ABSTRACT
Background: Studying how vaccination hesitancy has changed since the onset of the pandemic and understanding what changed people's opinions could help improve vaccination rate in susceptible populations with high background refusal rates. Method(s): Randomly selected hemodialysis patients in an inner-City Unit were surveyed in 2020 (19 by telephone) and 2021 (31 face to face) about vaccination history and attitudes towards vaccines. In 2020 participants were asked if they would receive a COVID-19 vaccine if available and in 2021 if they had received the vaccine. Respondents who planned to received the vaccine (2020) or received one or both doses (2021) were counted as VACYES while those who were unsure or refused were classified as VACNO. Respondents were also asked their primary reasons for their choice. Result(s): The 2021 group had a mean age of 56.1 +/- 17.9 yrs., mean time on dialysis was 6.2 +/- 7.2 yrs. There were 18 (58%) women and 13 (42%) men, 28 (90%) identified as black. The 2020 and 2021 groups were similar with respect to age, time on dialysis, sex, and race. In 2020, 21% were classified as VACYES compared to 84% of the 2021 sample (p < 0.001). Among VACNO pts the most commonly cited reason was "Safety" (80%). Between vaccinated and unvaccinated patients in 2021, there were no statistically significant differences with respect to age, time on dialysis, sex, race, education, insurance status and presence of diabetes. Among VACYES pts. the three most commonly cited reasons for their choice were "Recommended for people with underlying conditions" (38%), "Trust in healthcare" (45%), and "Safety of the vaccine" (44%). Conclusion(s): In our inner-city population: 1. Although people in our catchment have a low vaccination rate the majority of the dialysis population studied received the vaccine despite initial hesitancy. 2. Recommendations related to underlying conditions, improved confidence in the safety of the vaccine and trust in healthcare were the most important reasons for acceptance. 3. With vaccine efforts still underway, education programs should continue to focus on stressing the importance in people with underlying conditions, improving patient-provider partnering, and disseminating information regarding vaccine safety in order to improve adherence in our kidney disease patients, in whom almost 20% remain unvaccinated.
ABSTRACT
We investigated how food purchasing behavior changed in a cohort of inner-city dialysis patients during the COVID-19 pandemic. 33 dialysis patients were surveyed face-to-face about use of grocery stores, restaurants, take-out, and use of SNAP or other benefits over the past year. The survey also assessed patient attitudes and fear relating to COVID-19. Mean age was 57.1±17.9 yrs, 20 (61%) men, 91% identified as Black. 9/20 pts (27%) reported yearly income under $20,000 with 70% less than $40,000. The number of pts using SNAP, WIC, or Greenmarket Bucks to buy groceries increased from 21% before the pandemic to 33% after (p=0.019). Age correlated negatively with feeling safe eating at a restaurant indoors (r=-0.47, p=0.008), or outdoors (r=-0.58, p=<0.001) and increased use of take-out since the start of the pandemic (r=-0.39, p=0.032). There was a significant difference in pts who purchased breakfast (45.9±4.0 vs 65.3±3.6, p<.001), lunch (49.7±4.1 vs 65.3±4.0, p=.006), and dinner compared to those who didn’t (48.5±4.9 vs 60.9±3.9, p=0.031). There was a positive correlation between income and the frequency that pts purchased breakfast (r=0.45, p=0.048) and lunch (r=0.45, p=0.046). There was a negative correlation between age and the statement “I wish I could cook more meals at home” (r=-0.497, p=0.004) and a positive correlation with income (r=0.06, p=0.006). There was no association between age and income. Only 6% (2) pts were employed and both were <60 yrs old. In our population of inner-city dialysis pts: 1. Use of food assistance programs increased since the start of the pandemic. 2. Older pts felt less safe eating at restaurants regardless of whether it was indoors or outdoors and were more likely to make meals at home. 4. Younger patients were more likely to eat take-out food and reported they wished they could cook more meals at home. 5. Increased use of food programs and association of younger age or lower income with eating out suggests that careful nutritional guidance should be emphasized as dietary habits have changed since the pandemic and eating out has been associated with worse adherence to sodium and other restrictions in pts on dialysis.
