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Objective To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on protests by health workers. Methods We conducted an interrupted time series analysis of data from 159 countries for 2 years before and after the World Health Organization classified COVID-19 as a pandemic in March 2020, thus between 2018 and 2022. We produced models examining two main outcomes: (i) the total weekly number of health worker protests globally; and (ii) the number of countries with one or more health worker protests in a given week. Findings In total, there were 18 322 health worker protests in 133 countries between 2018 and 2022. The number of weekly health worker protests globally increased by 47% (30.1/63.5), an increase of 30.1 protests per week (95% confidence interval, CI: 11.7-48.6) at the onset of the COVID-19 pandemic. Furthermore, the number of countries experiencing such protests in a given week increased by 24% (5.7/24.1) following the declaration of the pandemic (an increase of 5.7 countries; 95% CI: 3.5-7.8). Conclusion The pandemic increased the overall level of health worker protests globally as well as the number of countries experiencing such protests. These protests highlight discontent in the health workforce. Given the ongoing global health workforce crisis, understanding and addressing the drivers of health worker discontent is important for global health policy and security. Objectif Evaluer l'impact de la pandemie de maladie a coronavirus 2019 (COVID-19) sur les manifestations du personnel de sante. Methodes Nous avons effectue une analyse de serie chronologique interrompue de donnees issues de 159 pays deux ans avant et deux ans apres la classification, par l'Organisation mondiale de la Sante, de la COVID-19 dans la categorie des pandemies en mars 2020, donc entre 2018 et 2022. Nous avons ensuite elabore des modeles pour deux elements principaux: (i) le nombre total de manifestations organisees chaque semaine par le personnel de sante; ainsi que (ii) le nombre de pays ou le personnel de sante a manifeste au moins une fois au cours d'une semaine donnee. Resultats Le personnel de sante a participe a un total de 18 322 manifestations dans 133 pays entre 2018 et 2022. Le nombre de manifestations hebdomadaires a augmente de 47% (30,1/63,5) a l'echelle planetaire, l'equivalent de 30,1 manifestations supplementaires par semaine (intervalle de confiance de 95%, IC: 11,7-48,6) au moment de l'apparition de la pandemie de COVID-19. En outre, le nombre de pays touches par ces manifestations au cours d'une semaine donnee a augmente de 24% (5,7/24,1) lorsque l'etat de pandemie a ete declare (ce qui represente une hausse de 5,7 pays; IC de 95%: 3,5-7,8). Conclusion La pandemie a entrame une recrudescence des manifestations organisees par le personnel de sante dans le monde, ainsi que du nombre de pays confrontes a de telles manifestations, ce qui illustre le mecontentement qui regne au sein du secteur. Etant donne la crise que connait actuellement le personnel de sante partout dans le monde, s'interesser et s'attaquer aux facteurs de mecontentement des soignants est essentiel pour la securite et la politique en matiere de sante mondiale. Objetivo Evaluar el Impacto de la pandemia de la enfermedad por coronavirus de 2019 (COVID-19) en las protestas del personal sanitario. Metodos Se realizo un analisis de series temporales interrumpidas de datos de 159 paises durante dos anos antes y despues de que la Organizacion Mundial de la Salud clasificara la COVID-19 como pandemia en marzo de 2020, es decir, entre 2018 y 2022. Se elaboraron modelos para examinar dos resultados principales: (i) el numero total semanal de protestas del personal sanitario en todo el mundo; y (ii) el numero de paises con una o mas protestas del personal sanitario en una semana determinada. Resultados En total, hubo 18 322 protestas de personal sanitario en 133 paises entre 2018 y 2022. El numero de protestas semanales del personal sanitario en todo el mundo aumento un 47% (30,1/63,5), lo que supone un aumento de 30,1 protestas por semana (intervalo de confianza del 95%, IC: 11,7-48,6) al inicio de la pandemia de la COVID-19. Ademas, el numero de paises que experimentaron este tipo de protestas en una semana determinada aumento un 24% (5,7/24,1) tras la declaracion de la pandemia (un aumento de 5,7 paises; IC del 95%: 3,5-7,8). Conclusion La pandemia aumento el nivel general de protestas del personal sanitario en todo el mundo, asi como el numero de paises que las experimentaron. Estas protestas ponen de manifiesto el descontento del personal sanitario. Dada la actual crisis mundial del personal sanitario, comprender y abordar los factores que impulsan el descontento del personal sanitario es importante para la politica y la seguridad sanitarias a nivel mundial., Introduction Protests, that is organized public demonstrations of grievances, by health workers have gained increasing attention in recent years. Health workforce crises are occurring around the world in both high- [...]

