ABSTRACT
Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023
ABSTRACT
Objective: To estimate the direct costs of hospital care according to coinfection in adult COVID-19 patients. Material(s) and Method(s): A retrospective follow-up study of adult patients hospitalized for COVID-19 between March and August 2020 at the San Vicente Foundation Hospitals (Medellin and Rionegro, Colombia). Patients whose diagnosis of SARS-Cov2 pneumonia was confirmed by RT-PCR test were included. Death from any cause and length of stay were considered outcome variables. Costs were estimated in 20 20 US dollars. Result(s): 365 patients with an average age of 60 years (IQR: 46-71), 40% female, were analyzed. 60.5% required an Intensive Care Unit (ICU). All-cause mortality was 2.87 per 100 patient-days. Patients admitted to the ICU who developed coinfection had an average length of stay of 27.8 days (SD:17.1) and an average cost of $23,935.7 (SD: $16,808.2);patients admitted to the ICU who did not develop a coinfection had an average length of stay of 14.7 days (SD:8.6) and an average cost of $9,968.5 (SD: $8,054.0). Conclusion(s): A high percentage of patients required intensive care, and there was a high mortality due to COVID-19. In addition, a higher cost of care was observed for those patients who developed coinfection and were admitted to ICU.Copyright © 2023 Asociacion Colombiana de Infectologia. All rights reserved.
ABSTRACT
Objectives: This study investigated the risk factors of developing COVID Syndrome and identified potential disease profiles that may exist among those who have contracted COVID-19. Method(s): Data on 13,953 adults who had experienced COVID-19 at any time were analyzed from the 2022 US National Health and Wellness Survey. XGBoost binary classification with 10-fold cross-validation was used to predict long COVID among those who reported experiencing COVID-19 and to extract feature importance. Synthetic minority oversampling technique (SMOTE) was used to address class imbalance in the outcome variable. Variable selection was conducted based on SHAP values. Fifty variables including demographic characteristics, COVID-19 symptoms, comorbidities, and health characteristics were used in the final model. Parameters were tuned using AUC. Among the 2,665 respondents who were diagnosed with long COVID, k-medoids clustering with t-SNE dimensionality reduction was implemented to determine whether distinct symptom profiles exist. Average silhouette score was used to determine the optimal number of clusters. Result(s): The XGBoost binary classification for predicting long COVID among those with COVID-19 had an AUC of 0.9145, accuracy of 0.9072, sensitivity of 0.9630, specificity of 0.8328, and Brier score of 0.0928. The most important features in predicting long COVID were age, smoking habits, COVID-19 vaccination status, certain COVID-19 symptoms experienced, and certain comorbidities. Among those diagnosed with long COVID, the clustering analysis found nine unique clusters of symptoms. The cluster that experienced the most severe symptoms was older, female, lower income, lower vaccination rate, and had more comorbidities like asthma, chronic bronchitis, and allergies. Conclusion(s): In a broadly representative US adult population, XGBoost model identified a selection of risk factors for developing long COVID. K-medoids clustering identified clusters of patients that were at risk for developing severe symptoms.Copyright © 2023
ABSTRACT
Introduction: Barriers to therapy for patients with lymphoma are an essential topic. The Lymphoma Coalition biennial global patient survey collects data on patient experiences, including challenges or limitations patients face in seeking medical attention or access to treatment. Due to Covid-19, patients with lymphoma have experienced high barriers. This study aims to rank the influence of core demographic variables in their ability to predict barriers to lymphoma treatment in 2020 and 2022. Method(s): The survey was deployed globally to lymphoma patients and caregivers in 2020 & 2022. The outcome variable was the identification of any barrier to receiving lymphoma treatment. Logit regression was used to model the outcome against core demographics. Variable importance was quantified with independent Monte Carlo resampling. Result(s): Barriers were significantly elevated in all regions in 2022 (p<0.0001). Those who are of older age were found to have fewer barriers to treatment: Unit OR = 0.965;95%CI [0.962 - 0.968]. Age was consistently a variable of high importance across most regions in both survey years (Table 1). In 2022, treatment delay due to concerns over COVID-19 was the second-ranked variable of importance in three regions. Conclusion(s): Barriers to treatment for patients with lymphoma increased dramatically across all regions from 2020-2022. Increased barriers to treatment in those of younger age were an unexpected finding. Heterogeneity in the impact of variables that influence access to treatment appears to be enhanced by participants' psychosocial impacts due to the pandemic. Policymakers and providers should actively rectify access disparities in their respective regions.
