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1.
Current developments in nutrition ; 2023.
Article in English | Europe PMC | ID: covidwho-2242499

ABSTRACT

Background The effects of coronavirus 2019 (COVID-19) remain a global public health emergency, due to the ensuing economic burden and death. With robust research into vaccines, antibody treatments, and antiviral drugs for COVID-19, there is still a dearth of evidence on the role of an individual's nutritional status on the severity of COVID-19. Objective This study aimed to investigate the association between selenium (Se) and zinc (Zn) status and COVID-19 severity among individuals in North Carolina diagnosed with COVID-19. Methods Subjects (n = 106) were recruited remotely as part of the Nutrition and COVID-19 in North Carolina (NC-NC) study and filled out online screening questionnaires and dietary surveys. Toenail samples from 97 participants were analyzed to determine Se and Zn concentrations. To assess the severity of SARS-CoV-2 ((severe acute respiratory coronavirus 2) infection, subjects were asked about the presence and duration of 10 commonly reported symptoms. These responses were used to calculate a COVID-19 Severity Index (CSI). The relationship between Se and Zn status (intake and toe-nail concentrations) and CSI was explored using regression analysis. Results Our results showed that the median (25, 75th percentiles) dietary Se and Zn intake from selected food sources were 65.2 μg (43.2, 112.9) and 4.3 mg (1.8, 8) respectively. Headache, cough, loss of smell or taste, and fever were reported by at least half of participants. In stepwise regression analysis, among individuals with low Se and Zn intake (below the median), Se intake was inversely associated with increasing CSI (β (95 % CI) = -0.66 (-1.21, -0.11);p=0.02). Conclusions Findings from this study support a potential benefit of increasing the intake of dietary Se to mitigate the severity of SARS-CoV-2 infection. Teaser text, Selenium intake is associated with elevated COVID-19 severity among young adults in North Carolina with low selenium and zinc intake.

2.
Crit Care Med ; 2023 Feb 15.
Article in English | MEDLINE | ID: covidwho-2238702

ABSTRACT

OBJECTIVES: The COVID-19 pandemic threatened standard hospital operations. We sought to understand how this stress was perceived and manifested within individual hospitals and in relation to local viral activity. DESIGN: Prospective weekly hospital stress survey, November 2020-June 2022. SETTING: Society of Critical Care Medicine's Discovery Severe Acute Respiratory Infection-Preparedness multicenter cohort study. SUBJECTS: Thirteen hospitals across seven U.S. health systems. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 839 hospital-weeks of data over 85 pandemic weeks and five viral surges. Perceived overall hospital, ICU, and emergency department (ED) stress due to severe acute respiratory infection patients during the pandemic were reported by a mean of 43% (sd, 36%), 32% (30%), and 14% (22%) of hospitals per week, respectively, and perceived care deviations in a mean of 36% (33%). Overall hospital stress was highly correlated with ICU stress (ρ = 0.82; p < 0.0001) but only moderately correlated with ED stress (ρ = 0.52; p < 0.0001). A county increase in 10 severe acute respiratory syndrome coronavirus 2 cases per 100,000 residents was associated with an increase in the odds of overall hospital, ICU, and ED stress by 9% (95% CI, 5-12%), 7% (3-10%), and 4% (2-6%), respectively. During the Delta variant surge, overall hospital stress persisted for a median of 11.5 weeks (interquartile range, 9-14 wk) after local case peak. ICU stress had a similar pattern of resolution (median 11 wk [6-14 wk] after local case peak; p = 0.59) while the resolution of ED stress (median 6 wk [5-6 wk] after local case peak; p = 0.003) was earlier. There was a similar but attenuated pattern during the Omicron BA.1 subvariant surge. CONCLUSIONS: During the COVID-19 pandemic, perceived care deviations were common and potentially avoidable patient harm was rare. Perceived hospital stress persisted for weeks after surges peaked.

