Ethnic, racial and migrant inequalities in respiratory health

Disparities in the incidence, prevalence, and morbidity and mortality rates of many respiratory diseases are evident among ethnic groups. Biological, cultural and environmental factors related to ethnicity can all contribute to the differences in respiratory health observed among ethnic minority groups, but the inequalities observed are most commonly due to lower socioeconomic position. People who migrate within a country or across an international border may experience an improvement in respiratory health associated with improvements in socioeconomic position. However, migrants may also experience worse health outcomes in destination countries, as they are faced by barriers in language and culture, discrimination, exclusion and limited access to health services. While some high-quality studies investigating ethnicity and respiratory health are available, further research into ethnic differences is needed. Improving the recording of ethnicity in health records, addressing barriers to accessing respiratory healthcare and improving cultural literacy more generally are some of the ways that inequalities can be tackled.Copyright © ERS 2023.

Characterization of Demographics and Concomittant Symptoms in Patients with Post COVID-19 Conditions or Long COVID

Objectives: Post COVID-19 conditions or long COVID continues to burden the healthcare system. With the introduction of new code in October 2021 to appropriately capture this condition (U09.9), we have enough data to understand the detailed demographic and clinical characterization of the patients with long COVID. As this new clinical entity continues to evolve, our study will provide insights for care management and planning. Method(s): We conducted a retrospective cohort study from a large deidentified database of US health insurance claims. The study population included all individuals with at least one ICD-10 code for COVID (U07.1) between June 1, 2021, and November 30, 2022. Individuals with at least one ICD-10 code for long COVID (U09.9), at least 7 days after COVID diagnosis were termed "Long COVID" patients. Index date was defined as the first long COVID diagnosis date. We also assessed the most prevalent diagnosis codes within the 30 days pre- and post-index to understand top symptoms. Result(s): A cohort of 253,145 patients (62% female patients;38% male patients) were identified. Among this cohort, 3.2% were pediatric patients aged 0 - 17 years;73.3 % aged 18 - 64 years and 23.5 % aged 65+ years. Most prevalent symptoms that increased in the 30 day pre- and post-index: Nervous system symptoms (6 fold), fatigue (7 fold), Dyspnea (4.3 fold), esophagitis (1.6 fold) chronic kidney disease (1.3 fold) among others. Conclusion(s): Our findings indicate that long COVID is more prevalent in females, with fatigue and dyspnea emerging as top symptoms. These findings are consistent with the published literature. However, we uncovered additional symptoms such as nervous system symptoms, chronic kidney disease among others. Additional analysis is planned to evaluate the association of these symptoms with sociodemographic features to understand the health inequity aspects of long COVID.Copyright © 2023

Bridging the gap: the challenge of mitigating health inequalities in lung cancer

Background: The COVID-19 pandemic, together with the cost-of- living crisis, have shone a light on health inequalities running through our society - not least in UK lung cancer. Lung cancer has the widest deprivation gap of all cancers. Despite published data about socio-economic factors, the amount of evidence available about other health inequalities is poor. Method(s): The Bridging the Gap report is the output from a Health Inequalities focus-group meeting of the UKLCC's Clinical Advisory Group in June 2022. These opinions were supplemented by views and information gathered from 15 interviews with leading lung cancer and health inequalities experts, from across the four UK nations in August/September 2022. Further desk research and literature reviews were carried out over the same period. Result(s): The report calls for a 'comprehensive' approach to data collection on health inequalities - to bridge gaps in current knowledge, improve outcomes and ensure people with lung cancer have equitable access to diagnosis, treatment, and care - wherever they live and from whatever background. Key recommendations include: * Extending the remit of the National Lung Cancer Audit (NLCA) to collect more data on ethnicity, LGBTQ+ and other health inequality factors - such as gender, religion and disability. * Establishing a single, coordinated data strategy, compiling evidence on health inequalities at local, regional and national levels. * Introducing a Personal Care and Access Card scheme, carried by the patient, combining their Holistic Needs Assessment information with their personal treatment and care plan to facilitate transfer of information between hospitals and specialists. * Disease awareness campaigns targeted to address local needs and communities. Conclusion(s): The UKLCC believes that - with the implementation of these recommendations and support from policy makers, commissioners and clinicians - we can successfully mitigate health inequalities in lung cancer and have further impact on lung cancer outcomes. Report accessible here: www.uklcc.org.uk/our-reports Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

