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Munasinghe LL, Yin W, Nathani H, Toy J, Sereda P, Barrios R, Montaner JSG, Lima VD. The impact of the COVID-19 pandemic on HIV treatment gap lengths and viremia among people living with HIV British Columbia, Canada, during the COVID-19 pandemic: Are we ready for the next pandemic? Soc Sci Med 2024; 350:116920. [PMID: 38703468 DOI: 10.1016/j.socscimed.2024.116920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Abstract
The SARS-CoV-2 (COVID-19) pandemic has impacted the care of people living with HIV (PLWH). This study aims to characterize the impact of the pandemic on the length of HIV treatment gap lengths and viral loads among people living with HIV (PLWH) in British Columbia (BC), Canada, with a focus on Downtown Eastside (DTES), which is one of the most impoverished neighbourhoods in Canada. We analyzed data from the HIV/AIDS Drug Treatment Program from January 2019 to February 2022. The study had three phases: Pre-COVID, Early-COVID, and Late-COVID. We compared results for individuals residing in DTES, those not residing in DTES, and those with no fixed address. Treatment gap lengths and viral loads were analyzed using a zero-inflated negative binomial model and a two-part model, respectively, adjusting for demographic factors. Among the 8982 individuals, 93% were non-DTES residents, 6% were DTES residents, and 1% had no fixed address during each phase. DTES residents were more likely to be female, with Indigenous Ancestry, and have a history of injection drug use. Initially, the mean number of viral load measurements decreased for all PLWH during the Early-COVID, then remained constant. Treatment gap lengths increased for all three groups during Early-COVID. However, by Late-COVID, those with no fixed address approached pre-COVID levels, while the other two groups did not reach Early-COVID levels. Viral loads improved across each phase from Pre- to Early- to Late-COVID among people residing and not residing in DTES, while those with no fixed address experienced consistently worsening levels. Despite pandemic disruptions, both DTES and non-DTES areas enhanced HIV control, whereas individuals with no fixed address encountered challenges. This study offers insights into healthcare system preparedness for delivering HIV care during future pandemics, emphasizing community-driven interventions with a particular consideration of housing stability.
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Affiliation(s)
| | - Weijia Yin
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hasan Nathani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Paul Sereda
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Loeb TB, Albarran GI, Lee E, McEwan JA, Dyer KE, Cooley-Strickland M, Norwood-Scott E, Ramm K, Kesblyan D, Barnes A, Novacek D, Chin D. Identifying social determinants of health in populations exposed to structural inequities: a qualitative study of the COVID-19 pandemic experiences of Black and Latinx people living with HIV and cardiovascular risks. Front Public Health 2024; 12:1336184. [PMID: 38873288 PMCID: PMC11169879 DOI: 10.3389/fpubh.2024.1336184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Introduction Black and Latinx communities experience inequities in the social determinants of health (SDOH) and high rates of chronic illnesses [e.g., cardiovascular disease (CVD), HIV]. The COVID-19 pandemic amplified these long-standing SDOH disparities. However, scant attention has been paid to the pandemic-related experiences of populations exposed to structural inequities. Methods Using a semi-structured interview guide, 60 in-depth telephone interviews were conducted with Black and Latinx people living with HIV (PLWH) and CVD risks to assess: (1) perceived personal and community risk for COVID-19; (2) knowledge of and access to COVID-19 public health information; (3) barriers to COVID-19 public health recommendations and vaccine uptake; and (4) perceptions of HIV, CVD, and COVID-19. Interviews were professionally transcribed into either English or Spanish. Spanish transcripts were translated into English. Rapid qualitative analysis was used to summarize each transcript into a structured templaicte corresponding to interview guide domains. Summaries were combined into matrices for identification and comparison of themes across domains. Results Participants reported risks for COVID-19 due to being immunocompromised and SDOH, including transportation, exposure to risks conferred by others, living in under-resourced neighborhoods, and housing insecurity. Participants engaged in protective countermeasures by adhering to public health mandates. Relationships with providers, participating in community support groups, and digital inclusion and literacy were salient with respect to dissemination of COVID-19 information and vaccine uptake. Experiences with managing a chronic illness facilitated vaccine acceptance. Participants described language barriers, experiences of discrimination, and a historical lack of trust in medical systems and vaccines. Discussion This study provides a real-time narrative from PLWH and CVD risks who were vulnerable during the height of the COVID-19 pandemic. Implications include the need for continuity with providers and established community networks, increasing internet access and digital health literacy, and addressing historical trauma incurred in medical settings. It is critical to understand the impact of traditional SDOH on those living with chronic illness as well as other social determinants that shed light on access to public health information, adherence to public health recommendations, and vaccine uptake among populations exposed to structural inequities.
