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1.
Lancet Global Health ; 10(2):E216-E226, 2022.
Article in English | Web of Science | ID: covidwho-1743600

ABSTRACT

Background Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11.3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study;9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study;and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1.87, 95% CI 1.65-2.12) than in MICs (1.41, 1.34-1.49) and LICs (1.35, 1 .25-1.46;interaction p<0.0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (>= 1 times/day) was 6.3% in HICs, 23.2% in MICs, and 14.0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47.2 mu M) than in MICs (31. 1 mu M) and LICs (25.2 mu M;ANCOVA p<0.0001). By contrast, it was higher among never smokers in LICs (18.8 mu M) and MICs (11.3 mu M) than in HICs (5.0 mu M;ANCOVA p=0.0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

2.
Cardiovasc Digit Health J ; 2(5): 256-263, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1734322

ABSTRACT

Background: Telemedicine and commercial wearable devices capable of detecting atrial fibrillation (AF) have revolutionized arrhythmia care during coronavirus disease 2019. However, not much is known about virtual patient-provider interactions or device sharing behaviors. Objective: The purpose of this study was to characterize how participants with or at risk of AF are engaging with their providers in the context of telemedicine and using commercially wearable devices to manage their health. Methods: We developed a survey to describe participant behaviors around telemedicine encounters and commercial wearable device use. The survey was distributed to participants diagnosed with AF or those at risk of AF (as determined by being at least 65 years old and having a CHA2DS2-VASc stroke risk score of >2) in the University of Massachusetts Memorial Health Care system. Results: The survey was distributed to 23,530 patients, and there were 1222 (5.19%) participant responses. Among the participants, 327 (26.8%) had AF and 895 (73.2%) were at risk of AF. Neither device ownership nor device type use differed by AF status. After adjusting for covariates that may influence surveyed participant communication patterns, we found that participants with AF were more likely to share their wearable device-derived data with providers (adjusted odds ratio 1.87; 95% confidence interval 1.02-3.41). Rates of sharing physical activity or sleep data were low for both groups and did not differ by AF status. Conclusion: Compared with participants at risk of developing AF, those with AF were more likely to share heart rate and rhythm data from their commercial wearable devices with providers. However, both groups had similar rates of sharing physical activity and sleep data, telemedicine engagement, and technology use and ownership.

3.
MEDLINE;
Preprint in English | MEDLINE | ID: ppcovidwho-326669

ABSTRACT

Background: Mental health problems increased during the COVID-19 pandemic. Knowledge that one is less at risk after being vaccinated may alleviate distress, but this hypothesis remains unexplored. Here we test whether psychological distress declined in those vaccinated against COVID-19 in the US and whether changes in perceived risk mediated any association. Methods: A nationally-representative cohort of U.S. adults (N=5,792) in the Understanding America Study were interviewed every two weeks from March 2020 to June 2021 (28 waves). Difference-in-difference regression tested whether getting vaccinated reduced distress (PHQ-4 scores), with mediation analysis used to identify potential mechanisms, including perceived risks of infection, hospitalization, and death. Results: Vaccination was associated with a 0.09 decline in distress scores (95% CI:-0.15 to -0.04) (0-12 scale), a 5.7% relative decrease compared to mean scores in the wave prior to vaccination. Vaccination was also associated with an 8.44 percentage point reduction in perceived risk of infection (95% CI:-9.15% to -7.73%), a 7.44-point reduction in perceived risk of hospitalization (95% CI:-8.07% to -6.82%), and a 5.03-point reduction in perceived risk of death (95% CI:-5.57% to -4.49%). Adjusting for risk perceptions decreased the vaccination-distress association by two-thirds. Event study models suggest vaccinated and never vaccinated respondents followed similar PHQ-4 trends pre-vaccination, diverging significantly post-vaccination. Analyses were robust to individual and wave fixed effects, time-varying controls, and several alternative modelling strategies. Results were similar across sociodemographic groups. Conclusion: Receiving a COVID-19 vaccination was associated with declines in distress and perceived risks of infection, hospitalization, and death. Vaccination campaigns could promote these additional benefits of being vaccinated.

4.
European Journal of Public Health ; 31:334-334, 2021.
Article in English | Web of Science | ID: covidwho-1610025
5.
European Journal of Public Health ; 31, 2021.
Article in English | ProQuest Central | ID: covidwho-1514879