3.
Acad Emerg Med ; 2023 Feb 15.
Article in English | MEDLINE | ID: covidwho-2246016

ABSTRACT

OBJECTIVES: The Enhancing the Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department (EQUIPPED) medication safety program involves three core components including provider education, clinical decision support, and audit and feedback using the American Geriatrics Society Beers Criteria to determine potentially inappropriate medications (PIMs). This study evaluated implementation of audit and feedback through a centralized informatics-based dashboard compared to academic detailing delivered one on one by an EQUIPPED champion. METHODS: In a cluster-randomized study (October 2019-September 2021), eight VA emergency department (EDs) implemented either the academic detailing (n = 4) or the dashboard (n = 4) strategy for the audit and feedback component of EQUIPPED. The primary outcome was the monthly proportion of PIMs prescribed to Veterans 65 years or older at ED discharge. Poisson regression was used to evaluate the proportion of PIMs prescribed 6 months prior to EQUIPPED implementation compared to 12 months following implementation. RESULTS: Eight VA ED sites successfully implemented the EQUIPPED program. During the 6-month baseline period, the academic detailing and dashboard sites had similar PIM prescribing rates of 8.01% for academic detailing versus 8.04% for dashboard (p = 0.90). Comparing 12 months of prescribing data after EQUIPPED implementation, the academic detailing group significantly improved PIM prescribing (7.07%) compared to the dashboard group (8.10%; odds ratio 1.14, 95% confidence interval 1.08-1.22, p ≤ 0.0001). Within the groups, two of the four academic detailing sites demonstrated statistically significant reductions in PIM prescribing. One of the four dashboard sites achieved nearly 50% relative reduction in PIM prescribing. CONCLUSIONS: Eight VA EDs successfully implemented the core components of the EQUIPPED program amid the unprecedented challenges posed by the COVID-19 pandemic. While the academic detailing approach to EQUIPPED audit and feedback was more effective at the group level to improve safe prescribing for older Veterans discharged from the ED, the trial suggests that dashboard-based audit and feedback is a reasonable strategy in resource-limited settings.

4.
Crit Care Explor ; 5(1): e0827, 2023 Jan.
Article in English | MEDLINE | ID: covidwho-2228129

ABSTRACT

Vascular dysfunction and capillary leak are common in critically ill COVID-19 patients, but identification of endothelial pathways involved in COVID-19 pathogenesis has been limited. Angiopoietin-like 4 (ANGPTL4) is a protein secreted in response to hypoxic and nutrient-poor conditions that has a variety of biological effects including vascular injury and capillary leak. OBJECTIVES: To assess the role of ANGPTL4 in COVID-19-related outcomes. DESIGN SETTING AND PARTICIPANTS: Two hundred twenty-five COVID-19 ICU patients were enrolled from April 2020 to May 2021 in a prospective, multicenter cohort study from three different medical centers, University of Washington, University of Southern California and New York University. MAIN OUTCOMES AND MEASURES: Plasma ANGPTL4 was measured on days 1, 7, and 14 after ICU admission. We used previously published tissue proteomic data and lung single nucleus RNA (snRNA) sequencing data from specimens collected from COVID-19 patients to determine the tissues and cells that produce ANGPTL4. RESULTS: Higher plasma ANGPTL4 concentrations were significantly associated with worse hospital mortality (adjusted odds ratio per log2 increase, 1.53; 95% CI, 1.17-2.00; p = 0.002). Higher ANGPTL4 concentrations were also associated with higher proportions of venous thromboembolism and acute respiratory distress syndrome. Longitudinal ANGPTL4 concentrations were significantly different during the first 2 weeks of hospitalization in patients who subsequently died compared with survivors (p for interaction = 8.1 × 10-5). Proteomics analysis demonstrated abundance of ANGPTL4 in lung tissue compared with other organs in COVID-19. ANGPTL4 single-nuclear RNA gene expression was significantly increased in pulmonary alveolar type 2 epithelial cells and fibroblasts in COVID-19 lung tissue compared with controls. CONCLUSIONS AND RELEVANCE: ANGPTL4 is expressed in pulmonary epithelial cells and fibroblasts and is associated with clinical prognosis in critically ill COVID-19 patients.