ABSTRACT
Intro: Dysregulated inflammation plays a key role in the development of severe SARS-CoV-2 infection. One of the key cellular signaling pathway involved in the inflammatory response is JAK/STAT signaling. Among the hospitalized Covid patients with hypoxia to reduce the progression to ARDS, immunomodulators have a definite role. Baricitinib is an oral selective Janus kinase 1/2 inhibitor with anti-inflammatory properties. This study evaluates the efficacy and all-cause mortality among moderate to severe Covid patients who received Baricitinib. Method(s): A retrospective case-control study was carried out among moderate to severe Covid patients who had received Baricitinib. COVID severity matched group from the same time period was selected as the control. We evaluated the efficacy (based on WHO-ordinal scale) and difference in all-cause mortality among case and control groups. Baseline characteristics and outcome variables were retrospectively captured from the hospital health information system. Finding(s): During our study period, 2547 active Covid patients have admitted, out of which 105 patients received Baricitinib. Based on the retrospective analysis 75 patients were selected as the case group and 75 covidpositive patients of similar age and sex were identified by a simple random selection technique to serve as a control group. The age group of the baricitinib group 60.82 (+/- 13) and the Control group 62.34 (+/-13). Among the participants, 62.66% were severe (58% Baricitinib group & 66% control), 36% were with moderate severity (40% Baricitinib group & 33.33% control). The all-cause mortality of cohort was 43% (n=64), 36% (n=27) of cases as compared to 49.3% (n=37) of control group, (P Value= 0.06). Improvement in WOS score by at least 1-point cases 47% and 37.3 % in controls, (P Value= 0.09). Conclusion(s): Baricitinib when combined with standard of care, among hospitalized patients with moderate to severe Covid infection, showed a trend towards clinical improvement and decreased all-cause mortality.Copyright © 2023
ABSTRACT
Background: There is still no specific treatment strategy for COVID-19 other than supportive management. The potential biological benefits of ozone therapy include reduced tissue hypoxia, decreased hypercoagulability, modulated immune function by inhibiting inflammatory mediators, improved phagocytic function, and impaired viral replication. This study aimed to evaluate the effect of intravenous ozonated normal saline on patients with severe COVID-19 disease. Method(s): In this study, a single centralized randomized clinical trial was conducted on 80 hospitalized patients with severe COVID-19. The patients were selected by random allocation method and divided into two groups A and B. In group A (control group), patients were given standard drug treatment, and in group B (intervention group), patients received ozonated normal saline in addition to the standard drug treatment. In the intervention group, 400 mL of normal saline was weighed by 40 mug/ kg of body weight and was injected into patients within 15 to 30 minutes (80 to 120 drops per minute). This process was done daily every morning for a week. Primary and secondary outcomes of the disease included changes in the following items: length of hospital stay, inflammatory markers including C-reactive protein (CRP), clinical recovery, arterial blood oxygen status, improvement of blood disorders such as leukopenia and leukocytosis, duration of ventilator attachment, and rapid clearance of lung lesions on CT scans. The need for intensive care unit (ICU) hospitalization, the length of ICU stay, and the mortality rate in patients of the two groups was compared. Result(s): According to the results of the initial outcome variable analysis, the probability of discharge of patients who received the normal ozonated saline intervention was 33% higher than patients who did not receive this intervention;however, this relationship was not statistically significant (HR = 0.67, 95%, CI = 0.42-1.06, P value = 0.089). The chance of ICU hospitalization in patients of the intervention group was three times more than that of the comparison group, but this relationship was not significant (odds ratio = 4.4 95% CI = 1.32-14.50, P value = 0.016). The use of ozonated normal saline was found to increase the risk of death by 1.5 times but this relationship was not statistically significant (odds ratio = 1.5, 95% CI = .24-9.75, P value = 0.646). Ozonated normal saline had a significant effect on changes in respiration rate (in the intervention group the number of breaths was decreased) and the erythrocyte sedimentation rate (in the intervention group the erythrocyte sedimentation rate was increased);however, it had no significant effect on other indicators. Conclusion(s): The present study showed that ozone therapy in hospitalized patients with severe COVID-19 could help improve some primary and secondary outcomes of the disease. Governments and health policymakers should make ozone therapy an available care service so that the need for advanced treatment facilities decreases;consequently, this measure may improve patient safety, prevent lung tissue destruction, and control cytokine storms in patients. Additionally, health decision-makers need to aim for the effective clinical improvement of patients, especially severe ones, and the reduction of their mortality. However, further large-scale multicenter studies with larger sample sizes considering drug side effects and other variables influencing the clinical course of COVID-19 can provide more information on the effectiveness and importance of ozone therapy.Copyright © 2023 The Author(s);Published by Kerman University of Medical Sciences.