We consider the problem of independence testing for two univariate random variables in a sequential setting. By leveraging recent developments on safe, anytime-valid inference, we propose a test with time-uniform Type-I error control and derive explicit bounds on the finite-sample performance of the test. We demonstrate the empirical performance of the procedure in comparison to existing sequential and nonsequential independence tests. Furthermore, since the proposed test is distribution-free under the null hypothesis, we empirically simulate the gap due to Ville's inequality, the supermartingale analogue of Markov's inequality, that is commonly applied to control Type-I error in anytime-valid inference, and apply this to construct a truncated sequential test. [ABSTRACT FROM AUTHOR]

Rationale: High costs of controller therapies may be a barrier to guideline-recommended asthma treatment. Objectives: We determined whether eliminating out-of-pocket (OOP) payments among low-income patients with asthma impacted controller medication use. Methods: We applied a controlled interrupted time series design to administrative claims data in British Columbia, Canada from 2017 to 2020. Cases were individuals with an annual household income <$13,750 in whom copays were eliminated in January 2019; there was no change in public coverage for the control group with annual income >$45,000. We evaluated trends in asthma medication costs, use, the ratio of inhaled corticosteroid-containing medications to all asthma medications, excessive use of short-acting β-agonists (more than one canister per month), and the proportion of days covered by controller therapies. Results: There were 12,940 cases (62% female; mean age, 30.3 yr; standard deviation [SD], 14.9) and 71,331 controls (55% female; mean age, 31.3 yr; SD, 16.3). Removal of OOP payments increased monthly mean medication costs by $3.32 (95% confidence interval [CI], $0.08 to $6.56, 2020 Canadian dollars), days' supply of controller medications by 1.50 days (95% CI, 0.61 to 2.40 d), and the ratio of inhaled corticosteroid-containing medications to total medications by 4.20% (95% CI, 0.73% to 7.66%) compared with the control group. The policy had no effect on the proportion of days covered by controller therapies (0.01; 95% CI, −0.01 to 0.04), but nonsignificantly decreased the percentage of patients with excessive short-acting β-agonist use (−6.37%; 95% CI, −12.90% to 0.16%). Conclusions: Removal of OOP payments increased the dispensation of controller therapies, suggesting cost-related nonadherence could impair optimal asthma management. [ABSTRACT FROM AUTHOR]

Objective To examine changes in vaccination of children younger than 1 year during the coronavirus disease 2019 (COVID-19) pandemic (March 2020-August 2021) in Haiti, Lesotho, Liberia and Malawi. Methods We used data from health management information systems on vaccination of children aged 12 months or younger in districts supported by Partners In Health. We used data from January 2016 to February 2020 and a linear model with negative binomial distribution to estimate the expected immunization counts for March 2020-August 2021 with 95% prediction intervals, assuming no pandemic. We compared these expected levels with observed values and estimated the immunization deficits or excesses during the pandemic months. Findings Baseline vaccination counts varied substantially by country, with Lesotho having the lowest count and Haiti the highest. We observed declines in vaccination administration early in the COVID-19 pandemic in Haiti, Lesotho and Liberia. Continued declines largely corresponded to high rates of COVID-19 infection and discrete stock-outs. By August 2021, vaccination levels had returned to close to or above expected levels in Haiti, Liberia and Lesotho; in Malawi levels remained below expected. Conclusion Patterns of childhood immunization coverage varied by country over the course of the pandemic, with significantly lower than expected vaccination levels seen in one country during subsequent COVID-19 waves. Governments and health-care stakeholders should monitor vaccine coverage closely and consider interventions, such as community outreach, to avoid or combat the disruptions in childhood