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Objectives: Malnutrition is a prevalent condition affecting 30-50% of hospitalized patients. Malnutrition is linked to impairments in health outcomes and increased economic burden on healthcare systems. We assessed the prevalence and burden of malnutrition by examining demographic characteristics, Disease Related Group (DRG) payments and associated claims among Medicare inpatients (65+ years) with and without COVID-19. Method(s): Hospital inpatient COVID-19 claims from the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) between October 2020 - September 2021 were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) were used for malnutrition diagnoses. Demographic variables were compared based on the COVID-19 status;economic burden was analyzed by DRG payment of malnutrition cases with and without COVID-19. Result(s): Among 7,394,657 Medicare inpatient claims, only 12% had a documented malnutrition diagnosis. Of these patients, 1.2% had COVID-19. Regardless of COVID-19 status, malnourished patients averaged 75 years of age, and were predominantly female (54%) and White (78%) followed by Black (14%), and Hispanic (2%). Sepsis, kidney failure, and urinary tract infection (UTI) were the most common primary diagnoses in malnourished patients, regardless of COVID-19 status. Malnourished patients with COVID-19 had significantly higher DRG payments ($27,407 vs. $18,327) and increased cost of outlier payment ($3,208 vs. $2,049) compared to those without COVID-19, regardless of other diagnoses. Conclusion(s): Malnutrition diagnosis was confirmed in only 12% of the Medicare inpatients, thus suggesting that malnutrition continues to be underdiagnosed and undertreated - evidenced by high rates of hospitalizations/claims and payments in both COVID-19 and non-COVID-19 cases. It is imperative for hospitals to implement nutrition-focused protocols to identify, diagnose and address malnutrition among all Medicare inpatients regardless of COVID-19 status (and especially among patients with sepsis, kidney failure, and UTI). Nutrition-focused protocols can effectively improve patient health outcomes and reduce healthcare costs.Copyright © 2023
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Objectives: The impact of the COVID-19 pandemic on mental health is not yet well-studied. This study's objective is to describe demographic characteristics of the population diagnosed with depression or anxiety, and to compare PHQ9 scores before and after the pandemic. Method(s): A retrospective cohort study was performed using Komodo Health's healthcare claims and EMR data, which included Patient Health Questionnaire-9 (PHQ9) survey responses. The study's baseline and follow-up periods were set as one year before and after 03/01/2020. Patients selected were >=18 years of age, had a MDD, GAD, or other psychiatric diagnosis in both periods, and had taken at least one PHQ9 survey in both periods, resulting in 10,433 patients. Demographic characteristics were described across age, gender, and race/ethnicity, and a subgroup analysis was performed on PHQ9 scores and depression categories using averages (mean, SD) and odds ratios. Result(s): Demographic analysis showed depression severity correlated with patients who were younger, female, and Black or Hispanic. Younger patients (<30) were more likely than older (>=30) to be in the moderately severe category or worse (PHQ9 score >=15) in both time periods (ORs 1.72 and 1.62, p<0.001). This was also true for female as compared to male (ORs 1.45 and 1.49, p<0.001), and Black or Hispanic as compared to White (ORs 1.87 and 1.47, p<0.001). However, mean PHQ9 scores tended to decrease in the follow-up period. The overall mean decreased slightly from 6.28 (SD 6.05) to 5.68 (SD 5.82), which was consistent in nearly all age, gender, and race/ethnicity subcategories. Conclusion(s): While the improvements in average PHQ9 scores were counterintuitive, given the harmful impacts of the pandemic, existing correlations between demographics and depression severity remained. One possible explanation is that this cohort definition selected for patients who received more consistent mental healthcare. Further study will investigate this and other possible factors.Copyright © 2023
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Case history: We present the case of a 31-year-old Hispanic male with history of recurrent bronchiectasis, invasive aspergillosis, and severe persistent asthma, who is now status post lung transplant for end-stage lung disease. He initially presented at 7 years of age with diarrhea, failure to thrive, and nearly absent immunoglobulin levels (IgG < 33 mg/dL, IgA < 7 mg/dL, IgM = 11 mg/dL, IgE = 4 IU/dL) necessitating IVIG treatment. Small intestinal biopsy showed villous atrophy consistent with autoimmune enteropathy. Sweat chloride was reported as indeterminate (44 me/dL). Initial WBC, platelet, and T- and NK-cell counts were within normal range, and B-cell count and percentage were borderline low. Most recently, he was found to have increased immature B-cell count (CD21low), decreased memory B-cells, and poor pneumococcal vaccine antibody response. Patient has been hospitalized numerous times with