How to read a paper about inequality in respiratory disease: Basic epidemiological principles and how inequalities are measured

Health inequalities in respiratory disease are widespread, and monitoring them is important for advocacy, the design and delivery of health services, and informing wider health policy. In this chapter, we introduce the different ways in which health inequalities can be quantified, including measures that quantify absolute and relative inequalities, and those that measure gaps between groups or differences across the entire social gradient. We consider the strengths and limitations of these different approaches and highlight things to look out for when reading a paper on health inequalities in respiratory health. These include how common the outcome is and whether other factors have been adjusted for, as both can have a crucial impact on interpretation and can lead to misleading conclusions.Copyright © ERS 2023.

Mitochondrial Neurogastrointestinal Encephalopathy (MNGIE) Disease

Does mens rea matter to the criminal legal system? Our study addresses this question by performing the first-ever empirical analysis of a culpable mental state's impact on administration of a criminal statute. We focus on the U.S. Supreme Court's 2019 decision in Rehaif v. United States, which applied a culpable knowledge requirement to the federal felon-in-possession statute, 18 U.S.C. 922(g). Prior to Rehaif, federal courts viewed 922(g)'s critical legal status element-whether a firearm or ammunition possessor meets the conditions for one of nine prohibited categories-as being subject to strict liability. After Rehaif, the government must now prove that the target of a 922(g) prosecution was aware of their prohibited legal status to secure a conviction. Our study provides reason to believe that this new mens rea requirement significantly reduced the number of defendants charged with 922(g) per month, the number of 922(g) charges filed each month, the number of 922(g) charges per defendant, and the likelihood that any individual charge of 922(g) would be adjudicated guilty. We estimate these charging reductions prevented 2,365.32 convictions and eliminated 8,419.06 years of prison sentences for 922(g) violations during the eight-month period between the issuance of the Rehaifopinion and the start of the COVID-19 pandemic, which severely disrupted federal criminal prosecutions. At the same time, we also find that the government's 922(g) conviction rate-the likelihood that someone charged by federal prosecutors with violating 922(g) will ultimately be found guilty-did not change after Rehaif. All told, our study indicates that mens rea can constrain prosecutorial discretion, lower convictions, and reduce punishment without bringing criminal administration to a halt.

Simulation to Educate Practicing Urologists in Rural Locations: Identifying Strategies to Increase Procedural Adoption

Introduction: The COVID-19 pandemic necessitated proliferation of telesimulation. This pedagogy may be useful in rural areas to increase procedural adoption and reduce healthcare disparities. Our aim was to determine the current status of surgical simulation education to retool rural practicing Urologists. Method(s): Literature search was performed with a trained librarian for PubMed, EMBASE and Web of Science. Title/ screening were performed to include all studies of surgical simulation involving rural surgical learners to identify simulation education opportunities for practicing rural Urologists. Data was then extracted: simulation event, skills focus, MERSQI score, type/number of learners, learner assessment and event evaluation. Result(s): Seven manuscripts met inclusion criteria. Most were published 2019-2020 and were cross sectional (5/7, 71%). Mean adjusted MERSQI score was 13 (range 6-15.5). A wide range of surgical skills were taught (incl. laparoscopy, cricothyroidotomy, chest tube insertion, damage control laparotomy), but no Urological surgical skills. Two articles described mobile simulation units for rural areas. A total of 232 learners were identified including 69 medical students. One fifth of rural learners were non-medical or non-physicians. Only one study involved faculty, who were general surgeons. Conclusion(s): Telesimulation education for practicing Urologists in rural areas is lacking. Current in-operating room telementoring for rural Urologists requires surgeons to travel and perform their first cases utilizing this new technique on patients. Telesimulation to teach Urological skills in rural areas of the US may increase dissemination of techniques with no patient risk and has significant potential to redress current healthcare disparities.

