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Aim: Our institute provided the required monthly insulin free to patients with type 1 diabetes, where either patients or parents became unemployed and/or economically weaker during the pandemic. Method(s): All 296 patients with type 1 diabetes were given questionnaires to assess their or their family's economic status during Covid-19. 33 patients fell below poverty line and had a Priority Household Card (with 35kgs of free rice every month) and ration cards enrolled for monthly free insulin scheme. The patients were given monthly requirements of insulin based on existing regimens. Their weight, HbA1c and episodes of ketoacidosis were measured at 3-and 6-months following initiation of the scheme. Additional financial and material support were organized from NGO's and philanthropic individuals. Measurable impact of this project was ascertained through glycaemic control through HbA1C levels prior and after, overall wellbeing and prevention of acute complications like ketoacidosis. Result(s): 33 patients enrolled for the study, 9 were less than 15 years of age, 19 between 15 and 30 years and 5 above 30 years of age. HbA1c levels fell cumulative by 0.8% by 3 months and 1.2% by six months. Weight increased by 1 kg by 3 months and 1.5 kg by six months. Few episodes of ketoacidosis were reported during six months primarily due to engagement issues issue rather than availability of insulin. Conclusion(s): There was a dramatic impact on overall wellbeing of these patients with type 1 diabetes with significant improvement on glycaemic control and on emotional by reducing the financial burden of procuring monthly doses of insulin.
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Purpose of Study: Since the COVID pandemic began, there have been a dearth of opportunities for pre-medical students to work with practicing physicians. This is even truer in health care shortage areas such as California's impoverished San Joaquin Valley where the majority of its residents live below the poverty line and face a number of socioeconomic and educational hardships. Inequitable educational opportunities, lack of STEM identity, as well as lack of access to local mentors contribute to underrepresentation of individuals with diverse racial and ethnic backgrounds in STEM professions, including medicine. In partnership with the UCSF Fresno Department of Pediatrics we created a summer virtual Medical Education Apprentice Fellowship to help address some of these issues. Methods Used: This seven-week summer program was directed towards disadvantaged high school and undergraduate students living in the San Joaquin Valley. Four pediatric subspecialists, 4 medical students, 64 undergraduate students, and 4 high school students participated in the program. Participants were divided into specialty teams based on their interests, with each team (burn surgery, endocrinology, gastroenterology, or pulmonology) led by a medical student and faculty. Overall, this program had three primary components: (1) creating animated medical education videos for use in clinics, (2) hosting patient case study series, and (3) providing mentorship and professional development. Summary of Results: Forty-seven percent of students reported being the first in their family to pursue a STEM-related field. Prior to entering this program, only 50% of students felt strongly confident in their ability to be successful in a STEM-related field, and only 30% had a mentor that they fully trusted for guidance and resources. After completing the seven week program, 93% of students reported that they felt the program allowed them to explore medicine in innovative ways, 88% reported that they had made fruitful connections and now have a mentor and resources to guide them, and nearly 75% of students indicated a desire to address the social and health needs of the San Joaquin Valley as a healthcare professional. Conclusion(s): Our Medical Education Apprentice Fellowship provided disadvantaged students in the San Joaquin Valley with an opportunity to improve their digital literacy skills and medical knowledge while receiving mentorship from medical students and physicians. Grassroots programs such as this that form collaborative partnerships between students and health care professionals can be used to foster future healthcare leaders in order to address the health provider shortage in the San Joaquin Valley while providing underrepresented youth the chance to become healthcare champions.
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Covid-19-a heinous event that had left an eternally unforgettable scar of troubles, setbacks and distress on the entire human population across the globe. No country could evade from the unfavorable consequences of it. All countries across the world found themselves engulfed in the hands of Covid-19. It had taken a serious toll on the healthcare system of every country across the world. In the context of India, which is a nation with a poor coverage of public healthcare facilities and annually 3.2% Indians falling below poverty line, made the country and its population the most vulnerable. During that time, the biggest question arose was the survival of the marginalized and disadvantaged section of the society. However, fortunately a tiny hope of survival for the population of India was ensured and extended by the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY). Thus, the authors of this research paper have attempted to figure out and critically examine the role played by AB PM-JAY in not only managing but also mitigating the outbreak of the virus in India and how it helped Indians sail through the storm of Covid-19. Besides, this paper tries to put views forward through analysis for the policy makers and healthcare stakeholders to become well-prepared for any such troublesome crisis in future. Moreover, secondary data is used to collect necessary information and critical descriptive analysis has been used to interpret the results of the study.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Child care closures have become pervasive in the U.S. due to the COVID-19 pandemic. Consequently, parents and caregivers' jobs have been affected as they have needed to care for children at home. This study estimated the burden of disrupted child care due to the COVID-19 pandemic and the pandemic's impact on employment among U.S. households between April and July 2021. Data came from the U.S. Census Bureau's Household Pulse Survey, Phase 3.1. The study sample included 55,312 households with any children in a child care arrangement. We estimated the prevalence of disrupted child care overall and by select sociodemographic and household characteristics as well as employment impacts among households that experienced disrupted child care. Overall, 20.4% (95% confidence interval: 19.1, 21.7) of U.S. households experienced disrupted child care; percentages varied by state from a low of 7.7% in Utah to a high of 29.4% in the District of Columbia. The prevalence of disrupted child care was highest among non-Hispanic Asian/Pacific Islander, non-Hispanic Black, low-income, and households that experienced material hardship. Adults were most likely to report supervising children while working, cutting work hours, and taking unpaid leave due to disruptions in child care. Continued support to the child care industry and to families with children may reduce the impacts of disrupted child care.
