PSYCHOLOGICAL DISTRESS OVER 12 MONTHS POST-DIAGNOSIS IN A NATIONAL EARLY INFLAMMATORY ARTHRITIS COHORT

BackgroundIn inflammatory arthritis patients, the concomitant decline of their mental wellbeing is an increasing concern[1,2]. It is important to not only describe the trajectory of psychological distress in early disease stages, but also understand which clinical outcome measures are most associated with these changes.ObjectivesUsing data from the National Early Inflammatory Arthritis Audit (NEIAA), we assessed trends in psychological wellbeing over 12 months after initial diagnosis and mapped these against clinical outcomes to identify significant associations.MethodsNEIAA collects data from patients referred with suspected early inflammatory arthritis in rheumatology services in England and Wales. We used data provided by 20,472 patients eligible for follow-up (diagnosis of inflammatory arthritis) between May 1st, 2018, and April 1st, 2022. Data items included baseline demographics e.g., age and gender, and clinical variables e.g., rheumatic disease comorbidity index (RDCI), DAS28, and patient reported outcomes.Psychological distress was measured by the sum score of Patient Health Questionnaire Anxiety and Depression Screener (PHQ4ADS). Using mixed effects regression models, we analysed the co-variability of PHQ4ADS with demographic factors and clinical outcomes over 12 months. Time was included as a dummy-coded covariant.ResultsThe analysis included 36% of patients (7,378 out of 20,472) who completed the baseline patient outcome survey. In this cohort, PHQ4ADS scores decreased from a baseline average of 4.7 (CI: [4.6, 4.8]) to 2.62 (CI: [2.5, 2.8]) at 12 months post-diagnosis. The proportion of patients screening positive decreased from 50.0% (CI: [48.9, 51.1]) at baseline to 23.8% (CI: [21.8, 25.9]) at 12 months.At baseline, psychological distress correlated significantly with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28 (Figure 1). No significant correlations were found between psychological distress and working diagnosis, seropositivity, or the assessment being recorded after the start of the COVID-19 pandemic. Younger ages were nonlinearly associated with higher distress levels (coefficient per decade: -0.006;p<0.001;CI: [-0.009, -0.003]) (Figure 1a). Distress levels in females were higher than that of males (coefficient: 0.5;p<0.001;CI: [0.4, 0.7]) (Figure 1b). White patients reported lower PHQ4ADS scores compared to non-white patients (coefficient: -0.7;p<0.001;CI: [-1.0, -0.4]) (Figure 1c). Higher distress levels were also associated with higher RDCI (coefficient: 0.2;p<0.001;CI: [0.1, 0.3]) and prior diagnosis of depression (coefficient: 1.8;p<0.001;CI: [1.5, 2.2]) (Figure 1d, 1e). Furthermore, higher baseline DAS28 scores correlated with more severe psychological distress (coefficient: 0.8;p<0.001;CI: [0.7, 0.8]) (Figure 1f).By 12-months, psychological distress decreased significantly overall, which correlated significantly with ethnicity (coefficient: 0.8;p=0.005;CI: [0.3, 1.4]) and baseline DAS28 (coefficient: -0.5;p<0.001;CI: [-0.6, -0.4]). Compared to white patients, the reduction was significantly greater for non-white patients, but the level of distress was no longer different at 12 months (Figure 1c). While those with higher baseline DAS28 showed a greater reduction in psychological distress, the distress levels remained higher at 12 months (Figure 1f).Figure 1.Changes in psychological distress correlated with age, gender, ethnicity, RDCI, prior depression diagnosis, and baseline DAS28.[Figure omitted. See PDF]ConclusionIn this early inflammatory arthritis cohort, mental health burden was high. Age, gender, ethnicity, RDCI, prior depression diagnosis and baseline DAS28 significantly correlated with psychological distress at baseline. Supporting mental health should be a focus of clinical care for this population and it may be beneficial to use an approach that is culturally valid for non-white patients and accounts for multimorbidity.References[1]Euesden, J, et al. Psychosomatic medicine 79.6 (2017): 638.[2]Lwin, MN, et al. Rheumatology and therapy 7.3 (2020): 457-471.AcknowledgementsThe authors would like to thank the Healthcare Quality Improvement Partnership (HQIP) as the commisioner of NEIAA, British Society for Rheumatology as the audit providers, Net Solving as the audit platform developers, and the Wellcome Trust (ST12406) for funding to support L.Z..Disclosure of InterestsLucy Zhao: None declared, James Galloway Speakers bureau: Has received honoraria from AbbVie Celgene, Chugai, Gillead, Janssen, Eli Lilly, Pfizer, Roche, and UCB, Jo Ledingham: None declared, Sarah Gallagher: None declared, Neena Garnavos: None declared, Paul Amlani-Hatcher: None declared, Nicky Wilson: None declared, Lewis Carpenter Consultant of: Statistical consultancy for Pfizer, Kirsty Bannister: None declared, Sam Norton Speakers bureau: Has received honoraria from Janssen and Pfizer.