Socio-economic and clinical drivers of COVID-19 mortality: An empirical analysis of the supply-side and demand-side moderators

The COVID-19 pandemic has disrupted everyday life globally, with severe consequences in several countries and regions. A key concern related to the COVID-19 pandemic is the wide variation in mortality across nations and sub-national locations such as states and counties. Anecdotal evidence, as well as evidence from CDC, indicates that the risk of spread as well as the risk of mortality from the pandemic is higher for regions with a population characterized by disadvantaged economic (income) and racial (underserved communities) and demographic profiles (age). Multiple studies have indicated that the most crucial step toward reducing mortality is expanding critical care capacity through procuring personal protective equipment (PPE) and ventilators and training critical care frontline employees. It is projected that with exponential growth in the pandemic spread, many regions would fall short of critical care capacity, increasing mortality.Furthermore, the pandemic has imposed high levels of constraints on resource availability, even in developed nations. Under resource constraints in critical care delivery, mitigation strategies need to account for the variation in observed cases and the disparity in mortality across locations. In my dissertation, I make a concerted effort to contribute toward understanding the sources of variation in mortality and propose a framework that enables pandemic preparedness and mitigation strategies that encapsulate the spatial and temporal variation in risk of mortality from COVID-19. The mitigation strategies are divided into supply-side and demand-side moderators of mortality. Accordingly, I focus on two mitigation strategies: (i) ICU capacity as a supply-side moderator and (ii) Vaccination coverage as a demand-side moderator. The overarching objective of my dissertation is to understand the role of supply-side and demand-side moderators of mortality, independently and jointly, of the association between socio-economic, demographic (henceforth referred to as social), and clinical risk factors and COVID-19 mortality. Much of the epidemiological literature on COVID-19 has focused on reducing the spread. However, the ultimate goal is to reduce mortality. There is a necessity in both practice and academic literature to understand actionable policies that can reduce mortality in general and spatial variation of mortality in specific. This dissertation research primarily leverages empirical methodology combining matching procedures with fixed effect modeling of panel data to test the hypothesized relationships of interest. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Societal drivers of antimicrobial resistance

Antimicrobial resistance is caused by and exacerbates social and health inequalities. Human and animal antimicrobial use is contributing as much as societal failures to dispose of and manage our waste and respect our environment. A multisector, multidisciplinary approach is required to resolve these issues.Copyright © ERS 2023.

Disparities in COVID-19 Related Outcomes in the United States By Race and Ethnicity: An Umbrella Review of Meta-Analyses

Objectives: Meta-analyses have investigated associations between race and ethnicity and COVID-19 outcomes. However, there is uncertainty about these associations' existence, magnitude, and level of evidence. We, therefore, aimed to synthesize, quantify, and grade the strength of evidence of race and ethnicity and COVID-19 outcomes in the US. Method(s): In this umbrella review, we searched four databases (Pubmed, Embase, the Cochrane Database of Systematic Reviews, and Epistemonikos) from database inception to April 2022. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews, version 2 (AMSTAR-2). The strength of evidence of the associations between race and ethnicity with outcomes was ranked according to established criteria as convincing, highly suggestive, suggestive, weak, or non-significant. The study protocol was registered with PROSPERO, CRD42022336805 Results: Of 880 records screened, we selected seven meta-analyses for evidence synthesis, with 42 associations examined. Overall, 10 of 42 associations were statistically significant (p <= 0.05). Two associations were highly suggestive, two were suggestive, and two were weak, whereas the remaining 32 associations were non-significant. The risk of COVID-19 infection was higher in Black individuals compared to White individuals (risk ratio, 2.08, 95% Confidence Interval (CI), 1.60-2.71), which was supported by highly suggestive evidence;with the conservative estimates from the sensitivity analyses, this association remained suggestive. Among those infected with COVID-19, Hispanic individuals had a higher risk of COVID-19 hospitalization than non-Hispanic White individuals (odds ratio, 2.08, 95% CI, 1.60-2.70) with highly suggestive evidence which remained after sensitivity analyses. Conclusion(s): Individuals of Black and Hispanic groups had a higher risk of COVID-19 infection and hospitalization. These associations of race and ethnicity and COVID-19 outcomes existed more obviously in the pre-hospitalization stage. More consideration should be given in this stage for addressing health inequity.Copyright © 2023