vaccination. Objectif Etudier les changements en matiere de vaccination des enfants ages de moins d'un an durant la pandemie de maladie a coronavirus 2019 (COVID-19) en Haiti, au Lesotho, au Liberia et au Malawi, entre mars 2020 et aout 2021. Methodes Nous avons utilise les donnees issues des systemes d'information pour la gestion de la sante et portant sur la vaccination des enfants de moins de 12 mois, dans les districts soutenus par l'association Partners In Health. Nous nous sommes appuyes sur des donnees collectees entre janvier 2016 et fevrier 2020, ainsi que sur un modele lineaire avec distribution binomiale negative, afin d'estimer les chiffres d'immunisation attendus pour la periode allant de mars 2020 a aout 2021 en appliquant des intervalles de prevision de 95%, en supposant qu'il n'y ait pas eu de pandemie. Enfin, nous avons compare ces previsions avec les valeurs observees, puis calcule les excedents ou deficits en la matiere pendant les mois de pandemie. Resultats Les chiffres de vaccination initiaux etaient tres differents d'un pays a l'autre, le Lesotho enregistrant le plus faible taux et Haiti, le plus eleve. Nous avons constate une diminution de l'administration des vaccins au debut de la pandemie de COVID-19 en Haiti, au Lesotho et au Liberia. Les baisses continues correspondaient a des niveaux eleves d'infection a la COVID-19 et a des ruptures de stock distinctes. En aout 2021, les taux de vaccination avaient repris un cours normal ou superieur a la norme en Haiti, au Liberia et au Lesotho; au Malawi, ils sont restes inferieurs aux resultats escomptes. Conclusion Les schemas de couverture vaccinale infantile ont varie en fonction des pays tout au long de la pandemie, avec des taux de vaccination nettement inferieurs aux previsions dans l'un des pays durant les vagues successives de COVID-19. Les gouvernements et acteurs du secteur de la sante devraient surveiller attentivement la couverture vaccinale et envisager des interventions telles que la sensibilisation communautaire s'ils souhaitent eviter ou mettre fin aux interruptions dans la vaccination des enfants. Objetivo Analizar los cambios en la vacunacion de los ninos menores de 1 ano durante la pandemia de la coronavirosis de 2019 (COVID-19) (entre marzo de 2020 y agosto de 2021) en Haiti, Lesotho, Liberia y Malawi. Metodos Se emplearon datos de los sistemas de informacion de gestion sanitaria sobre la vacunacion de ninos de 12 meses o menos en los distritos que reciben apoyo de Partners In Health. Se usaron datos de enero de 2016 a febrero de 2020 y un modelo lineal con distribucion binomial negativa para estimar las cifras de inmunizacion esperadas para el periodo de marzo de 2020 a agosto de 2021 con intervalos de prediccion del 95 %, suponiendo que no hay pandemia. Se compararon estos niveles esperados con los valores observados y se estimaron los deficits o excesos de inmunizacion durante los meses de la pandemia. Resultados El numero de vacunas de referencia vario bastante segun el pais, siendo Lesotho el que tuvo el numero mas bajo y Haiti el mas alto. Se observo una disminucion en la administracion de vacunas al principio de la pandemia de la COVID-19 en Haiti, Lesotho y Liberia. Las disminuciones continuas fueron en gran medida consecuencia de las altas tasas de infeccion por la COVID-19 y a la escasez de existencias. En agosto de 2021, los niveles de vacunacion se habian acercado o superado los niveles esperados en Haiti, Liberia y Lesotho; en Malawi los niveles seguian siendo inferiores a los esperados. Conclusion Los patrones de cobertura de la inmunizacion infantil variaron segun el pais en el transcurso de la pandemia, con niveles de vacunacion mucho mas bajos de lo esperado en un pais durante las siguientes oleadas de la COVID-19. Los gobiernos y las partes interesadas en la atencion sanitaria deben supervisar de cerca la cobertura de la vacunacion y contemplar intervenciones, como la divulgacion en la comunidad, para evitar o superar las interrupciones de la vacunacion infantil., Introduction The coronavirus disease 2019 (COVID-19) pandemic has severely affected health services globally, leading to concerns about disruptions to essential services such as immunizations. (1) Vaccinations, particularly those given in [...]