DIVERSITY IN CLINICAL TRIALS GAINS GROUND AMIDST COVID

More recent policies aim to offset years of underenrollment of minority groups by expanding enrollment criteria, including more research sites in minority communities, and engaging investigators with diverse backgrounds. FDA has also sought to promote research diversity through its Drug Trials Snapshots program, established in 2015 to increase the visibility of clinical trial enrollment by age, sex, ethnicity and race. According to a recent report on the program's impact, though, there still may be a ways to go for clinical trials to reflect the diversity of the US population.

Critical Feminista Dimensions to Informal Writing Groups for Women of Color Pursuing Doctoral Degrees

The anti-colonial struggle against literary assimilation and the claim to our linguistic space in validating our own stories as W°C, first generation college students, first generation college graduates, and caregivers to dependents, elders, and extended family members requires an activist spirit. [...]someone posted that they would be hosting a virtual writing group on Saturday mornings. A few text messages, utilization of social capital to invite non-M°CA members and a few electronic RSVPs later, we had commitments from the four of us. Being genuine and vulnerable through convivencia allowed us to place extreme care and attention on building social relationships while tearing down the conventional power structure often found in groups.

Tracking the Transit Divide: A Multilevel Modelling Approach of Urban Inequalities and Train Ridership Disparities in Chicago

Using a multilevel modelling approach, this study investigates the impact of urban inequalities on changes to rail ridership across Chicago's "L” stations during the pandemic, the mass vaccination rollout, and the full reopening of the city. Initially believed to have an equal impact, COVID-19 disproportionally impacted the ability of lower socioeconomic status (SES) neighbourhoods' to adhere to non-pharmaceutical interventions: working-from-home and social distancing. We find that "L” stations in predominately Black or African American and Hispanic or Latino neighbourhoods with high industrial land-use recorded the smallest behavioural change. The maintenance of higher public transport use at these stations is likely to have exacerbated existing health inequalities, worsening disparities in users' risk of exposure, infection rates, and mortality rates. This study also finds that the vaccination rollout and city reopening did not significantly increase the number of users at stations in higher vaccinated, higher private vehicle ownership neighbourhoods, even after a year into the pandemic. A better understanding of the spatial and socioeconomic determinants of changes in ridership behaviour is crucial for policymakers in adjusting service routes and frequencies that will sustain reliant neighbourhoods' access to essential services, and to encourage trips at stations which are the most impacted to revert the trend of declining public transport use.

The establishment of a national federation representing health workers from ethnic minorities

