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

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

Bacterial Infectious Diseases in the Covid-19 Era

The outbreak of SARS-CoV-2 in December 2019 in China quickly spread to the rest of the world. By March 2020, the World Health Organization declared the COVID-19 pandemic, and several mitigation strategies were implemented worldwide, highlighting social distancing, quarantine and the use of face masks. Since then, many studies have reported the impact of these interventions on the occurrence of other infectious diseases, especially bacterial infectious diseases disseminated through airborne. Invasive infections with respiratory bacterial pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Bordetella pertussis, Chlamydia pneumoniae and Mycoplasma pneumoniae have had a marked decline in several countries of the world. Low- and middle-income (LMIC) and high-income countries (HIC) were at different seasons of the year when COVID-19 started and interventions were implemented, but long-lasting consequences of seasonal differences are yet to be elucidated. In this session, we aim to describe the impact of COVID-19 and related intervention strategies in bacterial infectious diseases between LMIC and HIC;determine whether and how the onset of COVID-19 pandemic has changed the broader scenario of infectious diseases;and envision future and emerging infectious diseases in the post-pandemic world.Copyright © 2023

Correction

Reports an error in "Socioeconomic crisis and mental health stress among the middle-income group during the COVID-19 pandemic" by Sk. Faijan Bin Halim, Sojal Mridha, Nishad Nasrin, Md. Karimul Islam and Md. Tanvir Hossain (Sociological Spectrum, 2022, Vol 42[2], 119-134). The article listed above was intended to publish as part of the forthcoming "COVID-19: Health Inequities and Pandemic Disasters Yet to Come" special issue, but was mistakenly published in a previous issue. (The following abstract of the original article appeared in record 2022-75958-003). Following the spread of COVID-19, the prolonged lockdown has adversely affected not only the mental health but also the socioeconomic well-being of people, particularly the underprivileged population, across the world. This study was designed to assess the mental health of middle-income people and its association with the socioeconomic crises that emerged from the COVID-19 pandemic in Bangladesh. A semi-structured interview schedule in Bangla was administered to conveniently collect the data from 150 participants based on certain specifications. Findings suggest that COVID-19 status, household debt, and depression were significantly associated with mental stress among middle-income people. Depression, on the other hand, was substantially affected by socio-demographic and socioeconomic status as well as their hygiene and government support during the COVID-19 pandemic. Likewise, an individual's anxiety was determined by income during the COVID-19 pandemic, quarantine status, personal hygiene, and socio-demographic factors. To reduce the pandemic-induced stress, depression, and anxiety, the government should provide financial assistance through social safety net and create alternative livelihood opportunities using existing resources. Besides, policymakers should implement community awareness programs about the risk of COVID-19 to minimize both risk of infection and mental health stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Socioeconomic crisis and mental health stress among the middle-income group during the COVID-19 pandemic

[Correction Notice: An Erratum for this article was reported in Vol 42(3) of Sociological Spectrum (see record 2022-84985-006). The article listed above was intended to publish as part of the forthcoming "COVID-19: Health Inequities and Pandemic Disasters Yet to Come" special issue, but was mistakenly published in a previous issue.] Following the spread of COVID-19, the prolonged lockdown has adversely affected not only the mental health but also the socioeconomic well-being of people, particularly the underprivileged population, across the world. This study was designed to assess the mental health of middle-income people and its association with the socioeconomic crises that emerged from the COVID-19 pandemic in Bangladesh. A semi-structured interview schedule in Bangla was administered to conveniently collect the data from 150 participants based on certain specifications. Findings suggest that COVID-19 status, household debt, and depression were significantly associated with mental stress among middle-income people. Depression, on the other hand, was substantially affected by socio-demographic and socioeconomic status as well as their hygiene and government support during the COVID-19 pandemic. Likewise, an individual's anxiety was determined by income during the COVID-19 pandemic, quarantine status, personal hygiene, and socio-demographic factors. To reduce the pandemic-induced stress, depression, and anxiety, the government should provide financial assistance through social safety net and create alternative livelihood opportunities using existing resources. Besides, policymakers should implement community awareness programs about the risk of COVID-19 to minimize both risk of infection and mental health stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Correction