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Purpose - The purpose of this study is to examine the economic impact of COVID-19 and analyse how the corporate social responsibility (CSR) initiatives of Islami banks (IBs) can contribute to reducing the adverse economic impact in the context of Bangladesh. Design/Methodology/approach: Currently eight full-fledged IBs are functioning in Bangladesh adhering to the underlying principles of Shariah;among them, seven are actively engaged in CSR activities to help the underprivileged segments of its citizens. This study, through employing a content analysis method examined the information available from these IBs as well as other government sources and published materials to address the COVID-19 economic impacts, specially the role of these IBs. Finding(s): This study finds that along the line with national and international funds, IBs' CSR funds can also help address the economic downturn in Bangladesh caused by the COVID-19 pandemic. The study further identified that if IBs develop a consortium among themselves, the CSR funds can be better utilised for the socio-economic development of Bangladesh. Research limitations/implications: The scope of this study is somehow limited, as it has only considered the impact of CSR funds by IBs in Bangladesh. Further research can be conducted in future considering the total CSR funds by all banks, i.e., conventional and Islamic banks. Practical implications: This study demonstrated that IBs spend USD 83.30 million annually, which means USD 417 in five years period. Based on the recommendations of this study, all IBs may work together to develop a joint CSR strategy for the socio-economic development of Bangladesh. Considering Bangladesh's poverty level, such a joint CSR strategy would be helpful for the vulnerable population of the country. Originality/value: This study is unique in the sense that it seeks to address the economic challenges of COVID-19 in the context of Bangladesh with support from the CSR initiatives of IBs. This study has created a new insight for IBs into developing an integrated CSR strategy, which is expected to bring significant contributions to the livelihood of the susceptible citizens of this country. Copyright © 2023, Ibn Sina Trust. All rights reserved.
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Background. Telehealth platforms such as video and telephone visits serve as mechanisms for HIV care delivery during the COVID-19 pandemic. While telehealth may be instrumental in HIV care, its utilization, sustainability, and impact on patients' outcomes remain an area for further research. Hence, we compared people with HIV (PWH) utilizing telehealth services to those receiving in-person clinic services at Nebraska's largest HIV clinic in Omaha. Methods. HIV Care visits were classified into telehealth and in-person visits. We defined telehealth users as PWH who have utilized telephone or video visits at least once between April 2020 to March 2022. Clinical and demographic comparisons between both groupsweremade.Weconducted bivariate analyses and descriptive statistics for associations and proportions of visit type, viral loads (VL), and completed visits. Results. A total of 4,473 visits were completed among 1,308 unique patients (172 telehealth users versus 1136 in-person). Telehealth utilization was significantly higher among patients from cities other than Omaha (< 0.001) and those with income levels above the Federal Poverty Line (FPL) (0.001). Telehealth users made up 73.3% of missed appointments and 50% of canceled visits. Telehealth users were significantly more likely to have undetectable VL than in-person visit users (0.018). In addition, patients who were >= 45 years were significantly more likely to have undetectable VL than younger patients (< 0.001). There was no association between gender, race, or year of HIV diagnosis and visit type. Notably, transgender patients (n = 18) did not use telehealth. Overall telehealth utilization dropped from 64% of our total visits in April 2020 to 5% in March 2022. Conclusion. In our patient population, telehealth users were more likely to have undetectable VL, live far from the clinic, and have income levels above the FPL than in-person visit users. However, telehealth users were more likely to cancel or miss their medical appointments. Our data also suggest a low preference for telehealth among transgender people. Future studies should develop strategies to improve rates of completed visits among telehealth users, promote telehealth use among transgender men, and sustain the utilization of telehealth beyond the pandemic.