increasingly severe bronchiectasis, pneumonitis, and COVID-19 infections twice despite vaccination, leading to respiratory failure and lung transplantation. Family history is negative for immune deficiency and lung diseases. Discussion(s): Of these 3 VUSs (see the table), the one in IRF2BP2 has the most pathogenic potential due to its autosomal dominant inheritance, its location in a conserved domain (Ring), and previous case reports of pathogenic variants at the same or adjacent alleles 1-3. Baxter et al reported a de novo truncating mutation in IRF2BP2 at codon 536 (c.1606CinsTTT), which is similar to our patient's mutation. This patient was noted to have an IPEX-like presentation, with chronic diarrhea, hypogammaglobulinemia, and recurrent infections. Variant Functional Prediction Score for our variant predicts a potentially high damage effect. There are 2 other case reports of heterozygous mutations in loci adjacent to this allele;one (c.1652G>A)2 with a similar clinical phenotype to our patient and the other (C.625-665 del)3 with primarily inflammatory features and few infections. Impact: This case highlights a variant in IRF2BP2 associated with severe hypogammaglobulinemia, recurrent pulmonary infections, and autoimmune enteropathy. [Table presented]Copyright © 2023 Elsevier Inc.
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While both dementia and coronavirus disease 2019 (COVID-19) have differing etiology, there is a complex interplay between the two, especially when looking into their effects on certain sub-populations. Hispanic Americans face a higher burden of dementia and COVID-19 due to both modifiable and unmodifiable risk factors, age-related chronic diseases, and environmental factors. The major unmodifiable risk factors include increasing age and predisposing genetics, while the major modifiable risk factors include income/socioeconomic status, educational attainment, exercise, diet, and smoking/tobacco use. Furthermore, specific age-related chronic diseases such as diabetes, kidney disease, hypercholesterolemia, cardiovascular disease, and chronic lung diseases place Hispanic Americans at high risk for dementia and COVID-19. Lastly, Hispanic Americans face the additional disadvantage of environmental factors, such as social inequalities and lack of access to adequate healthcare resources. Given that Hispanic Americans are the largest racial/ethnic minority group within the United States, this chapter will focus upon the research associated with dementia and COVID-19 within the Hispanic American population of the United States. Furthermore, this chapter will explore the four major risk factor categories (unmodifiable risk factors, modifiable risk factors, age-related chronic diseases, and environmental factors), which contribute to the development of dementia and COVID-19 within the Hispanic American population of the United States. © 2023 Elsevier Inc. All rights reserved.
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Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.
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The COVID-19 pandemic impacted the educational experiences of diverse student populations throughout the country and among Virginia public schools. English Learners (ELs) had a unique set of needs and services prior to the pandemic, and potentially were more vulnerable to pandemic-related disruptions in typical school operations than other student groups. We analyze statewide, student-level administrative data on the composition of the EL population, the identification for and reclassification out of EL services, and the exit of ELs from public school enrollment in kindergarten through grade twelve between the 2010-11 and 2020-21 school years to examine changes between the pre-pandemic period and first post-pandemic onset year (2020-21). Our key findings include the following: (1) Following the onset of the pandemic, the number of students classified as EL decreased for the first time in a decade. Specifically, whereas the number of students classified as EL increased by 26.0% (25,171 more students) between 2010-11 and 2019-20, the number of students classified as EL decreased by 3.2% (3,852 fewer students) between 2019-20 and the first post-pandemic onset year (2020-21). (2) There was a 21.6% decline (6,223 fewer students) in the number of Virginia K-12 public school students newly identified for EL services in 2020-21 as compared to 2019-20. The drop in new EL identification occurred across student groups, but was largest among Hispanic students, economically disadvantaged students, and ninth graders. (3) The number of EL students reclassified as fully English proficient decreased by 57.3% (8,169 fewer students) in 2020-21 as compared to the pre-pandemic period. This decline is nearly three times the size of the previous largest year-to-year change. The drops in reclassification among ELs occurred across student groups and were somewhat larger among Hispanic and economically disadvantaged students. (4) EL students' exits from Virginia public schools in the post-pandemic onset were a continuation of pre-pandemic trends and did not meaningfully vary by race/ethnicity, economically disadvantaged status, or disability status.