5.
Vaccines (Basel) ; 11(1)2022 Dec 22.
Article in English | MEDLINE | ID: covidwho-2236551

ABSTRACT

Persons with diabetes mellitus may have an increased risk of severe illness or death from COVID-19 compared to persons without diabetes. Prior studies indicate that immune response and thus vaccine effectiveness might be lower in persons with diabetes. We aimed to systematically review the effectiveness of COVID-19 vaccines in adults with diabetes. Pubmed, Embase, Web of Science and Cochrane Library were searched for studies that evaluated the effectiveness of COVID-19 vaccines in adults with diabetes, published before 4 March 2022. Risk of bias in the included studies was evaluated using the ROBINS-I tool. At least two reviewers conducted the study selection, data extraction, and risk of bias assessment independently. After screening of 2196 studies, a total of 17 articles were included. Six different COVID-19 vaccines (Ad5-nCoV-S, AZD1222, BNT162b2, CoronaVac, JNJ-78436735, and mRNA-1273) were included in the synthesis. Vaccine effectiveness was reported for SARS-CoV-2 infection, symptomatic COVID-19, hospitalization, and death, and ranged from 24 to 96% in persons with diabetes, and from 33 to 97% in total study populations; effectiveness was generally lower for persons with diabetes. Odds ratios for breakthrough infection or severe COVID-19 ranged from 1.03 to 2.41 in vaccinated persons with diabetes compared to persons without diabetes. Even though the included studies were very heterogeneous, results from the synthesis indicate that effectiveness of COVID-19 vaccines might be lower in persons with diabetes. More research is needed on the comparison of vaccine effectiveness between persons with and without diabetes, and the effectiveness of repeat COVID-19 vaccinations.

6.
Curr Dev Nutr ; 7(3): 100044, 2023 Mar.
Article in English | MEDLINE | ID: covidwho-2232279

ABSTRACT

Background: The effects of coronavirus disease 2019 (COVID-19) remain a global public health emergency because of the ensuing economic burden and death. With robust research into vaccines, antibody treatments, and antiviral drugs for COVID-19, there is still a dearth of evidence on the role of an individual's nutritional status on the severity of COVID-19. Objective: This study aimed to investigate the association between selenium (Se) and zinc (Zn) status and COVID-19 severity among individuals diagnosed with COVID-19 in North Carolina. Methods: Subjects (n = 106) were recruited remotely as part of the Nutrition and COVID-19 in North Carolina (NC-NC) study and filled out online screening questionnaires and dietary surveys. Toenail samples from 97 participants were analyzed to determine Se and Zn concentrations. To assess the severity of severe acute respiratory coronavirus (SARS-CoV)-2 infection, subjects were asked about the presence and duration of 10 commonly reported symptoms. These responses were used to calculate a COVID-19 severity index (CSI). The relationship between Se and Zn status (intake and toenail concentrations) and CSI was explored using a regression analysis. Results: Our results showed that the median (25th, 75th percentiles) dietary Se and Zn intake from selected food sources were 65.2 µg (43.2, 112.9) and 4.3 mg (1.8, 8), respectively. Headache, cough, loss of smell or taste, and fever were reported by at least half of the participants. In stepwise regression analysis, among individuals with low Se and Zn intake (below the median), Se intake was inversely associated with increasing CSI (ß = -0.66; 95% CI: -1.21, -0.11; P = 0.02). Conclusions: Findings from this study support a potential benefit of increasing the intake of dietary Se to mitigate the severity of SARS-CoV-2 infection.