ContextThe Federation of Ethnic Minority Healthcare Organisations (FEMHO) was established in 2022 in light of the disproportionate inequalities experienced by this group before, during and after the COVID-19 pandemic.The FEMHO is as a multidisciplinary consortium representing Ethic Minority organisations and individuals within the health and social care in the UK. At the time of writing, FEMHO represents over 55,000 individual members, covering various disciplines, specialisms and levels of seniority, spanning across 43 organisations and interest groups. As a self-governed union, FEMHO encourages organisations to collaborate and work collectively to achieve better outcomes through the implementation of improved policies and opinion formers as well regulators and commissioners both locally and nationally.Issue/ChallengeOf the 1.2 million staff employed by NHS, 20.7% belong to Black, Asian and minority ethnic (BAME) background. However, analysis of deaths of NHS Staff during the pandemic showed that 64% of those who died belonged to a BAME background. Such disproportionate impacts were seen when the number of deaths amongst doctors and nurses were further analysed, where 20% of nursing staff identified as BAME yet 64% of nurses who died were BAME and 44% of medical staff identified as BAME and 95% of doctors who died were BAME.Doctors from BAME backgrounds also reported:Feeling less confident that appropriate adjustments had been made to mitigate riskFeeling less confident about PPE provision and feeling safe to report PPE shortagesHigher rates of bullying and harassment during the pandemic periodSuch inequalities are believed to be as a result of a number of structural inequalities that existed well beyond the pandemic. it also hypothesised that several inequalities may persist well beyond the pandemic, such as the disproportionate impact of long-covid of health workers from an ethnic minority, which is currently being investigated by researchers at the National Institute for Health Research (NIHR) Leicester Biomedical Research Centre.In view of these challenges, the FEMHO was established as a method of collaborating and co-ordinating the efforts of grassroots organisations, policy makers, regulators and commissioners to ensure that the lived experiences and potential solutions offered by organisations and individuals within this group can be better heard and acted upon.Assessment of issue and analysis of its causesThe FEMHO was established to promote a more concerted approach for the advocacy for health workers from ethnic minority backgrounds, with the aim of reducing the inequalities experienced by this group. A two pronged approach of galvanising grassroots organisations already working tirelessly to support ethnic minority health workers along with lobbying and collating interests amongst policy makers, commissioners and regulators was utilised.For grassroots organisations, a mixed methodology of targeted invitations and open advertisement of opportunities for membership was utilised. Several mediums were used to spread the word of such opportunities, including social media posts, word of mouth and email.For policy makers and systems leaders, a more targeted approach was adopted to acquire their support. A targeted email campaign was developed to raise awareness of FEMHO's work with the aim of acquiring their official support, particularly in the form of endorsing FEMHO's call for the inclusion of race inequality in the COVID-19 public enquiry.ImpactAt the time of writing, the FEMHO has been successful in galvanising the membership and support of both grassroots organisations and policy makers respectively at a national level.FEMHO now represents over 55,000 individual members, covering various disciplines, specialisms and levels of seniority, spanning across 43 organisations and interest groups.The targeted email campaign saw the achievement of 39 cross party MPs officially supporting FEMHO's call for inclusion of race inequality in the COVID-19 public enquiry.An inaugural meeting was also held within th Houses of Parliament, where grassroot organisation leads as well as MPs were invited to discuss the strategic priorities and direction of the organisation such as the organisations contribution to the COVID-19 public enquiry, to ensure that inequality is truly at the ‘forefront' of issues.Feedback acquired during the inaugural meeting from MPs and front-line workers was incredibly positive, with attendees welcoming this concerted approach to effect change.Challenges faced in this process largely themed around the limited time availability of the several individuals involved with this project. Executive members of the union as well as grassroots member leads largely worked full time in a variety of demanding healthcare professionals, making communication, organisation and prioritisation of voluntary roles such as contribution to FEMHO work difficult at times.InterventionThe intervention, being the development of a national union equipped with the lived experience and expertise of members who are able to effectively advocate for the interests for health workers from ethnic minority backgrounds, has had numerous positive outcomes:A shared space for grassroots organisations to share best practice for support of healthcare workers from ethnic minority backgroundsA concerted voice to contribute to policy change to address the structural inequalities that adversely impact healthcare workers from ethnic minority backgroundsFrom this experience thus far I have learnt that leadership, with regards to solving complex problems, can often be a journey of harnessing the voices, expertise and influence of several individuals and organisations to effect change. Such a journey can come with numerous hurdles: from stakeholder mapping to initiatives to promote cross-specialty, cross-seniority, cross-political party discussions. But I have learnt, particularly from the exec leadership team, made up Ade Adeyemi MBE (a Global Health Policy Expert) and Professor JS Bamrah CBE (Chair, British Association of Physicians of Indian Origin), and other notable individuals, that such efforts to galvanise individuals who have seemingly different priorities is often possible when you are able to see beyond this as a leader and define, clarify and communicate where such individuals share interests and focuses in common.Involvement of stakeholders, such as patients, carers or family members:As mentioned, the main stakeholders that had to be consulted within this process were front-line care workers from ethnic minority backgrounds and any relevant organisations who may work at a grassroots level to support them.Such stakeholders were involved through the establishment of communication channels as well as feedback sessions to ensure that the FEMHO was sufficiently and accurately representing the interests of the group in question.Key MessagesSolving complex problems as a leader requires the ability to create a collaborative environment that often sees the development, nurturing or new relationships at both an individuals and organisation levelLeaders are able to harness human energy through the development and forecast of a vision and mission that is inspiring and compelling, encouraging individuals to sacrifice their time for a matter bigger than themChange that is sustainable and impactful can often be slow, as seen with the policy changes we continue to advocate for as an organisation, but leaders must be patient.Lessons learntAs mentioned, I have learnt that to effect change, one must be patient as a leader. Our policy activities has taken a great deal of time to be heard and seen, and it can often be tempting to grow impatient and quit.Future barriers to our work include the degree to which can promote regular communication and collaboration amongst member organisations who are often time poor, competing with a number of other priorities such as a demanding full time career in healthcare. Other barriers include maintaining political interest from policy makers, commissioners, MPs, many of which may not hold positions for a long-term basis, as a r sult of the political nature of many of their positions.Measurement of improvementWe will measure the effect of our initiative through a series of feedback forms, particularly of member organisations and their members to assess the degree to which front-line care workers from ethnic minority backgrounds feel that progress in being made in the level of advocacy and campaigning on their behalf. Additionally, we will seek to gather feedback on our members perception of ways of working and any suggestions to ensure that all member organisations feel empowered to influence the direction of the federationStrategy for improvementAfter each feedback round, held on a quarterly basis, executive members of the FEMHO will analyse findings and implement changes accordingly where possible

