POLYMORPHISMS OF LEUKOCYTE GENES HUMAN AND CONGENITAL ANTIGEN IMMUNITY ASSOCIATED WITH DIFFERENT THE SEVERITY OF THE COURSE OF THE NEW CORONAVIRUS INFECTIONS

The most significant single nucleotide human leukocyte antigen genes polymorphisms and innate immunity genes associated with varying degrees of acute respiratory infection severity are considered–COVID-19 caused by the SARS-CoV-2 coronavirus. As data accumulated, it became clear that the SARS-CoV-2 virus exhibits significant regional, ethnic, and individual specificity. This is due to the population groups' genetic characteristics. This is necessary to reliably know the human genotype relationship with the COVID-19 course severity (asymptomatic, mild, moderate, severe, and extremely severe up to fatal outcomes) for more successful therapy and vaccination. At the same time, it was also known that the innate immunity system is on the first line of defense against the pathogenic penetration into the body, and the human leukocyte antigen system encodes molecules of the same name on the surface of cells that present various antigens, including viral infection pathogens, and determine the severity of the course of many diseases;therefore, these systems' genes. This approach makes it possible to assess the likelihood of a severe and extremely severe disease course in healthy and infected people, which in turn contributes to the correct therapy strategy, pharmacotherapy, and vaccination, as well as to create new antiviral therapeutic and preventive medicines. The genetically determined immune response heterogeneity to SARS-CoV-2 infection requires further study, since there is no unambiguous opinion about the leading mechanism that determines disease severity. The article can be used under the CC BY-NC-ND 4.0 license © Authors, 2022.

Did you say vulnerable populations?

The current new coronavirus pandemic has highlighted the importance of taking into consideration population groups particularly at risk of contracting Covid-19 disease or developing severe forms of the disease. The medical literature, the press and the authorities have thus stepped up the use of the expression <<vulnerable populations>> in recent weeks to refer to it. However, behind this general expression there are diverse but often interdependent realities whose specific consideration and understanding seem essential for the effective management of the epidemic and its health and socioeconomic consequences.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

How Will Demographic Change Affect the Disease Burden of Future Epidemics?

Intro: The burden of infectious diseases is influenced by the structure of the population at risk. Population ageing may have implications for the disease burden of future epidemics. Moreover, changing household structures induced by population ageing may influence the dynamics of disease transmission and burden of infections transmitted via close contact interactions. We aim to investigate the impact of demographic change on the disease transmission dynamics and future disease burden and illustrate this for COVID-19 and influenza-like illness (ILI). Method(s): We simulate the Belgian population between 2020 and 2050 using an individual-based model with census data. The simulated population structures were used as input for an infectious disease model that distinguishes between exposure to infection in the household versus exposure in the community at large. We mimicked outbreaks of COVID-19 and ILI of varying total final size. Finding(s): The simulated population ages between 2020 and 2050, which also affects household size and composition. As the proportion of elderly people in the population increases, the overall attack rate slightly decreases because older age groups have fewer contacts and are therefore less likely to incur and transmit infections. Despite the lower per-person attack rate, the estimated disease burden increases as morbidity and mortality increases with the age at infection. Conclusion(s): The demographic changes induced by population ageing have an impact on the burden of future outbreaks of COVID-19 and ILI in Belgium. The shifting age distribution implies that the elderly, a population group with increased morbidity and mortality in case of infection, make up an increasing proportion of the total population. Population ageing also leads to an increasing proportion of single-person households and collective households (e.g. nursing homes) in the population. Since the household attack rate varies by household size and composition, the living arrangements of the elderly population influences the disease burden of future epidemics to some extent.Copyright © 2023