7.
J Neurosurg ; : 1-11, 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-2231507

ABSTRACT

OBJECTIVE: The authors' objective was to investigate the impact of the global COVID-19 pandemic on hospital presentation and process of care for the treatment of traumatic brain injuries (TBIs). Improved understanding of these effects will inform sociopolitical and hospital policies in response to future pandemics. METHODS: The Michigan Trauma Quality Improvement Program (MTQIP) database, which contains data from 36 level I and II trauma centers in Michigan and Minnesota, was queried to identify patients who sustained TBI on the basis of head/neck Abbreviated Injury Scale (AIS) codes during the periods of March 13 through July 2 of 2017-2019 (pre-COVID-19 period) and March 13, 2020, through July 2, 2020 (COVID-19 period). Analyses were performed to detect differences in incidence, patient characteristics, injury severity, and outcomes. RESULTS: There was an 18% decrease in the rate of encounters with TBI in the first 8 weeks (March 13 through May 7), followed by a 16% increase during the last 8 weeks (May 8 through July 2), of our COVID-19 period compared with the pre-COVID-19 period. Cumulatively, there was no difference in the rates of encounters with TBI between the COVID-19 and pre-COVID-19 periods. Severity of TBI, as measured with maximum AIS score for the head/neck region and Glasgow Coma Scale score, was also similar between periods. During the COVID-19 period, a greater proportion of patients with TBI presented more than a day after sustaining their injuries (p = 0.046). COVID-19 was also associated with a doubling in the decubitus ulcer rate from 1.0% to 2.1% (p = 0.002) and change in the distribution of discharge status (p = 0.01). Multivariable analysis showed no differences in odds of death/hospice discharge, intensive care unit stay of at least a day, or need for a ventilator for at least a day between the COVID-19 and pre-COVID-19 periods. CONCLUSIONS: During the early months of the COVID-19 pandemic, the number of patients who presented with TBI was initially lower than in the years 2017-2019 prior to the pandemic. However, there was a subsequent increase in the rate of encounters with TBI, resulting in overall similar rates of TBI between March 13 through July 2 during the COVID-19 period and during the pre-COVID-19 period. The COVID-19 cohort was also associated with negative impacts on time to presentation, rate of decubitus ulcers, and discharge with supervision. Policies in response to future pandemics must consider the resources necessary to care for patients with TBI.

8.
J Patient Cent Res Rev ; 10(1): 38-44, 2023.
Article in English | MEDLINE | ID: covidwho-2226361

ABSTRACT

Purpose: We sought to determine if census tract-level (ie, neighborhood) COVID-19 death rates in Milwaukee County correlated with the census tract-level condition prevalence rates (CPRs) for individual COVID-19 mortality risk. Methods: This study used Milwaukee County-reported COVID-19 death rates per 100,000 lives for the 296 census tracts within the county to perform a linear regression with individual COVID-19 mortality risk CPR, mean age, racial composition of census tract (by percentage of non-White residents), and poverty (by percentage within census tract), followed by multiple regression with all 7 CPRs as well as the 7 CPRs combined with the additional demographic variables. CPR estimates were accessed from the Centers for Disease Control and Prevention 500 Cities Project. Demographics were accessed from the U.S. Census. The Milwaukee County Medical Examiner's office identified 898 deaths from COVID-19 in Milwaukee County from March 2020 to June 2021. Results: Among the variables included, crude death rate demonstrated a statistically significant association with the 7 COVID-19 mortality risk CPRs (as analyzed collectively), census tract mean age, and several of the CPRs individually. The addition of census tract age, race, and poverty in multiple regression did not improve the association of the 7 CPRs with crude death rate. Conclusions: Results from this population-level study indicated that census tracts with high COVID-19 mortality correlated with high-risk condition prevalence estimates within those census tracts, illustrating how health data collection and analysis at a census tract level could be helpful when planning pandemic-mitigating public health efforts.

9.
Gaceta Medica Estudiantil ; 2(3), 2021.
Article in Spanish | CAB Abstracts | ID: covidwho-2167711

ABSTRACT

Introduction: since the first cases of COVID-19 appeared, it has spread around the world dangerously fast. At the beginning, it was thought that it mainly affected adults and the elderly, but in early May 2020, cases of children began to be described, who after being infected, developed a multisystemic inflammatory syndrome, causing death in some cases.