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Affiliation(s)
- Tamra Burns Loeb
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Graciela I. Albarran
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ethan Lee
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jenna Alarcon McEwan
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Karen E. Dyer
- Independent Researcher, Los Angeles, CA, United States
| | - Michele Cooley-Strickland
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Enricka Norwood-Scott
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kate Ramm
- Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States
| | - David Kesblyan
- Research Volunteer, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aleeja Barnes
- Independent Volunteer, Los Angeles, CA, United States
| | - Derek Novacek
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Desert Pacific Mental Illness Research, Education, and Clinical Center, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Dorothy Chin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Kumsa FA, Fowke JH, Hashtarkhani S, White BM, Shrubsole MJ, Shaban-Nejad A. The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study. ARXIV 2024:arXiv:2405.18456v1. [PMID: 38855542 PMCID: PMC11160857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Prostate cancer is one of the leading causes of cancer-related mortality among men in the United States. We examined the role of neighborhood obesogenic attributes on prostate cancer risk and mortality in the Southern Community Cohort Study (SCCS). Methods From the total of 34,166 SCCS male participants, 28,356 were included in the analysis. We assessed the relationship between neighborhood obesogenic factors [neighborhood socioeconomic status (nSES) and neighborhood obesogenic environment indices including the restaurant environment index, the retail food environment index, parks, recreational facilities, and businesses] and prostate cancer risk and mortality by controlling for individual-level factors using a multivariable Cox proportional hazards model. We further stratified prostate cancer risk analysis by race and body mass index (BMI). Results Median follow-up time was 133 months [interquartile range (IQR): 103, 152], and the mean age was 51.62 (SD: ± 8.42) years. There were 1,524 (5.37%) prostate cancer diagnoses and 98 (6.43%) prostate cancer deaths during follow-up. Compared to participants residing in the wealthiest quintile, those residing in the poorest quintile had a higher risk of prostate cancer (aHR = 1.32, 95% CI 1.12-1.57, p = 0.001), particularly among non-obese men with a BMI < 30 (aHR = 1.46, 95% CI 1.07-1.98, p = 0.016). The restaurant environment index was associated with a higher prostate cancer risk in overweight (BMI ≥ 25) White men (aHR = 3.37, 95% CI 1.04-10.94, p = 0.043, quintile 1 vs. None). Obese Black individuals without any neighborhood recreational facilities had a 42% higher risk (aHR = 1.42, 95% CI 1.04-1.94, p = 0.026) compared to those with any access. Compared to residents in the wealthiest quintile and most walkable area, those residing within the poorest quintile (aHR = 3.43, 95% CI 1.54-7.64, p = 0.003) or the least walkable area (aHR = 3.45, 95% CI 1.22-9.78, p = 0.020) had a higher risk of prostate cancer death. Conclusion Living in a lower-nSES area was associated with a higher prostate cancer risk, particularly among Black men. Restaurant and retail food environment indices were also associated with a higher prostate cancer risk, with stronger associations within overweight White individuals. Finally, residing in a low-SES neighborhood or the least walkable areas were associated with a higher risk of prostate cancer mortality.
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Affiliation(s)
- Fekede Asefa Kumsa
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Jay H. Fowke
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Soheil Hashtarkhani
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Brianna M. White
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Martha J. Shrubsole
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Arash Shaban-Nejad
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
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Kumsa FA, Fowke JH, Hashtarkhani S, White BM, Shrubsole MJ, Shaban-Nejad A. The association between neighborhood obesogenic factors and prostate cancer risk and mortality: the Southern Community Cohort Study. Front Oncol 2024; 14:1343070. [PMID: 38720808 PMCID: PMC11078097 DOI: 10.3389/fonc.2024.1343070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/18/2024] [Indexed: 05/12/2024] Open
Abstract
Background Prostate cancer is one of the leading causes of cancer-related mortality among men in the United States. We examined the role of neighborhood obesogenic attributes on prostate cancer risk and mortality in the Southern Community Cohort Study (SCCS). Methods From the total of 34,166 SCCS male participants, 28,356 were included in the analysis. We assessed the relationship between neighborhood obesogenic factors [neighborhood socioeconomic status (nSES) and neighborhood obesogenic environment indices including the restaurant environment index, the retail food environment index, parks, recreational facilities, and businesses] and prostate cancer risk and mortality by controlling for individual-level factors using a multivariable Cox proportional hazards model. We further stratified prostate cancer risk analysis by race and body mass index (BMI). Results Median follow-up time was 133 months [interquartile range (IQR): 103, 152], and the mean age was 51.62 (SD: ± 8.42) years. There were 1,524 (5.37%) prostate cancer diagnoses and 98 (6.43%) prostate cancer deaths during follow-up. Compared to participants residing in the wealthiest quintile, those residing in the poorest quintile had a higher risk of prostate cancer (aHR = 1.32, 95% CI 1.12-1.57, p = 0.001), particularly among non-obese men with a BMI < 30 (aHR = 1.46, 95% CI 1.07-1.98, p = 0.016). The restaurant environment index was associated with a higher prostate cancer risk in overweight (BMI ≥ 25) White men (aHR = 3.37, 95% CI 1.04-10.94, p = 0.043, quintile 1 vs. None). Obese Black individuals without any neighborhood recreational facilities had a 42% higher risk (aHR = 1.42, 95% CI 1.04-1.94, p = 0.026) compared to those with any access. Compared to residents in the wealthiest quintile and most walkable area, those residing within the poorest quintile (aHR = 3.43, 95% CI 1.54-7.64, p = 0.003) or the least walkable area (aHR = 3.45, 95% CI 1.22-9.78, p = 0.020) had a higher risk of prostate cancer death. Conclusion Living in a lower-nSES area was associated with a higher prostate cancer risk, particularly among Black men. Restaurant and retail food environment indices were also associated with a higher prostate cancer risk, with stronger associations within overweight White individuals. Finally, residing in a low-SES neighborhood or the least walkable areas were associated with a higher risk of prostate cancer mortality.
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Affiliation(s)
- Fekede Asefa Kumsa
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Jay H. Fowke
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Soheil Hashtarkhani
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Brianna M. White
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Martha J. Shrubsole
- Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Arash Shaban-Nejad
- Department of Pediatrics, College of Medicine, The University of Tennessee Health Science Center (UTHSC) - Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
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Neshan M, Padmanaban V, Tsilimigras DI, Obeng-Gyasi S, Fareed N, Pawlik TM. Screening tools to address social determinants of health in the United States: A systematic review. J Clin Transl Sci 2024; 8:e60. [PMID: 38655456 PMCID: PMC11036426 DOI: 10.1017/cts.2024.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024] Open
Abstract
The Centers for Medicare & Medicaid Services have mandated that hospitals implement measures to screen social determinants of health (SDoH). We sought to report on available SDoH screening tools. PubMed, Scopus, Web of Science, as well as the grey literature were searched (1980 to November 2023). The included studies were US-based, written in English, and examined a screening tool to assess SDoH. Thirty studies were included in the analytic cohort. The number of questions in any given SDoH assessment tool varied considerably and ranged from 5 to 50 (mean: 16.6). A total of 19 SDoH domains were examined. Housing (n = 23, 92%) and safety/violence (n = 21, 84%) were the domains assessed most frequently. Food/nutrition (n = 17, 68%), income/financial (n = 16, 64%), transportation (n = 15, 60%), family/social support (n = 14, 56%), utilities (n = 13, 52%), and education/literacy (n = 13, 52%) were also commonly included domains in most screening tools. Eighteen studies proposed specific interventions to address SDoH. SDoH screening tools are critical to identify various social needs and vulnerabilities to help develop interventions to address patient needs. Moreover, there is marked heterogeneity of SDoH screening tools, as well as the significant variability in the SDoH domains assessed by currently available screening tools.