National asthma strategy-Monitoring progress using national asthma indicators

Introduction/Aim: Progress in achieving the Goals and Objectives of the National Asthma Strategy was measured using 10 national asthma indicators. The status of asthma in Australia was shown using indicators covering prevalence, mortality, hospital and emergency department (ED) visits and treatment and management. Findings are based on historical data up to the most recent data available so that progress could be assessed. Method(s): Data for each indicator has been sourced from the National Health Survey, Medicare Benefits Schedule, Pharmaceuticals Benefits Scheme, National Hospital Morbidity and Mortality Databases. Relevant analysis has been conducted to show changes over time and variation in progress across priority population groups. Result(s): In 2020-2021, 2.7 million Australians were living with asthma. Hospitalisations due to asthma declined between 2016-2017 and 2020-2021 by over 40%. ED visits also declined between 2018-2019 and 2019-2020 by about 10%. However variation can be seen in the use of these services across the country. These findings are potentially attributable to an indirect impact of the COVID-19 pandemic and the health protection measures put in place. Results also include data on mortality, use of General Practitioner services and the use of medicines to treat and manage asthma, psychological distress experienced by people with asthma, and interference of asthma on daily activities. Conclusion(s): Some favourable outcomes in some indicators show progress towards achieving the Goals and Objectives of the National Asthma Strategy. However, some results were impacted indirectly for the COVID-19 pandemic and variation across Australia can be demonstrated. Improved data is needed to understand the treatment and management of asthma in primary health care.

Role of vitamin D in modulating the immune response to SARS-CoV-2 and other coronavirus infections

In recent years, new data have been obtained on the significant prevalence of vitamin D (VD) deficiency in the population, and knowledge about the role of vitamin D in the regulation of many physiological processes in the body, including the functioning of the immune system, has increased. The SARS-CoV-2 pandemic has further highlighted the issue of an adequate immune response in vitamin D deficiency. Objective of the review. To present and summarize the evidence on the role of VD in different parts of the immune response in COVID-19, to analyze available studies of the VD status effect on the course and outcome of COVID-19 in patients from different population groups. Material and methods. A search of domestic and foreign literature on the role of VD in the immune response in respiratory viral infections and SARS-CoV-2, as well as practical measures of VD-status correction in COVID-19, was performed. We used Scopus, Web of Science, PubMed, Google Scholar, eLibrary, and Cyberleninka databases. Results. Numerous clinical and observational studies have found an association between 25-hydroxyvitamin D levels, COVID-19 severity, and mortality. This association can be explained by the multifaceted role of vitamin D in the physiology of the human immune and endocrine systems. On the immunological side, the active form of VD promotes the secretion of antimicrobial peptides responsible for inhibiting viral replication and stimulates autophagy by increasing the level of Beclin1 protein and decreasing the level of mTOR protein regulating cellular homeostasis. It leads to the presentation of antigens followed by activation of the antiviral pathway of type I interferons. VD also stabilizes intercellular junctions, including those in the airway epithelium, reducing their permeability to pathogens, stimulates the activity of angiotensin-converting enzyme-2, whose receptors are a conduit for SARS-CoV-2 into cells, and several pathophysiological responses associated with the disease symptoms and acute lung injury. Adequate vitamin D status can provide significant benefits during the pandemic. Conclusion. To date, ideas about the role of vitamin D in regulating the immune response in respiratory infections have significantly expanded. However, its use in the complex preventive measures and adjuvant therapy of viral infections, including COVID-19, should be the subject of further scientific research.

Active pharmacovigilance in patients immunized with the CoronaVac vaccine in the port of Cartagena group.

Introduction: The crisis caused during the COVID-19 pandemic led scientists around the world to think about the creation of different vaccines against SARS-CoV-2. One of them was the inactivated virus vaccine CoronaVac, which was approved by Colombia's Ministry of Health. However, there are few pharmacovigilance studies conducted by occupational medicine to know the adverse events caused by vaccines. Objective(s): To estimate the safety of the CoronaVac vaccine. Methodology: Descriptive, retrospective and quantitative study, in which a population group of 508 workers from the port of Cartagena group was chosen, who were selected under inclusion criteria, during the second period of 2021 and the first of 2022. Result(s): 3.54 % of workers reported adverse events within the study population. Men had the most reports with 72.2% and women 27.8%. The most affected population group in terms of age was those aged 30 to 35 years, with a report of 44.4%. Likewise, the systems where there was a higher percentage of reports were the musculoskeletal, respiratory, and nervous system for first, second and third doses respectively;with symptoms such as headache, malaise, fever, muscle and joint pain, followed by pain in the injection area. Conclusion(s): In this study it was possible to identify the adverse events reported by the study population. However, none of the events presented had a serious or negative influence on the health and integrity of the workers during the study period. In this way, the safety of the vaccine was estimated. It should be noted that the CoronaVac vaccine did not prevent the spread or possible reinfection of the virus. Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.

