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Elenis E, Kallner HK, Karalexi MA, Hägg D, Linder M, Fall K, Papadopoulos FC, Skalkidou A. Estrogen-modulating treatment among mid-life women and COVID-19 morbidity and mortality: a multiregister nationwide matched cohort study in Sweden. BMC Med 2024; 22:84. [PMID: 38414048 PMCID: PMC10898018 DOI: 10.1186/s12916-024-03297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND It has been repeatedly shown that men infected by SARS-CoV-2 face a twofold higher likelihood of dying, being hospitalized or admitted to the intensive care unit compared to women, despite taking into account relevant confounders. It has been hypothesized that these discrepancies are related to sex steroid hormone differences with estrogens being negatively correlated with disease severity. The objective of this study was therefore to evaluate COVID-19-related mortality and morbidity among peri- and postmenopausal women in relation to estrogen-containing menopause hormonal treatments (MHT). METHODS This is a national register-based matched cohort study performed in Sweden between January 1 to December 31, 2020. Study participants comprised women over the age of 53 years residing in Sweden. Exposure was defined as prescriptions of local estrogens, systemic estrogens with and without progestogens, progestogens alone, or tibolone. MHT users were then compared with a matched cohort of non-users. The primary outcome consisted of COVID-19 mortality, whereas the secondary outcomes included inpatient hospitalizations/outpatient visits and confirmed SARS-CoV-2 infection. Multivariable adjusted Cox regression-derived hazard ratios (HRs) were calculated. RESULTS Use of systemic estrogens alone is associated with increased COVID-19 mortality among older women (aHR 4.73, 1.22 to 18.32), but the association is no longer significant when discontinuation of estrogen use is accounted for. An increased risk for COVID-19 infection is further observed for women using combined systemic estrogens and progestogens (aHR 1.06, 1.00 to 1.13) or tibolone (aHR 1.21, 1.01 to 1.45). Use of local estrogens is associated with an increased risk for COVID-19-related death (aHR 2.02,1.45 to 2.81) as well as for all secondary outcomes. CONCLUSIONS Systemic or local use of estrogens does not decrease COVID-19 morbidity and mortality to premenopausal background levels. Excess risk for COVID-19 morbidity and mortality was noted among older women and those discontinuing systemic estrogens. Higher risk for death was also noted among women using local estrogens, for which non-causal mechanisms such as confounding by comorbidity or frailty seem to be the most plausible underlying explanations. TRIAL REGISTRATION DETAILS Not applicable.
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Affiliation(s)
- Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Reproduction Center, Women's Clinic, Uppsala University Hospital, Uppsala, Sweden.
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Maria A Karalexi
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - David Hägg
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Linder
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Adly HM, Saleh SAK, Garout MA, Abdulkhaliq AA, Khafagy AA, Saati AA, AlJahdali IA, Alandiyjany MN, Al-Tawfiq JA. Post COVID-19 Symptoms Among Infected Vaccinated Individuals: A Cross-Sectional Study in Saudi Arabia. J Epidemiol Glob Health 2023; 13:740-750. [PMID: 37665505 PMCID: PMC10686930 DOI: 10.1007/s44197-023-00146-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/23/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Multiple studies investigated the endurance and occurrence of symptoms three months after SARS-CoV-2 infection. This study examines the possible effects of COVID-19 vaccination on the persistence of post-recovery symptoms. PATIENTS AND METHODS A cross-sectional survey was conducted in Saudi Arabia to evaluate 14 prevalent long COVID-19 symptoms among vaccinated individuals. Patients self-reported their acute COVID-19 experience, demographic information, chronic conditions, vaccine history, and persistent symptoms. RESULTS Of the 484 patients, four respondents were excluded from the study as they had not received the vaccine, and 111 (23.1%) were vaccinated but did not get infected and were also excluded. The remaining 369 (76.9%) reported COVID-19 and a vaccination and thus they were included in the study. The occurrence of post-COVID-19 symptoms was reported in 59 (16.1%) for ≤ 3 months, 202 (54.8%) experienced persistent symptoms 3-6 months, and 108 (29.1%) reported symptoms lasting > 6 months. In relation to age group, persistent symptoms 3-6 months after recovery was more common in those > 50 years and symptoms lasting > 6 months were more common in 30-50 years of age (p < 0.001). Persistence of symptoms for 3-6 months was more common in those who were infected prior to vaccination compared to those who were infected after vaccination (P < 0.001). Of the included patients, 323 (87.5%) rated their health as good, 41 (11.1%) considered it fair, and 5 (1.4%) described their well-being as poor or terrible. CONCLUSION The study provides information of persistent symptoms in vaccinated individuals who had recovered from COVID-19 and highlights the need for targeted interventions to alleviate post-COVID-19 symptoms. The study is limited by its reliance on self-reported data and potential selection bias. Future research is needed to understand the mechanisms underlying persistent symptoms in vaccinated individuals and to identify effective interventions for long COVID.