Clinical Research Needs Greater Participant Diversity

"Minority populations were three times more likely to experience complications from COVID-19 but were not equitably represented in clinical trials for the vaccine," says Greater Gift board member Harsha Rajasimha, PhD, CEO and Founder, Jeeva Informatics Solutions, Inc. "This challenge presents itself across varying disease states. According to a recent article in the Harvard Business Review: "Most clinical trials are not representative of the general population or of those with a particular disease. [...]many may be missing required documentation to obtain an ITIN, such as a passport, which excludes potential trial participation entirely. Since payment received is considered reimbursement vs. compensation, there is no need for W-2 forms, which are often required by sponsors, sites, and CROs. * Relaxing of the regulation that governs principal investigator in-person oversight that greatly limits the locations where clinical trials can be conducted. * Pursuit of federal legislation that will allow reimbursement costs to clinical trial participants to be optional and non-taxable. * Introduce legislation that relaxes requirements that limit mobile clinical trial units from traveling to minority communities.

Medical Dental Integration in Wisconsin: Integrating dental hygienists into pediatric well child visits and prenatal care

Disparities exist in access to early oral health care, disproportionately impacting minority ethnic groups and populations with low socioeconomic status. Medical dental integration provides an opportunity to create a new dental access point for early prevention and intervention as well as care coordination. The Wisconsin Medical Dental Integration (WI-MDI) model expanded early access to preventive oral health services by integrating dental hygienists (DHs) into pediatric primary care and prenatal care teams to address oral health inequities with the goal of reducing dental disease. This case study will describe how DHs were incorporated into the medical care teams in Wisconsin and how legislation expanding scope of practice made this possible. Since 2019, five federally qualified health systems, one non-profit clinic, and two large health systems have enrolled in the WI-MDI project. Thirteen DHs have worked across nine clinics in the WI-MDI project and over 15,000 patient visits to a medical provider included oral health services provided by DHs from 2019 to 2023. Dental hygienists working in alternative practice models such as those demonstrated in the innovative WI-MDI approach are positioned to reduce oral health disparities through the provision of early and frequent dental prevention, intervention, and care coordination.