Supporting best practice telehealth in cancer care: Findings from a national study of telehealth use by cancer services and consumers during the COVID-19 pandemic

Aims: To understand consumer and clinician experiences in utilizing telehealth in cancer care since the introduction of newMedicare Benefits Schedule (MBS) item numbers for telehealth in response to the COVID-19 pandemic. Method(s): A mixed-methods approach was used to collect qualitative and quantitative data on telehealth use during the pandemic: MBS services for cancer-related professional attendances were examined by delivery type, provider type and population group. Health service staff (n = 59) and consumers (n = 1162) from cancer services acrossAustralia were invited to complete online surveys and semi-structured interviews about the use of video and telephone telehealth, perceived effectiveness of video and telephone compared to in-person consultations, and the key barriers and enablers. A virtual roundtable was held with more than 40 key cancer control stakeholders regarding strategies to support the cancer community to offer and utilize best practice approaches to telehealth. Result(s): Telehealth was used across all stages of the cancer care pathway, and was most frequently used during the 'treatment' and 'care after initial treatment and recovery' stages. Although video consults were perceived to be more effective than telephone consults, telephone use was more frequent. Patients and their carers often felt less engagedwith their clinician during telephone consults and perceived that they were rarely given a choice between the consultation modes. Key enablers included medical leadership and administrative support, remuneration (MBS telehealth items), reduced risk of infection, reduction in travel time and costs and existing relationship between patient and clinician. Key barriers included inadequate infrastructure, lack of training, access issues (e.g., internet connectivity) and not being offered the choice of a video consultation. Conclusion(s): Telehealth is appropriate for the delivery of cancer care. A hybrid model of care (telehealth and in-person options) and the ability to give consumers choice is integral to supporting best practice telehealth in cancer care.

Safety and Immunogenicity Outcomes of an Inactivated Viral Vaccine against SARS-CoV-2 (Covaxin)

Introduction: Bharat Biotech International Ltd in partnership with National Institute of Virology (NIV), has developed an indigenous whole virion inactivated Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) viral vaccine BBV-152 (Covaxin), formulated with Toll Like Receptors 7/8 agonist Imidazoquinoline (IMDG) molecule adsorbed to alum (Algel). Variety of factors other than environmental ones can affect vaccines efficiency outside the strict setting of clinical trials, like how the vaccine is stored or transported, and even how patients are vaccinated. In addition, the intrinsic capacity of the recipient to respond to a vaccine which is determined by sex, genetic factors, age, psychological stress, nutrition and other diseases are also likely to have an impact. Aim(s): To determine the safety, reactogenicity and immunogenicity of the inactivated whole virus vaccine (Covaxin) amongst hospital-based population groups. Material(s) and Method(s): The prospective analytical study was conducted in the Department of Microbiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India, from January 2021 to March 2021.The study primarily included Healthcare Workers (HCWs) employed at SMS Medical college and attached hospitals. In-vitro quantitative IgG antibodies against SARS-CoV-2 spike Receptor Binding Domain (RBD) were measured using Chemiluminescence Immunoassay (CLIA) based Advia centaur SARS-CoV-2 IgG, manufactured by Siemens Pvt Ltd, Munich, Germany, as per manufacture's instructions. Result(s): Out of total 223 individuals, 61.88 % (138/223) showed neutralising antibody titre of >1 index value by CLIA, rest 38.12% (85/223) were non reactive i.e., titre <1 index value, after four weeks of receiving first dose of Covaxin. After 2 to 4 weeks of receiving second dose 84.30% (188/223) showed neutralising antibody titre of >1 index value by CLIA, rest 15.70% (35/223) were non reactive i.e., titre <1 index value. After receiving first dose, 100% (223/223) of the participants developed localised pain and bodyache 33.63% (75/223). None of the participants showed any anaphylactic reaction or any emergency condition just after vaccination. Conclusion(s): Covaxin is a well-tolerated vaccine, and induces good humoral response against SARS-CoV-2 with a significant rise in the neutralising antibody titres. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