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INTRODUCTION: The COVID-19 pandemic facilitated telehealth adoption. Multiple barriers may impact accessibility to such services. We estimated the association between sociodemographic and clinical factors, with keeping telehealth appointments. METHOD(S): Single-center retrospective cohort study comprising consecutive telehealth appointments at the Division of Colorectal Surgery (March-December 2020). Demographics, appointment type, diagnosis, and distance to the hospital were collected. Federal Financial Institutions Examination Council's (FFIEC) website was used to obtain estimated family income and poverty levels based on home location. Multivariable clustered logistic regression estimated the association between sociodemographic characteristics and keeping telehealth appointments. RESULT(S): A total of 925 telehealth appointments were analyzed, of which 84.11% were kept. Non-White patients (odds ratio [OR] 0.59, 95% CI 0.39-0.90, p = 0.015), and those with follow-up appointments (OR 0.50, 95% CI 0.31-3.07, p = 0.006) had lower odds of keeping appointments when compared with White patients, and those having postoperative appointments, respectively. Patients who had attended college had higher odds of keeping appointments (OR 1.77, 95% CI 1.02-3.07, p = 0.044) when compared with those who declined to provide their education level (Figure 1). Age, sex, diagnosis, income level, and percentage of people living under poverty within census tracts per FFIEC were not predictors of keeping telehealth appointments. CONCLUSION(S): Patients self-identifying as non-White and presenting for non-postoperative follow-up visits were more likely to miss telehealth appointments. College education was associated with keeping appointments. Future studies could characterize barriers to telehealth programs implementation to optimize access among groups at high risk of non-compliance. (Figure Presented).
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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: Vulnerable patients, including minorities and underserved populations whose care relies on public hospitals, have limited access to advanced cardiac or respiratory care in shock centers or extracorporeal membrane oxygenation (ECMO)-capable hospitals, especially when socioeconomic or insurance barriers play a role in patient selection. Our aim is to describe the implementation of an ECMO program for cardiac and respiratory failure during the COVID-19 pandemic in the largest public health system in the country, as a strategy to mitigate healthcare disparities and improve access to care for minorities. METHODS: We collected clinical, demographic and socioeconomic data of all patients undergoing ECMO at Bellevue Hospital Center, the shock and ECMO center for New York City’s Health and Hospitals’ network. This public health system includes 11 Hospitals and provides care to 1 million New Yorkers. The decision to proceed with ECMO took place with a multidisciplinary team discussion, which was also in charge of providing longitudinal care during their hospitalization. RESULTS: A total of 49 patients were included [30 veno-venous (VV) ECMO, 19 venoarterial (VA) ECMO, including 9 extracorporeal cardiopulmonary resuscitation (ECPR)] from April 1st, 2020 to March 30th, 2022. The median age was 42.6 years, 57% were male, 38% were Hispanic, 35% African American, 14% white, 6% Asian and 8.2% had other ethnicities;33% were uninsured, 49% lived below the poverty level reported for New York City and 20% were undocumented. Level of education was 8th grade or less in 2.1%, high school in 24.5%, ≤ 2 years of college in 10.2%, >4 years of college in 12.2% and unknown in 51%. ECMO survival was 56% for VV ECMO, 44% for VA ECMO and 33% for ECPR. Survival to discharge was 56% for VV, 33% for VA and 33% for ECPR. One VV ECMO patient was bridged to lung transplant, there were no patients bridged to LVAD or heart transplant. Bleeding complications occurred in 3 patients (6%) and there were no procedural related complications. CONCLUSIONS: Our multidisciplinary ECMO program demonstrates feasibility to provide care to underserved and vulnerable populations with outcomes comparable to the national average, despite the challenges related to the potential limitations in bridging strategies for such patients. While socioeconomic and insurance status have a key role in bridging options for ECMO, they should not be a major determinant in denying patients advanced cardiopulmonary support if clinically indicated. CLINICAL IMPLICATIONS: Access to advance cardiorespiratory therapies including ECMO for vulnerable populations is a present need and is feasible with a multidisciplinary team DISCLOSURES: Speaker/Speaker's Bureau relationship with Zoll Please note: 3 years Added 04/04/2022 by Carlos Alviar, value=Honoraria No relevant relationships by Fariha Asef No relevant relationships by Sripal Bangalore No relevant relationships