Financial capability and households' financial vulnerability: evidence for the Spanish case

PurposeThe present study examines the potential relationship between financial capability and household financial vulnerability for a sample of Spanish individuals.Design/methodology/approachThe methodology combines a literature review deepening on the two concepts addressed in this paper – financial vulnerability and financial capability – and an empirical analysis. Based on a sample of 7,811 Spanish individuals taken from the Survey of Financial Competences, different probit regression models are used to test the relationship of key independent variables (namely, financial literacy, financial inclusion, and financial capability) with household financial vulnerability.FindingsEmpirical evidence points to the existence of a negative relationship between financial capability and household financial vulnerability. Besides, the variable on financial capability demonstrates, per se, a greater explanatory power than its two components (i.e. objective financial literacy and financial inclusion) separately, particularly in the case of financial literacy.Originality/valueThis paper contributes to the research on household finances along three main dimensions. Firstly, it enhances the research on financial capability by analysing how it relates to consumers' financial vulnerability;an association barely explored by the extant literature. Secondly, it gets closer to the multifaceted concept of financial vulnerability through a wide set of objective and subjective proxy variables. And thirdly, the empirical evidence found leads to proposing some recommendations aimed at improving households' financial capability.

The role of discrimination and vaccine distrust in vaccine uptake among Latines in the Midwest

Presents a study which aims to examine the role of discrimination and vaccine distrust in vaccine uptake among Latines in the Midwest. Participants were 137 adult Latine residents of Nebraska. The majority were cisgender women. Participants were recruited via bilingual flyers and referral from local community centers, public health agencies, medical clinics, cultural organizations, faith organizations, and educational systems in rural, urban, and ex-urban areas of Nebraska. At baseline, 53 participants reported having received the COVID-19 vaccine and 37 had registered to received it, meaning a majority had already taken steps to receive the vaccine. At follow-up, approximately two-thirds reported having already received the vaccine. Of the 19 who stated that they had not, 6 ad registered to received it. Thus, only 13 participants reported not having received the vaccine and not having registered to receive it. When asked about what would prevent them from receiving the vaccine, 35 reported not trusting the COVID-19 vaccine at baseline and 10 at follow-up. Structural barriers to vaccination were also identified by respondents, 25 at baseline and 6 at follow-up perceived cost as a barrier, 37 at baseline and 5 for follow-up reporting lack of insurance or not having insurance. While the current study provided only limited support for the Health Belief Model as applied to COVID-19 vaccine uptake among Latines, results still offer important insights into vaccine uptake and service utilization overall. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Limited Humoral and Specific T-Cell Responses After SARS-CoV-2 Vaccination in PWH With Poor Immune Reconstitution.

BACKGROUND: We analyzed humoral and cellular immune responses induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in people with human immunodeficiency virus (HIV; PWH) who had CD4+ T-cell counts <200/µL (HIV<200 group). METHODS: This prospective cohort study included 58 PWH in the HIV<200 group, 36 with CD4+ T-cell counts >500/µL (HIV>500 group), and 33 HIV-1-negative controls (control group). Antibodies against the SARS-CoV-2 spike protein (anti-S immunoglobulin [Ig] G) and the receptor-binding domain (anti-RBD IgG) were quantified before and 4 weeks after the first and the second doses of BNT162b2 or mRNA-1273 (at week 8). Viral neutralization activity and T-cell responses were also determined. RESULTS: At week 8, anti-S/anti-RBD IgG responses increased in all groups (P < .001). Median (interquartile range) anti-S and anti-RBD IgG levels at week 8 were 153.6 (26.4-654.9) and 171.9 (61.8-425.8) binding antibody units (BAU)/mL, respectively, in the HIV<200 group, compared with 245.6 (145-824) and 555.8 (166.4-1751) BAU/mL in the HIV>500 group and 274.7 (193.7-680.4) and 281.6 (181-831.8) BAU/mL in controls (P < .05). Neutralizing capacity and specific T-cell immune responses were absent or reduced in 33% of those in the HIV<200 group, compared with 3.7% in the HIV>500 group (P < .01). CONCLUSIONS: One-third of PWH with CD4+ T-cell counts <200/µL show low anti-S/anti-RBD IgG levels, reduced in vitro neutralization activity against SARS-CoV-2, and no vaccine-induced T cells after receiving coronavirus disease 2019 mRNA vaccines.

Correlation between Clinical and Immunological Variables and Humoral Response to SARS-CoV-2 Vaccination in Adult Patients with Antibody Deficiency Disorders.