Reports an error in "Socioeconomic crisis and mental health stress among the middle-income group during the COVID-19 pandemic" by Sk. Faijan Bin Halim, Sojal Mridha, Nishad Nasrin, Md. Karimul Islam and Md. Tanvir Hossain (Sociological Spectrum, 2022, Vol 42[2], 119-134). The article listed above was intended to publish as part of the forthcoming "COVID-19: Health Inequities and Pandemic Disasters Yet to Come" special issue, but was mistakenly published in a previous issue. (The following of the original article appeared in record 2022-75958-003). Following the spread of COVID-19, the prolonged lockdown has adversely affected not only the mental health but also the socioeconomic well-being of people, particularly the underprivileged population, across the world. This study was designed to assess the mental health of middle-income people and its association with the socioeconomic crises that emerged from the COVID-19 pandemic in Bangladesh. A semi-structured interview schedule in Bangla was administered to conveniently collect the data from 150 participants based on certain specifications. Findings suggest that COVID-19 status, household debt, and depression were significantly associated with mental stress among middle-income people. Depression, on the other hand, was substantially affected by socio-demographic and socioeconomic status as well as their hygiene and government support during the COVID-19 pandemic. Likewise, an individual's anxiety was determined by income during the COVID-19 pandemic, quarantine status, personal hygiene, and socio-demographic factors. To reduce the pandemic-induced stress, depression, and anxiety, the government should provide financial assistance through social safety net and create alternative livelihood opportunities using existing resources. Besides, policymakers should implement community awareness programs about the risk of COVID-19 to minimize both risk of infection and mental health stress. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Experiences of Healthcare Workers during the Second Wave of COVID-19 Crisis in the South Indian State of Kerala

Background. The COVID-19 pandemic has presented an unprecedented crisis and challenge for healthcare professionals globally. This study aims to explore the challenges faced by healthcare professionals during the second wave of COVID-19 in the south Indian state of Kerala. Methods. An online cross-sectional survey was designed and disseminated through social media and professional organizations to collect the relevant information from the healthcare workers. The questionnaire composed of demographics, and of questions about the employment, work role, and access to personal protective equipment. Results. Of the 423 responses received, 268 (63.3%) were nurses, followed by pharmacists (7.4%), doctors (14.6%), and allied healthcare professionals (4.4%). Nearly half i.e., 198 (46.8%) of the total responders, expressed concern about workrelated risks to themselves and their families. The primary concerns expressed by the participants include higher workload, psychological distress, shortage of quality personal protective equipment (PPE), lack of incentives, and social stigmatization. Just over a third of respondents (35%) perceived that care provided in their workplace was significantly worse than before the pandemic. Conclusion. The study offers lessons for hospitals in middle-income and lowincome countries to ensure a safe working environment for front-line healthcare workers in their fight against COVID-19. This implies the need to support with adequate safety kits, protocols, and support for both physical and mental health of the healthcare professionals.