by Samuel Bernard No relevant relationships by Lauren Bianco No relevant relationships by Nishay Chitkara No relevant relationships by Jennifer Cruz No relevant relationships by Michael DiVita Research support relationship with Eurofins Viracor Please note: 12/1/2021 ongoing Added 12/23/2021 by Randal Goldberg, value=Grant/Research Support No relevant relationships by Kerry Hena No relevant relationships by William Howe No relevant relationships by Norma Keller no disclosure on file for Ma-Rosario Mertola;no disclosure on file for Thor Milland;No relevant relationships by vikramjit mukherjee No relevant relationships by Kayla Nunemacher No relevant relationships by Mansi Patel No relevant relationships by Radu Postelnicu No relevant relationships by Deepak Pradhan No relevant relationships by Vito Stasolla no disclosure on file for Amit Uppal;No relevant relationships by Susan Vlahakis No relevant relationships by Kah Loon Wan no disclosure on file for Victoria Yunaev;
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Background: Foreign body ingestions (FBI) are most commonly seen in children aged 6 months to 4 years and occur at home. Most foreign bodies pass through the gastrointestinal tract without causing any injury. However, 10-20% of cases require endoscopic intervention and <1% require surgery. On March 4th, 2020, a state of emergency in California was announced in response to the evolving COVID-19 pandemic, including closure of all county public schools on March 13th, 2020, and a shelter-in-place order ceasing all non-essential business and travel on March 16th, 2020. Despite the breadth of data on FBIs prior to the pandemic, and others outlining findings from surgical perspectives or in other countries during the pandemic, there is limited data on FBIs and the COVID-19 pandemic in a US pediatric Level 1 Trauma Center in a state with extended and strict mandated shutdowns. Method(s): We used the National Electronic Injury Surveillance System (NEISS) data set for a single large tertiary center, retrospective analysis of FBI, patient demographics, and patient disposition between 3/16/2019-3/15/2021 to better characterize FBI prior to and during the COVID-19 pandemic. Our primary outcome measure was the number of patients presenting to our emergency department (ED) and admitted to our hospital for FBI. High Risk FBI were events involving button batteries, magnets, lead-based objects, or sharp objects (broken glass, needles, nails). We also conducted a secondary chart review to collect demographic data on FBI patients who required admission. All automatically collected data was qualitatively screened and systematically categorized for more effective data presentation. Result(s): While the overall number of presentations to the ED remained similar (279 to 268), there was a higher rate of admissions (8.9% vs 12.3%) during the pandemic. The average age of patients with an ingestion was 42.5 months pre-pandemic, 52.7 months during pandemic;the average age of patients admitted for an FBI was 35.4 months pre-pandemic, 50.9 months during pandemic. The number of high-risk ingestions during the pandemic (10.8% vs 14.2%) was higher. Of children who needed to be admitted, a greater number required endoscopic procedures during the pandemic (29.9% vs 38.5%). There was also a larger proportion of patients belonging to ethnic minorities (Black, Asian, Hispanic/Latino) that were admitted during the pandemic (45.5% vs 63.0%). Conclusion(s): Both ED and hospital admission data reflect the disruption to the home and work environments that the general population experienced in the pandemic. The increased average age of a FBI-presenting and FBI-admitted patient could reflect the increased incidence in older, possibly school-aged children, in light of the state-wide shutdown of schools and children being at home full-time. The increase in high risk and admission rates in the pandemic also suggests that mandates placing children in the home increase their exposure to harmful materials and increased risk of serious injury requiring invasive procedures. We serve a particularly vulnerable population;the majority of our patients are insured by Medicaid and of lower socioeconomic status (SES), and we would expect that the increase in FBI is correlated to SES. Moving forward, we would like to further investigate how the COVID-19 pandemic may have further exacerbated pediatric health disparities by analyzing health outcomes based on patients' preferred language (English or other) and home zip code and corresponding census info (median household income, percent living below the poverty line). In our at-risk population, based on the above data, we propose implementing proactive counseling by primary care providers (PCP) on safety around FBI. Education provided to families at PCP visits on securing dangerous objects in the home may help decrease FBI especially during times when children are required to be at home more often, like during a pandemic.
