An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: A nationwide register-based study in Sweden.

BACKGROUND: Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. METHODS: National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n = 5,987,189) by 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. FINDINGS: By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. INTERPRETATION: Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. FUNDING: SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.

An intersectional analysis of sociodemographic disparities in Covid-19 vaccination: a nationwide register-based study in Sweden

Background Studies on sociodemographic disparities in Covid-19 vaccination uptake in the general population are still limited and mostly focused on older adults. This study examined sociodemographic differences in Covid-19 vaccination uptake in the total Swedish population aged 18-64 years. Methods National Swedish register data within the SCIFI-PEARL project were used to cross-sectionally investigate sociodemographic differences in Covid-19 vaccination among Swedish adults aged 18-64 years (n=5,987,189) as of 12 October 2021. Using logistic regression models, analyses were adjusted for sociodemographic factors, region of residence, history of Covid-19, and comorbidities. An intersectional analysis approach including several cross-classified subgroups was used to further address the complexity of sociodemographic disparities in vaccination uptake. Findings By 12 October 2021, 76·0% of the Swedish population 18-64 years old had received at least two doses of Covid-19 vaccine, an additional 5·5% had received only one dose, and 18·5% were non-vaccinated. Non-vaccinated individuals were, compared to vaccinated, more often younger, male, had a lower income, were not gainfully employed, and/or were born outside Sweden. The social patterning for vaccine dose two was similar, but weaker, than for dose one. After multivariable adjustments, findings remained but were attenuated indicating the need to consider different sociodemographic factors simultaneously. The intersectional analysis showed a large variation in vaccine uptake ranging from 32% to 96% in cross-classified subgroups, reflecting considerable sociodemographic heterogeneity in vaccination coverage. Interpretation Our study, addressing the entire Swedish population aged 18-64 years, showed broad sociodemographic disparities in Covid-19 vaccine uptake but also wide heterogeneities in coverage. The intersectional analysis approach indicates that focusing on specific sociodemographic factors in isolation and group average risks without considering the heterogeneity within such groups will risk missing the full variability of vaccine coverage. Funding SciLifeLab / Knut & Alice Wallenberg Foundation, Swedish Research Council, Swedish government ALF agreement, FORMAS.

EARLY INFLAMMATORY ARTHRITIS REFERRALS SHOULD BE SEEN FACE-TO-FACE FOR THEIR INITIAL CONSULTATION: AN ANALYSIS OF RHEUMATOLOGY NEW PATIENT TELECONSULTATIONS

Background/Aims The COVID-19 pandemic has hugely impacted on the structure of rheumatology services across the country and remote consultations have become a familiarity. It is important to understand the effectiveness of new patient consultations conducted over the telephone, whether there is a role to continue using teleconsultations to triage referrals and whether there is a difference in outcomes based on the type of initial consultation [telephone or face-to-face (F2F)]. Methods All new referrals to our department that received an initial telephone consultation over a 2-month period (October-November 2020) were identified. The conversion rate to a F2F consultation and discharge rates were calculated. Referrals were also separated into two groups based on the referral details [early inflammatory arthritis (EIA) and nonearly inflammatory arthritis (non-EIA)]. Patients ultimately diagnosed with inflammatory arthritis (IA) were identified and separated into two groups according to their initial consultation;initial telephone consultation (October-November 2020) and initial F2F consultation (March-April 2021). The time from first encounter to disease-modifying antirheumatic drug (DMARD) initiation was calculated and compared between the two groups. Results October-November 2020: 154 new patient referrals had teleconsultation for their first appointment (44% were EIA referrals). 56% of the 154 patients were given a F2F appointment following the telephone consultation. The conversion rate was higher in the EIA group in comparison to the non-EIA group (69% vs 41%). 10 patients were diagnosed with IA (8 were EIA referrals) and the average time to initiation of DMARD was 55 days. 19% of the 154 patients were discharged following the initial telephone consultation, of which 72% were non-EIA referrals, with the most common diagnoses being mechanical/degenerative problems and fibromyalgia. These results were presented at a departmental meeting and it was agreed that all future new EIA referrals should have an initial F2F consultation to minimise the number of consultations and potential delays in treatment. March-April 2021: 319 patients had a F2F consultation for their first consultation. There were 39 patients with confirmed IA in this group (36 were EIA referrals). The average time to initiation of DMARD was 22 days, with 40% starting a DMARD on initial consultation. Conclusion There seems to be a role for teleconsultation for new patient referrals, as evidenced by a 19% discharge rate. However, high conversion rates to F2F appointment in the EIA group suggests that initial teleconsultations were not only ineffective but also led to slower DMARD initiation. One limitation of this project was that EIA patient sample sizes were small. As our specialty continues to utilise other modes of consultation beyond traditional F2F reviews, we must adapt and better identify which patients are most suitable for each particular mode of consultation.