Racism: the other pandemic

Billed as a review into ethnic disparities and covid-19, it devotes only a small proportion of its pages to ethnicity, and, while confirming what we knew—that people from ethnic minority groups are more likely to become infected and to die from covid-19—it makes no attempt to explain the disparities or make recommendations for action. Covid-19 has produced a "stress test” for structural racism in healthcare and public health, say Christine Douglass and colleagues (https://blogs.bmj.com/bmj/2020/06/08/structural-racism-in-society-and-the-covid-19-stress-test). The NHS's response in setting up a Race and Health Observatory is another (doi:10.1136/bmj.m2191).

Care Work Through Course Design: Shifting the Labor of Resilience

Drawing on the disability justice paradigm of care work (Piepzna-Samarasinha), this article moves to shift the labor of resilience from students to our course design, noting how models of student resilience are often tied to ableist expectations of performance and coherence. The authors share their ongoing experiments in creating disability-centric, care-centered course designs, which are meant to offer students more flexibility while respecting the required labor asked of instructors.

The Many Paths of Diversity in Clinical Trials

"Certain compounds affect certain populations," said Diana Foster, PhD, vice president, Strategy and Special Projects, Society for Clinical Research Sites (SCRS). A 2013 study of 167 new-molecule-based therapies showed that one in five of them acted differently in minority groups, in different races and ethnicities.4 "Diversity certainly has a higher profile now, but pharma began funding [our Diversity Site Assessment Tool project] four years ago," said Foster. COVID-19 was not the irnpetus for pharma's current focus on diversity in its trials, said Marie-Pierre Hellio Le Graverand, MD, DSc, PhD, senior vice president and Pfizer's Clinical Development & Operations, Global Product Development lead. In 1932, J.M. Adams wrote about the differences in blood pressure levels between a "group of white and [African American] workmen" in the American Journal of Medical Sciences.7 Researchers then started reporting that different types of people react differently to medical therapies.

Leadership in uncertain times

ContextThis work was carried out alongside the Association of Directors of Public Health (ADPHL) Steering Group on Supporting Black, Asian and minority ethnic communities during and beyond Covid – working with public health leaders in London, particularly local authority directors of public health and their teams.Issue/ChallengeDuring the first wave of the Covid pandemic, in 2020, there was renewed public and professional interest in ethnic inequalities in health, following the release of the Public Health England (PHE) reports, which highlighted the disproportionate impacts of COVID-19, particularly amongst Black, Asian and minority ethnic communities.At the same time, there was an increased social awareness of the impacts of racism and the Black Lives Matter movement, following the murder of George Floyd.There was a moment in time to speak out on the situation and that emboldened us to be heard in a way we haven't been heard before. Reflecting on our experience as black female public health leaders in the London public health landscape, the challenge was how we capture this and respond to this matter in a way that brings real change and maintains momentum.A particular piece of work was supporting the development of the ADPHL policy statement ‘Racism is a public health issue' and its related action plans.Traditionally, the medical/healthcare professions have been challenged in understanding and taking into account the impact of racism in health. There is an identified need for a different kind of health leadership during these uncertain times.-Although there is increased interest and discussion of racism and its impacts currently, we anticipate challenges with maintaining momentum, particularly at senior level, to embed lasting changeThere is limited research on the experiences of black leaders working in this context and how they are heard, involved or valuedAssessment of issue and analysis of its causesWe looked at examples of leadership on this subject matter at local, regional and national level, including an understanding, lived experiences and perception of discrimination, support at work and in health outcomes, health literacy and access, behaviour and attitudes, black and ethnic minority workforce experiences and morale.ImpactOur work has been recognised across London local authorities, wider health and care partners and national public health forums.We were awarded the Faculty of Public Health Sam Ramaiah Award.Our work has influenced partner organisations to develop actions plans or strategies around tackling structural racism (e.g. Greater London Authority).Our work has motivated fellow Directors and Consultants to have conversations on this uncomfortable subject matter, in a way they've never done before and consider how we maintain this momentum.It has also led to creating a safe space through a network of ‘Black' leaders, where we can reflect on our professional development in uncertain times.InterventionAs above, we wanted our voices to be heard in response to the challenges that were faced. During the process of developing the position statement and action plan, we considered our own positions as effective leaders in this space, how we continue to maintain momentum of this agenda, and influence other system leaders in tackling racism in public health.We invited speakers from other organisations to our working group to challenge us on these concepts as system leaders, and considered how we could bring the service users' voice to hold us to account, as well as provide their perspectives.We also organised and facilitated workshops with London local authority public health Directors and Consultants on this subject matter.Involvement of stakeholders, such as patients, carers or family members:There was no direct patient involvement, however we shared our lived experiences.Key MessagesReflecting on our experience as senior black healthcare leaders leading effective multicultural teams and addressing health inequalities we found that:There is change and changing language around racism and ealthCultural competency and cultural humility in leadership plays a crucial role and there are different views so we need to look at the different perspectives and actually understand what it meansAlthough leading whilst holding discomfort is universal there appears to be disproportionate burdenThe impact on perception, behaviour and morale from a workforce and patient/community perspectiveSupport and peer engagement does not always happenThe narrative can be deemed to be repetitive and nuances get missedLessons learntThere is interest in leading this wayHolding the ambiguity and discomfort is universal to leadership in this context and so as leaders of this agenda we need to ensure we do not respond to the pressure to react with immediacyWe learnt that we still need allies and we need timeMeasurement of improvementThis is ongoing and will be measured using qualitative approaches such as through the various dialogues across the public system, training and organisational development.Strategy for improvementWe will look at this as part of the workforce development, share at conferences and through the work with ADPH.