IMPACT OF FAMILY INCOME ON SANITATION, HYGIENE, AND DISEASES IN THE SULTANATE OF OMAN

Oman has performed very well in the healthcare sector since 1970, it has achieved great heights in healthcare delivery. As per world bank data 2020, Oman has achieved 99% in providing basic sanitation services among its citizen and it has maintained this level since 2015.[1]. Centre of Studies Research-CSR-MOH has prepared a strategic plan “Health Vision 2050 for Health Research “to make Oman a regional leader in the Research & Development of Health Sector. As per this document, its mission is to provide a platform and conduct Research in the healthcare sector to address and prioritize healthcare services and reduce inequality in healthcare services among its citizen. This can be a major boost and contribute to socioeconomic development irrespective of the income among the Omani citizen. [2]. For any country to become prosperous needs a large pool of human capital, which can be achieved by providing good education and cheap health services to its citizen. Efficient human capitols lead to a good economy which further leads good GDP for any country. We can say the GDP of any country and its human capital complement each other. In this research paper, I have studied and analyzed the “Income & Expenditure” dataset from the data portal offal Al-Dakhliyah region of Oman, Health Vision document-2050, and Oman World Health Survey-2008. As per the report, Oman has scored very well ahead among the Gulf Cooperation Council (GCC) in economic stability, health, civil society, governance, and environment, in current-level Sustainable Economic Development Assessment (SEDA) scores, according to a report.[9]. In this research paper, we have reviewed and studied the impact of family income on sanitation, hygiene, and disease. Qualitative and quantitative methods like data collection using questionnaires, and world bank data and also reviewed various related research papers for our analysis. In this research paper, we have compared pre & post covid impacts on sanitation and hygiene practices among Omani citizens. A systematic review of published literature (2000-2019) evaluating the impact of family income on sanitation, hygiene, and disease. In low-and middle-income families [we used world bank data], we sought to examine the relationship between WASH provisions in healthcare facilities (HCF) and patient satisfaction/care-seeking behavior.[3].

Perinatal COVID-19 Infection and Outcomes: A Retrospective Observational Study from a Low–Middle Income Setting

Aim: Coronavirus disease 2019 (COVID-19) pandemic is an ongoing emergency with limited data on perinatal outcomes. The aim of the study was to describe key maternal, perinatal, and neonatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from low–middle income settings. Materials and methods: We conducted a retrospective observational study in a tertiary level public hospital in India. All pregnant women admitted from May 2020 to July 2020 were included in the study. Maternal demography, medical and obstetric complications, clinical characteristics, and investigations were described. Symptomatic infected women were compared with the asymptomatic group for important outcomes. Key perinatal outcomes such as early pregnancy losses, fetal distress, stillbirths, and placental changes were evaluated. Neonatal characteristics of SARS-CoV-2 positive and negative pregnancies were described and compared. Results: Among the 702 pregnant women enrolled, the incidence of SARS-CoV-2 infection was 16.2%, with the majority being asymptomatic. Infected women had an increased mortality, while symptomatic women had a significant risk of stillbirth. Mean placental weight of infected women was significantly higher. Neonatal infection rate was 9.1%, with 50% manifesting mild respiratory symptoms without any mortality. Conclusion: This study provides a comprehensive description of important antenatal, intrapartum and neonatal complications and outcomes in a low–middle income setting characterized by high disease burden and an overwhelmed health care system. Clinical significance: Incidence of SARS-CoV-2 infection in pregnancy was 16.2%. The symptomatic infected women had increased stillbirth and mortality. Neonatal transmission was seen in 9.1% with good survival.

DOES UNCONSCIOUS SOCIOECONOMIC BIAS INFLUENCE TELE-EVALUATION OF OBSTRUCTIVE SLEEP APNEA? A TELE-EQUITY EXPLORATORY ANALYSIS