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Objectives: In the process of conducting research to understand barriers to colorectal cancer (CRC) screening in underrepresented groups such as Blacks and Hispanics, it became evident that there were also barriers to recruitment in this population. This study assesses the challenges faced in recruitment of focus group participants regarding CRC screening practices among underrepresented groups. Since the COVID-19 pandemic, qualitative research participants have primarily been interviewed through online video or audio interactions. However, as restrictions on in-person interactions have been lifted, in-person focus groups are being increasingly considered. Method(s): The study investigators began recruitment through community health workers in August 2022, when COVID-19 vaccines were available for all adults (age>18 years). Eligible individuals were: age 45-75, Black or Hispanic, with Medicaid or no insurance, and no family history of CRC or diagnosis of certain colon-related diseases. We combined in-person and virtual recruitment strategies, including posting flyers in communities, advertising our study at health fairs, and on social media. Participants would receive a $50 gift card. Result(s): Fifty-five met the eligibility criteria among 144 respondents, and 45 subjects (29 women and 16 men) agreed to be contacted. An average of 2.5 attempts were made per eligible subject. Unfortunately, we were able to recruit only four women (3 Hispanic and one non-Hispanic black). Traveling to the research site was a barrier to participation. Many subjects (49%) requested virtual participation (online video or audio interactions);some declined because the topic was too sensitive (considered taboo), and eligible men were reluctant to participate in-person. Conclusion(s): The requirement of in-person participation affected our recruitment goals, suggesting that COVID-19 has shifted the preferences of research participants to virtual interaction. In response to the eligible participant preferences, the study protocol has been revised to re-contact patients and schedule virtual FG sessions.Copyright © 2023
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Shortly after the novel coronavirus (now known as SARSCoV- 2) was recognized, data began to accumulate on the virus's effects on children. Initial data showed that children were more likely to be mildly affected, compared to adults, with lower risks of hospitalization and death. However, in April of 2020, reports appeared of a severe disease in children occurring about two-six weeks after infection with SARS-CoV-2. The features were similar to those seen in a rare vasculitis condition called Kawasaki disease. On May 14, 2020, the Centers for Disease Control and Prevention (CDC) issued a national health advisory regarding this new condition, which was called multisystem inflammatory syndrome in children (MIS-C). The current case definition for MIS-C includes six criteria: (1) serious illness leading to hospitalization or resulting in death;(2) age less than 21 years;(3) measured fever over 38 degrees Celsius or report of subjective fever;(4) laboratory evidence of inflammation;(5) new onset involvement in at least two of the following (cardiac involvement, mucocutaneous involvement, shock, gastrointestinal involvement, and hematologic involvement);and (6) laboratory-confirmed SARS-CoV-2 infection or an epidemiologic link to a person with COVID-19. According to CDC, as of January 3, 2023, there have been 9,333 patients in the United States meeting the case definition of MIS-C, with 76 deaths. The median age of patients was nine years, with half of those affected between the ages of five and 13 years. More than half of the reported patients on whom race-ethnicity information was available were in children who are Hispanic/Latino or Black, non-Hispanic. Over 60% of reported patients were male. Most affected children had previously been healthy. A better understanding of the pathogenesis of this serious illness is needed to provide better treatment options for children with MIS-C. Prevention of MIS-C is focused on the prevention of SARS-CoV-2 infection through staying up to date with COVID-19 vaccination, masking, and other prevention strategies.