10.
Acad Pediatr ; 2023 Jan 07.
Article in English | MEDLINE | ID: covidwho-2164925

ABSTRACT

OBJECTIVE: To examine changes in flourishing, school engagement, physical activity, and recreational screen time among school-aged children in the United States during the Coronavirus Disease 2019 (COVID-19) pandemic in 2020. METHODS: In this cross-sectional study, data come from the 2018-2020 National Survey of Children's Health for 68,203 children aged 6 to 17 years. Flourishing is always/usually curious to learn, resilient and having self-regulation. School engagement is always/usually completing homework and having interest in doing well in school. Other outcomes are daily 60+ minutes physical activity or number of such days, and daily recreational screen time or 2+ hours/day. Weighted regression models compare 2020 to 2019 and 2019 to 2018 adjusting for child/household covariates and state indicators. RESULTS: Among children age 6 to 17 years in 2020, there was a decline in flourishing (OR = 0.69; 95% CI, 0.63, 0.75), school engagement (OR = 0.71; 95% CI, 0.64, 0.79), physically active days (0.26 days, 95% CI, 35, 0.17), and daily 60+ minutes activity (OR = 0.91; 95% CI, 0.83, 1.00), and increase in daily recreational screen time (0.29 hours; 95% CI, 0.25, 0.34) and 2+ hours/day (OR = 1.65; 95% CI, 1.49-1.83) compared to 2019. These differences were observed across all evaluated demographic and socioeconomics subgroups. There were no significant differences between 2019 and 2018, indicating that the 2020-2019 differences were related to the pandemic rather than a continuation of prepandemic trends. CONCLUSIONS: Children's flourishing, school engagement, and physical activity declined while recreational screen time increased during the COVID-19 pandemic in 2020. Monitoring these outcomes in the long-run is important to assessing needs and promoting children's learning and development.

11.
Telemed J E Health ; 2022 May 24.
Article in English | MEDLINE | ID: covidwho-1866261

ABSTRACT

Purpose: To improve patient access to skin care, the Department of Veterans Affairs (VA) developed a patient-facing asynchronous mobile teledermatology application (app), which allows patients to follow up remotely with dermatologists. To understand how the app would be received in VA, we examined Organizational Readiness for Change (ORC), an important prelude to effective implementation, which includes the shared resolve and collective ability of organizational members to implement a change. Methods: We used a mixed-methods multiple case study approach to assess ORC at three VA facilities. Data derived from a site process call, surveys, and semistructured telephone interviews of VA staff, field notes, and administrative data. Results: Participants at all three facilities supported the intervention and recognized the value of using the app to increase patients' access to dermatologists, but expressed concerns largely related to disruption of the pre-existing clinical workflow. Participants at the facility most actively using the app had the highest overall ORC score and reported the most facilitators. Facility leadership support when guided by a clinical champion minimized barriers by recognizing the complexities of health care provision at specialty clinics. Discussion: While provider buy-in remained a barrier, leadership, guided by the clinical champion, played a critical role instituting implementation strategies. The strong association between the ORC survey score and the presence of facilitators and barriers suggests that the ORC survey may be a rapid, convenient, and effective tool for health care systems to identify favorable sites for wider implementation of mobile telehealth care. Clinical Trials Identifier: NCT03241589.

12.
Rapid Commun Mass Spectrom ; 37(5): e9452, 2023 Mar 15.
Article in English | MEDLINE | ID: covidwho-2148461

ABSTRACT

RATIONALE: We report the N-glycosylation pattern of Sf9 insect cell-derived recombinant spike proteins being developed as candidate vaccine antigens for SARS-CoV-2 (COVID-19) (Sanofi). The method has been optimised to produce peptides with single, isolated glycosylation sites using multiple protease digests. The development and use of glycopeptide libraries from previous developmental phases allowed for faster analysis than processing datasets from individual batches from first principles. METHODS: Purified spike proteins were reduced, alkylated, and digested with proteolytic enzymes. Three different protease digests were utilised to generate peptides with isolated glycosylation sites. The glycopeptides were then analysed using a Waters Q-TOF while using a data-dependent acquisition mass spectrometry experiment. Glycopeptide mapping data processing and glycan classification were performed using Genedata Expressionist via a specialised workflow that used libraries of previously detected glycopeptides to greatly reduce processing time. RESULTS: Two different spike proteins from six manufacturers were analysed. There was a strong similarity at each site across batches and manufacturers. The majority of the glycans present were of the truncated class, although at sites N61, N234, and N717/714 high mannose structures were dominant and at N1173/1170 aglycosylation was dominant for both variant proteins. A comparison was performed on a commercially available spike protein and our results were found to be similar to those of earlier reports. CONCLUSIONS: Our data clearly show that the overall glycosylation pattern of both spike protein variants was highly similar from batch to batch, and between materials produced at different manufacturing facilities. The use of our glycopeptide libraries greatly expedited the generation of site-specific glycan occupancy data for a large glycoprotein. We compared our method with previously obtained data from a commercially available insect cell-derived spike protein and the results were comparable to published findings.