ABSTRACT

Background Migrants in high-income countries (HICs) may have been disproportionately affected by the COVID-19 pandemic, yet the extent to which they are impacted, and their predisposing risk factors, are not clearly understood. We did a systematic review to assess clinical outcomes, indirect health and social impacts, and key risk factors in migrants. Methods Our systematic review following PRISMA guidelines (PROSPERO CRD42020222135) identified peer-reviewed and grey literature relating to migrants (foreign-born) and COVID-19 in 82 HICs. Primary outcomes were cases, hospitalisations and deaths from COVID-19 involving migrants;secondary outcomes were indirect health and social impacts and risk factors. Results 3016 data sources were screened with 158 from 15 countries included in the analysis. We found migrants are at increased risk of SARS-CoV-2 infection and are over-represented among cases (e.g. constituting 42% of cases in Norway [to 27/4/2020], 26% in Denmark [to 7/9/2020], and 32% in Sweden [to 7/5/2020]);some datasets from Europe show migrants may be over-represented in deaths with increased all-cause mortality in migrants in some countries in 2020. Undocumented migrants, migrant health and care workers, and migrants housed in camps have been especially affected, with certain nationality groups disproportionately impacted. Migrants experience a range of risk factors for COVID-19, including high-risk occupations, overcrowded accommodation, and barriers to healthcare including inadequate information, language barriers, and reduced entitlement. Conclusions Migrants in HICs are at high risk of COVID-19, with a range of specific risk factors that have not been well-considered in the public health response to date. These data are of immediate relevance to the policy response to the pandemic, with strategies urgently needed to reduce transmission. Migrant populations must also be better considered in national plans for COVID-19 vaccination roll-out. On behalf of ESGITM Key messages Migrants in high-income countries may be disproportionately represented in COVID-19 infections and deaths, with higher levels of many vulnerabilities and risk factors. Migrants must be better included in all aspects of the pandemic response, including vaccination roll-out.

6.
Investigative Ophthalmology and Visual Science ; 62(8), 2021.
Article in English | EMBASE | ID: covidwho-1378589

ABSTRACT

Purpose : COVID-19 and associated mitigation measures have caused unprecedented global disruption. It is not known whether there are disproportionate challenges for persons with a sensory disability. Our cross-sectional study assesses this impact of the pandemic on persons with and without visual or hearing loss. Methods : Experts from diverse disciplines developed a 34-item survey instrument, the Coronavirus Disability Survey, which includes items on general and psychological health, instrumental activities of daily living, isolation, financial and transportation challenges, and information access. The study population included 112 adults with moderate or worse visual impairment (<20/60 in better-seeing eye), 108 with hearing loss (defined using ICD10 codes), and 155 age/sex-matched controls recruited from the University of Michigan (UM) Health System. Survey administration was via email or telephone. The UM IRB approved this study and all participants provided informed consent. Results : Participants reported similarly high levels of disruption of their daily lives with 80% reporting a fair amount or a lot of disruption. Groups reported similar levels of COVID exposure (21%) and infection (45% of exposed). In the visual loss (VL) group, 18% reported a lot of difficulty or being unable to access routine medical care compared with 12% of hearing loss (HL) and 10% of control (C) groups (p=.02). The reasons for increased difficulty with instrumental activities of daily living varied: among those with VL 62% had difficulty due to fear of exposure (54% HI, 45% C);38% said the person assisting them was worried about exposure (6% HI, 7% C);and 12% cited decreased availability of public transportation (2% HI, 3% C). A greater proportion with VL began relying more on family for assistance (31% VI, 7% HI, 13% C) (p<.001 for all comparisons). Among all participants, 30% reported difficulty accessing trusted information about the pandemic;11% of those with VL found the information difficult to see or hear (1% HL, 2% C;p<.001). Conclusions : Individuals with VL may face increased disruption of their daily activities stemming from the pandemic and related mitigation measures, including in accessing healthcare, transportation, and information. Data-driven public health and policy decisions may benefit from a deeper understanding of the differential impact of the pandemic on these vulnerable groups.

7.
European Observatory on Health Systems and Policies. European Observatory Policy Briefs ; 2021.
Article in English | MEDLINE | ID: covidwho-1196319

ABSTRACT

COVID-19 can cause persistent ill-health. Around a quarter of people who have had the virus experience symptoms that continue for at least a month but one in 10 are still unwell after 12 weeks. This has been described by patient groups as "Long COVID". Our understanding of how to diagnose and manage Long COVID is still evolving but the condition can be very debilitating. It is associated with a range of overlapping symptoms including generalized chest and muscle pain, fatigue, shortness of breath, and cognitive dysfunction, and the mechanisms involved affect multiple system and include persisting inflammation, thrombosis, and autoimmunity. It can affect anyone, but women and health care workers seem to be at greater risk. Long COVID has a serious impact on people's ability to go back to work or have a social life. It affects their mental health and may have significant economic consequences for them, their families and for society. Policy responses need to take account of the complexity of Long COVID and how what is known about it is evolving rapidly. Areas to address include: The need for multidisciplinary, multispecialty approaches to assessment and management;Development, in association with patients and their families, of new care pathways and contextually appropriate guidelines for health professionals, especially in primary care to enable case management to be tailored to the manifestations of disease and involvement of different organ systems;The creation of appropriate services, including rehabilitation and online support tools;Action to tackle the wider consequences of Long COVID, including attention to employment rights, sick pay policies, and access to benefit and disability benefit packages;Involving patients both to foster self-care and self-help and in shaping awareness of Long COVID and the service (and research) needs it generates;and Implementing well-functioning patient registers and other surveillance systems;creating cohorts of patients;and following up those affected as a means to support the research which is so critical to understanding and treating Long COVID.

