Background The COVID-19 pandemic profoundly affected food systems including food security. Understanding how the COVID-19 pandemic impacted food security is important to provide support, and identify long-term impacts and needs. Objective The National Food Access and COVID research Team (NFACT) was formed to assess food security over different U.S. study sites throughout the pandemic, using common instruments and measurements. This study present results from 18 study sites across 15 states and nationally over the first year of the COVID-19 pandemic. Methods A validated survey instrument was developed and implemented in whole or part through an online survey of adults across the sites throughout the first year of the pandemic, representing 22 separate surveys. Sampling methods for each study site were convenience, representative, or high-risk targeted. Food security was measured using the USDA six-item module. Food security prevalence was analyzed using analysis of variance by sampling method to statistically significant differences. Results Respondents (n = 27,168) indicate higher prevalence of food insecurity (low or very low food security) since the COVID-19 pandemic, as compared to before the pandemic. In nearly all study sites, there is higher prevalence of food insecurity among Black, Indigenous, and People of Color (BIPOC), households with children, and those with job disruptions. The findings demonstrate lingering food insecurity, with high prevalence over time in sites with repeat cross-sectional surveys. There are no statistically significant differences between convenience and representative surveys, but statistically higher prevalence of food insecurity among high-risk compared to convenience surveys. Conclusions This comprehensive study demonstrates higher prevalence of food insecurity in the first year of the COVID-19 pandemic. These impacts were prevalent for certain demographic groups, and most pronounced for surveys targeting high-risk populations. Results especially document the continued high levels of food insecurity, as well as the variability in estimates due to survey implementation method. Summary Multi-site assessment demonstrates widespread food insecurity during COVID-19, especially on households with children, job loss, and Black, Indigenous, People of Color across multiple survey methods.

Four transcranial magnetic stimulation (TMS) devices are currently approved for use in treatment-resistant depression. The authors present the first data-driven study examining the patient- and technician-experience using three of these distinct devices. A retrospective survey design with both patient and technician arms was utilized. The study population included patients who received TMS for treatment-resistant depression at the Berenson Allen Center for Noninvasive Brain Stimulation for the first time between 2013 and 2016 and technicians who worked in the program from 2009 to 2017. Statistical analysis included t tests and analyses of variance to assess differences between and across the multiple groups, respectively. Patients treated with the NeuroStar device reported greater confidence that the treatment was being performed correctly compared with those treated with the Magstim device. Conversely, with regard to tolerability, patients treated with the Magstim device reported less pain in the last week and less pain on average compared with those treated with the NeuroStar device. On average, technicians reported feeling that both the Magstim and NeuroStar devices were significantly easier to use than the Brainsway Deep TMS H-Coil device. Additionally, they found the former two devices to be more reliable and better tolerated. Furthermore, the technicians reported greater confidence in the Magstim and NeuroStar devices compared with the Brainsway Deep TMS H-Coil device and indicated that they would be more likely to recommend the two former devices to other treatment centers.

ObjectivesThe objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations.DesignA systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews.Data sourcesMEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021.Eligibility criteria for selected studiesInclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools.Data extraction and synthesisTwo reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation.ResultsA total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings.ConclusionOur results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved.

Introduction As part of a study to assess the impact of the COVID-19 pandemic on the sleep of patients of a multidisciplinary sleep clinic, we surveyed how they accessed healthcare for sleep problems. Methods Patients were invited to complete an online survey in October 2020. Results 74 patients completed the survey (mean age 50.2 years, range 21–83 years, 56.8% female). 26/74 (35%) reported at least one delay in accessing healthcare for sleep problems. In particular, 7/49 (14.3%) had delays seeing a general practitioner whilst 16/43 (37.2%) experienced delays accessing a sleep physician. 7/26 (26.9%) reported delays booking a sleep study and 4/15 (26.7%) had delays hiring continuous positive airway pressure equipment. 11/31 (35.5%) experienced delays seeing a psychologist for sleep problems. 11/74 (14.9%) preferred to wait until they were able to attend the clinic in person. 21/74 (28.4%) had telehealth consultations with a sleep physician and/or psychologist. 19/21 (90.5%) described it easy to participate and 20/21 (95.2%) reported receiving satisfactory care through telehealth consultation. Only 5/21 (23.8%) preferred to attend in-person instead of participating in a telehealth consultation again. 11/74 (14.9%) had telephone consultations with a sleep physician and/or psychologist. 8/11 (72.7%) found it easy to participate and 8/11 (72.7%) reported receiving satisfactory care through telephone consultation. Only 3/11 (27.3%) preferred to attend in-person instead of participating in a telephone consultation again. Discussion During the COVID-19 pandemic, 35% of patients reported delays accessing healthcare for sleep problems. Most patients who participated in telehealth and telephone consultations described positive experiences.

Introduction Shift work disorder (SWD) involves excessive sleepiness and/or insomnia and is associated with poor health outcomes in those affected. This study assessed the prevalence of and risk factors for SWD during the first six-months of paramedics’ careers. Furthermore, the study explored potential mediators in the relationship between mental health and SWD risk. Methods Recruit paramedics’ (n=101) SWD risk (SWD-Screening Questionnaire) was assessed at baseline (i.e., before shift work) and at six-months after engaging in shift work as a graduate paramedic. Logistic regression models assessed whether baseline depression (Patient Health Questionnaire-9) and baseline anxiety (Generalised Anxiety Disorder Questionnaire-7) predicted a high risk for SWD at six-months. Lavaan path analysis was used to assess whether shift and sleep variables, created from participants’ sleep and work diaries, mediated the relationship between mental health and SWD risk. Results After six-months of emergency work 21.5% of paramedics were high risk for SWD. Baseline depression predicted 1.28-times greater odds for SWD at six-months. Shift and sleep variables were not mediators in the relationship between baseline mental health and subsequent SWD risk. Baseline depression was independently associated with increased sleepiness levels following paramedics’ major sleep periods across all work conditions (nightshift, workdays, and non-workdays) at six-months. Depression levels before shift work also predicted a greater perceived workload on nightshifts. Conclusions Depression symptoms before starting shift work are a modifiable risk factor for SWD. Moreover, the first six-months of paramedics’ careers is a critical period for implementing preventative measures for SWD, including interventions to decrease depression symptoms.