ABSTRACT
Background: Within the coronavirus 2019 (COVID-19) pandemic, literature has found worsened patient outcomes and increased virus transmissibility associated with reduced air quality. This factor, a structural social determinant of health (SDOH), has shown great promise as a link between air quality and patient outcomes during the COVID-19 pandemic. Researching SDOH within our patient populations is often difficult and limited by poor documentation or extensive questionnaires or surveys. The use of demographic data derived from the electronic health record (EHR) to more accurately represent SDOH holds great promise. The use of area-level determinants of health outcomes has been shown to serve as a good surrogate for individual exposures. We posit that an area level measure of air quality, the county-level Air Quality Index (AQI), will be associated with disease worsening in intensive care unit (ICU) patients being treated for COVID-19. Method(s): We will calculate AQI using a combination of open-source records available via the United States Environmental Protection Agency (EPA) and manual calculations using geospatial informatics systems (GIS) methods. Subjects will be identified as adult (> 18 years) patients admitted to Vanderbilt University Medical Center's ICUs between January 1, 2020, and March 31, 2022 with a positive SARS-CoV-2 laboratory analysis result. We will exclude patients without a home address listed. Patient demographic and hospital data from ICU admission to 28 days following admission will include: age, sex, home address, race, insurance type, primary language, employment status, highest level of education, and hospital course data. Together these will be collated to produce our primary outcome variable of WHO Clinical Progression Scale score. These validated scores range from 0 (uninfected) to 10 (dead) to track clinically meaningful progression of COVID-19 infected patients. Our AQI variable will be obtained from the EPA available county-level monitoring station spatial data combined with open-source state/county center point spatial data. These data contain historic cataloguing to determine air quality at both specific time points and averages over time. Where a county's average yearly AQI is not available due to lack of a monitoring station, we will use spatial data tools to calculate an average based on data from nearby stations. We will utilize yearly averages of AQI in the year prior to COVID-19 diagnosis to describe overall impact of air quality on patients' respiratory outcomes as opposed to single day exposures. Linkage of patient data to AQI database will be performed using patient addresses. Discussion(s): By combining area level data with electronic health record (EHR) data, we will be positioned to understand the contribution of environmental and social determinants of health on patient outcomes. Our long-term goal is to elucidate which social and environmental determinants of health are associated with worse outcomes from COVID-19 and other respiratory viruses, using data extracted from the EHR.
ABSTRACT
Background: Cystic fibrosis (CF) transmembrane conductance regulator (CFTR) modulator triple combination therapy (TCT) is available to approximately 85% of the U.S. CF population. Clinical trials of TCT demonstrate numerous improvements in physical health and healthrelated quality of life (HRQoL), but fewstudies have examined the effects of TCTon mental health and psychosocial outcomes, and little is known about whether gains in HRQoL are sustained over time.We aimed to describe the HRQoL and psychosocial outcomes of people with CF (PwCF) initiating TCT and explored changes in these outcomes up to 1 year after starting TCT. Method(s): This longitudinal study enrolled PwCF aged 14 and older who were followed at a large, combined pediatric and adult CF center. Questionnaires were administered within 6 months of initiating TCT (baseline) and 3, 6, and 12 months later. Study self-report measures evaluated were HRQoL (Cystic Fibrosis Questionnaire-Revised;CFQ-R), optimism, self-efficacy, medication-related beliefs (Medication Beliefs Questionnaire;MBQ), perceived social stigma of illness, and body image. Data were also collected from medical charts on measures of health and mental health screening. Four open-ended questionswere included at each timepoint to elicit qualitative data on experiences starting TCT. Longitudinal data were analyzed using linear mixed-effects models for repeated measures. Result(s): Sixty-three adults and adolescents with CF completed the full set of surveys at baseline. Mean participant age was 30.0 +/- 14.2. Fifty-four percent identified as female, 43% as male, and 2% as nonbinary. Seventyfour percent had private insurance. Mean percentage predicted forced expiratory volume in 1 second (FEV1pp) at baseline was 76.0 +/- 24.1%, and mean body mass index (BMI) was 22.9 +/- 3.1 kg/m2. At 12 months, mean FEV1pp was 80.8 +/- 21.9%, and mean BMI was 24.5 +/- 4.1 kg/m2. On standard measures used in CF mental health screening, mean baseline Patient Health Questionnaire (PHQ-9) score was 3.4 +/- 3.5, and mean General Anxiety Disorder score was 3.4 +/- 3.7. Mean PHQ-9 (3.5 +/- 4.0) and GAD-7 (3.4 +/- 3.7) scores at 12 months were similar to baseline. We found no statistically significant differences between the survey time points in participants' physical, respiratory, or emotional functioning on the CFQ-R, but there was a significant change in social functioning ( p < 0.001). There was no statistically significant change over time in optimism or selfefficacy, but there was a significant difference in CF medication beliefs between the four survey time points ( p = 0.008 for MBQ Importance subscale), with a decrease in perceived importance from baseline to 12 months. Conclusion(s): Whereas lung function and BMI increased in our sample by 12 months, similar improvementswere not seen in standard mental health outcomes. There was no change over time in physical, respiratory, or emotional functioning, optimism, or self-efficacy. Only CFQ-R social functioning had changed by 12 months, perhaps reflecting decreased COVID-related social isolation. There was also a change in medicationrelated beliefs, with a decrease in perceived importance of taking CF medications at 12 months. Future directions include conducting qualitative