Assessment of COVID-19–Driven Changes in an Integrated OBGYN-Addiction Treatment Clinic and Future Implications

ObjectiveThe COVID-19 pandemic prompted healthcare delivery changes, but the associated impacts on substance use disorder treatment outcomes among pregnant and parenting people are unknown. This study aims to (1) describe COVID-19–driven clinical practice changes, (2) evaluate clinic-level visit attendance patterns, and (3) compare patient-level treatment engagement outcomes across 3 COVID-19 pandemic phases in an OBGYN-addiction treatment clinic.Methods COVID-19 phases include pre–COVID-19 (August 2019–February 2020), early COVID-19 (March–December 2020), and COVID-19 vaccine (January–July 2021). OBGYN-addiction treatment clinical practice changes were summarized. Clinic-level attended medical provider visits were analyzed. Patient-level treatment engagement outcomes (buprenorphine continuation, visit attendance, and virtual visits) were assessed in a cohort of pregnant and parenting people enrolled in a clinic research registry. Mixed-level logistic regression models determined the relationship between the COVID-19 phases and the patient-level outcomes.Results The study site made several COVID-19–driven clinical practice changes, including implementing a hybrid virtual/in-person system for medical visits. Clinic-level medical provider appointments increased between the first and second COVID-19 phases and remained high in the third phase. Among participants included in patient-level outcome analyses (N = 27), there were no differences in the early COVID-19 phase compared with the pre–COVID-19 phase in buprenorphine continuation, any visits, or medical visits. There was a decrease in all patient-level outcomes in the COVID-19 vaccine phase compared with pre–COVID-19 (P < 0.05). Virtual visits increased between the first 2 phases and remained high during the third.Conclusion Within our OBGYN-addiction treatment clinic, implementation of tailored, patient-centered treatment strategies supported clinic- and patient-level treatment engagement throughout the pandemic

Free-living amoebae and their associated bacteria in Austrian cooling towers: a 1-year routine screening

Free-living amoebae (FLA) are widely spread in the environment and known to cause rare but often serious infections. Besides this, FLA may serve as vehicles for bacterial pathogens. In particular, Legionella pneumophila is known to replicate within FLA thereby also gaining enhanced infectivity. Cooling towers have been the source of outbreaks of Legionnaires' disease in the past and are thus usually screened for legionellae on a routine basis, not considering, however, FLA and their vehicle function. The aim of this study was to incorporate a screening system for host amoebae into a Legionella routine screening. A new real-time PCR-based screening system for various groups of FLA was established. Three cooling towers were screened every 2 weeks over the period of 1 year for FLA and Legionella spp., by culture and molecular methods in parallel. Altogether, 83.3 % of the cooling tower samples were positive for FLA, Acanthamoeba being the dominating genus. Interestingly, 69.7 % of the cooling tower samples were not suitable for the standard Legionella screening due to their high organic burden. In the remaining samples, positivity for Legionella spp. was 25 % by culture, but overall positivity was 50 % by molecular methods. Several amoebal isolates revealed intracellular bacteria.TRP 209-B20(VLID)308958

Assessment of COVID-19 Driven Changes in an Integrated OBGYN Addiction Treatment Clinic

Introduction:The COVID-19 pandemic emerged in the midst of the persistent opioid overdose epidemic in the United States. COVID-19 incidence and mortality are particularly high among at-risk groups, including those with opioid use disorder (OUD). Pregnant and parenting people are particularly vulnerable to the risks associated with both COVID-19 and OUD. Through the COVID-19 pandemic, changes in the delivery of care, such as a switch from face-to-face consultations to telemedicine, were made to optimize the accessibility and quality of care. No study has evaluated how OUD treatment outcomes evolved during the implementation of these care provision changes amongst this high priority population. This study compares buprenorphine continuation and visit attendance across three COVID-19 pandemic phases among pregnant and parenting people receiving buprenorphine for OUD.Methods:We conducted a secondary analysis from a cohort of patients from an OBGYN addiction treatment clinic research registry. All patients are invited to participate in the registry. For those who consent, monthly chart abstractions are conducted beginning with their first clinic visit. Inclusion criteria for the current study were having an OUD diagnosis, receiving buprenorphine during at least one 30-day period during the pre-COVID-19 phase, and initiating treatment by January 2020. Outcomes were buprenorphine continuation, total visit attendance (including behavioral health and medical provider visits) and percentage of virtual visits for each of the 30-day periods. Our independent variables were three COVID-19 phases: pre-COVID-19 phase (August 2019 - February 2020), early-COVID-19 phase (March 2020- December 2020), and late-COVID-19 phase (January 2021 - June 2021). Cohort characteristics are described using univariate statistics. Mixed effect regression models controlling for insurance type, age, race, and duration of treatment determined the impact of the COVID-19 phases on the outcome variables.Results:Participants (N=27) were about half Black (48.2%) and half White (51.9%) with a mean age of 31 years (SD=4.0). Most had Medicaid insurance (85.2%), were unemployed (74.1%), and living in their home (66.7%). More than half of the participants had custody of at least one child (63%). All had a mental health comorbidity and about half (51.9%) were prescribed psychiatric medications. The cohort averaged 23.31 (range 19-25) 30-day treatment periods during the study timeframe. Buprenorphine continuation significantly decreased after the pre-COVID-19 phase (96.5%, 91.2%, and 74.6%) of 30-day periods in each phase respectively. Overall, visit attendance in 30-day periods decreased significantly from the pre-COVID-19 phase(89.5%) to the early-COVID-19 phase (79.9%) and late-COVID-19 phase (64.6%). Percentage of 30-day periods with medical provider visits decreased significantly only for the third phase (86.7%, 78.0%, 64.6%) and behavioral health visits decreased significantly overall (32.3%, 19.8%, 7.2%). Percentage of 30-day periods with virtual visits increased substantially between the first two phases and remained high during the late-COVID-19 phase (0.39%, 47.8%, 39.6%).Conclusion:Buprenorphine continuation and visit attendance declined over the three COVID-19 phases. Yet, treatment engagement remained relatively high likely due to implementation of patient-centered treatment strategies that support recovery. The high rate of virtual visits into the late-COVID-19 phase further demonstrates that healthcare accessibility can be achieved for vulnerable populations in a telehealth-system