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Introduction: Lung cancer is the leading cause of cancer-related death in the US with an estimated 236,740 new cases and 130,180 deaths expected in 2022. While early detection with low-dose computed tomography reduces lung cancer mortality by at least 20%, there has been a low uptake of lung cancer screening (LCS) use in the US. The COVID-19 pandemic caused significant disruption in cancer screening. Yet, little is known about how COVID-19 impacted already low use of LCS. This study aims to estimate LCS use before (2019) and during (2020 and 2021) the COVID-19 pandemic among LCS-eligible population in the US. Method(s): We used population-based, nationally representative, cross-section data from the 2019 (n=4,484), 2020 (n=1,239) and 2021 (n=1,673) Behavioral Risk Factor Surveillance System, Lung Cancer Screening module. The outcome was self-reported LCS use among eligible adults in the past 12 months. For 2019 and 2020, the eligibility was defined based on US Preventive Services Task Force (USPSTF) initial criteria-adults aged 55 to 80 years old, who were current and former smokers (had quit within the past 15 years) with at least 30 pack years of smoking history. For 2021, we used the USPSTF updated criteria- adults aged 50 to 80 years, current and former smokers (who had quit within the past 15 years) with at least 20 pack years of smoking history. We applied sampling weights to account for the complex survey design to generate population estimates and conducted weighted descriptive statistics and logistic regression models. Result(s): Overall, there were an estimated 1,559,137 LCS-eligible respondents from 16 US states in 2019 (AZ, ID, KY, ME, MN, MS, MT, NC, ND, PA, RI, SC, UT, VT, WV, WI), 200,301 LCS-eligible respondents from five states in 2020 (DE, ME, NJ, ND, SD), and 668,359 LCS-eligible respondents from four states in 2021 (ME, MI, NJ, RI). Among 2,427,797 LCS-eligible adults, 254,890;38,875;and 122,240 individuals reported receiving LCS in 2019, 2020 and 2021, respectively. Overall, 16.4% (95% CI 14.4-18.5), 19.4% (95% CI 15.3-24.3), and 18.3% (95% CI 15.6-21.3) received LCS during 2019, 2020, and 2021, respectively. In all years, the proportion of LCS use was higher among adults aged 65-74, insured, those with fair and poor health, lung disease and history of cancer (other than lung cancer). In 2020, a higher proportion of adults living in urban areas reported receiving LCS compared to those living in rural areas (20.36% vs. 12.7%, p=0.01). Compared to non-Hispanic White adults, the odds of receiving LCS was lower among Hispanic adults and higher among Non-Hispanic American Indian/Alaskan Native adults in 2020 and 2021, respectively. Conclusion(s): LCS uptake remains low in the US. An estimated 2,011,792 adults at high-risk for developing lung cancer did not receive LCS during 2019, 2020 and 2021. Efforts should be focused to increase LCS awareness and uptake across the US to reduce lung cancer burden.
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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.