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Affiliation(s)
- Mahdi Neshan
- Department of General Surgery, Shahid Sadoughi University of
Medical Sciences and Health Services, Yazd,
Iran
| | - Vennila Padmanaban
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Diamantis I. Tsilimigras
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Samilia Obeng-Gyasi
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
| | - Naleef Fareed
- Department of Biomedical Informatics, College of Medicine,
The Ohio State University, Columbus,
OH, USA
| | - Timothy M. Pawlik
- Department of Surgery, The Ohio State University Wexner
Medical Center and James Comprehensive Cancer Center, Columbus,
OH, USA
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Eligulashvili A, Darrell M, Gordon M, Jerome W, Fiori KP, Congdon S, Duong TQ. Patients with unmet social needs are at higher risks of developing severe long COVID-19 symptoms and neuropsychiatric sequela. Sci Rep 2024; 14:7743. [PMID: 38565574 PMCID: PMC10987523 DOI: 10.1038/s41598-024-58430-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
This study investigated long COVID of patients in the Montefiore Health System COVID-19 (CORE) Clinics in the Bronx with an emphasis on identifying health related social needs (HRSNs). We analyzed a cohort of 643 CORE patients (6/26/2020-2/24/2023) and 52,089 non-CORE COVID-19 patients. Outcomes included symptoms, physical, emotional, and cognitive function test scores obtained at least three months post-infection. Socioeconomic variables included median incomes, insurance status, and HRSNs. The CORE cohort was older age (53.38 ± 14.50 vs. 45.91 ± 23.79 years old, p < 0.001), more female (72.47% vs. 56.86%, p < 0.001), had higher prevalence of hypertension (45.88% vs. 23.28%, p < 0.001), diabetes (22.86% vs. 13.83%, p < 0.001), COPD (7.15% vs. 2.28%, p < 0.001), asthma (25.51% vs. 12.66%, p < 0.001), lower incomes (53.81% vs. 43.67%, 1st quintile, p < 0.001), and more unmet social needs (29.81% vs. 18.49%, p < 0.001) compared to non-CORE COVID-19 survivors. CORE patients reported a wide range of severe long-COVID symptoms. CORE patients with unmet HRSNs experienced more severe symptoms, worse ESAS-r scores (tiredness, wellbeing, shortness of breath, and pain), PHQ-9 scores (12.5 (6, 17.75) vs. 7 (2, 12), p < 0.001), and GAD-7 scores (8.5 (3, 15) vs. 4 (0, 9), p < 0.001) compared to CORE patients without. Patients with unmet HRSNs experienced worse long-COVID outcomes compared to those without.
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Affiliation(s)
- Anna Eligulashvili
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Megan Darrell
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Moshe Gordon
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - William Jerome
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Kevin P Fiori
- Department of Pediatrics, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Seth Congdon
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Tim Q Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
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Giron NC, Cole MB, Nguyen KH. Use of and barriers to adopting standardized social risk screening tools in federally qualified health centers during the first year of the COVID-19 pandemic. Health Serv Res 2024; 59 Suppl 1:e14232. [PMID: 37715519 PMCID: PMC10796290 DOI: 10.1111/1475-6773.14232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE To describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020. DATA SOURCE 2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375). STUDY DESIGN We used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open-ended responses about tools and barriers. DATA COLLECTION None. PRINCIPAL FINDINGS In 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: -25.5, -0.3) and participating in Medicaid-managed care contracts (7.3 PP decrease, 95% CI: -14.2, -0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non-screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%). CONCLUSIONS Though most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors.
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Affiliation(s)
- Nicole C Giron
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Megan B Cole
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Kevin H Nguyen
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Samji H, Long D, Herring J, Correia R, Maloney J. Positive childhood experiences serve as protective factors for mental health in pandemic-era youth with adverse childhood experiences. CHILD ABUSE & NEGLECT 2024:106640. [PMID: 38278687 DOI: 10.1016/j.chiabu.2024.106640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/24/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND While adverse childhood experiences (ACEs) predict poorer mental health across the life course, positive childhood experiences (PCEs) predict better mental health. It is unclear whether PCEs protect against poor mental health outcomes and promote mental well-being in pandemic-era adolescents with ACEs. METHODS We examined the individual and joint contributions of ACEs and PCEs to mental health and well-being (MHW) in eleventh-grade British Columbian adolescents (N = 8864) during the fifth wave of COVID-19. We used a novel measure of ACEs that included community- and societal-level ACEs in addition to ACEs experienced at home to investigate the role of social and structural determinants of mental health in supporting the MHW of pandemic-era adolescents. A series of two-way ANCOVAs were conducted comparing MHW outcomes between adolescents with and without ACEs. Interaction effects were examined to investigate whether PCEs moderated the association between ACEs and MHW. RESULTS Adolescents with no ACEs had significantly better MHW than those with one or more ACE. Having six or more PCEs was associated with better MHW in adolescents with and without ACEs. PCEs significantly moderated the association between ACEs and depression. Effect sizes were larger for PCEs than ACEs in relation to depression, mental well-being, and life satisfaction. CONCLUSIONS PCEs may protect against depression among adolescents with ACEs and promote MHW among all pandemic-era adolescents. These findings emphasize the importance of addressing social determinants of mental health to mitigate the impact of ACEs and promote PCEs as part of a public health approach to MHW.
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Affiliation(s)
- Hasina Samji
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada; Population and Public Health Division, British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, British Columbia V5Z 4R4, Canada.
| | - David Long
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada; Faculty of Medicine, University of British Columbia, 317 - 2194, Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Jillian Herring
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Rachel Correia
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
| | - Jacqueline Maloney
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby V5A 1S6, British Columbia, Canada.