Landscape of Attitudes Towards Living Kidney Donation During the SARS-CoV-2 Pandemic in the United States: Results of a Public Opinion Survey

Purpose: Solid organ transplantation decreased during the SARS-CoV-2 pandemic largely due to temporary shutdowns. The pandemic revealed significant gaps in medical knowledge among the public;disinformation, distrust, and the advent of SARS-CoV-2 may have lingering effects on transplantation rates. We hypothesize that the SARS-CoV-2 pandemic has influenced interest in living kidney donation (LKD) among members of the public. Method(s): We surveyed 900 US adults (ages 25-65) in June 2021 about LKD knowledge, attitudes, perceived barriers/facilitators, and impact of the pandemic on their interest in LKD. We evaluated the relationships between self-reported characteristics and interest in LKD using Chi-square tests. Result(s): The experience of the SARS-CoV-2 pandemic increased interest in LKD for 12% of participants, decreased interest for 9%, and had no impact for 79%. Increased interest in LKD was significantly associated with White race (White only vs. Asian only: 12.4% vs. 9.4%, p=0.005), younger age (25-34 vs. 55-65: 16.7% vs. 6.1%, p<0.0001 and 35-44 vs. 55-65: 15.9% vs. 6.1%, p<0.0001), male gender (16.3% vs. 8.5%, p= 0.001), higher income ($100,000-149,000 vs. <$50,000: 18.9% vs. 7.5%, p=0.0008), and higher educational attainment (4-year degree vs. some college: 14.4% vs. 6.07%, p=0.0012 and post-graduate degree vs. some college: 21.5% vs. 6.1%, p= <0.0001). Conclusion(s): The SARS-CoV-2 pandemic only impacted 21% of participants' interest in LKD, highlighting an unexpected externality of the pandemic. These findings unveil new opportunities for community engagement and population groups to target in future education and outreach campaigns.

Selected Women's Health Disparities

The National Institutes of Health defines health disparities as "differences in incidence, prevalence, mortality, and burden of disease and other adverse health conditions that exist among specific population groups in the United States." There are measurable differences such as education, income, and location that tend to exist between races/ethnicities, sexual identities, and age groups associated with variations in health outcomes. Cardiovascular disease, COVID-19, cancer, and reproductive health are among the conditions that have been identified as having higher morbidity and mortality among women than men. Access to adequate healthcare, access to support services, or a female's genetic makeup further contribute to health disparities. Copyright © 2022, Jobson Publishing Corporation. All rights reserved.

COMPARISON OF CHARACTERISTICS AND OUTCOME OF COVID-19 INFECTION IN PATIENTS WITH LYMPHOPROLIFERATIVE DISEASE AND IN PATIENTS FROM THE GENERAL POPULATION -EXPERIENCE FROM THREE UNIVERSITY CENTERS