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Background: According to national prevalence data, SCD has an estimated economic burden of $2.98 billion per year in the United States and caring for a child with sickle cell disease (SCD) carries its own financial burden, resulting in higher healthcare costs and unintended days lost from employment. Social experiences are known to impact health outcomes in the general pediatric population. These experiences can be examined through the construct of social determinants of health (SDOH), the "condition in which people are born, grow, work, live and age" that impact their health. Since the WHO has designated COVID-19 a pandemic in January 2020, many families in the US have suffered financially, and during the shutdowns, there was a record number of jobs lost. The objective of this study was to determine the impact of the COVID-19 pandemic on financial and employment status of SCD Families Methods: This study was part of the larger CNH Sickle Cell Disease Social Determinants of Health study that was IRB approved. Caregivers of children with SCD completed a 30-question survey reporting their experiences with SDOH that included Demographics, USDA Food Security Scale, the We Care housing screening tool, and the validated COVID-19 Employment Status/COVID-19 related household finances survey in RedCap during clinic visits and hospitalizations Results: 99 caregivers of SCD patients responded to our survey (82.5% Female, 17.5% Male) (N=97). 93.9% identified as African-American, 3% identified as Hispanic or Latinx, 1% identified as "other". Of respondents, 66% were insured through on Medicaid and 33% had private insurance. Twenty-six percent endorsed food insecurity and 2724% relied on low-cost food. Thirty-one percent lived in an apartment, 67.768% lived in a home, 1% lived in shelter or transitional housing. Sixteen percent lived in subsidized or public housing. Thirty-seven (36.8%) percent reported at least once they were being unable to pay the mortgage or rent on time at least once, 9% (8.5%) reported living with other people because of financial difficulties, 55.2% reported their home not being heated, 7.2% reported being evicted from their home and 3.1% lived in an emergency shelter or transitional housing. 6.1% had an educational level of high school graduation or less, 42.2% were college graduates or completed additional post-graduate education (N=98). Two weeks prior to the pandemic, 61.5% worked full time, 13.5% worked part time, 6.3% were unemployed with only 2.1% working from home of the 96 caregivers who responded to this question. 15.5% (N=12 of 77) reported losing their job or were furloughed during the pandemic;34.4% (N=33 of 96) reporting at least one household member losing a job or a significant amount of income. Twenty-five percent (N=21 of 83) reported it was difficult to get work/school done because of the home environment. 36.4 % (N=35 of 96) reported household income was significantly less since February 2020. 53% (N=52 of 97) worried their household income has been or will be negatively impacted by the COVID-19 pandemic. Additionally, 48.9% (N=47 of 96) worried the value of their assets (housing, savings, other financial assets) has been or will be negatively impacted by COVID-19 and its effects. Since February 2020, 9.8% (N= 9 of 97) received unemployment insurance, 30.9% (N=29 of 94) received SNAP or food stamps, 16.5% (N= 15 of 91) received from the food pantry, 6.6% (N=6 of 90) applied for temp ass.
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The following are the highlights of our study: * Vaccine hesitancy in Southern states is complex and extends beyond health literacy. * Vaccine hesitancy in Southern states transcends many sociodemographic differences. * Effective public health communication should be unambiguous about negative externalities of COVID-19 beyond individual threats. _____ The COVID-19 pandemic caused by SARS-CoV-2 remains a public health crisis, accounting for more than 100 million confirmed cases with more than 1,121,800 deaths in the United States as of April 26, 2023.1 Despite widespread vaccination efforts by the US government and public health leadership, the rate of vaccine uptake is still far from desirable, as researchers estimate that about 70% to 85% of the country will need to be immunized before SARS-CoV-2 can be fully contained through herd immunity.2 As of April 19, 2023, about 81% of the US population had received at least 1 dose, whereas 69.4% had completed a full primary vaccine series and only 16.7% had received an updated bivalent booster, with variations in the rate of vaccination across states and regions.3 The Southern states (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Virginia, and West Virginia) have relatively lower rates of full vaccination (primary series) compared with other states (mean of 61.3%, ranging from 53.2% in Alabama to 79.9% in Maryland);6 Southern states rank among the 10 states with the lowest fully vaccinated rates in the nation.3 The predominant barrier to uptake has been vaccine hesitancy,4-9 defined as the intention to delay or refuse taking vaccinations despite availability and accessibility.10,11 It may be influenced by complex contextual factors, ranging from individual and group factors to vaccine-specific characteristics.10 In particular, individual factors may be related to health literacy (HL),12 which is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.13 HL is a phenomenon that involves individuals, families, communities, and systems, and it could be implicated in the level of COVID-19 vaccine hesitancy.5 Although HL is a major determinant of individuals' health behaviors,14 a systematic review study reported that HL's relationship with vaccination uptake prior to the COVID-19 pandemic was unclear because of variations in assessment tools, target populations, and