1Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA; 2G Oppenheimer Center for Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California, Los Angeles, California, USA. Correspondence: Lin Chang, MD. E-mail: [email protected].
Despite being creatures of the province under the Canadian Constitution, municipalities are emerging as a partner by taking action on problems seemingly outside their jurisdiction. Because Ontario municipalities have delegated authority from the Province to directly use and manage the Great Lakes-St. Lawrence River Basin, they have reason to be engaged in related policy development and act as partners in this intergovernmental framework. How can municipalities, however, truly act as a partner with those that have ultimate authority over them? Using the example of bulk water transfers, findings from this study provide an understanding of opportunities and barriers for wider municipal involvement within the Basin. While some municipalities can be considered principal actors, differing priorities and limited resources constrain the role municipalities can play as a whole. Further, although municipalities want to be treated like a partner, they remain bound by provincial and federal decisions, thus, limiting the partnership scope.
Student-run clinics (SRCs) are widespread, but studies on their educational impact are limited. We surveyed preclinical medical, nursing, and pharmacy students about their experiences in a hepatitis B elective which provided opportunities to they could volunteer at hepatitis B screening and vaccination SRCs. Student responses revealed positive perceptions of the volunteer experience. Benefits included interacting with patients, developing clinical skills, providing service to disadvantaged populations, and collaborating with health professional peers. Students who participated in clinic reported enhanced skills compared to those who did not attend. SRCs play a valuable role in instilling positive attitudes and improving skills.
Abstract Objective To determine absolute and relative risks of either symptomatic or asymptomatic SARS-CoV-2 infection for late cardiovascular events and all-cause mortality. Methods We conducted a retrospective double-cohort study of patients with either symptomatic or asymptomatic SARS-CoV-2 infection [COVID-19(+) cohort] and its documented absence [COVID-19(-) cohort]. The study investigators drew a simple random sample of records from all Oregon Health & Science University (OHSU) Healthcare patients (N=65,585) with available COVID-19 test results, performed 03.01.2020 - 09.13.2020. Exclusion criteria were age < 18y and no established OHSU care. The primary outcome was a composite of cardiovascular morbidity and mortality. All-cause mortality was the secondary outcome. Results The study population included 1355 patients (mean age 48.7±20.5 y; 770(57%) female, 977(72%) white non-Hispanic; 1072(79%) insured; 563(42%) with cardiovascular disease (CVD) history). During a median 6 months at risk, the primary composite outcome was observed in 38/319 (12%) COVID-19(+) and 65/1036 (6%) COVID-19(-) patients ( p =0.001). In Cox regression adjusted for demographics, health insurance, and reason for COVID-19 testing, SARS-CoV-2 infection was associated with the risk of the primary composite outcome (HR 1.71; 95%CI 1.06-2.78; p =0.029). Inverse-probability-weighted estimation, conditioned for 31 covariates, showed that for every COVID-19(+) patient, the average time to all-cause death was 65.5 days less than when all these patients were COVID-19(-): average treatment effect on the treated -65.5 (95%CI -125.4 to -5.61) days; p =0.032. Conclusions Either symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of late cardiovascular outcomes and has causal effect on all-cause mortality in a late post-COVID-19 period. ClinicalTrials.gov Identifier: NCT04555187 Key messages What is already known about this subject Acute, symptomatic COVID-19 can cause acute cardiovascular manifestations. Post-acute or “long” COVID-19 can be a debilitating disease following acute infection with a heterogenous presentation. What might this study add? Either symptomatic or asymptomatic SARS-CoV-2 infection is associated with increased risk of late cardiovascular outcomes. Either symptomatic or asymptomatic SARS-CoV-2 infection has causal effect on all-cause mortality in a late post-COVID-19 period. How might this impact on clinical practice? As we begin to care for more survivors of COVID-19, we will need to better understand not only how to care for their acute symptoms and complications following infection, but also recognize future cardiovascular risk and mitigate such risk with appropriate screening and preventative measures.
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