Background: Patients with lymphopproliferative diseases (LPD) and covid-19 have poor outcome as consequence of inadequate humoral and cellular immunity due to the hematological disease itself but also due to the administered chemotherapy which further increases the risk of complications and mortality. Aims: The aim of this study is to analyze demographic and clinical characteristics, laboratory parameters, the presence of comorbidities, laboratory parameters, disease status, as well as outcome of the patients with COVID-19 and lymphoproliferative disease and compare them with characteristics of covid-19 infection in patients from general population (GP). Methods: This is a prospective multicenter observational study conducted in the following 3 University centers in period from 15 March 2020 to 31 October 2021. The study included hospitalized patients diagnosed with COVID-19 infection: 161 patients with LPD and 162 patients from the GP. Statistical analysis included demographic statistics, the χ2 test, the Mann-Whitney test, Kaplan-Meier method for analysis of survival and multivariate logistic regression model for analysis of risk factors for mortality. Results: In the LPD group, there were 54 patients (33.54%) with chronic lymphocytic leukemia (CLL), 72 patients (44.72%) with Non-Hodgkin lymphoma/Hodgkin lymphoma (NHL/HL) and 35 patients (21.74%) with multiple myeloma (MM). Ninety-six (59,63%) patients were on active treatment and 14(8.7%) patients were newly diagnosed. The LPD and GP group differed significantly in relation to age (66 vs. 54 years), gender (male: 60.2% vs. 75.3%), presence of comorbidities (109, 67.7% vs. 81, 50%) patients, covid score (mild 22.5% vs. 1.9%, moderate 80, 50.3% vs. 121, 74.7%), and severe/critical 44(27.1%) vs. 38(23.4%) patients. Group of patients with LPD had also significantly lower level of hemoglobin, lowest value of lymphocytes, platelets, higher level of CRP, ferritin, Ddimer (on admission and maximal values) and LDH with respect to group of patients from GP. Mortality rate was higher in LPD group of patients than in GP group (45, 28% vs. 26, 16%) patients. Among the LPD group, the highest mortality rate was observed in patients with MM (16, 45.71%) patients, followed by CLL (15, 27.9%) patients and NHL/HL group (14, 19.4%) patients. Independent factors related to survival are high value of D dimer, anemia (hemoglobin <100g/l) and moderate/critical COVID score in LPD group, while maximal value of CRP, anemia, leucocytosis and age (>60 years) in GP group. Summary/Conclusion: Our study showed significant difference in the characteristics and outcome in covid-19 between patients with LPD and patients from GP. Patients with LPD are older, they have significantly higher inflammatory parameters and more frequent presence of comorbidities compared to patients from GP. Independent factors related to survival in the LPD group are high values of D dimer, moderate/critical COVID score and anemia, while maximal values of CRP, anemia and older age are identified in the GP group.

Effectiveness of COVID -19 vaccine on cancer patients in one Latin American country: A follow-up of ACHOC-C19 study

Background: In our experience during the first year of development of ACHOC-C19 study, we observed 26% mortality in patients with cancer and COVID 19 infection. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in this kind of population. It was proposed to evaluate the effectiveness of immunization during the second phase of our investigation. Methods: Cohort study derived from the National Registry of Patients with Cancer and COVID-19 (ACHOCC-19). Data were collected from June 2021 since vaccine was available. Patients were: older than 18 years, diagnosed with cancer (solid tumors), treated and/or under follow-up, and with COVID-19 infection. The comparative analysis of the vaccinated and non-vaccinated cohort is presented. Outcomes included: all-cause mortality within 30 days of infection diagnosis, hospitalization, and mechanical ventilation. Effect estimation was performed through relative risk (RR) and multivariate analysis for each event, using generalized linear models of the binomial family. Results: 896 patients were included, 470 were older than 60 years (52.4%) and 59% women (n = 530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of hospitalization among the unvaccinated was 42.4% (n = 307), and among the vaccinated, 29% (n = 50);invasive mechanical ventilation requirement was 8.4% (n = 61) in unvaccinated, and 4.6% (n = 8) in vaccinated. The cumulative incidence of mortality from all causes in the unvaccinated was 17% (n = 123) and in the vaccinated 4.65% (n = 8). Table summarizes the multivariate analysis. The adjusted RR for mortality for the unvaccinated is 3.4 (95% CI: 1.7-6.8), for hospitalization 1.36 (95% CI: 1.08-1.72), and for mechanical ventilation 2.1 (95% CI: 1.02-4.2). Conclusions: The incidence of complications and death in patients with cancer and COVID-19 infection is significantly higher in those who have not received a vaccination schedule compared to those who have been vaccinated. Immunization should be promoted and intensified in this population group.