outcome measures across available limited studies.15 Evidence suggests a relationship between HL and COVID-19 vaccine hesitancy.12,16,17 In the United States, a study among women recently released from jails found that low HL is related to COVID-19 vaccine hesitancy.16 Similarly, a study in Turkey found that low HL and a high perception of health care system distrust are associated with higher vaccine hesitancy.17 A study in China found that higher HL is associated with low likelihood of COVID-19 vaccine hesitancy, and the effect was moderated by stress.12 Overall, to the best of our knowledge, no study has examined the association between HL and COVID-19 vaccine hesitancy in populations with low vaccine uptake within the United States, including those residing in the Southern states, which served as the impetus for this study.18,19 This study aimed to estimate the level of HL among a population residing in Southern states and its association with vaccine hesitancy. Nearly 20% of the United States population had still not received a single dose of COVID-19 vaccine as of April 26, 2023, despite increases in both vaccine availability and individual eligibility over the previous 2 years.20 The observed trends in overall and region-specific COVID-19 cases and rates of vaccination in the United States demonstrate the need to examine the impact of HL on vaccine hesitancy in the Southern states, especially with the release of simplified eligibility guidelines and expanded booster recommendations.21 METHODS Participants This study included adults 18 years and older. Upon receiving institutional review board (IRB) approval from East Tennessee State University (IRB No. c0221.22e), a cross-sectional study was initiated. Race/ethnicity was collected as: (1) Asian or Pacific Islander, (2) Black or African American, (3) Hispanic/Latino, (4) Native American or Alaskan Native, (5) non-Hispanic White, (6) biracial or multicultural, and (7) race/ethnicity not listed here. Because of small sample sizes for non-White racial/ethnic groups in the study population, race/ethnicity was recoded as non-Hispanic White and other.
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Objectives: To compare pregnancy loss rates, preterm birth rates and gestational age at delivery in women vaccinated against COVID-19 during pregnancy vs. those unvaccinated. Method(s): Data were captured from Dorsata Prenatal, an electronic medical record (EMR) system that captures obstetrical data for tens of thousands of pregnancies annually. Patients who delivered between February 11, 2021-June 2, 2022, were included. The vaccinated group included women who had at least one COVID-19 vaccination documented in their EMR between 30 days prior to pregnancy and delivery. The unvaccinated group included women without a COVID-19 vaccination documented. The primary outcome measure was gestational age (GA) at delivery. We analyzed the data using chi-square tests, with significance set at p<0.01. Result(s): A total of 51,994 pregnant women were identified-7,947 (15.3%) in the vaccinated group and 44,047 (84.7%) in the unvaccinated group. Vaccination rate varied by race (Asian: 19.7%;White: 17.3%;Black: 11.2%, P<0.001), ethnicity (Latino: 8.6%;Not-Latino: 18.7%;P<0.001), marital status (Married: 19.2%;Single: 8.8%;P<0.001), mother's age (>=35 years: 20.0%;<35 years 14.2%;P<0.001), and region (Northeast: 19.2%;South: 15.2%;West: 9.1%;P<0.001). The vaccinated group had significantly lower rate of preterm delivery (Gestational Age [GA]<37 weeks;vaccinated: 7.8% vs. unvaccinated: 9.6%;P<0.001), and significantly lower rates of pregnancy loss (GA<20 weeks;vaccinated: 1.1% vs. unvaccinated: 4.1%;P<0.001). Conclusion(s): This is one of the largest real-world studies to date in women who received the COVID-19 vaccination during pregnancy. Vaccination rates varied significantly across race/ethnicity. Vaccinated patients had lower preterm delivery and pregnancy loss rates compared with unvaccinated patients.Copyright © 2023
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Introduction: Historically, clinical trial patient populations have lacked adequate diversity while studies have shown that differences exist in the biological response of different ethnicities to various healthcare interventions. Minority populations have suffered higher rates of Covid-19 infection, hospitalization, and mortality than their non-Hispanic white counterparts. It is vital that Covid-19 treatment research is appropriately diverse. This paper aims to define the demographic characteristics of COVID-19 therapeutic clinical trials to date. Method(s): A literature search initially returned 117 unique publications, 67 of which met the inclusion criteria and were analyzed. Main variables of interest were reporting of demographic data, percent white, Black, and Asian, and type of study. Statistical analysis was carried out via Stata software. Result(s): Among analyzed studies, 74.63% reported demographics. The demographic representation was 78.87%, 12.27% and 8.86% for white, Black, and Asian populations. Among vaccine related studies, the representation for Black, Asian, and Hispanic individuals was 5.01%, 6.40%, and 13.71%. A qualitative analysis of outlier studies with high (>30%) Black populations revealed that none were vaccine related, 1/3 were in hospitalized patients, and none were related to pharmacologic interventions. Of the studies with low levels (<2%) of Black patients, 4/6 were vaccine related, none were in hospitalized patients, and all were related to pharmacologic interventions. Conclusion(s): This analysis reveals concerning trends in therapeutic clinical trial enrollment to date. In the context of yet another health insult that disproportionately affects minority populations, America's scientific community is not doing enough to produce equitable scientific evidence on Covid-19 treatment.