Subject(s)
COVID-19 , Spike Glycoprotein, Coronavirus , Humans , COVID-19/prevention & control , COVID-19/virology , Glycopeptides/chemistry , Peptide Hydrolases , Peptides , Polysaccharides/analysis , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/chemistry , Vaccines, Synthetic , COVID-19 Vaccines
14.
mBio ; : e0291622, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2116506

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has radically altered daily life. Effective antiviral therapies to combat COVID-19, especially severe disease, remain scarce. Molnupiravir is an antiviral that has shown clinical efficacy against mild-to-moderate COVID-19 but failed to provide benefit to hospitalized patients with severe disease. Here, we explained the mechanism behind the failure of molnupiravir in hospitalized patients and identified alternative dosing strategies that would improve therapeutic outcomes in all patients with COVID-19. We showed that delaying therapy initiation markedly decreased the antiviral effect of molnupiravir, and these results were directly related to intracellular drug triphosphate pools and intracellular viral burden at the start of therapy. The adverse influence of therapeutic delay could be overcome by increasing drug exposure, which increased intracellular molnupiravir triphosphate concentrations that inhibited viral replication. These findings illustrated that molnupiravir must be administered as early as possible following COVID-19 symptom onset to maximize therapeutic efficacy. Higher doses may be effective in patients hospitalized with severe disease, but the safety of high-dose molnupiravir regimens is unknown. Our findings could be extended to design effective regimens with nucleoside analogs for other RNA viruses, especially those with pandemic potential. IMPORTANCE In this study, we showed that early intervention with molnupiravir resulted in a greater antiviral effect, and we explained the mechanism behind this phenomenon. Our results predicted and explained the failure of molnupiravir in hospitalized patients and highlighted the utility of preclinical pharmacodynamic studies to design optimal antiviral regimens for the treatment of viral diseases. This contrasts with the procedure that was implemented early in the pandemic in which clinical studies were conducted in the absence of preclinical experimentation. These findings are significant and demonstrated the importance of experimental approaches in antiviral development for treatments against COVID-19 as well as other viral diseases.

15.
Int J Environ Res Public Health ; 19(22)2022 Nov 21.
Article in English | MEDLINE | ID: covidwho-2116203

ABSTRACT

There is widespread recognition that the world of work is changing, and agreement is growing that the occupational safety and health (OSH) field must change to contribute to the protection of workers now and in the future. Discourse on the evolution of OSH has been active for many decades, but formalized support of an expanded focus for OSH has greatly increased over the past 20 years. Development of approaches such as the National Institute for Occupational Safety and Health (NIOSH)'s Total Worker Health® concept and the World Health Organization (WHO)'s Healthy Workplace Framework are concrete examples of how OSH can incorporate a new focus with a wider view. In 2019, NIOSH initiated a multi-year effort to explore an expanded focus for OSH. This paper is a report on the outputs of a three-year cooperative agreement between NIOSH and The University of Texas School of Public Health, which led to subject matter expert workshops in 2020 and an international conference of global interest groups in 2021. This article traces the background of these meetings and identifies and assesses the lessons learned. It also reviews ten thematic topics that emerged from the meetings: worker health inequalities; training new OSH professionals; future OSH research and practice; tools to measure well-being of workers; psychosocial hazards and adverse mental health effects; skilling, upskilling and improving job quality; socioeconomic influences; climate change; COVID-19 pandemic influences; and strategic foresight. Cross-cutting these themes is the need for systems and transdisciplinary thinking and operationalization of the concept of well-being to prepare the OSH field for the work of the future.