8.
European Observatory on Health Systems and Policies. European Observatory Policy Briefs ; 2020.
Article in English | MEDLINE | ID: covidwho-1181976

ABSTRACT

Preoccupation with the value created by health systems has been longstanding, and will likely only intensify given the ongoing health systems strains and shocks such as the COVID-19 pandemic. But the focus so far has usually been limited to value as seen from the perspectives of certain actors in the health system and/or to certain dimensions of value. In this policy brief we call for a shared understanding of value that embraces the health system in its entirety, including preventive services and other public health functions. We then define value to be the contribution of the health system to societal wellbeing. Any meaningful formulation of the concept of wellbeing includes health, and by extension health systems, as an important contributor to our wellbeing. Health improvement, responsiveness, financial protection, efficiency and equity are widely accepted as health systems' core contributions to wellbeing. Health systems can also contribute to wellbeing indirectly through the spillover effects that its actions have on other sectors. Health systems are shaped by a wide array of actors, including national policy-makers, purchasers, providers, practitioners, citizens and patients. These different actors make important but discrete contributions to value, so in order to maximize it, their actions should be aligned. The aim should be to create a value-based health system. A range of policy levers can be used to enhance value, ranging from cross-sectoral policies to involving patients in decision-making. While such levers normally focus on one or two dimensions of value, it is important to ensure that they do not undermine other dimensions or the efforts of other actors. Effective governance of the whole health system is needed to ensure that stakeholder perspectives and policy levers are aligned to promote a common concept of health system value and, ultimately, of societal wellbeing. There are governance tools, such as the Transparency, Accountability, Participation, Integrity and Capacity (TAPIC) framework, that can help achieve this. Moving towards a value-based health system will often be a gradual process, focusing first of all on the areas where it might make the biggest difference.

9.
Eurohealth ; 26(3):3-5, 2020.
Article in English | GIM | ID: covidwho-1080033

ABSTRACT

Europe may be united politically, but it is divided by health. 30 years after the physical borders between East and West came down, the health of those in central Europe still lags far behind that of their western neighbours yet their health services continue to suffer from under investment. The gap is particularly large for the health workforce. The COVID pandemic has shone a light on these long-standing inequalities, but as Europe moves forward into a post-pandemic period, it has an opportunity to address them. This pandemic will not be the last. If Europe is to be prepared for future threats, it must begin the process of creating a European Health Union, in which a strong, resilient, and equitable health workforce will play a major role.

10.
Eurohealth ; 26(2):20-24, 2020.
Article in English | CAB Abstracts | ID: covidwho-942022

ABSTRACT

From the early days of the pandemic policy analysts have been trying to understand what constitutes a resilient health systems response. This article takes stock of the national responses over the past ten months and distils strategies and general lessons for enhancing health systems resilience. Among health systems functions, effective governance, while not easy to pinpoint or secure, has been key to a resilient response, constituting a mortar binding everything else together. The pandemic has also highlighted the importance of solidarity, both within and between countries - bringing us to a realisation that we cannot be truly safe until everybody is safe. Over the course of the pandemic, the focus in studying resilience has broadened towards a more holistic recovery that extends beyond the health system.

11.
Eurohealth ; 26(2):34-39, 2020.
Article in English | GIM | ID: covidwho-942006

ABSTRACT

In order to ease lockdown restrictions and prevent a second wave of infections, countries must be able to find, test, trace, isolate and support new COVID-19 cases. The simplicity of the 'test, trace, isolate' mantra dramatically understates the multitude of time-dependent processes that must occur seamlessly for the strategy to work effectively. We reconceptualise the way out of lockdown as a Snakes and Ladders boardgame. To succeed, countries must ensure that people with COVID-19 progress through the board as quickly as possible by putting in place measures that enhance their public health capacity (i.e. landing on ladders) and prevent setbacks caused by having insufficient capacity (i.e. avoiding snakes).

12.
Eurohealth ; 26(2):45-50, 2020.
Article in English | GIM | ID: covidwho-941935

ABSTRACT

Surveillance and monitoring systems are central to governments' responses to the COVID-19 pandemic. This article focuses on assessing differences in mortality recording across countries and over time, to inform country comparisons. We show that variations in definitions, testing policies and changes over time affect international and intra-country comparability. Estimating excess deaths is therefore increasingly used to monitor the impact of COVID-19, with early evidence showing a major increase in excess mortality in countries most affected. Enhanced monitoring of the impact of COVID-19 on mortality using multiple data sources, with data published in a timely and accessible manner, is thus important.

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