Motivating Ethnic Minority Students in Hong Kong to Learn Chinese Culture with EduVenture VR

This paper presents our initiative for leveraging SV-IVR (spherical video-based immersive virtual reality) to give Hong Kong ethnic minority students exposure to local Chinese culture via EduVenture VR-an interactive learner-immersed virtual interactive learning application. The work was conducted in the COVID-19 pandemic context;outdoor fieldwork-based learning was not recommended in the circumstance. The research participants were 63 ethnic minority students (from Grade 7 to Grade 9) from a Hong Kong secondary school. The ARCS model of instructional motivation was employed to evaluate the motivational effectiveness of the Chinese culture learning activity supported by EduVenture VR. In the study, we obtained positive results in terms of the 4 motivational dimensions: "Attention," "Relevance," "Confidence' and "Satisfaction."

Impact of COVID-19 on Neighborhood Social Support and Social Interactions in Umea Municipality, Sweden

The objectives are to, for neighborhoods with different levels of social capital, (1) map out the levels of social interactions, emotional support, and instrumental support before the COVID-19 crisis, (2) analyze how social interactions, emotional support, and instrumental support had changed during the pandemic and, (3) analyze changes in self-rated health during the pandemic. This study is based on a telephone survey with a subsample of 168 respondents in Umea municipality who participated in a large base-line social capital survey in 2006. We asked whether neighbors talk to, care for, and help each other, before and during the Covid crisis. Individuals rated their health as poor or good. We compared people's self-rated health and their perceptions about their neighborhoods between those who lived in high or low/medium social capital neighborhoods. Before the pandemic, participants in high social capital neighborhoods reported more active neighborhood interaction and support. During the crisis, social interaction and support increased in all neighborhoods, but more in high social capital neighborhoods. Overall, people seemed to help and care for each other more during than before the crisis. More individuals in the high social capital neighborhoods reported improvement in their health during the pandemic, than those in the low/medium social capital neighborhoods. Our findings indicate that neighborhoods social capital can be strengthened during a crisis, in particular in areas with existing high levels of social capital. The findings need to be interpreted carefully due to its small sample size but observed patterns warrant further investigation.

Formation of oxidized gases and secondary organic aerosol from a commercial oxidant-generating electronic air cleaner

The COVID-19 pandemic increased the demand for indoor air cleaners. While some commercial electronic air cleaners can be effective in reducing primary pollutants and inactivating bioaerosol, studies on the formation of secondary products from oxidation chemistry during their use are limited. Here, we measured oxygenated volatile organic compounds (OVOCs) and the chemical composition of particles generated from a hydroxyl radical generator in an office. During operation, enhancements in OVOCs, especially low-molecular-weight organic acids, were detected. Rapid increases in particle number and mass concentrations were observed, corresponding to the formation of highly oxidized secondary organic aerosol (SOA) (O:C ∼1.3), with an enhanced signal at m/z 44 (CO2+) in the organic mass spectra. These results suggest that organic acids generated during VOC oxidation contributed to particle nucleation and SOA formation. Nitrate, sulfate, and chloride also increased during the oxidation without a corresponding increase in ammonium, suggesting organic nitrate, organic sulfate, and organic chloride formation. As secondary species are reported to have detrimental health effects, further studies should not be limited to the inactivation of bioaerosol or reduction of particular VOCs, but should also evaluate potential OVOCs and SOA formation from electronic air cleaners in different indoor environments. © 2021 American Chemical Society.