INNOVATIVE CLINICAL TRIAL DESIGNS EMERGE FROM PANDEMIC

The plan is to enroll 2,400 patients in a Phase III study in collaboration with the National Institute of Allergy and Infectious Diseases (NIAID) and utilizing its COVID-19 Prevention Network. Because long-term care facilities lack the infrastructure to conduct clinical trials, Lilly assembled a customized fleet of recreational vehicles with lab equipment and research personnel able to provide intravenous infusion of the test drug to patients at selected sites. Main factors for these disparities is that minorities show a higher prevalence of debilitating health conditions (obesity, heart disease, diabetes), poor healthcare, and greater exposure to contamination through jobs and crowded living conditions. Sponsors seek to locate clinical trial test sites in neighborhoods with high minority populations and are working with local church groups and community organizations to overcome fear of medical institutions.

Rashford, racism, and bankrupt excuses

Ian Sinha and colleagues include the rising tide of food insecurity in their list of ways in which children's health and wellbeing are being sidelined by covid-19.1 The long term harm of poor health in childhood is well established, and a policy focus is urgently needed, they say. Children don't choose the poverty they are born into and live with, or the parental circumstances that lead to them being unvaccinated, unfed, or brought up on junk food.23 The incidence of covid-19 is low in children, but evidence grows of a rare, multisystem inflammatory syndrome related to Kawasaki disease.4 The illness is severe and disproportionately affects black children, although outcomes are favourable with intensive hospital care. The ISARIC study of 20 000 hospital inpatients clarifies the comorbidities that lead to hospital admission.7 But our ability to understand the high impact of covid-19 on ethnic minority patients and staff continues to be hampered by absent, limited, and poor quality data.

Increasing ethnicity reporting to better understand cultural needs accessing a primary care talking therapy service.