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9
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Washington T, Lewinson TD. Healthcare Social Workers' Scope of Practice during COVID-19. Healthcare (Basel) 2024; 12:174. [PMID: 38255063 PMCID: PMC10815567 DOI: 10.3390/healthcare12020174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
The COVID-19 pandemic pushed the U.S. healthcare system to its limits, resulting in the need for flexibility in care delivery. This study aimed to describe healthcare social workers' scope of practice since the start of the pandemic. Semi-structured interviews for this qualitative study were conducted using the Zoom platform between July and August 2020. This study used a basic qualitative content analysis with integrated deductive and inductive coding to explore participant perspectives. Their scope was assessed based on healthcare social work practice standards. Four practice standards and eight themes that emerged from the data were knowledge and skills (care planning and intervention and social worker-patient relationship), workload sustainability (workload expansion and workload facilitators), interdisciplinary collaboration (collaborating beyond the scope of responsibilities and collaboration challenges), and cultural competency (institutional and societal). The findings add a deeper understanding of the roles social workers perform, how they think about these roles, how they want to be understood, and how they are best utilized in ways consistent with their training and expertise. Moving forward, healthcare systems may consider well-delineated roles and responsibilities for everyday practice and during pandemics.
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Affiliation(s)
| | - Terri D. Lewinson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH 03755, USA;
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Contreras J, Nussbaum J, Cangialosi P, Thapi S, Radakrishnan A, Hall J, Ramesh P, Trivieri MG, Sandoval AF. Pulmonary Hypertension in Underrepresented Minorities: A Narrative Review. J Clin Med 2024; 13:285. [PMID: 38202292 PMCID: PMC10779488 DOI: 10.3390/jcm13010285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Minoritized racial and ethnic groups suffer disproportionately from the incidence and morbidity of pulmonary hypertension (PH), as well as its associated cardiovascular, pulmonary, and systemic conditions. These disparities are largely explained by social determinants of health, including access to care, systemic biases, socioeconomic status, and environment. Despite this undue burden, minority patients remain underrepresented in PH research. Steps should be taken to mitigate these disparities, including initiatives to increase research participation, combat inequities in access to care, and improve the treatment of the conditions associated with PH.
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Affiliation(s)
- Johanna Contreras
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
| | - Jeremy Nussbaum
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
| | - Peter Cangialosi
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
| | - Sahityasri Thapi
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
| | - Ankitha Radakrishnan
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
| | - Jillian Hall
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (J.H.); (P.R.)
| | - Prashasthi Ramesh
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA 19140, USA; (J.H.); (P.R.)
| | - Maria Giovanna Trivieri
- Division of Heart Failure and Cardiac Transplantation, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (J.N.); (P.C.); (S.T.); (A.R.); (M.G.T.)
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11
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Manns BJ, Thomas S, Farinu O, Woolfork M, Walker CL. Hyperlocal lessons from the COVID-19 pandemic: Toward an equity-centered implementation science approach. SOCIAL SCIENCES & HUMANITIES OPEN 2024; 9:10.1016/j.ssaho.2024.100844. [PMID: 38463244 PMCID: PMC10922000 DOI: 10.1016/j.ssaho.2024.100844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
COVID-19 vaccination campaigns across the US were implemented to mitigate the disproportionate hospitalizations and unnecessary deaths across many communities that experienced unequal gaps in initial vaccine distribution rollout and uptake. In parallel, the COVID-19 pandemic created declines in routine vaccination coverage for adults, adolescents, and children; particularly, in communities experiencing overlapping social disadvantage. Community-based efforts offer a solution to narrow immunization gaps but have not been replicated consistently nor demonstrated widespread success during the pandemic as evidenced by prevailing disparities in immunization uptake. We offer an equity centered implementation science approach that involves co-designing, co-implementing, and co-evaluating solutions with the community and all partners investing in the shared goal of sustainable improvement in health outcomes.
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Affiliation(s)
- Brian J. Manns
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen Thomas
- Maryland Center for Health Equity, University of Maryland, College Park, MD, USA
| | - Oluyemi Farinu
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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12
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Athe R, Dwivedi R, Singh K, Babusab Hulmani S, Karadi N, Boraiah C, Vasu S. Impact of COVID-19 on the Mental Health of Healthcare Workers and Job Loss From a Gender Perspective in India: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e48219. [PMID: 38050506 PMCID: PMC10693901 DOI: 10.7759/cureus.48219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
The COVID-19 pandemic caused significant stress and anxiety among the general population and healthcare workers (HCWs) worldwide. India is one of the countries severely impacted by the pandemic. This review explores the gender perspective of mental health conditions among HCWs and job loss during the pandemic in India. Electronic databases (PubMed, Scopus, and Web of Science) were searched for articles published till March 2021. Studies that reported the prevalence of depression, anxiety, stress, and worry among HCWs in India during the pandemic and job loss in both males and females due to COVID-19 were included. We used a random-effects model to estimate pooled prevalence rates with 95% CIs. We assessed heterogeneity using the I2 statistic. The meta-analysis included 11 studies; the pooled prevalence of depression, anxiety, stress, and worry among HCWs was 34.9% (95%CI 27.33, 42.47), 35.4% (95%CI 24.46, 46.33), 32.9% (95%CI 25.43, 40.37), and 42.87% (95%CI 25.83, 59.91), respectively. The pooled prevalence of job loss due to COVID-19 was 16.6% (95%CI 8.34, 19.66). We employed meta-regression and Egger's regression for publication bias. The meta-analysis findings suggest that the prevalence of depression, anxiety, stress, and worry among HCWs in India during COVID-19 was high. Furthermore, job loss due to COVID-19 has also been prevalent in India. These findings emphasize the need for mental health support for HCWs and those who have lost their jobs during the pandemic. It is essential to prioritize mental health and job creation policies in India to support individuals affected by COVID-19.
