This cohort study assesses the incidence of emergency department (ED) visits in Hong Kong, China, for sexual abuse among youth before and during the COVID-19 pandemic.

Prevalent coagulopathy and thromboembolism are observed in severe COVID-19 patients with 40% of COVID-19 mortality being associated with cardiovascular complications. Abnormal coagulation parameters are related to poor prognosis in COVID-19 patients. Victims also displayed presence of extensive thrombosis in infected lungs. Vitamin K is well-known to play an essential role in the coagulation system. Latest study revealed an existing correlation between vitamin K deficiency and COVID-19 severity, highlighting a role of vitamin K, probably via coagulation modulation. In agreement, other recent studies also indicated that anti-coagulant treatments can reduce mortality in severe cases. Altogether, potential mechanisms linking COVID-19 with coagulopathy in which vitamin K may exert its modulating role in coagulation related with disease pathogenesis are established. In this review, we discuss the recent evidence supporting COVID-19 as a vascular disease and explore the potential benefits of using vitamin K against COVID-19 to improve disease outcomes.

The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.

BACKGROUND Healthcare avoidance in the COVID-19 Pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behaviour during pandemic waves and inferred its impact on excess non-COVID-19 death toll. OBJECTIVE To measure the impact of hospital avoidance behaviour on excess mortality using emergency department (ED) patient data from 2016 to 2021, during which Hong Kong experienced a unique COVID-19 pandemic with four distinct waves of case number surges. METHODS Our data is taken from the CDARS Hong Kong Hospital Authority administrative database, which oversees all local public hospitals and plays a prominent role in emergency care provision. To estimate excess mortality, two-stage least squares was utilised with daily tallies of ED visit and 28-day mortality. Elderly records were categorised by the residential care home for elderly status (RCHE) and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. RESULTS Compared with the average in 2016-2019 average there was a reduction in total ED visits in 2020 of 25·4%. During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7·82% compared with 2016-2019. The estimated total elderly excess non-COVID 28-day death by reduced ED visits throughout 2020 to 2021 is 1,958 (1,100-2,820, no time lag). The actual excess death in 2020 and 2021 are 3,143 and 4,013 respectively, with 2016-2019 average as the benchmark. Death on Arrival (DOA)/ Death before Arrival (DBA) increased by 35·1% in 2020, while non-DOA/DBA mortalities increased only by a moderate 4·65%. In both DOA/DBA and non-DOA/DBA, the increases were higher during wave periods than in non-wave periods. Moreover, non-RCHE patients saw a greater reduction in ED visit than RCHE residents across all waves by more than 10%. Most of the subset comorbidities demonstrated an annualised reduction in visit in 2020. Renal diseases and severe liver diseases saw a notable death increase. CONCLUSIONS We demonstrated a statistical method to estimate hospital avoidance behaviour during a pandemic, and quantified the consequential excess 28-day mortality, with a focus on elderlies, who had high frequencies of ED visit and deaths. This study serves as an informed alert and possible investigation guideline to healthcare professionals about hospital avoidance behaviour and its consequences.