BACKGROUND: The COVID-19 pandemic highlighted the under-utilisation of statutory mental health care services by minority ethnic groups in the United Kingdom (UK). AIM: To improve ethnicity reporting to better understand the needs of patients accessing a primary care talking therapies service. METHOD: We conducted a clinical audit to observe outcomes from pre-COVID (2019), first wave of COVID-19 (2020) and 2021 for three broad ethnic categories: black African/Caribbean, Asian and white British. Intervention was conducted on staff to improve data recording of ethnicity. A patient survey was sent to those identified as dropped out from treatment from May 2020 to April 2021. A total of 229 patients responded to the survey. The survey asked for reasons that impacted on not continuing with sessions. RESULTS: Quantitative analysis showed a statistically significant difference on discharge outcome between white British and black African/Caribbean (p=<0.0001), with black African/Caribbean patients most likely to drop out of treatment, and in 2020 the Asian population was below the recovery target of 50%. Qualitative analysis revealed therapist factors included lack of confidence in therapist and not being listened to, patient factors included neurodiversity, being unsure whether it would be helpful and confidentiality concerns, and service factors included being notified of discharge from the service, remote delivery of therapy, treatment options, and treatment materials. DISCUSSIONS: Services must work towards improving service provision by capturing hidden disparities and socialising treatment to meet the needs of minority ethnic groups in the UK. The present study recommends culturally adapted treatment and co-producing therapy materials.

Coverage, completion and outcomes of COVID-19 risk assessments in a multi-ethnic nationwide cohort of UK healthcare workers: a cross-sectional analysis from the UK-REACH Study.

INTRODUCTION: There are limited data on the outcomes of COVID-19 risk assessment in healthcare workers (HCWs) or the association of ethnicity, other sociodemographic and occupational factors with risk assessment outcomes. METHODS: We used questionnaire data from UK-REACH (UK Research study into Ethnicity And COVID-19 outcomes in Healthcare workers), an ethnically diverse, nationwide cohort of UK HCWs. We derived four binary outcomes: (1) offered a risk assessment; (2) completed a risk assessment; (3) working practices changed as a result of the risk assessment; (4) wanted changes to working practices after risk assessment but working practices did not change.We examined the association of ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk variables on our outcomes using multivariable logistic regression. RESULTS: 8649 HCWs were included in total. HCWs from ethnic minority groups were more likely to report being offered a risk assessment than white HCWs, and those from Asian and black ethnic groups were more likely to report having completed an assessment if offered. Ethnic minority HCWs had lower odds of reporting having their work change as a result of risk assessment. Those from Asian and black ethnic groups were more likely to report no changes to their working practices despite wanting them.Previous SARS-CoV-2 infection was associated with lower odds of being offered a risk assessment and having adjustments made to working practices. DISCUSSION: We found differences in risk assessment outcomes by ethnicity, other sociodemographic/occupational factors and actual/perceived COVID-19 risk factors. These findings are concerning and warrant further research using actual (rather than reported) risk assessment outcomes in an unselected cohort.

What does back to school look like this year?

Contemporary Pediatrics" talked with Nathaniel Beers, MD, MPA, FAAP, executive vice president of Community and Population Health at Children's National Hospital in Washington DC, and a general and developmental behavioral pediatrician , about what this school year may look like for children and adolescents, and what pediatricians can do to help them play catch-up. There was a lot of interest in getting those activities moving quickly, because people recognize the value they had to students and their social/emotional development as well as their overall mental health. Encourage children to do reading over the summer, play some math games on the computer....These can help create structure as well, which they need once the school year begins.

Taking Class Seriously

This article critically analyzes the human rights perspective upon what has emerged as one of the most significant socioeconomic and political challenges confronting many millions of people residing within high-income, liberal-democratic societies: rising poverty and socioeconomic inequality. This article argues that international and domestic human rights law and the social and political imaginaries of the wider human rights community largely fail to adequately diagnose and effectively respond to poverty and inequality within high-income, liberal-democratic societies. As a political and ethical doctrine founded upon a normative commitment to social justice, human rights should be taking the lead in efforts to condemn, understand, and develop responses to the poverty and inequality which blight the lives of many millions of people within many of the world's most affluent and, allegedly, most "liberal” societies. Human rights law has historically not done so. We, as a community, have not done so. This article offers a specific explanation for this continuing failure, by focusing upon the absence of any concerted recognition of or engagement with social class as it contributes to and compounds our exposure to poverty and inequality. Human rights remain largely blind to the many ways in which social class is intricately connected to poverty and inequality. The human rights community within high-income, liberal-democratic societies characteristically fails to take class seriously. Building upon previous writing in this area, this article explains why class is rarely recognized or engaged with by the human rights community. This article also sets out the basis for how we might begin the task of overcoming this highly damaging class blindness, to set the stage for what the author asserts as an urgent need if human rights is to provide the kind of political and ethical leadership required to effectively engage with poverty and inequality in affluent societies: the degentrification of human rights.