Subject(s)
COVID-19 , Occupational Health , United States , Humans , Occupational Health/education , Pandemics/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Workplace , Public Health
16.
Health Aff (Millwood) ; 41(11): 1583-1589, 2022 11.
Article in English | MEDLINE | ID: covidwho-2109346

ABSTRACT

In response to the COVID-19 pandemic, many US states implemented eviction moratoriums in 2020. Evidence from eviction filings from that year shows short-term declines in eviction filings. This study examined the short-term effects of these state eviction moratoriums in 2020 on the mental health status of renters. It employed nationally representative data from the Behavioral Risk Factor Surveillance System and a triple-difference design that compared renters with homeowners while leveraging state differences in moratoriums over time. During 2020 forty-three states and Washington, D.C., implemented eviction moratoriums of varying scope and enforcement. Some moratoriums targeted the whole eviction process, including early stages, whereas others focused on the later stages of eviction. We found that state moratoriums were associated with an improvement in mental health, including fewer days not in good mental health in the past thirty days and a lower likelihood of frequent mental distress (fourteen or more days not in good mental health in the past thirty days). Overall, there is some evidence from this study pointing to potential short-term benefits from state eviction moratoriums in 2020 to the mental health and well-being of renters, which would be important to consider when formulating policies that affect residential stability.


Subject(s)
COVID-19 , Mental Disorders , Humans , Mental Health , Housing , Pandemics/prevention & control , Mental Disorders/epidemiology
17.
Crit Care Explor ; 4(10): e0773, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2087871

ABSTRACT

Respiratory virus infections cause significant morbidity and mortality ranging from mild uncomplicated acute respiratory illness to severe complications, such as acute respiratory distress syndrome, multiple organ failure, and death during epidemics and pandemics. We present a protocol to systematically study patients with severe acute respiratory infection (SARI), including severe acute respiratory syndrome coronavirus 2, due to respiratory viral pathogens to evaluate the natural history, prognostic biomarkers, and characteristics, including hospital stress, associated with clinical outcomes and severity. DESIGN: Prospective cohort study. SETTING: Multicenter cohort of patients admitted to an acute care ward or ICU from at least 15 hospitals representing diverse geographic regions across the United States. PATIENTS: Patients with SARI caused by infection with respiratory viruses that can cause outbreaks, epidemics, and pandemics. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measurements include patient demographics, signs, symptoms, and medications; microbiology, imaging, and associated tests; mechanical ventilation, hospital procedures, and other interventions; and clinical outcomes and hospital stress, with specimens collected on days 0, 3, and 7-14 after enrollment and at discharge. The primary outcome measure is the number of consecutive days alive and free of mechanical ventilation (VFD) in the first 30 days after hospital admission. Important secondary outcomes include organ failure-free days before acute kidney injury, shock, hepatic failure, disseminated intravascular coagulation, 28-day mortality, adaptive immunity, as well as immunologic and microbiologic outcomes. CONCLUSIONS: SARI-Preparedness is a multicenter study under the collaboration of the Society of Critical Care Medicine Discovery, Resilience Intelligence Network, and National Emerging Special Pathogen Training and Education Center, which seeks to improve understanding of prognostic factors associated with worse outcomes and increased resource utilization. This can lead to interventions to mitigate the clinical impact of respiratory virus infections associated with SARI.