analyses of open-ended questions and further examining data on social stigma, motivation to take medications, and body image, as well as examining relationships between outcome variables and baseline FEV1 and BMICopyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Introduction: COVID-19 may lead to heterogeneous needs for ventilator therapy, whether oxygen therapy (OT), noninvasive ventilation (NIV), high-flow nasal catheter (HFNC) or their combination (NIV + HFNC). The purpose of the study was to describe, retrospectively, the mortality rate, intensive care unit length of stay (ICU-LOS) and time to orotracheal intubation of COVID-19 patients under OT, NIV, HFNC or combined (NIV + HFNC). A retrospective cohort study was done analyzing official medical data from March 2020 up to July 2021. (CAAE: 52534221.5.0000.5249). Method(s): The inclusion criteria were age > 18 years-old, and positive swab test for COVID-19 or computed tomography consistent of COVID-19. The exclusion criteria were hospital LOS less than 3 days, patients whose therapy (OT, NIV, HFNC or NIV + HFNC) lasted less than 48 h, and missing data about the outcome variables. The primary outcome was mortality rate, while secondary outcomes were ICU-LOS and time to orotracheal intubation. Chi-Square test was used to assess mortality rate. The Mann-Whitney U test was applied to assess differences in ICU-LOS and time to orotracheal intubation (p < 0.05). Result(s): Overall, 1371 patients were enrolled. 880, 120, 35, and 148 patients were submitted to OT, NIV, HFNC or NIV + HFNC, respectively. The mortality rates were 8.4%, 29.6%, 22.2%, and 33.2% for OT, NIV, HFNC or NIV + HFNC, respectively (p < 0.001). The ICU-LOS was higher in NIV + HFNC (median [IQR] 15 days [16]) than NIV (9 days [10]) and OT (4 days [5], p < 0.001). The time to orotracheal intubation was higher in NIV (6 days [6]), HFNC (6 days [4.5]), and NIV + HFNC (6 days [6]) than OT (2 days [4]), p < 0.001. Mortality rate and ICU-LOS were higher in those patients requiring the combination of NIV and HFNC. Conclusion(s): Although the type of ventilator therapy may be associated to increased mortality rate and ICU-LOS, we cannot assure causality due to exploratory nature of the retrospective study, but a marker of severity.
ABSTRACT
Objective: Describe incidental tomographic in the sample, correlating them with risk factors for chest diseases and sociodemographic data. Method(s): This is a retrospective and observational study covering 162 patients admitted to the COVID sector of the HU/UFJF, from April 1, 2020, to July 7, 2021, with a confirmed laboratory diagnosis of COVID-19. The variables were described in absolute and relative frequencies. The comparison of the correlation between the outcome variable (the tomographic findings) for independent samples was performed using Pearson's chi-square test (without correction) or Fisher's test when relevant. Result(s): Of the 162 patients, 15.4% had a solitary pulmonary nodule;14.8% had multiple pulmonary nodules;1.8%, lung mass;3.1%, mediastinal mass, and 9.3% had mediastinal adenomegaly. Findings such as excavations, pleural effusion, emphysema, PTE, pneumothorax, chronic interstitial disease, cavitation, aneurysms, and significant atheromatosis, classified in this study in the "Other" category showed impressive results, with an overall prevalence of 81.5%. This study demonstrated that 34% of patients had two or more types of incidental CT findings and that 88.3% of patients had at least some type of incidental CT finding. Conclusion(s): The pandemic of SARS-CoV-2 infections has brought a series of challenges and lessons learned to healthcare teams around the world. The massive implementation of highly sensitive diagnostic methods, such as chest tomography, ends up bringing an additional challenge, which is to deal with incidental findings, making good clinical reasoning necessary to avoid unnecessary investigations and not leave without diagnosis and treatment of diseases in early and asymptomatic stages.Copyright © 2023 Faculdade de Medicina de Ribeirao Preto - U.S.P.. All rights reserved.
ABSTRACT
Purpose of study Government interventions, such as mandating the use of masks and social distancing, play a crucial role in controlling the spread of disease during a pandemic. Currently, there is a disconnect between policy and public adherence. The Health Belief Model states health initiatives will be successful if they can target perceived barriers, benefits, self efficacy, and threats. Our goal was to explore the roles of education, income, and country on misperceptions, risk perceptions and personal risk perceptions about COVID-19. Methods used The data used in this study were supplied by Pennycook et, al. Data were extracted from three pre-registered surveys conducted by the polling firm Prolific. Binary logistic regressions were conducted to investigate the roles country, education, and income had on outcome variables. Summary of results Across the United States (USA), Canada, and United Kingdom (UK), individuals in the highest income quartile were significantly less likely to hold misperceptions (OR=0.61) and less likely to perceive personal risk (OR=0.38) regarding COVID-19 compared to individuals in the lowest income quartile. When comparing these income quartiles in the USA, the difference in perceived risk was heightened (OR=0.21). Citizens of the UK were more likely to have risk perceptions compared to citizens of the USA (OR=1.50). Citizens of Canada were less likely to perceive personal risk compared to citizens of the USA (OR=0.40). Conclusions Public health initiatives can induce maximal behavior change if they successfully target perceived barriers, benefits, self efficacy and threats. Proper risk perception and understanding of COVID-19 is necessary in order for the public to adhere to government initiatives. People of the lowest income quartiles were shown to have more misperceptions and personal risk perceptions across all three countries. This highlights the socioeconomic impact COVID- 19 has on the global community. Our findings support past research on the importance of education and income in affecting health perceptions and outcomes. Further research is needed to explore interventions to minimize misperceptions, accurately shape risk perception, and effectively communicate science.