A Comparative Study of Peripartum Mental Health Disorders between COVID-19-infected and Non-infected during the Pandemic

Introduction: This study was done to compare the prevalence of mental health disorders between COVID-19-infected and non-infected mothers during the COVID-19 pandemic. The secondary objective was to find out the risk factors and long-term outcome of peripartum depression (PPD). Material(s) and Method(s): This was an observational and comparative study using a questionnaire-based direct interview, conducted in a tertiary hospital. After judging the inclusion and exclusion criteria, 842 subjects were selected between September 2020 to December 2020. The Edinburgh postnatal depression scale (EPDS) and COVID-19 anxiety scale (CAS) was used for evaluation of the mental health. Subjects with PPD were followed up for a year. Result(s): The mean age of the subjects was 24.8 +/- 3.9 years, 142 (16.8%) were confirmed COVID-19 positive. Overall, 317 (37.6%) had possible PPD (EPDS >=14) and 763 (90.6%) had peripartum anxiety (EPDS anxiety subscore >=4). While there was no significant difference in the prevalence of PPD (32.6% vs 39%, p = 0.12), peripartum anxiety was higher among COVID non-infected subjects (91.6% vs 86.6%, p = 0.04). Furthermore, COVID-19-related anxiety was higher among COVID-19-infected compared to the non-infected [17 (10-28) vs 15 (8-25), p = 0.00]. In multivariate analysis, medical comorbidities (p = 0.000), history of psychiatric illness (p = 0.002), domestic violence (p = 0.032) and obstetric complications (p = 0.000) were significant risk factors for PPD. Among the subjects who had PPD, only 35% still had depression after a year. Conclusion(s): This study provides an in-depth analysis of PPD and anxiety during the COVID-19 pandemic, the risk factors, and the long-term effects. Clinical significance: It highlights the importance of routine screening for perinatal mental health disorders and early psychiatric consultation when required.Copyright © The Author(s).

Commencing colorectal cancer screening at age 45 years in U.S. racial groups.

Screening for colorectal cancer (CRC) is cost-effective for reducing its mortality among the average-risk population. In the US, CRC incidence and mortality differ among racial/ethnic groups, with non-Hispanic Blacks (NHB) and American Indian/Alaska Natives showing highest incidence and mortality and earlier presentation. Since 2005, some professional societies have recommended CRC screening for NHB to commence at 45 years or earlier; this was not implemented due to lack of recommendation from key groups that influence insurance payment coverage. In 2017 the highly influential U.S. Multi-Society Task Force for Colorectal Cancer recommended screening to commence at 45 years for NHB; this recommendation was supplanted by data showing an increase in early-onset CRCs in non-Hispanic Whites approaching the under-50-year rates observed for NHB. Subsequently the American Cancer Society and the USPSTF recommended that the entire average-risk population move to commence CRC screening at 45 years. Implementing screening in 45-49-year-olds has its challenges as younger groups compared with older groups participate less in preventive care. The US had made extensive progress pre-COVID-19 in closing the disparity gap for CRC screening in NHB above age 50 years; implementing screening at younger ages will take ingenuity, foresight, and creative strategy to reach a broader-aged population while preventing widening the screening disparity gap. Approaches such as navigation for non-invasive and minimally invasive CRC screening tests, removal of financial barriers such as co-pays, and complete follow up to abnormal non-invasive screening tests will need to become the norm for broad implementation and success across all racial/ethnic groups.

Refining the process: Safety net dental professionals' experiences with teledentistry implementation during the first year of COVID-19.