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Affiliation(s)
- Heba M Adly
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Saleh A K Saleh
- Biochemisty Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- Oncology Diagnostic Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohammed A Garout
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Altaf A Abdulkhaliq
- Biochemisty Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Khafagy
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdullah A Saati
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imad A AlJahdali
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Maher N Alandiyjany
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, 21955, Makkah, Saudi Arabia
- Quality and Development Affair, Batterjee Medical College, 21442, Jeddah, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
- Infectious Diseases Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
- Infectious Diseases Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Mosnaim G, Carrasquel M, Wolfson AR, Peters J, Lang D, Rathkopf M. Social Determinants of Health and COVID-19. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3347-3355. [PMID: 37507069 DOI: 10.1016/j.jaip.2023.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/22/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected disadvantaged populations. Many of the factors related to the disproportionate impact on underserved communities are related to social determinants of health, defined by the World Health Organization as the nonmedical factors that influence health outcomes. They include the wider set of forces and systems shaping the conditions of daily life. This work explores the interrelationships between social determinants of health and access to care, health care professional and supply shortages, social and environmental factors, health behaviors, vaccine uptake, and treatment options on COVID-19 health outcomes. Increased awareness of inequities, learning from failures, and leveraging new opportunities to partner with key stakeholders in underserved communities create empowerment and preparedness to face new challenges.
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Affiliation(s)
- Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois.
| | - Michelle Carrasquel
- Division of Allergy and Immunology, Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jonny Peters
- Division of Allergy and Clinical Immunology at Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - David Lang
- Division of Allergy and Clinical Immunology, Department of Medicine, Cleveland Clinic., Milwaukee, Wis
| | - Melinda Rathkopf
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
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Sevian H, King-Meadows TD, Caushi K, Kakhoidze T, Karch JM. Addressing Equity Asymmetries in General Chemistry Outcomes Through an Asset-Based Supplemental Course. JACS AU 2023; 3:2715-2735. [PMID: 37885568 PMCID: PMC10598836 DOI: 10.1021/jacsau.3c00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 10/28/2023]
Abstract
Undergraduate first-semester general chemistry (GC1) functions as a gatekeeper to STEM degrees, asymmetrically impacting students who are nonwhite, from lower socioeconomic groups, non-native English speakers, two-year college transfers, and first-generation in college. Nationally, just under 30% of students earn grades of D, F, or withdraw (termed DFW) in GC1; however, DFW rates are much higher for subgroups underrepresented in STEM occupations. Socioeconomic inequalities tend to increase over an individual's lifetime due to the magnification of cumulative disadvantage. Because undergraduate degrees correlate with higher employment and STEM occupations correlate with higher earnings, GC1 represents a critical path point where disparities can be interrupted. The most common strategy employed for GC1 is deficit remediation for students determined to be at risk of DFW. Unfortunately, extensive evidence demonstrates that the use of remediation strategies for GC1 does not sustain benefits for students. In this work, an asset-based approach, less prevalent in higher education than preuniversity, was employed to stress test theories about interrupting disparities in STEM education. This causal-comparative study involving 1,807 observations reports on a 1-credit asset-based supplemental course in which DFW-potential students at a minority-serving institution coenrolled during six semesters. The study outlines this intervention, its impact on GC1 outcomes, and its potential residual impact on progression to the next course in the general chemistry sequence (GC2). Descriptive and hierarchical inferential analysis of the data revealed socially important patterns. The asset-based intervention successfully attracted students with greater cumulative disadvantage. The intervention closed asymmetries between students identified as DFW-potential and ABC-potential in GC1 when a nontraditional curriculum was used but not when a traditional curriculum was used. Mixed results and contingent effects were found for the intervention's impact on subsequent course outcomes. Taking at least 11 credits in the semester of taking GC1 provided an inoculate for participants in the asset-based intervention, increasing the likelihood of passing GC2.