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) has affected hospitalization of cardiac patients, both in terms of number of hospitalizations as well as hospital outcomes. In this study, we intended to understand the effects of COVID-19 pandemic on heart failure hospitalizations in the state of California. HYPOTHESIS: We hypothesized that adverse hospital outcomes such as in-hospital mortality, mechanical ventilation, mechanical circulatory support, vasopressor use, and acute respiratory distress syndrome (ARDS) would be higher among heart failure hospitalizations during 2020, compared to 2019. METHOD(S): The current study was a retrospective analysis of data collected and stored in California State Inpatient Database (SID) during March to December of 2019 and 2020. All adult (>=18 years of age) hospitalizations with heart failure were included for the analysis. ICD-10-CM diagnosis and procedure codes were used for identifying hospitalizations and procedures. We used propensity score matching and conditional logistic regressions to find the association between hospitalizations during 2019 versus 2020 with respect to outcome variables. RESULT(S): There were 101,032 (56.0%) heart failure hospitalizations during March to December of 2019, compared to 79,637 (44.0%) during March to December of 2020 (relative decrease, 21.2%). Hospitalizations for COVID-19 increased from 2,252 to 46,217 during the same period (relative increase, 19521.3%). Adverse hospital outcomes such as in-hospital mortality rates (2.9% versus 2.7%, P=0.003), mechanical ventilation (2.9% versus 2.2%, P<0.001), mechanical circulatory support (0.7% versus 0.5%. P<0.001), vasopressor use (1.3% versus 1.0%, P<0.001), and ARDS (0.1% versus 0.06%, P=0.007) were significantly higher in 2020, compared to 2019. Conditional logistic regression analysis showed that the odds of adverse clinical outcomes such as in hospital mortality (OR, 1.09;95% CI, 1.06-1.11), mechanical ventilation (OR, 1.07;95% CI, 1.05-1.09), vasopressor use (OR, 1.07;95% CI, 1.04-1.10), and ARDS (OR, 1.74;95% CI, 1.58-1.91) were significantly higher among heart failure hospitalizations in 2020. However, the odds of mechanical circulatory support did not differ between the two-time frames. CONCLUSION(S): Our study found that patients with heart failure hospitalized during the COVID-19 pandemic had greater in-hospital adverse events such as greater in-hospital mortality, mechanical ventilation use, vasopressor use, and ARDS. These findings warrant that heart failure requires prompt hospitalization and aggressive treatment irrespective of restrictive mandates during COVID-19 pandemic.Copyright © 2022
ABSTRACT
Purpose: Studies conducted prior to COVID-19 suggested that racial/ethnic disparities in breast cancer screening percentages have substantially reduced over time. COVID-19 has had devastating effects on racial/ethnic minorities and resulted in delays in preventive breast cancer screening. Our purpose was to determine if racial/ethnic minorities were less likely to receive recommended breast cancer screening after the resumption of preventive care during the COVID19 pandemic. Method(s): HIPAA-compliant, institutional review board exempt retrospective cohort study was performed at a multi-location academic medical center located in the Midwest. Patients included women aged 50-74 years old between June 2021 and May 2022, derived from the electronic medical records. Primary outcomes variables included receipt of screening mammogram within the last two years. Primary exposure variables included race (American Indian/Alaska Native, Asian/Native Hawaiian/Other Pacific Islander, Black or African American, White) and ethnicity (Hispanic/Latino, and Not Hispanic/Latino). Binary outcomes were analyzed using logistic regression, adjusted for potential confounders (insurance, age, preferred language, employment status, rural status). Result(s): 37,509 female patients without histories of mastectomies were included (mean age 63.1). 73.8% of eligible patients received a mammogram within the last two years. By race, 74.7% of White patients, 57.6% of Black patients, 67.0% of Asian/Pacific Islander patients, and 60.1% of American Indian patients received a screening mammogram within the last two years. In our unadjusted analyses, Black (OR 0.46, 95% CI 0.41 to 0.52, p < 0.001), Asian (OR 0.69, 95% CI 0.60 to 0.79, p < 0.001), and American Indian patients (OR 0.51, 95% CI 0.39 to 0.66, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Black (OR 0.54, 95% CI 0.47 to 0.61, p < 0.001), Asian (OR 0.79, 95% CI 0.68 to 0.92, p = 0.003), and American Indian patients (OR 0.63, 95% CI 0.48 to 0.82, p = 0.001) were less likely to receive recommended mammography screening. By ethnicity, 74.1% of Non-Hispanic patients and 64.2% of Hispanic patients received a screening mammogram within the last two years. In our unadjusted analyses, Hispanic patients (OR 0.62, 95% CI 0.55 to 0.71, p < 0.001) were less likely to receive recommended mammography screening. In our adjusted analyses, Hispanic patients (OR 0.92, 95% CI 0.79 to 1.08, p = 0.338) were comparably likely to receive recommended mammography screening. Patients with non-English preferred languages, uninsured or Medicaid patients, and patients living in rural areas were less likely to receive recommended mammography screening (p < 0.001). Conclusion(s): Racial/ethnic minority patients were less likely to receive recommended cancer screening after the resumption of preventive breast cancer screening during the COVID-19 pandemic. Targeted outreach efforts are required to ensure equitable access to breast cancer screening for racial/ethnic minorities, patients with non-English preferred languages, uninsured, Medicaid, and rural patients.