The challenge of meeting protein requirements in critically ill patients in the COVID era

Critically ill patients often face progressive and rapid losses of body and muscle mass due to hypermetabolism and increased protein catabolism. Certain population groups (such as obese patients or those requiring Continuous Renal Replacement Therapy (CRRT) require a higher protein provision as advised by both ASPEN1 and ESPEN2. Furthermore, critically ill patients often receive significant energy provision from non-nutritional sources such as propofol. As a consequence, calorie provision via enteral feed is commonly restricted to avoid overfeeding, and protein provision to the patient is further compromised. Retrospective data was collected for 58 patients who were either confirmed or suspected of COVID-19 and admitted to the Intensive Care Unit (ICU) during April 2020. 31% (n=18) of patients were unable to meet their protein requirements from the feed formula alone, based on initial dietetic assessment. Recommended protein requirements were not achieved in any patients who were obese (n=10;defined as BMI ≥30 kg/m2) or receiving CRRT (n=6). The maximum protein provision for obese patients was 1.5g/kg IBW and 1.6g/kg for patients receiving CRRT. The situation was exacerbated for patients receiving high dose propofol (defined as >10 ml/hr), where protein provision decreased to 0.8 – 1.2g/kg and 1.1 – 1.3g/kg respectively. [Formula presented] In the non-obese, non-CRRT ICU population, the available enteral feeding regimes were appropriate to meet the majority of patients’ protein requirements (as shown in Figure 1). However the review almost certainly overestimates protein provision, as percentage feed delivery was not assessed and the results assume 100% feed delivery. We know from previous audits on our unit that feed delivery is often <80% of target, and although this review was based on COVID-19 patients, the ‘typical’ patients in ICU often have specific nutrition requirements, which includes high protein. The challenges faced during COVID-19 has raised awareness of the importance of protein delivery in ICU and our review highlights the need to continually monitor and augment protein delivery in critically ill patients. The findings support the need for a high protein supplement in specific population groups;particularly those who may be obese, require CRRT or are receiving high dose propofol in an ICU setting. 1 McClave S A, Taylor B E, Martindale R G et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr 2016;40(2): 159-211. 2 Singer P, Blaser A R, Berger M M et al. ESPEN Guideline on clinical nutrition in the intensive care unit Clin Nut 2019;38: 48-79

THE ABILITIES OF VITAMIN AND MINERAL SUPPLEMENTS DURING THE COVID-19 PANDEMIC

The insufficient provision of micronutrients (vitamins A, D, E, C, and B-group, the minerals zinc, iron, selenium, magnesium, copper, and phosphorus) weakens the immune response, which can increase the risk of infection, contribute to disease severity and COVID-19 complications. The population of Russia, both adults and children, has deficiencies of multiple micronutrients (vitamins D, B-group, calcium, magnesium, zinc, and iodine), their simultaneous deficiency is experienced by about one third of the surveyed population. The micronutrients in the body are interconnected to form metabolic networks. A lack of one or more vitamins can disrupt the conversion of other vitamins to their biologically active forms, causing a functional vitamin deficiency. The percentage of vitamins and minerals in the diet of the population is a modifiable risk factor for infectious diseases. This implies replenishing the insufficient dietary intake of micronutrients not only to cover the needs of the body, but also to achieve their optimal provision. We are not dealing with therapy with and use of vitamins in pharmacological dosages. The intake of multivitamins provides protection against COVID-19, a decrease in the severity of the disease, a reduction in the manifestations of post-COVID sequels, and an increase in the efficiency of vaccination. Optimization of the vitamin status in all population groups through the intake of vitamin and mineral supplements (VMS) containing a complete set of vitamins and immunotropic elements is an underestimated important preventive factor in protecting from viral infections. Conclusion: The relevance of taking VMS in pregnancy and lactation during the pandemic is becoming even more important. During the pandemic, the use of VMS by pregnant and lactating women will not only improve their own micronutrient status and subsequently optimize the percentage of vitamins and minerals in breast milk, and thus the micronutrient status of the baby, but will also contribute to the body's resistance to disease.

WERE FORCIBLY DISPLACED PEOPLE PRIORITIZED IN THE COVID-19 NATIONAL RESPONSE PLANS?