Introduction: Telemedicine, once of limited scope, has become common and widespread due to the present and ongoing SARSCoV- 2 pandemic. Center to home delivery, the most common model, allows for convenient and efficient care. Concurrent with this groundshift, there is increasing attention to disparities in medical services, and how these disparities may impact patient outcomes. Telemedicine could be used to help bridge barriers to timely quality care, however, patient access and longstanding institutional biases may limit the potential. Healthcare providers must actively develop systems to ensure that telemedicine is optimized for people across the income spectrum. This exploratory analysis examined how economic disparities in patients being evaluated for obstructive sleep apnea may be associated with providers clinical impressions. The objective was to study the inter-method reliability of pre-test probability of obstructive sleep apnea assessed via telemedicine and in-person evaluations, and to compare that reliability between income classes. Methods: This is a secondary analysis of a pre-pandemic interrater reliability study, conducted between March 2017 and January 2019. Our researchers completed a randomized, blinded study comparing the pre-test probability of obstructive sleep apnea between an in-person physician and a separate physician seeing the same patient via televideo conferencing. Patients referred to the University of Rochester (UR) Sleep Center were eligible for the study. Women and men 30-70 years old were invited to participate. The patients were not necessarily referred to the center for evaluation of sleep disordered breathing. Patients with dementia, hearing or visual loss, severe psychiatric or developmental illness, or not fluent in English were excluded. Patients had adequate computer literacy, access to high speed internet, and a computing device with appropriate video camera and microphone.The primary objective of the original study was to assess the interrater reliability between the in-person and telemedicine raters for pre-test probability of sleep apnea (high, moderate, or low). Providers used clinical judgement from the history and examination to determine pre-test probabilityFor this present analysis, we assessed the inter-method reliability separately for strata defined by reported annual income level: low income (< $50,000), middle income ($50,000-$100,000), and high income (> $100,000). Reliability was quantified for each stratum using weighted kappa statistics given the ordinal nature of the outcome variable, pre-test probability of obstructive sleep apnea (high, moderate, or low). Weighted kappa statistics were compared between the income strata (high vs. middle, high vs. low, middle vs. low). The operant statistic assumed an approximate standard normal distribution under the null hypothesis of equal kappa values in the two income strata. The Bonferroni method was used to adjust the p-values for the three pairwise comparisons performed among the three income strata. Results: Data from 53 patients were avaiable for this analysis. 11 of these patients were in the low income group, 22 in the middle income, and 16 were in the high income group. 9 patients did not include their income bracket, and were not included in the analysis. Inter-method reliabilities, assessed using weighted kappa, were 0.83 (low income), 0.24 (middle income), and 0.66 (high income). When comparing between the strata, the kappa statistics were significantly different (p=0.005) between the low and moderate income groups. There was a trend between the high and moderate income groups that did not meet statistical significance (p=0.07). Conclusion: The intermethod reliability was substantial in the low income stratum, moderate in the high income stratum, and slight in the middle income group based on the kappa statistic. There was a significant difference in the reliability values of telemedicine versus in-person assessments between the low and middle income brackets, and there was a trend between the high and mo er te groups. Since the raters were unaware of the patients income levels, this association might suggest possible unconscious bias in evaluating for OSA. It may also suggest that beyond access to telemedicine technology, the quality of the care may also be influenced by socioeconomic factors. With telemedicine in its early stages, it is important to develop this technology that will minimize biases that could result from patients economic fortunes.

Harnessing Telemedicine to Improve Access to Care During the COVID-19 Pandemic

Objective: Before COVID-19, telemedicine had gained traction as a clinical tool, which was reflected by the adoption of new billing codes. Here we report outcomes in our Endocrine practice, which rapidly switched to exclusively tele-health in March 2020 with no pre-existing systems or protocols for this transition. We hypothesized that barriers to care, including patients’ health literacy, access to technology/internet, and access to remote monitoring tools such as blood pressure cuffs and weight scales, would make the transition to tele-health less successful in a low-income urban setting than in the suburbs. Methods: We measured show rates at Temple Endocrinology outpatient clinic sites using the CPT coding system to compare all scheduled appointments with all completed visits. We selected periods from April 1st to July 31st of 2019 and the same dates in 2020, because outpatient visits were exclusively in-person (2019) or exclusively tele-health (2020). Appointments included both faculty and fellow clinics. Data were stratified by service location amongst four major clinic sites that serve patients of different socioeconomic and ethnic backgrounds – namely, Temple University Hospital (TUH) in North Philadelphia, an urban federally designated medically underserved area, Temple Fort Washington (FW) serving a high-income suburban area, Temple Center City (CC) serving a high-income urban area, and Temple Jeanes, serving a middle-income suburban area. Results: Surprisingly, the proportion of completed outpatient visits at TUH increased from 68.2% (n = 2,965/4,346) in 2019 to 72.9% (n = 2,997/4,109) in 2020 (p = 0.00001), with an absolute increase of 1.01% in our completed encounters. In contrast, at FW, the proportion of completed outpatient visits decreased from 89.8% (n = 378/421) in 2019 to 79.3% (n =211/266) in 2020 (p = 0.00014). At CC, 90.2% (n = 342/379) visits were completed in 2019 and 89.5% (n = 366/409) in 2020 (p = 0.73). At Jeanes, rates were 75.8% (n = 485/640) in 2019 and 76.7% (n = 615/802) in 2020 (p = 0.69). Discussion/Conclusion: Despite the speed with which we transitioned to an entirely tele-health-based practice at the start of the pandemic, we found that we were equally – if not more able – to complete clinical Endocrinology visits with our population of underserved patients in North Philadelphia. In contrast, at our suburban FW campus, the show rates fell. We are currently examining disease acuity, transportation issues related to in-person visits, and internet access through smartphones in the populations served by TUH and FW. Overall, our data suggest that tele-health can be a successful option for Endocrine practice in an underserved urban area.