ABSTRACT
Background: It is believed that COVID-19, in those with comorbidities, has an increasingly rapid and severe progression, often resulting in mortality. This study explores various comorbid conditions, disease severity, and clinical outcomes in patients infected with COVID-19. Method(s): This is a prospective observational study. Clinical data of COVID-19 patients admitted at Goa Medical College between November 23, 2020, to December 23, 2020, are summarized and analyzed using Google forms, spreadsheets, and R programming language. Result(s): A total of 100 patient data was collected, including 5% mild, 61% moderate, and 34% severe cases. Fever (83%) was the most common symptom, followed by dry cough (83%), dyspnoea (79%), and fatigue (32%). The most common comorbidities identified were diabetes (66%), hypertension (57%), and cardiovascular and cerebrovascular conditions (27%). Clinical outcome in patients was pneumonia (84%), ARDS (40%), bronchiolitis (10%), and shock (3%). Conclusion(s): Our study estimated that older men with underlying hypertension, diabetes, cardiovascular, and cerebrovascular conditions are at higher risk for severe clinical form. Fever, cough, and dyspnea were the most common signs on admission. The laboratory parameters showed a significant increase in CRP, ferritin, LDH, procalcitonin, ESR, and d-dimer in the case of SARS-CoV-2 infection.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
ABSTRACT
Background: The COVID-19 death rate has varied by country. Although studies have suggested some biomedical risk factors including hypertension, social factors may not yet be explored enough to prepare for the next pandemic, which might include health policies such as the role of achievement of universal health coverage (UHC). In this study, global data were probed from an ecological perspective. Methods: COVID-19 pandemic-relevant data were obtained from websites provided by WHO, UN, and academic society. The outcome variable was defined as annual COVID-19 deaths per 100,000 population in 2020 and 2021. The chronic disease mortality defined by addition of mortalities from cardiovascular diseases and neoplasms in 2019 in the same unit as the outcome variable, and Socio-Demographic Index (SDI), a new metric for social development created by Global Burden of Disease Study were used for main variables. Also, non-communicable disease risk factors and social factors including the UHC service coverage index were for independent variables. Countries which had elderly population (age > = 65 y.o.) over seven per cent and between middle and high SDI quintiles (divisions by SDI) were included for analyses. Results: The COVID-19 mortality was significantly higher in 2021 than in 2020, particularly in high-middle SDI quintile countries. A multiple regression model suggested that the preceding chronic disease mortality positively correlated to the COVID-19 mortality, in contrast to a negative correlation of SDI (Table 1). By multiple logistic regression models using dummy variables for the three-quantile groups of the SDI-to-mortality negative slope coefficient levels as an indicator of social disparity, i.e., Mild Medium and Steep, respectively, aging (elderlies' proportion), raised blood pressure prevalence (SBP > = 140 and/or DBP > = 90 mmHg), obesity prevalence (BMI > = 30 kg/m2), current tobacco use, and alcohol consumption per capita had a positive correlation as a way of slope gradient order. On the other hand, among risk factors, diabetes prevalence had a negative correlation to Steep. With data from a systematic review, angiotensin converting enzyme 1 homozygote insertion (II) polymorphism prevalence was correlated with Mild. The UHC service coverage index had a significant protective correlation. Conclusion: Taken together, the disparity in the chronic disease burden was a culprit for the impact of the pandemic, especially among countries in the middle of transition to advanced society, represented by middle and high-middle SDI. Therefore, accelerating primary care system under UHC should offer the key to the alleviated chronic disease burden and the next pandemic preparedness.