BACKGROUND: Prophylactic vaccination has proven to be the most effective strategy to fight the COVID-19 pandemic. METHODS: This was a prospective observational cohort study involving 30 predominantly antibody deficiency disorders (ADD)-afflicted adult patients on immunoglobulin replacement therapy vaccinated with three doses of the mRNA-1273 COVID-19 vaccine, and 10 healthy controls. Anti-RBD IgG antibodies were determined in plasma samples collected just before the first dose of mRNA-based COVID-19 vaccine and on weeks 4, 8, 24, and 28 following the first vaccination. Patients were categorized based on the levels of anti-RBD antibodies determined on w8 as non-, low-, and responders. Chi-square and Kruskal-Wallis tests were used to see if any variables correlated with humoral response levels. Any adverse effects of the mRNA-based vaccine were also noted. RESULTS: The COVID-19 vaccine was safe and well-tolerated. The humoral response elicited at w8 after vaccination depended on the type of ADD, the type of immunoglobulin deficiency, the presence of granulomatous lymphocytic interstitial lung disease, recent use of immunosuppressive drugs, and the switched memory B cells counts. The third vaccine dose boosted humoral response in previous responders to second dose but seldom in non-responders. CONCLUSIONS: The humoral response of patients with predominant ADD depends mostly on the type of immunodeficiency and on the frequency of B and T cell populations.

Kinetics of immune responses elicited after three mRNA COVID-19 vaccine doses in predominantly antibody-deficient individuals.

Mass vaccination campaigns reduced COVID-19 incidence and severity. Here, we evaluated the immune responses developed in SARS-CoV-2-uninfected patients with predominantly antibody-deficiencies (PAD) after three mRNA-1273 vaccine doses. PAD patients were classified based on their immunodeficiency: unclassified primary antibody-deficiency (unPAD, n = 9), common variable immunodeficiency (CVID, n = 12), combined immunodeficiency (CID, n = 1), and thymoma with immunodeficiency (TID, n = 1). unPAD patients and healthy controls (HCs, n = 10) developed similar vaccine-induced humoral responses after two doses. However, CVID patients showed reduced binding and neutralizing titers compared to HCs. Of interest, these PAD groups showed lower levels of Spike-specific IFN-γ-producing cells. CVID individuals also presented diminished CD8+T cells. CID and TID patients developed cellular but not humoral responses. Although the third vaccine dose boosted humoral responses in most PAD patients, it had limited effect on expanding cellular immunity. Vaccine-induced immune responses in PAD individuals are heterogeneous, and should be immunomonitored to define a personalized therapeutic strategies.

Depression among medical students in the United States during the COVID-19 pandemic: The role of communication between universities and their students.

OBJECTIVE: Medical students are vulnerable to stress and depression during medical school, and the COVID-19 pandemic may have exacerbated these issues. This study examined whether depression risk was associated with COVID-19 pandemic-related medical school communication. METHODS: A 144-item pilot cross-sectional online survey of medical students in the US, between September 1st, 2020 and December 31st, 2020. Items on stress, depression, and communication between students and their medical schools were included. This study examined associations of student perceptions of universities' communication efforts and pandemic response with risk of developing depression. RESULTS: The sample included 212 students from 22 US states. Almost half (48.6%) were at risk of developing depression. Students felt medical schools transitioned well to online platforms and the curriculum was just as rigorous as in-person courses. Students at risk of developing depression reported communication was poor more frequently compared to students at average risk. Students at risk of depression were more than 3 times more likely to report their universities' communication about scholarships or other funding was poor in adjusted analyses. CONCLUSIONS: Universities communicated well with medical students during the pandemic. However, this study also highlights the need for ongoing efforts to address student mental health by medical schools.

Morbid obesity is associated with mortality and acute kidney injury in hospitalized patients with COVID-19.