ABSTRACT
It has been reported that older pts adapt better to dialysis than younger pts. We investigated in response by age to various stressors encountered during the COVID-19 pandemic in a population of inner-city dialysis patients. A survey was conducted in a random sample of 32 dialysis patients. Patients were asked about their fluid intake, general attitudes towards medical recommendations, and changes in their wellbeing due to COVID19. The PSS (Perceived Stress Scale) and KAS-R (Kim Alliance Scale Revised) were also used. Mean age was 56.8 ± 18.2 years. 15 pts (46.9%) were <60 yrs (younger) and 17 (53.1%) were ≥60 yrs (older). Mean dialysis time was 88.0 ± 104.0 months. There were 20 (62.5%) male, 29 (90.6%) identified as black, 18 (56%) had a high school diploma or less, and 14 (44%) completed some college or more. 7% (1) of older and 46% (6) of younger pts reported “some of the time” or “never” rather than "most of the time" when asked how often they followed the fluid restriction recommendations (p=0.034). 29% (4) of younger pts reported fluid restrictions were difficult to follow, vs. none of the older pts (p=0.037). 33% (5) of younger pts reported “poor” or “average” when asked about wellbeing prior to the pandemic and 100% (15) of older patients reported “good” (p=0.05). When asked to rate their stress level over the last year, 64% (9) of younger pts reported being somewhat or very stressed and 79% (11) of older pts reported not at all or a little stressed (p=0.015). 29% (4) of younger pts stated they sometimes work well with their provider and 100% (15) of older patients stated always (p=0.026). There were no statistically significant differences between the groups for sex, race, or education. In our population during the pandemic: 1. Younger pts were less adherent to fluid restriction and found them more difficult to follow. 2. Older pts were more likely to report feeling good prior to the pandemic and were less stressed following it. 3. Older pts were more likely to report a good relationship with their provider. 4. Younger pts may need more support through the pandemic as they appear to be coping less well, feel less connected, and are less able to follow important dietary restrictions. (Table Presented) This case highlights the uncommon sequelae of untreated primary hyperparathyroidism which is rare since the introduction of automated chemistry analyzers [2]. Pancreatitis is reported in < 3% of patients with hyperparathyroidism and is seldom seen in current practice. Nephrocalcinosis and pancreatitis are rare complications of untreated hyperparathyroidism and could have been averted with the definitive treatment of parathyroidectomy.
ABSTRACT
Understanding factors that impact vaccine hesitancy in underserved populations is of paramount importance. A random sample of 31 dialysis pts were surveyed regarding COVID-19 vaccination status, attitudes towards vaccines and perception of healthcare/government authority. Respondents who received both doses, one dose, or were planning on doing so were recorded as VACYES while those who were unsure or refused were recorded as VACNO. Mean age was 56.1 ± 17.9 yrs, time on dialysis 6.2 ± 7.2 yrs with 18 (58%) women, 13 (42%) men, 28 (90%) identified as black. 84% had received the vaccine. There were no statistically significant differences between VACYES and VACNO for age, time on dialysis, sex, race, education, insurance status, and presence of diabetes. VACYES were more likely to agree with trust in the information about the vaccine (r = 0.57, p < 0.001), felt confident about the safety and efficacy (r = 0.75, p < 0.001), and trusted government guidelines regarding COVID-19 (r = 0.73, p < 0.001). Pts who believed it was okay for the government to mandate vaccinations (r = 0.52, p = 0.003), mandate COVID-19 vaccinations (r = 0.58, p = 0.001), and believe we should all follow government guidelines to protect public health (r = 0.41, p = 0.02) were also more likely to be VACYES. They also believed that hospitals could care for them if sick with COVID-19 (r = 0.62, p < 0.001), felt they had an active partnership with their provider (r = 0.42, p = 0.02) and felt having regular contact with their physician was the best way to avoid illness (r = 0.38, p = 0.04). VACNO pts were more likely to say they had less contact with medical professionals regarding their dialysis restrictions (r = - 0.63, p < 0.001) and felt their provider did not listen to them (r = - 0.38, p = 0.04). In our population of inner-city dialysis patients: 1. The majority are vaccinated against COVID-19. 2. Pts were more likely to have received the vaccine if they had trust in the government regarding COVID-19 and in the healthcare system in general. 3. Pts who reported more shared decision making were more likely to receive the vaccine and this should be emphasized in education efforts for vaccine acceptance in our vulnerable population.