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Affiliation(s)
- Ramesh Athe
- Data Science and Intelligent Systems, Indian Institute of Information Technology Dharwad, Dharwad, IND
| | - Rinshu Dwivedi
- Science and Humanities, Indian Institute of Information Technology Tiruchirappalli, Tiruchirappalli, IND
| | - Kasha Singh
- Computer Science and Engineering, Indian Institute of Information Technology Dharwad, Dharwad, IND
| | - Sabiha Babusab Hulmani
- Computer Science and Engineering, Indian Institute of Information Technology Dharwad, Dharwad, IND
| | - Nikhita Karadi
- Computer Science and Engineering, Indian Institute of Information Technology Dharwad, Dharwad, IND
| | - Chaithanya Boraiah
- Computer Science and Engineering, Indian Institute of Information Technology Dharwad, Dharwad, IND
| | - Sindhu Vasu
- Science and Humanities, Indian Institute of Information Technology Tiruchirappalli, Tiruchirappalli, IND
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13
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Keller SA, Lim S, Buckingham WR, Kind AJH. Life Course Assessment of Area-Based Social Disadvantage: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6982. [PMID: 37947540 PMCID: PMC10647563 DOI: 10.3390/ijerph20216982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
Area-based social disadvantage, which measures the income, employment, and housing quality in one's community, can impact an individual's health above person-level factors. A life course approach examines how exposure to disadvantage can affect health in later life. This systematic review aimed to summarize the approaches used to assess exposure to area-based disadvantage over a life course, specifically those that define the length and timing of exposure. We reviewed the abstracts of 831 articles based on the following criteria: (1) whether the abstract described original research; (2) whether the study was longitudinal; (3) whether area-based social disadvantage was an exposure variable; (4) whether area-based social disadvantage was assessed at multiple points; and (5) whether exposure was assessed from childhood to older adulthood. Zero articles met all the above criteria, so we relaxed the fifth criterion in a secondary review. Six studies met our secondary criteria and were eligible for data extraction. The included studies followed subjects from childhood into adulthood, but none assessed disadvantages in late life. The approaches used to assess exposure included creating a cumulative disadvantage score, conducting a comparison between life course periods, and modeling the trajectory of disadvantage over time. Additional research was needed to validate the methodologies described here, specifically in terms of measuring the impact of area-based social disadvantage on health.
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Affiliation(s)
- Sarah A. Keller
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
| | - Sarah Lim
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
| | - William R. Buckingham
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
| | - Amy J. H. Kind
- Center for Health Disparities Research, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
- Wisconsin Alzheimer’s Disease Research Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
- Department of Medicine, Geriatrics Division, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53726, USA
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14
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Tall J, Biel M. The Effects of Social Determinants of Health on Child and Family Mental Health: Implications of the COVID-19 Pandemic and Beyond. Curr Psychiatry Rep 2023; 25:387-394. [PMID: 37470927 DOI: 10.1007/s11920-023-01436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE OF REVIEW This review aims to expand understanding of the effect of SDOH on youth and family mental health outcomes. The review highlights significant findings from recent literature across SDOH categories (Economic Stability, Education Access/Quality, Health Care Access/Quality, Neighborhood/Built Environment, and Social/Community Context). This review also aims to demonstrate how the COVID-19 pandemic influences these effects. RECENT FINDINGS Economic instability (i.e., poverty, food insecurity) is associated with poorer MH outcomes. The COVID-19 pandemic limited access to mental health resources, including reduced opportunities for school-based mental health services and insurance barriers. Systemic factors, such as community violence and racism, exacerbate MH disparities. Policy decisions, especially those addressing poverty, can help youth and family exposures to SDOH, ACEs, and TS, which can help improve youth mental health outcomes at the population level. Findings on negative consequences of SDOH factors should be balanced with reporting findings of resiliency and other associated protective factors.
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Affiliation(s)
- Jasmine Tall
- The Chicago School of Professional Psychology, 901 15th St NW, 20005, Washington, DC, USA.
| | - Matthew Biel
- Georgetown University Medical Center, MedStar Georgetown University Hospital, Washington, DC, USA
- Early Childhood Innovation Network, Washington, DC, USA
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15
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Nelson SB, Dugdale CM, Brenner IR, Crawford A, Bilinski A, Cosar D, Pollock NR, Ciaranello A. Prevalence and Risk Factors for School-Associated Transmission of SARS-CoV-2. JAMA HEALTH FORUM 2023; 4:e232310. [PMID: 37540523 PMCID: PMC10403780 DOI: 10.1001/jamahealthforum.2023.2310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/30/2023] [Indexed: 08/05/2023] Open
Abstract
Importance School-associated SARS-CoV-2 transmission is described as uncommon, although the true transmission rate is unknown. Objective To identify the SARS-CoV-2 secondary attack rate (SAR) in schools and factors associated with transmission. Design, Setting, and Participants This cohort study examined the risk of school-based transmission of SARS-CoV-2 among kindergarten through grade 12 students and staff in 10 Massachusetts school districts during 2 periods: fall 2020/spring 2021 (F20/S21) and fall 2021 (F21). School staff collected data on SARS-CoV-2 index cases and school-based contacts, and SAR was defined as the proportion of contacts acquiring SARS-CoV-2 infection. Exposure SARS-CoV-2. Main Outcomes and Measures Potential factors associated with transmission, including grade level, masking, exposure location, vaccination history, and Social Vulnerability Index (SVI), were analyzed using univariable and multivariable logistic regression models. Results For F20/S21, 8 school districts (70 schools, >33 000 students) were included and reported 435 index cases (151 staff, 216 students, and 68 missing role) with 1771 school-based contacts (278 staff, 1492 students, and 1 missing role). For F21, 5 districts (34 schools, >18 000 students) participated and reported 309 index cases (37 staff, 207 students, and 65 missing role) with 1673 school-based contacts (107 staff and 1566 students). The F20/S21 SAR was 2.2% (lower bound, 1.6%; upper bound, 26.7%), and the F21 SAR was 2.8% (lower bound, 2.6%; upper bound, 7.4%). In multivariable analysis, during F20/S21, masking was associated with a lower odds of transmission compared with not masking (odds radio [OR], 0.12; 95% CI, 0.04-0.40; P < .001). In F21, classroom exposure vs out-of-classroom exposure was associated with increased odds of transmission (OR, 2.47; 95% CI, 1.07-5.66; P = .02); a fully vaccinated vs unvaccinated contact was associated with a lower odds of transmission (OR, 0.04; 95% CI, 0.00-0.62; P < .001). In both periods, a higher SVI was associated with a greater odds of transmission. Conclusions and Relevance In this study of Massachusetts schools, the SAR for SARS-CoV-2 among school-based contacts was low during 2 periods, and factors associated with transmission risk varied over time. These findings suggest that ongoing surveillance efforts may be essential to ensure that both targeted resources and mitigation practices remain optimal and relevant for disease prevention.