Change in care during the COVID-19 pandemic: single-centre experience in a middle-income setting

Objectives: To assess the impact of the lockdown during the first wave of the COVID-19 pandemic and remote monitoring on patients’ health statusand daily maintenance therapy in a middle-income resource setting.Methods: During the first wave of the pandemic period, we changed fromregular clinic visits to telephone visit calls to monitor our patients’ healthcondition and adherence to physiotherapy and physical exercise. We alsocompared their weight and FEV1 before and after lockdown.Results: A total of 120 patients or their parents have been contacted bytelephone call visits over a 10-week period. During this period, 38 patients(28.33%) were identified to have pulmonary exacerbation;89.5% wereprescribed oral antibiotics, and 3% were hospitalised to get IV antibiotics.Moreover, 8% of the patients presented other CF complications. Most of thepatients (95%) did not change the frequency of the daily physiotherapy theyused to perform independently. However, only 27% continued performingassisted physiotherapy with a physiotherapist. Moreover, 71% of thepatients who performed regular physical exercise changed the frequencyand the type of exercise during the quarantine period. Furthermore, meanFEV1 and body weight increased significantly after the lockdown period.The mean FEV1% increased significantly over the 4-month quarantineperiod (mean, 95% Confidence Interval ΔFEV1 (3.19;0.36–6.02), p = 0.028;while the mean weight increased significantly;mean, 95% ConfidenceInterval ΔWeight, kg (1.0;0.61–1.4);p < 0.0001.Conclusions: During the COVID-19 pandemic, the implementation oftelephone contact processes aiming for CF patients’ appropriate care is ofgreat importance. Further studies are needed to evaluate patient outcomeswhen transitioning from face-to-face clinics to telemedicine clinics

Effect of covid-19 pandemic on non-covid illness in the general population of pakistan

Aim: The goal of this study was to examine the influence of the Covid-19 pandemic 2020 on the health-seeking behavior of the general public in a lower-middle-income nation like Pakistan by looking at the availability, accessibility, and usage of health infrastructure. Methodology: In this cross-sectional study, 394 Pakistani patients completed an online questionnaire measuring their willingness to seek medical treatment, reporting for follow-up visits, and the ease of getting medical care about their medical condition, both before and after the pandemic. The information was then examined. Results: During the pandemic, 21.8 percent of patients visited a health center for follow-up. Fear of infection from the health institution kept 20.3 percent of patients from showing up for follow-up. 17.5 percent of patients had significant symptoms from their underlying sickness but delayed going to the doctor due to the fear of the virus. Patients' appointments were canceled or rescheduled in 20.1 percent of cases, while 54.1 percent did not feel the need to visit a health center. Conclusion: Fear of the virus, lockdowns, limitations, and other reasons have resulted in a substantial proportion of the population avoiding ER/health facility visits while suffering symptoms that necessitate medical attention. The long-term impact on a developing country's healthcare system, such as Pakistan, will be negative unless extraordinary steps are made to provide safe, accessible, and cheap health care during the epidemic.