally, network ties significantly moderate the connections between independent variables (IVs) and dependent variables (DV). This study contributes to the existing body of literature by examining the relationships between green entrepreneurial orientations, green marketing orientation, innovative capabilities, network ties, and the resilience of SMEs in the context of the COVID-19 pandemic. The findings provide practical implications for SME managers, policymakers, and entrepreneurs, offering insights to enhance sustainability and resilience. Moreover, this study contributes to theoretical knowledge by highlighting the mediating role of innovative capabilities and the moderating role of network ties in the examined relationships.

关键词： QUALITATIVE RESEARCH   CREDIBILITY   CONSTRUCT   WORK  

摘要： ObjectivesEarly in the COVID-19 pandemic, little was known about managing sick patients, but emergency department (ED) clinicians had to decide which treatments and care processes to adopt. Our objective was to describe how ED clinicians learned about innovations and how they assessed them for credibility during the *** purposively sampled clinicians from hospital-based EDs to conduct focus groups with ED clinicians and staff. We used both inductive and deductive approaches to conduct thematic analysis of *** conducted focus groups with clinicians from eight EDs across the United States. We found that ED clinicians in our sample relied on friends and colleagues or departmental and institutional leadership for information on innovations. They used social media sources when they came from credible accounts but did not directly seek information from professional societies. Clinicians reported a range of challenges to obtain credible information during the pandemic, including a fractured and changing information environment, policies misaligned across clinical sites or that conflicted with clinical knowledge, high patient volume, fear of harming patients, and untimely information. Facilitators included access to experienced and trusted colleagues and leaders and practicing at multiple *** cited anecdotal evidence, institutional practice, and word-of-mouth-rather than peer-reviewed evidence and professional society communications-as their primary sources of information about care innovations during the early phases of the pandemic. These results underscore the importance of developing trusted local mechanisms and wider networks to identify and vet information for frontline clinicians during rapidly emerging public health emergencies.

关键词： COVID-19   dentistry   pandemic   pediatric dentistry   teaching   university  

摘要： Purpose To assess the impact of transformations in pediatric dental clinics following reopening during the COVID-19 pandemic on pediatric dentistry procedures performed by dental students. Methods Data were collected from electronic clinical records of Integrated Dental Clinical disciplines (I, II, III, and IV) from 2018 to 2023. The procedures were categorized into phases: prevention/stabilization, restorative/definitive, and maintenance. The data were analyzed descriptively and by t-test considering the pre-pandemic and pandemic periods (alpha = 5%). Results During the pandemic, Integrated Dental Clinics I and III saw increased prevention/stabilization procedures percentages (92.4% and 74.3%) compared to pre-pandemic (84.9% and 70%), while Integrated Dental Clinic II and IV saw a decline (76.6% and 66.1%) compared to pre-pandemic (79.1% and 67.9%). Restorative/definitive procedures decreased in Integrated Dental Clinic I and III (5.5% and 20.3%) from pre-pandemic period (10% and 24.1%) but increased in Integrated Dental Clinic II and IV (18.3% and 26.2%) from pre-pandemic (15.3% and 25%). Maintenance procedures decreased in Integrated Dental Clinic I, II, and III (2.1%, 5%, and 5.4%) compared to pre-pandemic (5.1%, 5.6%, and 6%), except for Integrated Dental Clinic IV, which saw an increase (7.8% from 7.2%). Despite the percentage changes, no significant differences were found between the periods analyzed (p > 0.05). However, when considering the total procedures across all disciplines and phases, there was a significant decrease during the pandemic in phases 1 and 3 (p < 0.05). Conclusion Despite the changes in pediatric dentistry procedures, the transformations within the dental clinic suggest tangible benefits for the teaching-learning process and safe patient care.

关键词： menopause   COVID-19   fear   SARS-CoV-2   QUALITY-OF-LIFE   ANXIETY   HEALTH   DEPRESSION   TRANSITION   PREVALENCE   OUTBREAK   NURSES   SIGNS  

摘要： Objectives: This study aimed to determine the relationship between the fear of COVID-19 and menopausal symptoms in women during the menopausal period. Methods: This study is a descriptive cross-sectional study. This study was completed with a total of 161 women who met the inclusion criteria. Data were collected face-to-face using the Personnel Information Form, Menopause Symptom Assessment Scale, and Coronavirus 19 Phobia Scale. Results: There is a slightly positive relationship between the social subscale of the COVID-19 fear scale and the somatic subscale of the menopause symptoms scale. There is a slightly positive relationship between the economic subscale of the COVID-19 scale and the psychological subscale of the menopausal symptoms scale. There is a slightly positive correlation between the total score of the total COVID-19 phobia scale and the somatic and psychological subscales of the menopause symptoms assessment scale. However, there is no significant relationship between the total score of the COVID-19 phobia scale and the total score and urological subscale of the menopause symptoms assessment scale. Conclusions: It has been determined that fear of COVID-19 is slightly positively associated with somatic and psychological complaints in menopausal women.