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Affiliation(s)
- Sandra B. Nelson
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Caitlin M. Dugdale
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Isaac Ravi Brenner
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Allison Crawford
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Alyssa Bilinski
- Department of Health Services, Policy and Practice and Department of Biostatistics, Brown School of Public Health, Providence, Rhode Island
| | - Duru Cosar
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
| | - Nira R. Pollock
- Harvard Medical School, Boston, Massachusetts
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Andrea Ciaranello
- Division of Infectious Diseases, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston
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16
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Navario PS, Upadhaya N, Hall BJ, Yang LH. Editorial: Global mental health among marginalized communities in pandemic emergencies. Front Public Health 2023; 11:1249575. [PMID: 37546296 PMCID: PMC10402728 DOI: 10.3389/fpubh.2023.1249575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Affiliation(s)
- Peter S. Navario
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, NY, United States
- HealthRight International, New York, NY, United States
| | | | - Brian J. Hall
- New York University School of Global Public Health, New York, NY, United States
- NYU Shanghai Center for Global Health Equity, Shanghai, China
| | - Lawrence H. Yang
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, United States
- Columbia University Mailman School of Public Health, New York, NY, United States
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17
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Lefebvre G, Haddad S, Moncion-Groulx D, Saint-Onge M, Dontigny A. Socioeconomic disparities and concentration of the spread of the COVID-19 pandemic in the province of Quebec, Canada. BMC Public Health 2023; 23:1096. [PMID: 37280572 DOI: 10.1186/s12889-023-15983-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Recent studies suggest that the risk of SARS-CoV-2 infection may be greater in more densely populated areas and in cities with a higher proportion of persons who are poor, immigrant, or essential workers. This study examines spatial inequalities in SARS-CoV-2 exposure in a health region of the province of Quebec in Canada. METHODS The study was conducted on the 1206 Canadian census dissemination areas in the Capitale-Nationale region of the province of Quebec. The observation period was 21 months (March 2020 to November 2021). The number of cases reported daily in each dissemination area was identified from available administrative databases. The magnitude of inequalities was estimated using Gini and Foster-Greer-Thorbecke (FGT) indices. The association between transmission and socioeconomic deprivation was identified based on the concentration of transmission in socially disadvantaged areas and on nonparametric regressions relating the cumulative incidence rate by area to ecological indicators of spatial disadvantage. Quantification of the association between median family income and degree of exposure of dissemination areas was supplemented by an ordered probit multiple regression model. RESULTS Spatial disparities were elevated (Gini = 0.265; 95% CI [0.251, 0.279]). The spread was more limited in the less densely populated areas of the Quebec City agglomeration and outlying municipalities. The mean cumulative incidence in the subsample made up of the areas most exposed to the pandemic was 0.093. The spread of the epidemic was concentrated in the most disadvantaged areas, especially in the densely populated areas. Socioeconomic inequality appeared early and increased with each successive pandemic wave. The models showed that areas with economically disadvantaged populations were three times more likely to be among the areas at highest risk for COVID-19 (RR = 3.55; 95% CI [2.02, 5.08]). In contrast, areas with a higher income population (fifth quintile) were two times less likely to be among the most exposed areas (RR = 0.52; 95% CI [0.32, 0.72]). CONCLUSION As with the H1N1 pandemics of 1918 and 2009, the SARS-CoV-2 pandemic revealed social vulnerabilities. Further research is needed to explore the various manifestations of social inequality in relation to the pandemic.
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Affiliation(s)
| | - Slim Haddad
- Direction de santé publique du CIUSSS-CN, Quebec City, QC, Canada.
- Centre de Recherche en Santé Durable VITAM, Quebec City, QC, Canada.
| | | | | | - André Dontigny
- Direction de santé publique du CIUSSS-CN, Quebec City, QC, Canada
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18
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Tiwari S, Petrov A, Mateshvili N, Devlin M, Golosov N, Rozanova-Smith M, Welford M, DeGroote J, Degai T, Ksenofontov S. Incorporating resilience when assessing pandemic risk in the Arctic: a case study of Alaska. BMJ Glob Health 2023; 8:bmjgh-2022-011646. [PMID: 37286235 DOI: 10.1136/bmjgh-2022-011646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
The discourse on vulnerability to COVID-19 or any other pandemic is about the susceptibility to the effects of disease outbreaks. Over time, vulnerability has been assessed through various indices calculated using a confluence of societal factors. However, categorising Arctic communities, without considering their socioeconomic, cultural and demographic uniqueness, into the high and low continuum of vulnerability using universal indicators will undoubtedly result in the underestimation of the communities' capacity to withstand and recover from pandemic exposure. By recognising vulnerability and resilience as two separate but interrelated dimensions, this study reviews the Arctic communities' ability to cope with pandemic risks. In particular, we have developed a pandemic vulnerability-resilience framework for Alaska to examine the potential community-level risks of COVID-19 or future pandemics. Based on the combined assessment of the vulnerability and resilience indices, we found that not all highly vulnerable census areas and boroughs had experienced COVID-19 epidemiological outcomes with similar severity. The more resilient a census area or borough is, the lower the cumulative death per 100 000 and case fatality ratio in that area. The insight that pandemic risks are the result of the interaction between vulnerability and resilience could help public officials and concerned parties to accurately identify the populations and communities at most risk or with the greatest need, which, in turn, helps in the efficient allocation of resources and services before, during and after a pandemic. A resilience-vulnerability-focused approach described in this paper can be applied to assess the potential effect of COVID-19 and similar future health crises in remote regions or regions with large Indigenous populations in other parts of the world.
