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.

Child, adolescent, and parent mental health in general population during a year of COVID-19 pandemic in belgium: a cross-sectional study

Background: This study aims to evaluate the mental health status of children, adolescents and their parents during the first year of COVID-19 pandemic in Belgium. Method(s): Analysis compared results before and during the second national lockdown, which started on November 2nd 2020. A cross-sectional online survey was conducted between May 2020 and April 2021. Result(s): Two hundred and eighteen adults and 273 children fully completed the survey. Almost one in five children (17.9%) presented moderate-to-severe scores of depression. Adolescents presented a higher level of depression than children (p = 0.007). The rate of moderate-to-severe depression scores (10.8% to 21%, p = 0.007) and internalized symptoms increased during the second lockdown (p < 0.001). Parents' depression (p < 0.001) and anxiety (p = 0.027) levels also increased during the second lockdown. Logistic regression showed that the use of psychotropic medication in parents and parents' depression scores were risk factors for children to have worse depression scores. Conclusion(s): The second lockdown appears to worsen the effects of the pandemic on children's and parents' mental health. There is a need to implement specific interventions targeting both children/adolescents and their parents to support them during lockdown periods and improve mental health outcomes.Copyright © 2022, The Author(s).

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.

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.

COVID-19 and the changing roles of social workers in minority communities: Lessons from the Israeli ultra-Orthodox community

Minority groups have been disproportionately vulnerable to COVID-19's effects. Whereas, social workers have been instrumental in countering those effects, their roles have been understudied, particularly during the ‘new normal' that followed the outbreak. This gap is addressed by drawing on interviews with 28 social workers in the Jewish ultra-Orthodox (Haredi) society in Israel, held after the outbreak and during the ‘new normal'. Three main roles are identified: first responders, during the outbreak;a voice for community needs, in the ‘new normal';and policy translators – throughout. The findings contribute a temporal aspect to the literature by highlighting social workers' dynamic roles. [ FROM AUTHOR] Copyright of International Social Work is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The impact of confinement by COVID-19 on the academic year. Case study: Gypsy pupils

The urgent virtualisation of academic activity in educational centres forced by the confinement decreed in Spain between the months of March and May 2020 posed a challenge previously unknown to the entire educational community. Information and communication technologies became essential tools to guarantee the continuity of the course. This situation highlighted the lack of technological equipment for the most vulnerable groups of the population and further increased the << digital divide >>, putting at risk the monitoring and school performance of pupils in these sectors. Among the most affected groups is that of gipsy students, as demonstrated in schools such as CEIP Nueva Segovia, (Segovia, Spain). This paper is the result of a qualitative and quantitative research carried out in this school, which has made it possible to identify and analyse the technological devices available to gipsy students, the perception of the different members of the educational community on the use of technologies and, finally, the training of these members in relation to new technologies. The results reveal the needs not only for equipment, but also for training in new technologies that both families and students have. These results show the importance of a new curricular approach for pupils with educational compensation needs to eliminate this situation of inequality.

Asian communities' well-being in Aotearoa during Covid-19: The mitigating role of sense of belonging in the relationship between racism and life satisfaction

INTRODUCTION: Anti-Asian racism was a feature of the social response to the Covid-19 pandemic, and its impact on the well-being of Asian communities warrants closer examination. The current study aimed to gauge whether the sense of belonging mitigated the adverse effects of racism on life satisfaction for self-identified Asian New Zealanders.METHODS: This analysis included 1341 responses to a cross-sectional online survey conducted in 2021. Descriptive analyses outline how components of a sense of belonging were distributed among participants and those who experienced racism during the Covid-19 pandemic. We used linear regression to examine the role of a sense of belonging as a potential pathway variable in the association between experiencing racism and life satisfaction.FINDINGS: In this survey, four out of 10 participants reported experiencing racism in the first 18 months of the pandemic. Participants' life satisfaction decreased slightly since January 2020 (p<0.001). Experiencing racism was associated with decreased life satisfaction. All the components of sense of belonging reduced the magnitude of this negative association between racism experience and life satisfaction, in particular, expressing one's own ethnic identity and belonging in Aotearoa.CONCLUSIONS: Given that anti-Asian racism is currently a feature of life and a significant stressor during the pandemic, this study provides empirical evidence of the protective role of a sense of belonging against anti-Asian racism. This study focused on Asian members in Aotearoa New Zealand, but its practical implications have the potential to support other minoritised ethnic communities who also experience racism during the pandemic and beyond.

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.

How Ethnic Minority SME Owners in the UK can Create Value Amid Informal Institutional Voids

This article shows that the COVID-19 pandemic exposed informal institutional voids that exist for Black, Asian and Minority Ethnic (BAME) business owners in the United Kingdom. Based on a primary database of surveys and semi-structured interviews, the results show that many BAME small and medium-sized enterprise (SME) owners encountered informal institutional voids that White SME owners did not face during the pandemic. The article also shows how these BAME SME owners created value amid these institutional voids and how they can continue to do so. The article concludes by suggesting that bridging these voids is crucial for promoting a more inclusive environment where ethnic and non-ethnic entrepreneurs can succeed. It also presents policy implications and offers directions for future research.