BACKGROUND & AIMS: Mexico has one of the highest mortality rates by COVID-19 worldwide. This may be partially explained by the high prevalence of overweight/obesity found in general population; however, there is limited information in this regard. Furthermore, acute kidney injury (AKI) and need for renal replacement therapy (RRT) associated to obesity in patients with COVID-19 are still topics of discussion. AIM: To explore the association of obesity, particularly morbid obesity, with mortality and kidney outcomes in a Mexican population of hospitalized patients with COVID-19. METHODS: Retrospective cohort study of 773 patients with COVID-19 hospitalized in a tertiary-care teaching hospital in the Mexican state of Jalisco. Baseline body mass index was classified as: normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obesity (30-39.9 kg/m2), and morbid obesity (≥40 kg/m2). AKI was diagnosed according to KDIGO clinical practice guidelines. RESULTS: At baseline, 35% of patients had overweight, 39% obesity and 8% morbid obesity. Patients with obesity were younger, more frequently women and with hypertension than normal weight and overweight patients. Frequency of complications in the univariate analysis were not significantly associated to obesity, however in the multivariate analysis (after adjusting for baseline clinical and biochemical differences), morbid obesity was significantly associated to an increased risk of AKI [OR = 2.70 (1.01-7.26), p = 0.05], RRT [OR = 14.4 (1.46-42), p = 0.02], and mortality [OR = 3.54 (1.46-8.55), p = 0.005]. CONCLUSIONS: Almost half of the sample had obesity and morbid obesity. Morbid obesity was significantly associated to an increased risk of AKI, RRT and mortality in hospitalized patients with COVID-19.

Risk factors for mortality of adult patients with COVID-19 hospitalised in an emerging country: a cohort study.

OBJECTIVE: To describe mortality of in-hospital patients with COVID-19 and compare risk factors between survivors and non-survivors. DESIGN: Prospective cohort of adult inpatients. SETTING: Tertiary healthcare teaching hospital in Guadalajara, Mexico. PARTICIPANTS: All patients with confirmed COVID-19 hospitalised from 25 March to 7 September 2020 were included. End of study: 7 November 2020. PRIMARY OUTCOME MEASURES: Patient survival analysed by the Kaplan-Meier method and comparison of factors by the log-rank test. Mortality risk factors analysed by multivariate Cox's proportional-hazard model. RESULTS: One thousand ten patients included: 386 (38%) died, 618 (61%) alive at discharge and six (0.6%) remained hospitalised. There was predominance of men (63%) and high frequency of overweight-obesity (71%); hypertension (54%); diabetes (40%); and lung (9%), cardiovascular (8%) and kidney diseases (11%); all of them significantly more frequent in non-survivors. Overweight-obesity was not different between groups, but severity of disease (Manchester Triage System and quick Sequential Organ Failure Assessment) was significantly worse in non-survivors, who were also significantly older (65 vs 45 years, respectively) and had haematological, biochemical, coagulation and inflammatory biomarkers more altered than survivors. Mortality predictors were invasive mechanical ventilation (IMV; OR 3.31, p<0.0001), admission to intensive care unit (ICU; OR 2.18, p<0.0001), age (OR 1.02, p<0.0001), Manchester Triage System (urgent OR 1.44, p=0.02; immediate/very urgent OR 2.02, p=0.004), baseline C reactive protein (CRP; OR 1.002, p=0.009) and antecedent of kidney disease (OR 1.58, p=0.04) CONCLUSIONS: Mortality in hospitalised patients with COVID-19 in this emerging country centre seemed to be higher than in developed countries. Patients displayed a high frequency of risk factors for poor outcome, but the need for IMV, ICU admission, older age, more severe disease at admission, antecedent of kidney disease and higher CRP levels significantly predicted mortality.

Regulated Intramembrane Proteolysis of ACE2: A Potential Mechanism Contributing to COVID-19 Pathogenesis?

Since being identified as a key receptor for SARS-CoV-2, Angiotensin converting enzyme 2 (ACE2) has been studied as one of the potential targets for the development of preventative and/or treatment options. Tissue expression of ACE2 and the amino acids interacting with the spike protein of SARS-CoV-2 have been mapped. Furthermore, the recombinant soluble extracellular domain of ACE2 is already in phase 2 trials as a treatment for SARS-CoV-2 infection. Most studies have continued to focus on the ACE2 extracellular domain, which is known to play key roles in the renin angiotensin system and in amino acid uptake. However, few also found ACE2 to have an immune-modulatory function and its intracellular tail may be one of the signaling molecules in regulating cellular activation. The implication of its immune-modulatory role in preventing the cytokine-storm, observed in severe COVID-19 disease outcomes requires further investigation. This review focuses on the regulated proteolytic cleavage of ACE2 upon binding to inducer(s), such as the spike protein of SARS-CoV, the potential of cleaved ACE2 intracellular subdomain in regulating cellular function, and the ACE2's immune-modulatory function. This knowledge is critical for targeting ACE2 levels for developing prophylactic treatment or preventative measures in SARS-CoV infections.