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Child physical activity and play are critical for healthy development, and parks/playgrounds are important public spaces that provide physical activity/play opportunities. This study was conducted to assess changes in park/playground utilization by Special Supplemental Nutrition Program for Women, Infants and Children (WIC)-participating children from 2008 to 2020, and whether the COVID-19 pandemic was associated with lower park/playground utilization and racial/ethnic disparities in park/playground utilization. Cross-sectional data from the 2008-2020 triennial Los Angeles County WIC Survey (n = 21,886) were used, and analyses stratified by child age (4-23 months, 24-59 months). Odds ratios (OR) and 95 % confidence intervals (CI) for the relationship between year and park/playground utilization frequency were determined from multinomial logistic regression, and racial/ethnic disparities were assessed by interacting year with race/ethnicity. Among children 24-59 months of age, park/playground utilization increased compared to never from 2011 to 2017 compared to 2008 (Every day, 2011-2017: OR [95 % CI]: 2.69 [1.93, 3.75], 4.71 [3.23, 6.86], 10.20 [6.91, 15.06]; 3-6 days/week 2011-2017: 1.54 [1.13, 2.10], 3.11 [2.18, 4.45], 3.94 [2.71, 5.72]; 1-2 days/week, 2014-2017; 1.53 [1.08, 2.18], 1.63 [1.13, 2.37]). Associations reversed in 2020, with 36 % lower odds of every day (OR [95 % CI]: 0.64 [0.48, 0.85]), 85 % lower odds of 3-6 days/week (0.15 [0.11, 0.20]) and 89 % lower odds of 1-2 days/week (0.11 [0.09, 0.15]) park/playground utilization compared to never than in 2008. Park/playground utilization frequency increased from 2008 to 2017, but progress reversed during the COVID-19 pandemic in 2020. Results for children ages 4-23 months were similar. Future public health restrictions to public recreation facilities should consider realistic limitations to potential benefits and the potential for unintended consequences before implementation.
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BACKGROUND: Low-income individuals, particularly ethnic/racial minorities, are at higher risk of contracting and dying from coronavirus disease 2019 (COVID-19) but little is known about their experiences with public health policies. Here we report findings related to health equity of a study exploring experiences of low-income Michigan residents during the pandemic. METHODS: We conducted semi-structured phone interviews with Michigan residents ages 18-65. with annual income below 200% of the federal poverty level (FPL). Interviewees were selected to achieve balance in geographic residence, age, gender, and race/ethnicity. Interviews, conducted in English or Spanish, asked about: sources of COVID19 information, perceived risk of infection, protective behaviors, and experiences with COVID-19 policies. Five team members independently performed thematic analyses using Dedoose version 8.3.45, with 2-3 analysts per interview. Analysts tagged excerpts with themes and subthemes, drafted a codebook with inclusion and exclusion criteria and examples, and compared coding until reaching consensus. RESULTS: 24 people (11 men and 13 women), aged 20-65 years (mean=39) participated. 9 participants were non-Hispanic white, 6 were Hispanic (4 interviewed in Spanish), 8 were African American, and 1 was Native American. 7 participants lived in rural areas. 3 of 21 themes with 9 subthemes illustrated health equity implications. Interviewees described difficulty protecting themselves and their family from COVID-19 (housing density, multi-generational household, working in person), for instance “it's a very reduced space. we're all like sharing the same environment and breathing the same air . infected people are separated, but we didn't have that privilege.” They talked about financial hardship (unreliable work, limiting expenses due to financial stress, job loss due to pandemic, the need to work). A waiter said “So first thing, they had to reduce the number of people who visit the restaurant .You wouldn't be getting that much income as you got during the pre-COVID-19 period .” A man moved into his travel trailer “because I can't afford to rent a house anymore, you know? You've got to bring water in . In the winter, you don't have electricity. So you've gotta use a a ventless heater and then buying extra gas to cook on and, you know, just wondering if you're gonna make it.” Interviewees also described resiliency (social unity, feeling of security due to having health insurance), for instance “I make sure that we do fun stuff even still with things shutting down.” CONCLUSIONS: This diverse group of low-income Michiganders described difficulty protecting themselves from COVID-19 along with detrimental impacts from the pandemic on housing and finances. To counter health disparities exacerbated by the pandemic, policy needs to address overcrowded housing, economic hardship, and risk accompanying in-person employment.