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Affiliation(s)
- Hannah Sevian
- Department
of Chemistry, University of Massachusetts
Boston, Boston, Massachusetts 02125, United States
| | - Tyson D. King-Meadows
- Department
of Political Science, University of Massachusetts
Boston, Boston, Massachusetts 02125, United States
| | - Klaudja Caushi
- Department
of Chemistry, University of Massachusetts
Boston, Boston, Massachusetts 02125, United States
| | - Tamari Kakhoidze
- Department
of Chemistry, University of Massachusetts
Boston, Boston, Massachusetts 02125, United States
| | - Jessica M. Karch
- Department
of Chemistry, University of Massachusetts
Boston, Boston, Massachusetts 02125, United States
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Yoo W, Hong Y, Oh SH. Communication inequalities in the COVID-19 pandemic: socioeconomic differences and preventive behaviors in the United States and South Korea. BMC Public Health 2023; 23:1290. [PMID: 37407976 DOI: 10.1186/s12889-023-16211-8] [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: 01/19/2023] [Accepted: 06/28/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Communication inequalities are important mechanisms linking socioeconomic backgrounds to health outcomes. Guided by the structural influence model of communication, this study examined the intermediate role of health communication in the relationship between education, income, and preventive behavioral intentions during the COVID-19 pandemic in the United States and South Korea. METHODS The data were collected through two online surveys conducted by two professional research firms in the US (April 1-3, 2020) and South Korea (April 9-16, 2020). To test the mediating role of health communication, as well as the hypothesized relationships in the proposed model, we performed a path analysis using Mplus 6.1. RESULTS In analyzing survey data from 1050 American and 1175 Korean adults, we found that one's socioeconomic positions were associated with their intentions to engage in COVID-19 preventive behaviors through affecting their health communication experiences and then efficacious beliefs. Differences in education and income were associated with willingness to engage in preventive behaviors by constraining health communication among people with low levels of education and income. The findings showed notable differences and some similarities between the US and South Korea. For example, while income was positively associated with health communication in both US and South Korea, education was only significantly related to health communication in US but not in South Korea. CONCLUSIONS This study suggests health communication strategies such as choice of communication channels and messages to promote intention for COVID-19 prevention behaviors in particular consideration of individual differences in socioeconomic positions in countries with different cultural features. Pubic policies and health campaigns can utilize the suggestions to promote efficacy and preventive behavioral intention during early pandemics.
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Affiliation(s)
- Woohyun Yoo
- Department of Media and Communication & Institute of Social Sciences, Incheon National University, Incheon, South Korea
| | - Yangsun Hong
- Department of Communication and Journalism, University of New Mexico, Albuquerque, NM, USA.
| | - Sang-Hwa Oh
- Charles H. Sandage Department of Advertising, College of Media, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Fernández-Martínez NF, Ruiz-Montero R, Gómez-Barroso D, Rodríguez-Torronteras A, Lorusso N, Salcedo-Leal I, Sordo L. Socioeconomic differences in COVID-19 infection, hospitalisation and mortality in urban areas in a region in the South of Europe. BMC Public Health 2022; 22:2316. [PMID: 36503482 PMCID: PMC9742010 DOI: 10.1186/s12889-022-14774-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To analyse differences in confirmed cases, hospitalisations and deaths due to COVID-19 related to census section socioeconomic variables. METHODS: Ecological study in the 12 largest municipalities in Andalusia (Spain) during the first three epidemic waves of the COVID-19 (02/26/20-03/31/21), covering 2,246 census sections (unit of analysis) and 3,027,000 inhabitants. Incidence was calculated, standardised by age and sex, for infection, hospitalisation and deaths based on average gross income per household (AGI) for the census tracts in each urban area. Association studied using a Poisson Bayesian regression model with random effects for spatial smoothing. RESULTS There were 140,743 cases of COVID-19, of which 12,585 were hospitalised and 2,255 died. 95.2% of cases were attributed to the second and third waves, which were jointly analysed. We observed a protective effect of income for infection in 3/12 cities. Almeria had the largest protective effect (smoothed relative risk (SRR) = 0.84 (0.75-0.94 CI 95%). This relationship reappeared with greater magnitude in 10/12 cities for hospitalisation, lowest risk in Algeciras SRR = 0.41 (0.29-0.56). The pattern was repeated for deaths in all urban areas and reached statistical significance in 8 cities. Lowest risk in Dos Hermanas SRR = 0.35 (0.15-0.81). CONCLUSIONS Income inequalities by geographical area were found in the incidence of COVID-19. The strengths of the association increased when analysing the severe outcomes of hospitalisations and, above all, deaths.