Assessment of COVID-19 Driven Changes in an Integrated OBGYN Addiction Treatment Clinic

Introduction:The COVID-19 pandemic emerged in the midst of the persistent opioid overdose epidemic in the United States. COVID-19 incidence and mortality are particularly high among at-risk groups, including those with opioid use disorder (OUD). Pregnant and parenting people are particularly vulnerable to the risks associated with both COVID-19 and OUD. Through the COVID-19 pandemic, changes in the delivery of care, such as a switch from face-to-face consultations to telemedicine, were made to optimize the accessibility and quality of care. No study has evaluated how OUD treatment outcomes evolved during the implementation of these care provision changes amongst this high priority population. This study compares buprenorphine continuation and visit attendance across three COVID-19 pandemic phases among pregnant and parenting people receiving buprenorphine for OUD.Methods:We conducted a secondary analysis from a cohort of patients from an OBGYN addiction treatment clinic research registry. All patients are invited to participate in the registry. For those who consent, monthly chart abstractions are conducted beginning with their first clinic visit. Inclusion criteria for the current study were having an OUD diagnosis, receiving buprenorphine during at least one 30-day period during the pre-COVID-19 phase, and initiating treatment by January 2020. Outcomes were buprenorphine continuation, total visit attendance (including behavioral health and medical provider visits) and percentage of virtual visits for each of the 30-day periods. Our independent variables were three COVID-19 phases: pre-COVID-19 phase (August 2019 - February 2020), early-COVID-19 phase (March 2020- December 2020), and late-COVID-19 phase (January 2021 - June 2021). Cohort characteristics are described using univariate statistics. Mixed effect regression models controlling for insurance type, age, race, and duration of treatment determined the impact of the COVID-19 phases on the outcome variables.Results:Participants (N=27) were about half Black (48.2%) and half White (51.9%) with a mean age of 31 years (SD=4.0). Most had Medicaid insurance (85.2%), were unemployed (74.1%), and living in their home (66.7%). More than half of the participants had custody of at least one child (63%). All had a mental health comorbidity and about half (51.9%) were prescribed psychiatric medications. The cohort averaged 23.31 (range 19-25) 30-day treatment periods during the study timeframe. Buprenorphine continuation significantly decreased after the pre-COVID-19 phase (96.5%, 91.2%, and 74.6%) of 30-day periods in each phase respectively. Overall, visit attendance in 30-day periods decreased significantly from the pre-COVID-19 phase(89.5%) to the early-COVID-19 phase (79.9%) and late-COVID-19 phase (64.6%). Percentage of 30-day periods with medical provider visits decreased significantly only for the third phase (86.7%, 78.0%, 64.6%) and behavioral health visits decreased significantly overall (32.3%, 19.8%, 7.2%). Percentage of 30-day periods with virtual visits increased substantially between the first two phases and remained high during the late-COVID-19 phase (0.39%, 47.8%, 39.6%).Conclusion:Buprenorphine continuation and visit attendance declined over the three COVID-19 phases. Yet, treatment engagement remained relatively high likely due to implementation of patient-centered treatment strategies that support recovery. The high rate of virtual visits into the late-COVID-19 phase further demonstrates that healthcare accessibility can be achieved for vulnerable populations in a telehealth-system

Planification stratégique pour la gestion des écosystèmes de rivières alpines

International audienceWithin the framework of the Interreg Alpine Space project "SPARE", project partners from six Alpine countries are working together to advance the harmonization of human use requirements and the protection of Alpine rivers. Five different pilot areas across the Alpine space (Dora Baltea, IT; Drôme, FR; Inn, CH; Soča, SL; Steyr, AT) are committed to integrative river and catchment management, and engaged in participatory processes, to improve existing river management practices and to increase awareness and knowledge about the ecosystem services of healthy rivers. The poster will present preliminary outputs of the three-year project, such as the experiences learnt from the five pilot areas, a pan-Alpine overview of priority rivers with high protection needs and an interactive online platform for knowledge exchange & policy support.Dans le cadre du projet Interreg Alpine Space «SPARE», les partenaires du projet de six pays alpins travaillent ensemble pour faire progresser l'harmonisation des besoins humains avec la protection des écosystèmes aquatiques. Cinq zones pilotes à travers l'espace alpin (Dora Baltea, IT, Drôme, FR, Inn, CH, Soča, SL, Steyr, AT) se sont engagées à gérer leurs rivières et bassins versants de manière intégrative, et à mettre en oeuvre des processus participatifs, à la fois pour améliorer les pratiques de gestion des rivières et pour accroître la sensibilisation et les connaissances sur les services écosystémiques des rivières en bonne santé. Le poster présentera les résultats préliminaires du projet triennal, tels que les expériences acquises dans les cinq zones pilotes, un aperçu pan-alpin des cours d'eau prioritaires ayant des besoins de protection élevés et une plateforme interactive en ligne pour l'échange de connaissances et l'appui aux politique