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Introduction: The COVID-19 pandemic has deteriorated sleep health in the United States (U.S.) and worldwide. Most studies that have examined the association between COVID-19 and sleep outcomes have used a non-probability sampling with potential sampling bias and limited generalizability. We examined the association between diagnosed COVID-19 and sleep health in a large representative sample of civilian adults aged ≥18 years in the U.S. Methods: This study was based on data from the 2020 National Health Interview Survey (NHIS) of adults (n=17,636). Sleep health was captured by self-reported sleep quantity [(very short (≤ 4 hours), short (5-6 hours), healthy (7-8 hours), or long (≥9 hours)] and sleep complaints (trouble falling and staying asleep;with responses ranging from never to every day) in the past 30 days. To account for correlated residuals among the endogenous sleep outcomes, generalized structural equation modeling (GSEM) was conducted with COVID-19 diagnosis as the predictor of interest. Other covariates (age, sex, race/ethnicity, education, employment, poverty level, marital status, birthplace, health insurance, region of residence, metropolitan areas, number of children and adults in the household, obesity, and sleep medication) were included in the models. NHIS complex probability sampling design was accounted for in descriptive and GSEM analyses. Results: About 4.2% of adults had a positive COVID-19 diagnosis. Among them, 3.1% had very short sleep, 24.2% had short sleep, 59.9% had healthy sleep, and 12.8% had long sleep;37.0% had trouble falling some days, 10.9% most days, and 6.5% every day;and 33.7% had trouble staying asleep some days, 13.9% most days, and 6.6% every day. Findings from GSEM revealed that a history of COVID-19 almost doubled the odds of having short sleep (OR: 1.9;95% CI: 1.1-3.4;p=0.032). No significant associations were found between COVID-19 and the other sleep outcomes. Conclusion: Individuals with a COVID-19 diagnosis were more likely to report very short sleep, although they did not exhibit a greater likelihood of reporting more sleep complaints. Further research using longitudinal national data and examining environmental factors are needed to determine causality.
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Introduction: In 2020, poverty in the United States increased as the COVID-19 pandemic led to the loss of work and/or income. Recent research has also shown that stress caused by the pandemic has led to increased rates of poor sleep. While insomnia rates have increased nationwide, it is not yet known if those living in poverty experienced insomnia symptoms at disproportionate rates. This study examined the effect poverty has had on insomnia symptom severity, as well as whether perceived stress mediated this association. Methods: Survey data was collected from 3,775 U.S. adults (83.1% White, 78.6% female, age = 18 - 86 years old) during the initial months of the COVID-19 pandemic (April-June 2020). These data were used for a secondary analysis. Participants completed an online survey aimed to assess basic demographics, sleep, physical activity, social engagement, and overall stress levels. Poverty was defined using the poverty guidelines provided by the Department of Health and Human Services (i.e., based on self-reported income and family/household size). The Insomnia Severity Index (ISI) was used to assess insomnia symptoms. Perceived stress was assessed using the Perceived Stress Scale (PSS). Results: 316 participants (8.4%) met criteria to be considered living below the poverty threshold. Those below the poverty threshold had a mean ISI of 10.20 (95% CI: 9.54, 10.86), while those above the poverty threshold had a mean ISI of 8.33 (95% CI: 8.13, 8.53). Put differently, 26.6% of those below the poverty threshold met criteria for clinical insomnia (i.e., ISI > 14), whereas 15.9% of those above the poverty threshold met criteria for clinical insomnia. Finally, a mediation test (with bootstrapping) confirmed that the association between poverty and insomnia was partially mediated by perceived stress (indirect effect = 1.15, 95% CI: 0.76, 1.55). Conclusion: While poverty guidelines vary by state, these data generally support that there are notable disparities in sleep and insomnia based on family/household income, and that these differences are, in part, due to greater perceived stress. This may be due to increased stress related to loss of work or income. Future studies examining the impact of pandemic stress on insomnia should consider the role of socio-economic status.
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Introduction & Objectives: The impact of the COVID-19 pandemic on health care access and delivery in the US has been reported for hospital admissions and in the outpatient setting for a few selected health conditions. However, the impact on specialty care has not been adequately characterized. We therefore aimed to determine trends in outpatient urologic care visit and procedural volume in 2020, using a specialty-wide, community-based registry. Materials & Methods: The American Urological Association Quality (AQUA) Registry collects data via automated extraction from electronic health record systems at 157 urology practices representing 3,165 providers (roughly one-quarter of US urologists) across 48 US states and territories. We analyzed trends in care delivery from February 2020 to July 2020 based on patient, practice, and local/regional demographic and pandemic response features. The primary outcomes were mean visit volume and procedure volume per practice per week, and we compared each week to the corresponding week in 2019. Results: There were 2,750,001 patients in our cohort, accounting for 8,953,832 outpatient visits and 1,570,161 procedures. We found large (>40%) declines in outpatient visits from March to April 2020 across all demographic groups and US states, regardless of timing of stay-at-home orders. Visits recovered through May and early June, but began falling again by early July (see Figure). Non-urgent visits and procedures decreased more (39–47%) than visits for urgent diagnoses (29–43%);surgical procedures for non-urgent conditions also decreased more (37–53%) than those for potentially urgent conditions (13–21%). African American and Hispanic patients had smaller decreases in visits compared with Asian and Caucasian patients, but also slower recoveries back to baseline. Medicare-insured patients (mostly over 65 years old) had the steepest declines (50%) while those on Medicaid (generally low-income) had among the lowest percentage of recovery to baseline (84.4%). Practices in zip codes with lower median incomes, higher poverty levels, and lower urologist to population ratios had smaller decreases in outpatient visits. (Figure Presented) Conclusions: This study provides timely, real-world evidence on the magnitude of decline in the provision of urological care across demographic groups and practice settings, and demonstrates a differential impact on the utilization of urologic health services by sociodemographic strata and specific diagnoses.