OBJECTIVES: Teledentistry helped dentistry adapt to pandemic-era challenges; little is known about dental professionals' teledentistry experiences during this time. This analysis sought to understand professionals' pandemic teledentistry experiences and expectations for the modality's future. METHODS: We conducted virtual individual interviews (n = 21) via Zoom to understand how federally qualified health centers (FQHCs) delivered oral care during the first year of the pandemic, including but not limited to the use of teledentistry. We independently coded each transcript, then identified themes and sub-themes. RESULTS: We identified three major themes: (1) Logistical and equity considerations shaped teledentistry's adoption; (2) Team-based factors influenced implementation; and (3) Teledentistry's future is as-yet undetermined. CONCLUSIONS: Experiences with teledentistry during the first year of COVID-19 varied substantially. Future directions should be more deliberate to counter the urgency of pandemic-style implementation and must address appropriate use, reimbursement guidance, patient and provider challenges, and customizability to each clinic's context.

Risk-efficacy framework - a new perspective on threat and efficacy appraisal and the role of disparity.

The current study aims to provide a more nuanced understanding of threat and efficacy appraisal and account for the influence of disparity in the accessibility to risk prevention resources in predicting attitudes and behaviors. We propose a Risk-Efficacy Framework by integrating theories, including the extended parallel process model, health belief model, social cognitive theory, and construal level theory of psychological distance to achieve such a goal. An online survey targeting the U.S. population was conducted to empirically test the model (N = 729). The survey measured people's threat and efficacy appraisals related to COVID-19 and its vaccines and their attitudes and behavioral intention. The results of the survey supported the model's propositions. Specifically, perceived susceptibility moderated perceived severity's effects on attitudes and behaviors, such that perceived severity's influence attenuated as perceived susceptibility increased. Perceived accessibility to risk prevention resources moderated the influence of self and response efficacy. The former's effects on attitudes and behaviors increased, and the latter's effects decreased when perceived accessibility was high. The proposed framework provides a new perspective to examine the psychological determinants of prevention adoption and contributes to designing and implementing campaigns distributing prevention to underserved populations. The framework offers insights for risk managers such as public health authorities by articulating the dynamic nature of risks. When communicating early-stage lesser-known risks to the public, campaigns should highlight their severity and the response efficacy of risk solutions. Differently, more resources should be devoted to cultivating self-efficacy for widespread risks with more mitigation resources.

Understanding gender disparity: factors affecting higher education self-efficacy of students in Malaysia

PurposeGender disparity is a global phenomenon where females outnumber male participants. It has been observed that males are the early leaver from higher education, thus reflecting a severe concern about social instability. Malaysia is a prominent example where females outnumber males in higher education. In this context, this paper aims to examine the effect of individual, social and financial factors on the higher education self-efficacy of male and female students. It develops a comprehensive understanding of gender-based decision factors in pursuing higher education. Design/methodology/approachThe hypothesis was formed based on a comprehensive literature review following the hypothetico-deductive positivist approach. These hypotheses were tested based on a sample of 250 respondents. A multiple regression analysis was deployed to test the relationship between the dependent variable and its predictors. FindingsThe results suggest that male and female students' self-efficacy depends on five determinants, i.e. family influence, peer influence, career expectancy outcome, gender roles and institutional factors. Male students tend to be influenced more by these five determinants than females. Additionally, male students with better financial backgrounds are more likely to have higher self-efficacy, whereas gender roles negatively affect male and female students' self-efficacy for higher education. Research limitations/implicationsThe breakout of COVID-19 resulted in the selection of limited students in Malaysia. Due to restricted movement orders, it was impossible to reach out to the students for data collection. Future research could include a broader area to include multiple other regions of Malaysia. For a broader aspect, the study could be conducted in other areas/countries where the problem of less male participation exists. Practical implicationsThe relationship between higher education self-efficacy is assessed with social, financial and institutional factors for male and female students. It will enable the stakeholders and policymakers to make better decisions in increasing the self-efficacy of students to attain equity in higher education institutions. Social implicationsThe finding of this paper will assist in increasing male participation in higher education institutions to avoid any social instability. Originality/valueThis paper contributes to the literature in understanding the causes of gender gap reversal, focusing on Malaysian higher education institutions. It also provides empirical evidence to look at potential factors that affect the higher education self-efficacy of male and female students.