Background Forcibly displaced people represent a huge humanitarian problem globally. At the end of 2020, the total number was 82,4 million;from those, 34,4 million were refugees, asylum seekers, and Venezuelan displaced abroad. Forcibly displaced people were identified as priority populations during the pandemic due to their risk of being the last served populations with healthcare. This paper aimed to identify if this population was prioritized in the COVID-19 national response plans of a sample of 86 countries. Methods This study is part of a document analysis of 86 COVID-19 national response plans, assessing the degree of comply to quality parameters of effective priority setting. One of the parameters included was the degree to which vulnerable populations such as forcibly displaced people were explicitly prioritized for receiving COVID-19 related interventions or for continuity of non-COVID healthcare services. The analysis involved assessing whether and how forcibly displaced people were prioritized in the COVID-19 national response plans. This was compared with the displaced populations identified in the host countries' UNHCR Forced Displacement 2020 report. Results Only five countries among 86 analyzed prioritized forcibly displaced people in their COVID-19 national response plans. Among the top ten forcibly displaced people hosting countries, Uganda was the only one with an explicit prioritization of this vulnerable group. Although Turkey, Colombia, and Germany account for nearly one-fifth (6,6 million) of refugees, asylum seekers and Venezuelans displaced abroad, none of the COVID-19 response plans of these countries prioritized these populations. Discussion Few countries recognized forcibly displaced people as a vulnerable population in their COVID-19 response and preparedness plans. Governments may have incorporated actions and interventions for these vulnerable groups after publishing the COVID-19 response plans. It would be essential to evaluate the impact of this lack of prioritization on the health and wellbeing of these population groups.

WHY SHOULD INDIGENOUS COMMUNITIES BE AMONG THE HIGHEST PRIORITY POPULATIONS FOR MENTAL HEALTH AND WELLBEING RESOURCING AND ACTION IN THE FACE OF CLIMATE CHANGE, AND WHAT SOLUTIONS CAN THEY CONTRIBUTE TO THE WIDER COMMUNITY?

Objectives: To identify: (1) which population groups are most vulnerable to climate change health and mental health (MH) impacts? (2) In strengths rather than deficit framing, which should be the highest priority populations for MH and well-being prevention, clinical amelioration and community mobilisation? (3) What factors contribute to the highest-level priority due to vulnerability to climate change MH impacts? We suggest the populations with the highest social determinants gaps, health comorbidities and over-incarceration. Findings: The extremes are often found in both the most urban and the most remote settings. Why are culturally strong, proud and resilient Indigenous communities still so prone to climate change-related events? Especially as Aboriginal and Torres Strait Islander communities have achieved so much, leading Australia and the world, for the first 16 months of COVID-19 outcomes in Indigenous communities? Conclusion: In terms of the approach taken to improving the MH and well-being of most Indigenous and other priority populations most vulnerable to climate changerelated events, we need a better balance between traditional cultural-healing approaches, communitycontrolled and clinically determined solutions. Indigenous communities can contribute considerably to MH and well-being solutions for themselves and for the wider community.

Suicide Among Adults During COVID-19 Pandemic;Rates and Trends

BACKGROUND: Mental health problems were heterogeÂneously increased among the population groups during the COVID 19 pandemic.1 The pandemic promoted existAîng suicide risk factors such as illicit drugs and alcohol use, access to lethal means, and social disconnectedness.2 According to the CDC, 40% of US adults reported sympÂtoms of depression, anxiety, or increased substance use during COVID-19, and 10.7% of the participants reported suicidal ideation.3 OBJECTIVE: This study aimed to compare suicide rates among adult population (18-64 years old) in Marion County, Indiana in 2019 and 2020. METHODS: Data for 2019 and 2020 was ed from coroners' records in Marion County, Indiana. In 2019 and 2020, a cumulative total of 130 and 157 suicide cases were reported, respectively. We identified 104 adult suicide cases in 2019 and 116 adult suicide cases in 2020 with age range of 18 to 64 years. We analyzed the data for age, race, genÂder, job, marital status and the method of suicide. RESULTS: From 2019 to 2020, adult suicides increased by 11.5%, from 104 to 116 cases. In 2019, cases were highest during the month of January (14.4%). Most cases were white (79.8%). The average age was 39.6 years old and male to female ratio was 3.9:1.1. Almost half of the cases (49%) were unemÂployed and 36.5% were employed. Regarding marital status, 47.1% of those died by suicide were never marÂried, 27.8% were married and 19.2% were divorced. Regarding the method of suicide, gunshot wound was the most common method (58.6%), followed by hangAîng (32.6%), drug toxicity, asphyxiation, and sharp force trauma with 1.9% each. In 2020, cases were highest in January (12%) and December (11.2%). In 2019, most cases were white (76.72%). The average age was 35.7 years old and male to female was 8.6:3. About one third of cases (33.6%) were unemployed and 43.1% were employed. Regarding mariÂtal status, the majority (58.6%) were never married, while 23.2% and 13.7% were married and divorced respectively. The most common method of suicide was gunshot wound (63.7%), followed by hanging (24.1%), drug toxicity (4.3%), and asphyxiation (4.3%). CONCLUSION: Suicide rates among adults increased by 11.5% in Marion County, Indiana. While white males had the highest suicide rates during both years, female suicides increased from 20% in 2019 to 26% in 2020. Average age of those who died by suicide was younger in 2020. A rise in suicide was seen in unmarried and employed individuals. Suicide by gunshot wounds and drug toxicity also increased. Our findings echoed the CDC findings.3 Public health measures which target certain population groups such can mitigate suicide rates during a global pandemic.