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In this manuscript, we highlight the virtual Future Ready Lab as one example of an innovative internship concept designed to increase the quantity of meaningful paid internship experiences available for students to participate in, prepare for further education, and be able to compete in the 21st Century workforce. The Lab's premise is to provide access to student populations (e.g., economically disadvantaged, Black, and Latinx students) who oftentimes are not afforded the opportunity to hone their 21st Century skills in a high-impact internship experience. The virtual nature of the Future Ready Labs provided opportunities for high school students to participate, despite transportation limitations, social distancing, emerging safety precautions, and requirements based on the COVID-19 pandemic. In this manuscript, we help fill gaps in existing literature concerning how schools support students' work-based learning experiences during times of crisis, particularly for diverse and economically disadvantaged learners. We conclude with recommendations for practice, and a broader work-based learning framework for how partnerships can be forged and sustained in high schools across the nation, as well as implications for educational policy, practice, and research. [ FROM AUTHOR] Copyright of Education & Urban Society is the property of Sage Publications Inc. 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.)
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When initially surveyed between April and July of 2021, more respondents reported that they heard of clinical research studies looking for volunteers in the last six months compared to previous studies. Among all survey respondents, a significant increase in awareness of clinical research studies seeking volunteers was reported (63%) compared to 2019 (54%). Awareness of clinical research studies looking for volunteers was significantly higher among both Black (69%) and Hispanic (71%) respondents (Figure 1), as compared to those identifying as white (62%) or Non-Hispanic (61%). When asked how they became aware of clinical research studies looking for volunteers, top-cited sources for both Hispanic and Black respondents included: social media sites (38%, 40%);traditional advertisements (e.g., on TV, newspaper, radio;37%, 37%);and online advertisements (31%, 35%).
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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
ABSTRACT
Purpose: The authors seek to demonstrate, from a Hispanic-serving institution (HSI) perspective, the importance of utilizing High Impact Practices (HIPs) for not only more meaningful student employment initiatives, but to benefit the campus community and prepare Hispanic students for success post-graduation. Design/methodology/approach: Evaluation of current practices in academic libraries aided the design of the new staffing model, location and name. A survey of research desk student assistants was designed and implemented approximately one academic year after changes were executed. Survey data combined with follow-up interviews summarized the qualitative-focused assessment of the research desk's evolution and verified the validity of maintaining HIPs in libraries for Hispanic student success. Findings: The transition of the reference desk to a student-staffed research desk was successful in that librarians were able to dedicate more time to other endeavors, such as campus outreach and collection development. The High Impact Practice (HIP)-focused desk model, along with new, customized onboarding and training materials, fulfilled their goals of giving student assistants meaningful employment on campus while also bridging the gap between the library and the mostly Hispanic, first-generation student population. An assessment from the student assistants' point of view helped them further analyze the new research desk model. They found that student assistants noticed the ease with which their peers approached the desk and how their skills learned on the research desk transferred to their classes and future careers. Research limitations/implications: Due to the COVID-19 pandemic and the restructuring of library personnel the authors were unable to implement library patron surveys to evaluate the new desk model. Originality/value: Many academic libraries and partners have made the transition to student-staffed help desks or offer peer-to-peer tutoring or mentoring services. HIPs positively impact marginalized student populations scholastically, but no current studies discuss the effect on the Hispanic student population from an HSI perspective. This study illuminates the wholistic influence HIPs have on Hispanic student assistants, not only their work and peers, but the affect on their academic and personal lives. © 2023, Emerald Publishing Limited.