ABSTRACT
Purpose: There is limited data on the outcomes beyond the acute illness among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). The current study sought to describe the predictors of 6-month survival among a single center cohort of LT. *Methods: We included all the LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021;n=54;median age: 60, 20-73 years;M:F 37:17). All patients completed at least 6-month follow up from COVID-19 diagnosis. We reviewed patient characteristics, presenting features, clinical course, and laboratory abnormalities at presentation and during the acute illness. We reviewed the hospital course and post-discharge outcomes including lung function loss among COVID-19 survivors. Median follow-up duration was 304 days. Six-month survival after COVID-19 was analyzed as the primary outcome variable. Result(s): Restrictive lung disease was the most common LT indication (n=41, 75.9%) and most had undergone bilateral LT (n=43, 79.6%). Patients were a median of 48 months (range <1-139 months) from their transplant. Majority of the patients required hospitalization (n=48) and significant proportion of patients developed respiratory failure (n=26). One month survival was 90.7% (n=49) while the survival dropped to 81.5% (n=44) by 6-month follow-up. On univariate analysis, females (35.3% vs 10.8%) and those with pre-existing chronic lung allograft dysfunction (CLAD, 33.3% vs 11.1%) experienced worse 6-month survival. Peak lactate dehydrogenase (LD) levels had the strongest association with 6-month survival on Mann Whitney U comparisons. On receiver operator characteristic curve analysis, the peak LD levels had an area under the curve of 82.9% (69.1-96.7%, p=0.002) with 400 U/L identified as the best cut-off. A peak LD level >400 U/L during the acute illness from COVID-19 was significantly associated with worse 6-month survival (OR, 95% CI: 4.38, 1.31-14.65, p=0.02).On Cox proportion hazard analysis, female gender (adjusted HR: 5.38, 1.13-25.64;p=0.035), pre-infection CLAD (5.63, 1.24-25.57;p=0.025) and peak LD levels >400 U/L (7.49, 1.72-35.53;p=0.007, see Figure for the Kaplan-Meier survival analysis) were independently associated with survival after COVID-19 among LT patients. Conclusion(s): COVID-19 is associated with significant mortality among LT patients with several patients succumbing beyond the period of acute illness. Female gender, established CLAD prior to COVID-19 and an LD>400 U/L at any time during the acute illness are adverse prognostic markers and may form the basis of customized management strategies. (Table Presented).
ABSTRACT
SESSION TITLE: Impact of Health Disparities and Differences SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Previous studies have demonstrated that Black patients with acute respiratory distress syndrome (ARDS) have significantly higher mortality than white patients. However, the mechanisms underlying these differences are unknown. We sought to determine if there are racial differences in the delivery of prone positioning (PP) and low tidal volume ventilation (LTVV). We hypothesized that compared to white patients, Black patients would have similar rates of LTTV but lower rates of PP, because of racial differences in family communication and that PP is more likely to be discussed with families than LTTV. METHODS: We performed a retrospective cohort study of Black and white patients with ARDS with and without COVID-19 who underwent mechanical ventilation (MV) in any of five hospitals of one health system from March 2020 to July 2020. We included patients with P:F < 150 at the time of or within 24 hours of intubation. The primary exposure was self-reported race. The primary outcome variables were (1) PP at any time during hospitalization and (2) percentage of time of the first 72 hours of MV with tidal volumes (Vt) < 6.5 ml/kg ideal body weight. We performed unadjusted analyses comparing patient characteristics and outcomes between black and white patients, and adjusted analyses of outcomes using multivariable regression including age, sex, Sequential Organ Failure Assessment (SOFA score), COVID status, height, and weight as covariates. RESULTS: The cohort included 71 (43%) white patients and 94 (57%) Black patients. Patients had a median age of 63 (IQR 53 to 72), 82 (50%) were male, and median SOFA score at the start of MV was 11 (IQR 8 to 13). Among all patients, 38/71 (54%) of white patients vs 39/94 (41%) of Black patients received PP (p=0.125). Black patients received Vt < 6.5 ml/kg ideal body weight for a median of 96% of the first 72 hours of MV, compared to 82% in white patients (p=0.08). After adjusting for COVID, BMI, sofa, age, gender, Black race was not significantly associated with lower likelihood of PP (OR 0.69, 95% CI 0.33-1.43, p 0.32), but was associated with increased adherence to LTVV (mean difference 12.9%, p-value 0.039). CONCLUSIONS: In this retrospective study of patients with ARDS, we found that Black race was not associated with receipt of PP but was associated with higher adherence to LTVV, contrary to our hypotheses. However, our study is limited by a small sample size in a single health system and a predominance of patients with COVID-19 with higher rates of adherence to evidence-based care for ARDS. Delivery of PP and LTVV may not explain racial differences in outcomes for COVID-19 ARDS;however, further research is required to understand the mechanisms underlying worse outcomes among black patients with ARDS. CLINICAL IMPLICATIONS: Further research is required to better understand the causes of worse outcomes in Black patients with ARDS. DISCLOSURES: No relevant relationships by Barry Fuchs No relevant relationships by Lilian Iglesias No relevant relationships by Meeta Kerlin No relevant relationships by Rachel Kohn No relevant relationships by Allyson Lieberman No relevant relationships by Stefania Scott No relevant relationships by Gary Weissman