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.

Age, race/Hispanic origin, and COVID-19 mortality among sickle cell disease patients in the United States

The COVID-19 pandemic remains a global health challenge, with 6.7 million deaths worldwide as of January 2023. It has illuminated the health iniquities in underserved communities and populations like those with sickle cell disease (SCD). Researchers have associated the COVID-19 outcome among SCD patients in other regions of the globe. The purpose of this retrospective cross-sectional observational study was to investigate the relationship between age, race/Hispanic origin, and COVID-19 mortality among persons with SCD in the United States from January 2020 to March 2021. The Krieger ecosocial theory of disease distribution framed the study. Data were drawn from an existing Centers for Disease Control and Prevention provisional SCD death data set (N = 140). The binary logistic regression analysis result showed a statistically significant relationship between age and race/Hispanic origin and COVID-19 mortality. The variability between ages was 42.9%;race/Hispanic origin was 29.9%;and age and race/Hispanic origin were the highest, with 62.4% dying from COVID-19. Non-Hispanic Black patients were 9.6 times more likely to die overall but those aged 60+ were 17.5 times more likely to die from COVID-19 than the reference groups (0-19-year-old and other race). This study can benefit the research community, public health workers, medical professionals, and policymakers to understand better and influence policy on developing and prioritizing age- and race-tailored preventive protocols and medical care. They may minimize pain and suffering while mitigating mortality from COVID-19 and other unforeseen future pandemics within the SCD community at home and abroad and positively effect social change. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Diversity in medical publications: a cross-sectional evaluation of COVID- 19 vaccine research

Objective: Representing diverse perspectives in medical publications is of great importance. We assessed diversity among investigators, study participants, authors and tweeters of recent publications on COVID-19 vaccine trials, a topic likely to have significant global implications. Research design and methods: Primary publications reporting on COVID vaccine randomized controlled trials (RCTs) were identified via PubMed (n=302 hits, 23 September 2022). The 100 articles with the greatest impact (Altmetric score) were selected for evaluation. National affiliation of authors and investigators, and demographics of participants were collected. Geographic locations of Tweets mentioning the publications were collected via Altmetric. Result(s): In our preliminary analysis, as expected, selected publications most frequently appeared in top-tier journals, e.g. New England Journal of Medicine (n=24) and Lancet (n=19), and had high Altmetric scores (median 886, range 30-29,153). Articles included authors from mean 2.2 countries, most frequently the USA (n=43 articles), the UK (n=31) and China (n=23). Investigators' locations were often not reported, but most frequent were the UK (n=2711 investigators), USA (n=1029) and South Africa (n=269). There was a gender balance among participants across the studies (mean 49.4% female). The most frequent ethnic groups were white, Hispanic and Asian. Tweets mentioning the publications most commonly came from the USA (8.1%), the UK (3.1%) and Japan (2.9%). Conclusion(s): Despite COVID-19 being a global health emergency, most authors, investigators and readers of high impact COVID-19 vaccine RCT publications were from a small group of countries, with some notable exceptions. Numerous studies did not report the geographic location of investigators or participant ethnicity. Consistent and transparent reporting would support the drive towards greater diversity and representation in medical research.

Citizenship Wanted, but Denied: The Racial Prerequisite Cases and Their Role in Institutionalizing Racism Against Asians: a Journal for Readers, Students and Teachers of History

This article explores the racial prerequisite cases, which were dubious court decisions that attempted to rationalize pseudo-scientific evidence and common knowledge as reasons for who could and could not be considered for, and who was ultimately denied, U.S. citizenship. These cases are historical antecedents of the current anti-Asian racism that has become even more pronounced as a result of COVID-19. Social studies educators can leverage these court cases to teach about controversial and relevant issues that connect to current immigration and citizenship policies, as well as provide historical context for contemporary discussions about race and racism.

The "epidemic within the pandemic”: meeting the needs of racially minoritised women experiencing domestic abuse during the Covid-19 pandemic