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Affiliation(s)
- Nicolás F Fernández-Martínez
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Rafael Ruiz-Montero
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Diana Gómez-Barroso
- grid.413448.e0000 0000 9314 1427Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain ,grid.466571.70000 0004 1756 6246CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Alejandro Rodríguez-Torronteras
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain
| | - Nicola Lorusso
- Dirección General de Salud Pública, Consejería de Salud y Consumo, Junta de Andalucía, Spain
| | - Inmaculada Salcedo-Leal
- grid.411349.a0000 0004 1771 4667Unidad de Gestión Clínica Medicina Preventiva y Salud Pública, Hospital Universitario Reina Sofía, Córdoba, 14004 Spain ,grid.428865.50000 0004 0445 6160Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Luis Sordo
- grid.466571.70000 0004 1756 6246CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ,grid.4795.f0000 0001 2157 7667Departamento de Salud Pública y Materno-Infantil, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Téllez-González MA, Pineda-Juárez JA, Suárez-Cuenca JA, Escamilla-Tilch M, Santillán-Cortez D, García S, Alcaraz-Estrada SL, Pérez-Razo JC, Delgado-Quintana CA, Vargas-Hernández J, Muñoz-López S, Escarela-Serrano M, Santosbeña-Lagunes M, Alanís-Vega A, Vázquez-Alvarado RP, Merino-Rajme JA, Mondragón-Terán P. Epidemiological Profile and Social Welfare Index as Factors Associated with COVID-19 Hospitalization and Severity in Mexico City: A Retrospective Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14803. [PMID: 36429525 PMCID: PMC9690264 DOI: 10.3390/ijerph192214803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Epidemiological data indicate that Mexico holds the 19th place in cumulative cases (5506.53 per 100,000 inhabitants) of COVID-19 and the 5th place in cumulative deaths (256.14 per 100,000 inhabitants) globally and holds the 4th and 3rd place in cumulative cases and deaths in the Americas region, respectively, with Mexico City being the most affected area. Several modifiable and non-modifiable risk factors have been linked to a poor clinical outcome in COVID-19 infection; however, whether socioeconomic and welfare factors are associated with clinical outcome has been scanty addressed. This study tried to investigate the association of Social Welfare Index (SWI) with hospitalization and severity due to COVID-19. A retrospective analysis was conducted at the Centro Médico Nacional "20 de Noviembre"-ISSSTE, based in Mexico City, Mexico. A total of 3963 patients with confirmed or suspected COVID-19, registered from March to July 2020, were included, retrieved information from the Virology Analysis and Reference Unit Database. Demographic, symptoms and clinical data were analyzed, as well as the SWI, a multidimensional parameter based on living and household conditions. An adjusted binary logistic regression model was performed in order to compare the outcomes of hospitalization, mechanical ventilation requirement (MVR) and mortality between SWI categories: Very high (VHi), high (Hi), medium (M) and low (L). The main findings show that lower SWI were independently associated with higher probability for hospital entry: VHi vs. Hi vs. M vs. L-SWI (0 vs. +0.24 [OR = 1.24, CI95% 1.01-1.53] vs. +0.90 [OR = 1.90, CI95% 1.56-2.32] vs. 0.73 [OR = 1.73, CI95% 1.36-2.19], respectively); Mechanical Ventilation Requirement: VHi vs. M vs. L-SWI (0 vs. +0.45 [OR = 1.45, CI95% 1.11-1.87] vs. +0.35 [OR = 1.35, CI95% 1.00-1.82]) and mortality: VHi vs. Hi vs. M (0 vs. +0.54 [OR = 1.54, CI95% 1.22-1.94] vs. +0.41 [OR = 1.41, CI95% 1.13-1.76]). We concluded that SWI was independently associated with the poor clinical outcomes in COVID-19, beyond demographic, epidemiological and clinical characteristics.
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Affiliation(s)
| | | | | | - Mónica Escamilla-Tilch
- Centro Médico Nacional “20 de Noviembre”, Coordination of Research, Mexico City 03229, Mexico
| | - Daniel Santillán-Cortez
- Centro Médico Nacional “20 de Noviembre”, Coordination of Research, Mexico City 03229, Mexico
| | - Silvia García
- Centro Médico Nacional “20 de Noviembre”, Clinical Research Service, Mexico City 03229, Mexico
| | | | - Juan Carlos Pérez-Razo
- Centro Médico Nacional “20 de Noviembre”, Genomics Research Division, Mexico City 03229, Mexico
| | | | | | - Sandra Muñoz-López
- Centro Médico Nacional “20 de Noviembre”, COVID-19 Group, Mexico City 03229, Mexico
| | | | | | | | | | | | - Paul Mondragón-Terán
- Centro Médico Nacional “20 de Noviembre”, Coordination of Research, Mexico City 03229, Mexico
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Aung KZ, Kuroda Y, Hinoura T. Socio-Demographic, Health, and Transport-Related Factors Affecting the COVID-19 Outbreak in Myanmar: A Cross-Sectional Study. Cureus 2022; 14:e29693. [DOI: 10.7759/cureus.29693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
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