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Affiliation(s)
- Sweta Tiwari
- ARCTICenter, College of Social & Behavioral Sciences, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Andrey Petrov
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Nino Mateshvili
- ARCTICenter, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Michele Devlin
- Center for Strategic Leadership, United States Army War College, Carlisle, Pennsylvania, USA
| | - Nikolay Golosov
- Department of Geography, Pennsylvania State University, Harrisburg, Pennsylvania, USA
| | - Marya Rozanova-Smith
- Department of Geography, Columbian College of Arts and Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Mark Welford
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - John DeGroote
- Department of Geography, University of Northern Iowa, Cedar Falls, Iowa, USA
| | - Tatiana Degai
- Anthropology, University of Victoria, Victoria, British Columbia, Canada
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19
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Sharrief A, Guzik AK, Jones E, Okpala M, Love M, Ranasinghe TIJ, Bushnell C. Telehealth Trials to Address Health Equity in Stroke Survivors. Stroke 2023; 54:396-406. [PMID: 36689591 PMCID: PMC11061884 DOI: 10.1161/strokeaha.122.039566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.
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Affiliation(s)
- Anjail Sharrief
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
- University of Texas Health Sciences Center, McGovern Medical School, Stroke Institute
| | - Amy K Guzik
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
| | - Erica Jones
- University of Texas Southwestern Medical Center, Department of Neurology
| | - Munachi Okpala
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
| | - Mary Love
- University of Houston College of Nursing
| | | | - Cheryl Bushnell
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
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Schwartz DL, Stewart A, Harris L, Ozdenerol E, Thomas F, Johnson KC, Davis R, Shaban-Nejad A. The Memphis Pandemic Health Informatics System (MEMPHI-SYS)-Creating a Metropolitan COVID-19 Data Registry Linked Directly to Community Testing to Enhance Population Health Surveillance. Disaster Med Public Health Prep 2022; 17:e326. [PMID: 36503600 PMCID: PMC9947040 DOI: 10.1017/dmp.2022.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The current coronavirus disease (COVID-19) pandemic has placed unprecedented strain on underfunded public health resources in the Southeastern United States. The Memphis, TN, metropolitan region has lacked infrastructure for health data exchange.This manuscript describes a multidisciplinary initiative to create a community-focused COVID-19 data registry, the Memphis Pandemic Health Informatics System (MEMPHI-SYS). MEMPHI-SYS leverages test result data updated directly from community-based testing sites, as well as a full complement of public health data sets and knowledge-based informatics. It has been guided by relationships with community stakeholders and is managed alongside the largest publicly funded community-based COVID-19 testing response in the Mid-South. MEMPHI-SYS has supported interactive Web-based analytic resources and informs federally funded COVID-19 outreach directed toward neighborhoods most in need of pandemic support.MEMPHI-SYS provides an instructive case study of how to collaboratively establish the technical scaffolding and human relationships necessary for data-driven, health equity-focused pandemic surveillance, and policy interventions.
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Affiliation(s)
- David L. Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
- Corresponding authors: David L. Schwartz, ; Arash Shaban-Nejad,
| | - Altha Stewart
- Department of Psychiatry, University of Tennessee Health Sciences Center College of Medicine, Memphis, TN, USA
- Office of Community Health Engagement, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Laura Harris
- Department of Psychiatry, University of Tennessee Health Sciences Center College of Medicine, Memphis, TN, USA
- Office of Community Health Engagement, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Esra Ozdenerol
- Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, TN, USA
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Robert Davis
- University of Tennessee Health Science Center—Oak Ridge National Laboratory Center for Biomedical Informatics, Oak Ridge, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Arash Shaban-Nejad
- University of Tennessee Health Science Center—Oak Ridge National Laboratory Center for Biomedical Informatics, Oak Ridge, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
- Corresponding authors: David L. Schwartz, ; Arash Shaban-Nejad,
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21
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Alidadi M, Sharifi A. Effects of the built environment and human factors on the spread of COVID-19: A systematic literature review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 850:158056. [PMID: 35985590 PMCID: PMC9383943 DOI: 10.1016/j.scitotenv.2022.158056] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 05/25/2023]
Abstract
Soon after its emergence, COVID-19 became a global problem. While different types of vaccines and treatments are now available, still non-pharmacological policies play a critical role in managing the pandemic. The literature is enriched enough to provide comprehensive, practical, and scientific insights to better deal with the pandemic. This research aims to find out how the built environment and human factors have affected the transmission of COVID-19 on different scales, including country, state, county, city, and urban district. This is done through a systematic literature review of papers indexed on the Web of Science and Scopus. Initially, these databases returned 4264 papers, and after different stages of screening, we found 166 relevant papers and reviewed them. The empirical papers that had at least one case study and analyzed the effects of at least one built environment factor on the spread of COVID-19 were selected. Results showed that the driving forces can be divided into seven main categories: density, land use, transportation and mobility, housing conditions, demographic factors, socio-economic factors, and health-related factors. We found that among other things, overcrowding, public transport use, proximity to public spaces, the share of health and services workers, levels of poverty, and the share of minorities and vulnerable populations are major predictors of the spread of the pandemic. As the most studied factor, density was associated with mixed results on different scales, but about 58 % of the papers reported that it is linked with a higher number of cases. This study provides insights for policymakers and academics to better understand the dynamic roles of the non-pharmacological driving forces of COVID-19 at different levels.
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Affiliation(s)
- Mehdi Alidadi
- Graduate School of Engineering and Advanced Sciences, Hiroshima University, Hiroshima, Japan.
| | - Ayyoob Sharifi
- Graduate School of Humanities and Social Science, Network for Education and Research on Peace and Sustainability (NERPS), and the Center for Peaceful and Sustainable Futures (CEPEAS), Hiroshima University, Japan.
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22
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Visual Preoperative Risk Depiction Tools for Shared Decision-making: A Pilot Study from the Surgeon's Perspective. Plast Reconstr Surg Glob Open 2022; 10:e4690. [PMID: 36467117 PMCID: PMC9708169 DOI: 10.1097/gox.0000000000004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED Shared decision-making (SDM) and effective risk communication improve patient satisfaction, adherence to treatment, and understanding of perioperative care pathways. Available risk calculators are less relevant for low-risk operations. The aim of this pilot study was to develop graphical risk visualization tools to enhance surgical SDM discussions preoperatively. METHODS Complications for reduction mammoplasty and skin grafting in a burns setting were sourced from the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator, the American Society of Plastic Surgeons website, peer-reviewed literature, and available clinical data. Pre- and postoperative patient satisfaction data were collected from the published literature on Breast-Q patient-reported outcomes for reduction mammoplasty. Everyday risk comparisons were collected from a general online database search. Three distinct risk depiction tools (spiral, tile, and scatter plot) were developed in the Microsoft Office Suite. Anonymous REDCap surveys were sent to healthcare practitioners for feedback. RESULTS Twenty-six survey results were collected. Twenty-four respondents (92%) agreed these graphics would be useful for SDM discussions. Nineteen respondents (73%) either agreed or strongly agreed that these graphics depicted risk in a meaningful way. Fifteen respondents (58%) indicated they would use these graphics in daily practice. The majority of respondents preferred the spiral design (58%). Areas for improvement included design simplification and written explanations to accompany graphics. Feedback from the survey was incorporated into the spiral design. CONCLUSIONS Risk visualization tools meaningfully depict surgical risks to improve communication in SDM. This study proposes a tool that can be adapted for many surgical procedures.