PurposeIn March 2020, the UK entered its first lockdown responding to the Covid-19 pandemic. In the same month, the Domestic Abuse Bill had its first reading in Parliament. Charities and non-governmental organisations critiqued the Bill for failing to protect migrants from domestic abuse, and not complying with the Istanbul Convention. Drawing on interviews with staff from Southall Black Sisters, this paper aims to foreground the experiences of practitioners within the women's sector to explore the unique experiences and challenges migrant and racially minoritised women encountered when seeking support from domestic abuse during the Covid-19 pandemic. It highlights how the pandemic-related lockdowns created barriers to accessing support services and housing, creating an epidemic within the pandemic, and how minoritised women and the organisations that supported them had to overcome structural barriers and racism.Design/methodology/approachIn-depth semi-structured interviews were conducted with staff from a leading women's organisation that supports migrant and racially minoritised women. Four participants were asked questions within four themes: domestic abuse before and during the pandemic;accessing support from and reporting domestic abuse;accessibility of resources;and post-pandemic challenges. A phenomenological approach was used to analyse the transcribed interviews.FindingsParticipants consistently highlighted the unique threats and barriers migrant and racially minoritised women faced when seeking support. Barriers included racism, language barriers, cultural constraints, the triple threat of destitution, detention, deportation, and political resistance to protect migrant women from destitution/homelessness.Originality/valueThis paper provides a unique insight into the experiences of staff members within a specialist by and for women's support organisation in England and their perspectives on the barriers racially minoritised and migrant women experienced during the Covid-19 pandemic. It offers rare insights into how service users' needs changed during the lockdowns and how the pandemic affected their ability to operate.

Clinical and laboratory markers of severity of the new coronavirus infection (COVID-19).

The aim of the research. To study clinical and laboratory features of the new coronavirus infection (COVID-19) in order to develop a model that would allow, taking the publicly available research methods into account, to carry out early diagnosis of severe community-acquired pneumonia against the background of the new coronavirus infection. Material and methods. A total of 82 COVID-19 patients who complied with inclusion and exclusion criteria were enrolled. Depending on the clinical severity, three study groups were formed: group 1 included 13 patients with uncomplicated COVID-19, group 2 consisted of 39 patients with non-severe forms of pneumonia that developed against COVID-19 and group 3 was comprised of 30 patients with COVID-19 complicated by severe pneumonia. The groups were comparable in age and gender. All patients underwent general clinical examination, laboratory tests, including general and biochemical blood analysis, as well as chest computed tomography. Results. The clinical picture in COVID-19 patients differed depending on the disease severity. Coughing and shortness of breath were more often observed in patients with severe pneumonia;sore throat, on the contrary, was more often noted in patients with uncomplicated COVID-19. On admission to the inpatient facility, patients with severe pneumonia had higher body temperature and respiratory rate, with simultaneous decrease in blood oxygen saturation. One half of the patients with severe pneumonia had hypertensive disease in medical history, and one third had ischaemic heart disease. As a rule, uncomplicated COVID-19 patients did not have ischaemic heart disease. It was found through laboratory analysis of blood that groups of patients significantly differed in the levels of neutrophils, lymphocytes, monocytes, basophils and eosinophils. Conclusion. The use of such clinical and laboratory data as acute respiratory failure, fever, the levels of neutrophils, monocytes, lymphocytes, eosinophils and basophils makes it possible to identify patients with more severe pneumonia against the background of COVID-19 even before chest computed tomography. Key words:.Copyright © 2022, Krasnoyarsk State Medical University. All rights reserved.

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.

The covid-19 pandemic: A double threat to Chinese americans' mental health

Objective: To explore the double psychosocial threats of the COVID-19 pandemic, targeted behavior toward Chinese Americans, and the correlates to their mental health. Methods: A quantitative, cross-sectional, and descriptive design was utilized by using a purposive convenience sample of 301 Chinese Americans over the age of 18 residing in the United States. Online data collection was conducted through the social media platform WeChat from April 8–21, 2021. Descriptive statistical analysis was used for the participants' demographic characteristics, Multidimensional Scale of Perceived Social Support (MSPSS), Double Threat Situations, COVID-19 Racial Discrimination, and General Anxiety Disorder-7 (GAD-7). Stepwise logistic regression was conducted to verify predictors for anxiety levels by GAD-7. Results: In this sample (N = 301), 127 (42.19%) were male and 174 (57.81%) were female. The average age was 41.67 (SD = 5.89). Among MSPSS subscales, social support from family (MSPSS-Fam, 79.73%, n = 240) and social support from significant others (MSPSS-SO, 73.75%, n = 222) were high. 231 (76.74%) reported threats due to their Chinese ethnic background during the COVID-19 outbreak. Predictors for the high anxiety level by GAD-7 were COVID-19 racial discrimination from the local community (OR = 0.47, 95% CI = 0.39–0.71, p < 0.001), media/online (OR = 0.36, 95% CI = 0.26–0.53, p < 0.001), the perceived threat from the COVID-19 virus (OR = 0.33, 95% CI = 0.23–0.51, p < 0.001) and Perceived racism threat from Chinese background related to COVID-19 (OR = 0.31, 95% CI = 0.21–0.49, p < 0.001). Conclusions: COVID-19 double-threats (The virus and racial discrimination) situations are significantly related to the high level of anxiety among Chinese Americans. The sense of belonging and social perceptions of Chinese immigrants is closely related to public health problems in Western societies and needs to be addressed at all levels. Our findings call for the attention of healthcare workers to specific racism double-threatened situations and high mental health risks, as well as direct and indirect ethnic discrimination that Chinese Americans are experiencing during this pandemic, the long-term influences and effective coping ways related to this issue should be explored in further research. © 2023, Tech Science Press. All rights reserved.