Background: Prior research has shown that patients with stable ischemic heart disease who undergo delayed coronary artery bypass graft (CABG) surgery face higher mortality rates than those who receive CABG within the time recommended by physicians. However, this research did not account for percutaneous coronary intervention (PCI), a widely available alternative to delayed CABG in many settings. We sought to establish whether there was a difference in mortality between timely PCI and delayed CABG. Methods: We identified 25,520 patients 60 years or older who underwent first-time non-emergency revascularization for angiographically-proven, stable left main or multi-vessel ischemic heart disease in British Columbia between January 1, 2001, and December 31, 2016. We estimated unadjusted and adjusted mortality after index revascularization or last staged PCI for patients undergoing delayed CABG compared to timely PCI. Findings: After adjustment with inverse probability of treatment weights, at three years, patients who underwent delayed CABG had a statistically significant lower mortality compared with patients who received timely PCI (4.3% delayed CABG, 13.5% timely PCI; risk ratio 0.32, 95% CI 0.24–0.40). Interpretation: Patients who undergo CABG with delay have a lower risk of death than patients who undergo PCI within appropriate time. Our results suggest that patients who wish to receive CABG as their revascularization treatment will receive a mortality benefit over PCI as an alternative strategy. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, a group of health program implementors and research analysts across seven low- and middle-income countries (LMICs) alongside Boston-based collaborators convened to implement data-driven approaches for public health response. An intensive statistics and data science training short course was developed to ensure that in-country researchers could implement the necessary statistical methods for COVID-19 surveillance. The main goal of the course was to enable interpretation of findings from time series analyses and flag potential data issues. This manuscript summarizes our experience teaching this course, including a detailed course overview, participant feedback, and thoughts on how targeted, online courses can be used to support statistical capacity building in LMICs. [ABSTRACT FROM AUTHOR]

Purpose: The magnitude of repeat exposures to culprit medications after hospital discharge is not well studied. We combined prospective cohort data with administrative health data to understand the frequency of repeat exposures to culprit medications after discharge and the risk factors for their occurrence. Methods: This was a retrospective analysis of three prospective cohorts of patients who presented to the hospital with an adverse drug event in British Columbia, from 2008 to 2015 (n = 849). We linked prospectively identified adverse drug events to administrative data to examine patterns of redispensing of culprit medications. We used Cox regression to assess risk factors for re‐exposure, and conducted subgroup analyses for essential vs. nonessential medications. Results: Among 849 diagnosed adverse drug events, 45.2% had subsequent culprit medication redispensing within a year of hospital discharge. The factors associated with re‐exposures included atrial fibrillation, adverse drug event type (e.g. adverse reaction), culprit medication type, and longer historical duration of medication use. Conclusions: Re‐exposures to culprit medications occurred in almost half of the adverse drug events diagnosed in emergency departments. Many of these were appropriate re‐exposures to essential medications for indications in which the risk of uncontrolled disease likely outweighed the risk of a repeat adverse event. More research is needed to understand re‐exposures to nonessential medications or medications with safer alternatives. [ABSTRACT FROM AUTHOR]