18.
Sci Total Environ ; 849: 157881, 2022 Nov 25.
Article in English | MEDLINE | ID: covidwho-2049903

ABSTRACT

OBJECTIVES: To examine the impact of the Intercontinental Terminals Company (ITC) fire and COVID-19 on airborne particulate matter (PM) concentrations and the PM disproportionally affecting communities in Houston using low-cost sensors. METHODS: We compared measurements from a network of low-cost sensors with a separate network of monitors from the Environmental Protection Agency (EPA) in the Houston metropolitan area from Mar 18, 2019, to Dec 31, 2020. Further, we examined the associations between neighborhood-level sociodemographic status and air pollution patterns by linking the low-cost sensor data to EPA environmental justice screening and mapping systems. FINDINGS: We found increased PM levels during ITC fire and pre-COVID-19, and lower PM levels after the COVID-19 lockdown, comparable to observations from the regulatory monitors, with higher variations and a greater number of locations with high PM levels detected. In addition, the environmental justice analysis showed positive associations between higher PM levels and the percentage of minority, low-income population, and demographic index. IMPLICATION: Our study indicates that low-cost sensors provide pollutant measures with higher spatial variations and a better ability to identify hot spots and high peak concentrations. These advantages provide critical information for disaster response and environmental justice studies. SYNOPSIS: We used measurements from a low-cost sensor network for air pollution monitoring and environmental justice analysis to examine the impact of anthropogenic and natural disasters.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollution/analysis , COVID-19/epidemiology , Communicable Disease Control , Environmental Justice , Environmental Monitoring , Explosions , Humans , Particulate Matter/analysis
19.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1923945

ABSTRACT

Even as patients with T2D have been shown to have increased COVID-related morbidity and mortality, little is known on the impact of COVID on appointment adherence. This report reviews the impact of culturally-relevant diabetes clinics on adherence to clinical appointments, (pre-and during COVID) . This is a retrospective observational study using EMR data of adult patients with T2D managed at Joslin Diabetes Center before the COVID pandemic (April 20to Dec. 2019) and during the COVID pandemic (April 2020 to Dec. 2020) . Demographic and clinical visit data were extracted from patients seen at least once in both time periods. Clinical appointment adherence and outcomes were compared to patients in the general adult diabetes clinic (GADC) versus the Asian American Diabetes Initiative clinic (AADI) . 297 adult patients with T2D were seen in the AADI clinic and 4,655 patients were seen in the GADC clinics. The AADI clinic catered to a significantly larger proportion of patients who were non-native English speaking (46.1% vs. 8.7%, p<0.001) and on Medicaid (8.4% vs. 4.6%, p<0.001) . Early in the pandemic, virtual appointments were the major source of kept visits, with in-person kept appointments adherence returning in late 2020 (Oct-Dec.) . While the AADI clinic saw no significant changes in kept appointment rates, the GADC clinic had significantly fewer kept appointments overall compared to a similar time frame pre-COVID (pre: 71.7% vs. during: 63.5%, p=0.03) . Both clinics had significantly higher no-show rates during the pandemic. Comparing clinical outcomes, while GADC clinic patients saw a decline in their eGFR during the pandemic (80 vs. 75;p-value=0.04) , the AADI clinic did not observe a significant change in their patient's renal status (82 vs. 83;p-value=0.93) . Our study shows that culturally oriented clinics like the AADI can successfully allow lower-incomes and older adults to acclimatize to telehealth services while also ensuring ongoing clinical wellbeing.

20.
SSM Popul Health ; 19: 101156, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1907808

ABSTRACT

This study aimed to investigate the association between adult food insecurity (FI) and symptoms of generalized anxiety disorder (GAD) and major depressive disorder (MDD) in two Brazilian cities during the coronavirus disease (COVID-19) pandemic. This study used data derived from a cross-sectional survey of 1693 adults. Interviews were conducted using an electronic questionnaire. The FI was measured using the Brazilian Food Insecurity Scale. The Generalized Anxiety Disorder-7 was used to measure the symptoms of GAD. The Patient Health Questionnaire-9 was used for MDD symptoms. The association between FI, GAD, and MDD symptoms was investigated using a Poisson regression model with robust variance to estimate the prevalence ratio and 95% confidence interval (95% CI). In regression models, a linear association between FI levels and outcomes was observed, with severe food insecurity having a 3.56 higher prevalence of GAD symptoms (95% CI: 2.23, 5.68) and a 3.03 higher prevalence of MDD (95% CI: 1.55, 5.90). In the stratified analyses, worse results were observed for females and males, individuals with non-white race/skin color, those without children, and those with lower monthly family income. In conclusion, the FI was associated with symptoms of GAD and MDD, and the sociodemographic characteristics interfered in this association. Therefore, we recommend the improvement of public health and social protection policies for food-insecure people.

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