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Background. Nationally, younger adults and racial minorities have lower levels of influenza vaccination (influenza vaccination = vaccine) than non-Hispanic White adults. During the 2015-16 season, most vaccine decliners in our program were male, black, and 45-66 years of age. As part of a quality improvement (QI) initiative to increase 2020-21 vaccine coverage amongst PLWH, we sought to compare patient characteristics between vaccine recipients and non-recipients. Methods. Our program cares for 60% of Delawareans with HIV. The largest site in Wilmington was the QI site. IRB exemption was received, and pre-defined sociodemographic and HIV-specific variables were extracted from the EMR and CareWare from 1 Oct 2020 through 31 March 2021. Patient reports of external vaccine required confirmation. All PLWH ≥ 18 years of age, including those newly establishing care, met eligibility criteria. Comparisons between vaccinated and unvaccinated PLWH were performed using Wilcoxon rank sum tests for continuous variables and chi-squared tests for categorical variables. A multivariable logistic regression model, including age, sex, race, insurance, poverty level, HIV status, and virologic suppression, was used to predict vaccine. Results. 780 patients met study inclusion criteria and 86% (667/780) received vaccine. Characteristics of PLWH with and without vaccine are presented in Table 1. Older age, lower HIV viral load, and virologic suppression had a statistically significant (p< 0.05) association with vaccine receipt in unadjusted analysis. Only older age (p< 0.01) was significantly associated with vaccine in logistic regression modeling (Table 2), however this relationship was non-linear. Conclusion. A very high rate of PLWH received vaccine, far exceeding local and national benchmarks, with EMR data unlikely to have fully captured all vaccines. The role of the COVID-19 pandemic in vaccine amongst PLWH is not yet known. While older age was associated with vaccine in adjusted analysis, the number of unvaccinated patients was small, confidence intervals wide, and associations consequently weak. Larger studies are needed to further investigate factors associated with vaccine receipt amongst PLWH.
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Background. Medicaid expansion has been adopted by 38 states and the District of Columbia,1,2 contributing to lower rates of uninsured individuals in the US.3 During the COVID-19 pandemic, Medicaid enrollment offset employer-based insurance losses precipitated by the recession.4 The aim of this study was to evaluate whether Medicaid expansion may have impacted COVID-19 mortality. Methods. We conducted an ecologic study that included all US counties in the 50 states and District of Columbia. County-specific Medicaid expansion status was based on whether expansion was adopted within the state. COVID-19 cases and deaths for each county were obtained from the Centers of Disease Control (CDC). Unadjusted and multivariable negative binomial regression with robust standard errors to account for clustering of counties within each state were used to evaluate the association of COVID-19 case fatality rate and Medicaid expansion status. Adjusted models included the addition of four sets of county-level covariates thought to influence the association of Medicaid status and COVID-19 fatality rate: demographics, comorbidities, economic indicators, and physician density. These analyses were then performed in subgroups of counties defined by urbanicity (metro, suburban or rural) and quartiles of poverty rates. Incidence Rate Ratios (IRR) and 95% confidence intervals (CI) are reported. Results. A total of 1,814 Medicaid expansion and 1,328 non-expansion counties were included in the analysis. Crude case fatality rates were 2.1% (non-expansion) and 1.8% (expansion). Medicaid expansion was not associated with a significantly lower COVID-19 case fatality rate in either the unadjusted (IRR: 0.86;95% CI: 0.74, 1.01) or fully adjusted (IRR: 1.02;95% CI: 0.90, 1.16) models. In adjusted models, Medicaid expansion status was also not associated with differences in COVID-19 case fatality rate when counties were stratified by either urbanicity or percent of individuals living below the poverty line. Conclusion. In this county-level analysis, Medicaid expansion status was not associated with a significant difference in county-level COVID-19-related case fatality rates among people of all ages. Future individual-level studies are needed to better characterize the effect of Medicaid on COVID-19 mortality.