ABSTRACT
Objectives: To examine the role of telemedicine in providing access to outpatient psychotherapy for children and young adults with incident major depressive disorder (MDD) before and during the COVID-19 pandemic, overall and by race and ethnicity. Method(s): Medical claims from a large, national insurer were retrospectively analyzed to identify two cohorts of individuals aged 10-26 years old, based on incident diagnosis ("index") date of MDD (pre-COVID: March-December 2018, COVID: March-December 2020). We tracked health care utilization, utilization by site of care, modality of care, and psychotherapy Results: The majority of patients in the two cohorts (pre-COVID: N=7,758, COVID: N=8,517) were White (78.9% and 78.8%, respectively), followed by Hispanic (11.5% and 10.9%), Black (6.6% and 7.1%), and Asian (3.0% and 3.2%). While pre-index utilization was similar between cohorts, the COVID cohort had 919 psychotherapy visits per 1,000 patients compared to 735 for the pre-COVID cohort in the month post-index. The increase in visits is largely attributable to an increase in telemedicine visits for the COVID cohort. Similarly, psychotherapy visits increased for all racial and ethnic groups in the COVID cohort compared to the pre-COVID cohort in the month post-index: 22.3% for Whites (931 visits per 1,000 patients in COVID cohort vs. 759 in pre-COVID cohort), 45.0% for Asians (951 vs. 656), 20.5% for Blacks (792 vs. 657) and 46.5% for Hispanics (860 vs. 587). Conclusion(s): Telemedicine increased access to mental health services during the pandemic across races and ethnicities, but racial and ethnic disparities persisted. Health systems should capitalize on the telehealth infrastructure developed during the pandemic to sustain this increased access to care while continuing work to reduce disparities.Copyright © 2023
ABSTRACT
Objectives: The use of virtual care has accelerated since the emergence of COVID-19 pandemic. This study aims to analyze the differences in patient characteristics between new and existing type 2 diabetes mellitus (T2DM) patients that utilized virtual care. Method(s): Adult patients (age318 years) with T2DM who had a virtual care (phone or video) visit between April 1, 2020 and March 31, 2022 from the OptumLabs Data Warehouse were identified. The date of the first virtual visit was defined as the index date. Patients were required to be continuously insured at least 1 year prior to their index date (baseline) and at least 90 days of follow-up coverage. T2DM patients were categorized as newly diagnosed and as existing T2DM patients based on whether a diabetes diagnosis was observed in the baseline or not. Result(s): A total of 1,864,203 unique T2DM patients were eligible, with18.5% identified as newly diagnosed and 81.5% as existing T2DM patients. On average, newly diagnosed T2DM patients were younger than existing T2DM patients. Majority (54.5%) of newly diagnosed T2DM patients were commercially insured compared to only 38.6% existing T2DM patients. Among the existing T2DM patients, 61.2% were White, 17.9% Non-Hispanic Black, 12.7% Hispanic and 8.2% others. Of this population, 12.7 % had a household income >= $125,000, 13.3% had at least a Bachelor's degree, and 80.3% reside in a metropolitan area. For the newly diagnosed T2DM cohort, 59.7% were White, 15.3% Non-Hispanic Black, 13.4% Hispanic, and 11.6% others. More of the newly diagnosed T2DM cohort had higher household income, higher education, and resided in a metropolitan area compared to patients with existing T2DM. Conclusion(s): T2DM patients that used virtual care were heterogenous in terms of their baseline characteristics. This underscores the emerging trend that virtual care can potentially play a complementary role in managing patients with diabetes.Copyright © 2023