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23
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Erben Y, Prudencio M, Marquez CP, Jansen-West KR, Heckman MG, White LJ, Dunmore JA, Cook CN, Lilley MT, Qosja N, Song Y, Hanna Al Shaikh R, Daughrity LM, Bartfield JL, Day GS, Oskarsson B, Nicholson KA, Wszolek ZK, Hoyne JB, Gendron TF, Meschia JF, Petrucelli L. Neurofilament light chain and vaccination status associate with clinical outcomes in severe COVID-19. iScience 2022; 25:105272. [PMID: 36213006 PMCID: PMC9531935 DOI: 10.1016/j.isci.2022.105272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/13/2022] [Accepted: 09/30/2022] [Indexed: 02/08/2023] Open
Abstract
Blood neurofilament light chain (NFL) is proposed to serve as an estimate of disease severity in hospitalized patients with coronavirus disease 2019 (COVID-19). We show that NFL concentrations in plasma collected from 880 patients with COVID-19 within 5 days of hospital admission were elevated compared to controls. Higher plasma NFL associated with worse clinical outcomes including the need for mechanical ventilation, intensive care, prolonged hospitalization, and greater functional disability at discharge. No difference in the studied clinical outcomes between black/African American and white patients was found. Finally, vaccination associated with less disability at time of hospital discharge. In aggregate, our findings support the utility of measuring NFL shortly after hospital admission to estimate disease severity and show that race does not influence clinical outcomes caused by COVID-19 assuming equivalent access to care, and that vaccination may lessen the degree of COVID-19-caused disability.
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Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Mercedes Prudencio
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - Christopher P. Marquez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Launia J. White
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Judith A. Dunmore
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Casey N. Cook
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | | | - Neda Qosja
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Yuping Song
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Rana Hanna Al Shaikh
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | - Gregory S. Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Katharine A. Nicholson
- Sean M. Healey & AMG Center for ALS, Massachusetts General Hospital (MGH), Boston, MA 02114, USA
| | | | - Jonathan B. Hoyne
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Tania F. Gendron
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
| | - James F. Meschia
- Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Leonard Petrucelli
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA
- Neuroscience Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, Jacksonville, FL 32224, USA
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24
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Richter L, Heidinger T. Poverty in old age in times of COVID-19-Empirical results from Austria. Front Public Health 2022; 10:972076. [PMID: 36466524 PMCID: PMC9713516 DOI: 10.3389/fpubh.2022.972076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022] Open
Abstract
Early in the pandemic, researchers were cautioning that COVID-19 and the associated health policy countermeasures would have an increased negative impact on groups that were already vulnerable before the pandemic. One of these groups are older people affected by poverty, who according to official figures make up 13.9% of older population in Austria. Even before the pandemic, their living situation was considered precarious. Not without reason, this group has been identified as a high-risk group of the pandemic, due to their increased likelihood of severe COVID-19 related illness and their limited monetary resources and thus lower chances of coping with the pandemic. Nevertheless, research on this group has remained sparse to date. Therefore, the aim of the study is to focus on older people (60+ years) below the poverty line and to compare them with non-poor individuals. Data from the SHARE (Survey of Health Aging and Retirement in Europe) project is used, combining data from the two SHARE Corona Surveys (summer 2020 and summer 2021) and the SHARE Corona Special Austria Survey (December 2020) to gain the most complete picture of life situation during the pandemic. Results demonstrate that older people in poverty were more likely to report poor subjective health before as well as during the pandemic yet were significantly more likely to refuse vaccination against COVID-19, despite adhering to other measures against the pandemic to the same extent as non-poor people. Restrictions in the health care system affected both groups equally and no significant differences in the frequency of social contacts could be found. However, older people below the poverty line were significantly more likely to rely on social support to obtain necessities during the pandemic and were less likely to use the internet. Together, these results point out that disadvantage exist for the older poor in some but not all areas of life during the pandemic. This paper is aimed at providing first insights into the lives of poor older persons during a taxing time and may perhaps inspire more in-depth study of this particularly understudied population.
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Affiliation(s)
- Lukas Richter
- Department of Social Sciences, St. Pölten University of Applied Sciences, St. Pölten, Austria
| | - Theresa Heidinger
- Department of Gerontology and Health Research, Karl Landsteiner University of Health Sciences, Krems an der Donau, Lower Austria, Austria
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25
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Shaban-Nejad A, Michalowski M, Bianco S, Brownstein JS, Buckeridge DL, Davis RL. Applied artificial intelligence in healthcare: Listening to the winds of change in a post-COVID-19 world. Exp Biol Med (Maywood) 2022; 247:1969-1971. [PMID: 36426683 PMCID: PMC9703021 DOI: 10.1177/15353702221140406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This editorial article aims to highlight advances in artificial intelligence (AI) technologies in five areas: Collaborative AI, Multimodal AI, Human-Centered AI, Equitable AI, and Ethical and Value-based AI in order to cope with future complex socioeconomic and public health issues.
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Affiliation(s)
- Arash Shaban-Nejad
- UTHSC-ORNL Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA,Arash Shaban-Nejad.
| | - Martin Michalowski
- School of Nursing, University of Minnesota Twin Cities, Minneapolis, MN 55455, USA
| | - Simone Bianco
- Altos Labs – Bay Area Institute of Science, Redwood City, CA 94065, USA
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
| | - Robert L Davis
- UTHSC-ORNL Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38103, USA
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