Indian Act Philanthropy: Why are Community Foundations Missing from Native Communities in Manitoba, Canada?: Revue Canadienne de Recherche sur les OSBL et l'Économie Sociale (ANSERJ)

Un modèle philanthropique axé sur le développement communautaire serait-il en train de renforcer les politiques coloniales plutôt que d'offrir des bénéfices économiques équitables? Cette étude analyse les transcriptions de vingt webinaires publics sur la philanthropie et la Loi sur les Indiens et évalue les 54 fondations communautaires établis au Manitoba, Canada. Ces 54 fondations servent seulement les villes et municipalités des colons-il n'y en a pas une seule dans les communautés autochtones. Comme elles ne desservent que leurs régions géographiques spécifiques, les fondations communautaires au Manitoba concentrent la richesse dans les villes et municipalités dominées par les colons, accaparant des ressources qui pourraient aider les communautés autochtones. Ce modèle philanthropique, en excluant les communautés les plus pauvres du Manitoba, renforce la marginalisation, la pauvreté et les risques de santé dans les communautés autochtones.Alternate :Could a philanthropic model aimed at community development enforce colonial policy rather than providing equitable economic opportunity? This research analyzes the transcripts of 20 public webinars on philanthropy and the Indian Act and maps the 54 community foundations in Manitoba, Canada. All 54 community foundations in Manitoba service only settler-dominated cities and municipalities, with none on Native communities. As community foundations serve only their specific geographical areas, the community foundations in Manitoba effectively concentrate wealth in settler-dominated cities and municipalities, taking away needed resources from Native communities. In excluding the poorest communities in Manitoba, this philanthropic model further entrenches marginalization, poverty, and health risks for Native people on Native communities.

Racism in pediatric health

SPECIAL REPORT Since the inception of the United States, social, economic, political, and scientific institutions have been built on a foundation emphasizing the inferiority of individuals related to phenotypic differences.1 This hierarchy ensconced white individuals as superior to all other groups with Native Americans and Blacks on the bottom. Some fifty years after the discovery of the genetic code, at a White House ceremony in 2000 to announce the discovery, Craig Venter, a pioneer of DNA sequencing, observed, "The concept of race has no genetic or scientific basis. With structural or institutional racism, there is decreased access to health care and resources for education, leading to lower health literacy and fewer health care providers of color.12'13 Over time, this has led to a distrust of the health care system as a whole by POC due to widely publicized historical events such as the Tuskegee Syphilis Study and the Marion tuberculosis outbreak. [...]non-Hispanic Blacks have a higher prevalence of recurrent asthma exacerbations and hospitalizations than Whites after adjusting for demographic and socioeconomic factors.16 One study revealed that with non-Black children, poor children were 45% more likely than children who were not poor to have asthma.

India and Covid-19: decisive but controversial actions seem to be working

A disclaimer to start with: in a federal union of 1.3 billion persons comprising 17 per cent of humankind, 36 states and territories, multiple languages and ethnic groups, few if any observations are valid across the whole country. Democracies find it hard to make tough decisions and to adapt when they need to improvise without precedents;pre-emption to tackle a problem before it becomes a crisis is never a democratic strength, especially in a federation. India took relatively early steps against Covid-19: visas were rescinded on March 18;international flights stopped on March 22;and domestic flights were terminated on March 24. Prime Minister Narendra Modi called for a 12-h nation-wide voluntary curfew on 22 March, marked with high observance, which was a dress rehearsal for a full lock-down from 24 March for 21 days with relaxations for medicines, media, banks and groceries. The national closure was the most comprehensive in history. At that stage, India had registered 500 cases and 10 deaths. The trade-off was to lose lives to Covid-19, or gain time to prepare health services and risk the economic consequences. Modi acted quickly although it caused hardship to millions. By and large, the lockdown was observed, justifying the theory that Indians react best in emergency mode.