ABSTRACT
Background: The COVID-19 pandemic remains a large contributor to the global burden of disease. SARS-CoV-2 RNAemia detection has been connected to higher mortality, but consistent data of solid organ transplant (SOT) recipients have not been analyzed. Aim: To determine and quantify RNAemia at hospital admission and its impact on robust unfavorable clinical outcomes. Methods: From January 6, 2020 to August 13, 2021, we followed a multicenter cohort of 408 immunocompetent and 47 SOT patients hospitalized with COVID-19. Outcome variables were 30-day allcause mortality and invasive mechanical ventilation. Multivariate Cox regression analyses were performed and a propensity score (PS) was calculated. Results: SARS-CoV-2 RNAemia was demonstrated in 104 (22.9%) patients. Those with RNAemia were more frequently transplanted and presented a higher proportion of severe symptoms and signs. Mortality was 29.8% (31/104) and 3.4% (12/351) in RNAemic and non-RNAemic patients (p <0.001). The multivariate analysis adjusted by PS selected CURB-65≥2 (HR, 3.61;95% CI, 1.18-11.01;p = 0.02) and RNAemia (HR, 7.46;95% CI, 2.41-25.38;p = 0.001) as independent predictors of death. In the PS matching, SOT patients showed higher prevalence of RNAemia (57.6% vs. 13.6%) and mortality (HR, 4.56;95% CI, 1.47-7.13;p = 0.01). Conclusions: Positive RNAemia is an independent predictor of unfavorable outcome in immunocompetent and SOT. High viral load was linked to worse prognosis in a univariate analysis. Our findings help elucidate the pathogenesis of SARS-CoV-2 and provide insights for the better management of patients.
ABSTRACT
Child and spousal abuse rates tend to increase during various disasters. This study sought to determine the prevalence and determinants of older adults' experiences of increased verbal or physical conflict (+VPC) as a proxy for elder abuse during the COVID-19 pandemic. Data stem from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study of 51,338 Canadians aged 45-85 at baseline. We analyzed the data of participants aged 55 or older at core follow-up 1 who also participated in a CLSA COVID-19 substudy (n = 24,306). Experiencing +VPC was the main outcome variable;explanatory variables included gender identity, sexual orientation, age group, race/ethnicity, educational attainment, marital status, household income, working status, living arrangement (alone vs. with others), social support availability, cohesion in the community, self-rated health, anxiety, depression, and previous history of elder abuse. The overall weighted prevalence of +VPC was 7.4%. Gay/bisexual men, 55-64 age group, living with others, low social support, poor social cohesion, low self-rated health, poor mental health, and history of psychological or physical abuse were each significantly associated with +VPC. Weighted multivariable logistic regression revealed that male gender, living with others, higher depression and anxiety scores, and a history of psychological abuse were independent predictors of +VPC. Implications for postpandemic recovery and prevention strategies during future disasters include targeted outreach programs for the most vulnerable group, which included males and younger older adults between 55 and 64 years as well as those with mental health issues and/or history of elder psychological abuse.
ABSTRACT
Introduction/ Background: In response to the disruption of care driven by the pandemic outbreak, MomCare, (digital pregnancymodel) provided dedicated support to pregnant women and healthcare facilities including i. overview of prioritized health data and birth planning ii. extended bed allowance, iii. emergency ambulance during curfew iv. MS campaign v. COVID-19 preparedness support. Methods: The retrospective study uses cross sectional data of 13,443 pregnant women enrolled into the program across 26 clinics within Nairobi, Kisumu and Kakamega. Care utilization and outcomes data collected during the 6 months prior to COVID-19 outbreak (September 2019 - February 2020) and those collected during the first 6 months of the pandemic (March 2020 - August 2020) were compared using paired t-tests. All tests with pvalues less than 0,05 are considered significant. Results: Comparison of the fifteen outcome variables across the two periods and the three counties shows that in Kisumu and Kakamega counties, the percentage of skilled deliveries increased significantly (p0.05). Other indicators of quality of care, including the percentage of caesarian deliveries, folate/iron supplements, urinalysis, ultrasound, oxytocin, and hemoglobin tests at delivery, were maintained. Only the provision of Vitamin K to newborns dropped significantly (p0.01) during the pandemic (Nairobi and Kakamega). Impact: MomCare's response plan proved effective to support health seeking behavior, access to care and quality care delivery during the pandemic outbreak;mitigating against indirect deaths maternal, neonatal, stillbirths. These results prove the value of a digital health system infrastructure that links demand and supply as an effective epidemic preparedness approach. Conclusion: MomCare's findings suggest that a digital platform efficiently supported sustained quality care delivery connecting mothers and facilities during the pandemic outbreak. There is a wide opportunity for public health practitioners to promote data-driven, patient centered personalized care, guarantee transparency, and ensure that vulnerable individuals continue to access quality pregnancy care.