Prevalence and Associated Factors of Psychosocial Impact of COVID-19 Pandemic among different population groups in Lahore, Pakistan: a cross-sectional study

Background: COVID-19 pandemic presents a consequential threat to individual's mental health in addition to obvious health-related impact. Aim: To focus on prevalence as well as related factors of psychosocial impact of COVID-19 in Lahore, Pakistan. Methods: Our study design was analytical cross-sectional, and study population comprised 382 participants including healthcare workers, teachers, students, and household members. We used non-probability convenience sampling method. We built a structured self-administered questionnaire for collection of data and psychological impact was measured with Impact of Event Scale-Revised (IES-R). Results: Independent factors related to psychological impact were identified using bivariate logistic regression and all significant factors at p-value 0.25 were processed using multivariate model. AORs with 95% CIs were used to assess magnitudes of associations. Prevalence of psychological impact in Pakistan is 53.4%. Being female (β=1.517;AOR=4.561;95%CI: 2.838-7.329)and covering mouth when coughing and sneezing (β=0.486;AOR=1.626;95%CI: 1.012-2.612)are significantly associated with psychosocial impact after logistic regression. Prevalence of psychological impact in Pakistan is very high. Conclusion: Henceforth, policy makers need to consider psychological issues while planning pandemic-related interventions.

Did you say vulnerable populations?

The current new coronavirus pandemic has highlighted the importance of taking into consideration population groups particularly at risk of contracting Covid-19 disease or developing severe forms of the disease. The medical literature, the press and the authorities have thus stepped up the use of the expression «vulnerable populations» in recent weeks to refer to it. However, behind this general expression there are diverse but often interdependent realities whose specific consideration and understanding seem essential for the effective management of the epidemic and its health and socioeconomic consequences.

Characterization of SARS-CoV-2 infection in older adults in Cuba, March-June 2020

Introduction: COVID-19 has the potential to impact any population group, however, older adults have a worse prognosis and a higher mortality rate. Objective: Characterize the clinical-epidemiological variables of older adults with SARS-CoV-2 in the first three months of the epidemic in Cuba. Methods: An observational cross-sectional study was conducted in Cuban patients aged 60 years and older, with epidemiological discharge of SARS-CoV-2 infection, between March 11 and June 11, 2020. A questionnaire with clinical and sociodemographic variables was applied. Statistical analyses were performed using the SPSS 22.0 statistical package. Results: 241 patients were studied, 52.3 % presented mild or moderate symptoms. There was an increase in average age from asymptomatic to severe. Blood group O (46.1%) was the most frequent;however, those in group A showed an increased risk of developing symptoms. The most common associated diseases were high blood pressure, cardiovascular disease and diabetes mellitus. Fever, dry cough and shortness of breath were the most frequent symptoms. Conclusions: Patients with blood group A, hypertensive patients and associated cardiovascular diseases presented an increased risk of suffering from symptomatic forms. The vulnerability of older adults comes not only from their age, but also from associated chronic diseases, which is why the protection of this population group is essential.