Socioeconomic Factors Associated with Delay of Minimally Invasive Benign Gynecologic Surgery and Impact of the COVID-19 Pandemic

Objective: The effects of demographic and socioeconomic characteristics on delay of minimally invasive gynecologic surgery (MIGS) before and during the COVID-19 pandemic were studied. The primary outcome was interval between first MIGS appointment and date of surgery. Materials and Methods: This retrospective cohort study used electronic medical record data of a historical cohort who had benign MIGS in 2014-2016 (n = 370) and a cohort in 2020 during the COVID pandemic (n = 249). Included procedures were laparoscopic hysterectomy, myomectomy, adnexal surgery, or endometriosis excision. Patient demographics (race, ethnicity, age, marital status, language, insurance, and socioeconomic factors) were evaluated for associations with surgery delay (> 90 days from initial consultation to operating room date). Results: Median time to surgery was 21 days faster during the pandemic. In the historical cohort, 61% patients waited >90 days, and in the pandemic cohort, 47% patients waited >90 days. In the pandemic cohort, race and primary language were new factors associated with surgery delays. During the pandemic, a greater proportion of patients having surgery delays were Black or other races, compared to White, and a greater proportion did not speak English. After adjusting for referral indications, in multivariable logistic regression, patients who reported Other race had 3 times the odds of surgery delay, compared to White patients. Black patients had higher odds of surgery delay, although this estimate was less precise. Patients with a non-English primary language had >4 times the odds of surgery delay. Ethnicity, insurance and employment status, median household income, neighborhood segregation, and distance to hospital were not associated with surgery delay. Telemedicine accounted for 71% of visits in the pandemic cohort and was associated with a significant decrease in surgery delays with a median wait time of 87 days for patients seen via telemedicine, compared to 101 days for patients seen in-person. A higher proportion of patients using telemedicine were White and spoke English. Hispanic/Latino ethnicity, non-English primary language, and unemployment were associated with in-person versus telemedicine visits. Visit type was not correlated with insurance status, median household income, neighborhood segregation, and distance from the hospital. A risk score was calculated to summarize the estimated effect of intersectionality of multiple identities;multiple minority characteristics were correlated with surgery delays. Time to benign MIGS decreased from historical baselines during the pandemic, indicating improved access to surgical care. This benefit did not apply equally. Disproportionately, White patients who spoke English had no delays and used telemedicine;racial minority patients who did not speak English had greater odds of surgery delays and in-person appointments. Conclusions: Telemedicine can improve access to both MIGS care and surgical outcomes;additional strategies are needed to ensure that all patients receive care advances equitably. (J GYNECOL SURG 20XX:000)

Vaccination, human mobility, and COVID-19 health outcomes: Empirical comparison before and during the outbreak of SARS-Cov-2 B.1.1.529 (Omicron) variant.

The B.1.1.529 (Omicron) variant surge has raised concerns about the effectiveness of vaccines and the impact of imprudent reopening. Leveraging over two years of county-level COVID-19 data in the US, this study aims to investigate relationships among vaccination, human mobility, and COVID-19 health outcomes (assessed via case rate and case-fatality rate), controlling for socioeconomic, demographic, racial/ethnic, and partisan factors. A set of cross-sectional models was first fitted to empirically compare disparities in COVID-19 health outcomes before and during the Omicron surge. Then, time-varying mediation analyses were employed to delineate how the effects of vaccine and mobility on COVID-19 health outcomes vary over time. Results showed that vaccine effectiveness against case rate lost significance during the Omicron surge, while its effectiveness against case-fatality rate remained significant throughout the pandemic. We also documented salient structural inequalities in COVID-19-related outcomes, with disadvantaged populations consistently bearing a larger brunt of case and death tolls, regardless of high vaccination rates. Last, findings revealed that mobility presented a significantly positive relationship with case rates during each wave of variant outbreak. Mobility substantially mediated the direct effect from vaccination to case rate, leading to a 10.276 % (95 % CI: 6.257, 14.294) decrease in vaccine effectiveness on average. Altogether, our study implies that sole reliance on vaccination to halt COVID-19 needs to be re-examined. Well-resourced and coordinated efforts to enhance vaccine effectiveness, mitigate health disparity and selectively loosen non-pharmaceutical interventions are essential to bringing the pandemic to an end.