ABSTRACT
Background Few church-based health interventions have evaluated the influence of neighborhood-level social determinants of health (SDOH) on adopting heart-healthy lifestyles;none has occurred in Louisiana. We aimed to characterize neighborhood-level SDOH that may influence the ability to adopt a heart-healthy lifestyle among Black community church members in New Orleans, LA. Methods This mixed methods study used quantitative data (surveys) and qualitative data (focus groups) to explore SDOH at the neighborhood- and church-area- level, including factors related to the physical (e.g., walkability, accessibility to recreational facilities) and social (e.g., social cohesion, perceived safety) environments. Descriptive analyses were conducted for quantitative data. Qualitative data were coded and analyzed using grounded theory and thematic analysis. Results Among survey respondents (n = 302, 77 % female, 99 % Black), most reported having walkable neighborhood sidewalks and high neighborhood social cohesion. Two-thirds did not feel violence was a problem in their neighborhood and felt safe walking, day, or night. Focus group participants (n = 27, 74 % female, 100 % Black) reported facilitators to heart-healthy living, including social support promoting physical activity, intentionality in growing, buying, and preparing produce, and the neighborhood-built environment. Reported barriers included: crime, the COVID-19 pandemic, individual-level factors limiting physical activity, and city-wide disparities influencing health. Participants discussed strategies to promote healthy living, centered around the theme of establishing and rebuilding community relationships. Conclusions Future health interventions aimed at improving cardiovascular outcomes among church communities should continue to inquire about neighborhood-level SDOH and tailor interventions, as appropriate, to address barriers and leverage facilitators within these communities.
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected patients with kidney disease, causing significant challenges in disease management, kidney research and trainee education. For patients, increased infection risk and disease severity, often complicated by acute kidney injury, have contributed to high mortality. Clinicians were faced with high clinical demands, resource shortages and novel ethical dilemmas in providing patient care. In this review, we address the impact of COVID-19 on the entire spectrum of kidney care, including acute kidney injury, chronic kidney disease, dialysis and transplantation, trainee education, disparities in health care, changes in health care policies, moral distress and the patient perspective. Based on current evidence, we provide a framework for the management and support of patients with kidney disease, infection mitigation strategies, resource allocation and support systems for the nephrology workforce.
Subject(s)
Acute Kidney Injury , COVID-19 , Humans , Pandemics , SARS-CoV-2 , Renal Dialysis , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , KidneySubject(s)
COVID-19 , Cardiovascular Diseases , American Heart Association , Ethnicity , Humans , Racial Groups , Registries , SARS-CoV-2 , United States/epidemiologySubject(s)
Betacoronavirus , Black or African American , Coronavirus Infections , Healthcare Disparities , Indians, North American , Pandemics , Pneumonia, Viral , Racism , Trust , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/ethnology , Coronavirus Infections/therapy , Female , Humans , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/ethnology , Pneumonia, Viral/therapy , SARS-CoV-2 , United States/epidemiology , United States/ethnologyABSTRACT
Kidney transplant recipients who develop symptoms consistent with coronavirus disease 2019 (COVID-19) are bringing unique challenges to health care professionals. Telemedicine has surged dramatically since the pandemic in effort to maintain patient care and reduce the risk of COVID-19 exposure to patients, health care workers, and the public. Herein we present reports of 3 kidney transplant recipients with COVID-19 who were managed using telemedicine via synchronous video visits integrated with an electronic medical record system, from home to inpatient settings. We demonstrate how telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding a visit to an emergency department or outpatient clinic. While there is limited information about the duration of viral shedding for immunosuppressed patients, our findings underscore the importance of using telemedicine in the follow-up care for kidney transplant recipients with COVID-19 who have recovered from symptoms but might have persistently positive nucleic acid tests. Our experience emphasizes the opportunities of telemedicine in the management of kidney transplant recipients with COVID-19 and in the maintenance of uninterrupted follow-up care for such immunosuppressed patients with prolonged viral shedding. Telemedicine may help increase access to care for kidney transplant recipients during and beyond the pandemic as it offers a prompt, safe, and convenient platform in the delivery of care for these patients. Yet, to advance the practice of telemedicine in the field of kidney transplantation, barriers to increasing the widespread implementation of telemedicine should be removed, and research studies are needed to assess the effectiveness of telemedicine in the care of kidney transplant recipients.
Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/therapy , Kidney Transplantation/adverse effects , Pneumonia, Viral/therapy , Postoperative Complications/therapy , Telemedicine/methods , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Female , Humans , Immunocompromised Host/immunology , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Postoperative Complications/diagnosis , Postoperative Complications/immunology , SARS-CoV-2ABSTRACT
The pandemic of coronavirus disease 2019 (CoVID-19) has been an unprecedented period. The disease afflicts multiple organ systems, with acute kidney injury (AKI) a major complication in seriously ill patients. The incidence of AKI in patients with CoVID-19 is variable across numerous international studies, but the high incidence of AKI and its associated worse outcomes in the critical care setting are a consistent finding. A multitude of patterns and mechanisms of AKI have been elucidated, and novel strategies to address shortage of renal replacement therapy equipment have been implemented. The disease also has had consequences on longitudinal management of patients with chronic kidney disease and end stage kidney disease. Kidney transplant recipients may be especially susceptible to CoVID-19 as a result of immunosuppression, with preliminary studies demonstrating high mortality rates. Increased surveillance of disease with low threshold for testing and adjustment of immunosuppression regimen during acute periods of illness have been recommended.
Subject(s)
Acute Kidney Injury/etiology , Betacoronavirus , Coronavirus Infections/complications , Kidney Failure, Chronic/therapy , Kidney Transplantation , Pneumonia, Viral/complications , Renal Insufficiency, Chronic/drug therapy , Acute Kidney Injury/epidemiology , Acute Kidney Injury/therapy , Age Factors , Angiotensin-Converting Enzyme 2 , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/mortality , Critical Care , Healthcare Disparities , Humans , Immunosuppression Therapy/adverse effects , Immunosuppression Therapy/methods , Incidence , Kidney Failure, Chronic/complications , Kidney Transplantation/adverse effects , Kidney Transplantation/methods , Kidney Transplantation/mortality , Pandemics , Peptidyl-Dipeptidase A , Pneumonia, Viral/epidemiology , Pneumonia, Viral/mortality , Renal Insufficiency, Chronic/complications , Renal Replacement Therapy/instrumentation , Risk Factors , SARS-CoV-2 , Sex Factors , Transplant Recipients , Vulnerable PopulationsABSTRACT
PodcastThis article contains a podcast athttps://www.asn-online.org/media/podcast/JASN/2020_07_21_JASN2020060809.mp3.