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Background. During the COVID-19 pandemic, we realized the importance of limiting in-clinic interactions with patients who were stable on antiretroviral therapy to promote social distancing. Our HIV clinic adopted telemedicine practices, in line with the HHS Interim Guidance for COVID-19 and Persons With HIV. Several HIV clinics reported lower viral suppression rates during the pandemic. We aim to describe the implementation process as well as year one outcomes of telemedicine at our clinic. Methods. In March 2020, we created telemedicine protocols;we also designed and continuously updated algorithms for determining patient eligibility for telemedicine based on recent viral loads and last clinic visit. We monitored outcomes through electronic medical record chart reviews between May 1, 2020, and April 30, 2021. We collected patient demographics, and federal poverty level (FPL) information. We collected baseline and post-intervention rates of viral load suppression (VLS, defined as HIV RNA < 200 copies per mL), medical visit frequency (MVF, defined as percentage of patients who had one visit in each 6 months of the preceding 24 months with at least 60 days between visits) and lost to care (LOC, no follow up within 12 months period). Results. We conducted a total of 2298 ambulatory medical visits;1642 were in person and 656 (29%) were telemedicine visits. Out of those, 2177 were follow up visits (649, 30% telemedicine). There was no difference of telemedicine utilization based on race (28% in African Americans vs. 32% in Whites);ethnicity (30% in Hispanic vs. 30% in Hon-Hispanic);gender (24% in females vs. 30% in males);or FPL (28% in FPL < 200% vs. 31% in FPL >200%). By the end of April 2021, overall clinic VLS rate was 94%, MVF was 48%, and there were 40 patients LOC compared to 92%, 49%, and 43 patients in April 2020, respectively. Conclusion. Telemedicine was a safe alternative to routine in-person HIV care during the COVID-19 pandemic. We observed similar rates of utilization across demographic and FPL status. Applying selection criteria, viral suppression and retention in care rates were not adversely impacted by shift to telemedicine modality.
ABSTRACT
Background. The National Institutes of Health Office of AIDS Research recommend that patients with HIV be prioritized for COVID-19 vaccination due to high rates of co-morbidities and sociodemographic risk factors that place them at increased risk for severe disease. However, COVID-19 vaccines were not distributed specifically to those in high-risk medical categories in Nebraska, and HIV clinics were not included in the state's COVID-19 vaccine delivery system. As a result, barriers to vaccine uptake emerged and interventions to mitigate them were needed. Methods. A multi-faceted and iterative program aimed at improving COVID-19 vaccine uptake was implemented at the University of Nebraska Medical Center's (UNMC) HIV clinic in Omaha, Nebraska in January 2021. A multidisciplinary task force was established in late January 2021 and met on a weekly basis to provide staff and patient education, linkage to vaccines, and review and analysis of vaccine completion rates as shown in the figure. Outreach interventions were continuously revised based on patient and staff feedback as well as updated data and vaccine availability. Results. All 1188 patients of the UNMC HIV clinic were ultimately eligible for the COVID-19 vaccine, but availability was on a rolling basis by age group, profession, county, and, ultimately, co-morbidities. 76% were male, 45.8% non-white, median age 48, and 73% had income less than 400% of federal poverty level. Of the 1188 eligible patients, 63.1% (n=751) had received at least one dose the COVID-19 vaccine and 59.3% (n=705) had completed the COVID-19 vaccine series by June 4, 2021. In comparison, 49.32% of the population of the state of Nebraska had initiated the COVID-19 vaccine series and 43.12% had completed the vaccine series by that date. Among our clinic patients, 27.9% (n=261) of those who had received at least one vaccine were assisted by our task force. 4.5% were noted to have a potential barrier at the time of outreach and these included hesitancy (3.5%), language (1.2%) and transportation (0.9%). Conclusion. A multi-faceted and iterative program to improve COVID-19 vaccine uptake in a high-risk patient population resulted in high rates of vaccine completion.
ABSTRACT
Study Objectives: Due to their ubiquity, smartphone applications are becoming increasingly important for emergency response, including providing a means of mobilizing volunteer responders. Data from these applications may be useful for identifying potential disparities in emergency response by revealing geographic gaps and racial and income-based inequity in the availability of volunteers. This could in turn be used to create targeted interventions to increase equitable emergency response coverage. The purpose of our study was to examine associations between race, SES factors, and access to emergency resources using data from PulsePoint (PP), a smartphone-based emergency response application for public cardiac arrest. We sought to contextualize this investigation to the COVID-19 pandemic, to further understand how pandemic conditions may intersect with existing inequities. Methods: The PP responder position data from the Allegheny County PP deployment was aggregated into zip code-level totals from data samplings taken from August 2019 to May 2020 using geospatial informatics software (QGIS). These totals were stratified into pre- and intra-pandemic periods, as well as by racial and demographic characteristics obtained from the US Census Bureau. The change in available responders at the zip-code level, as well as the association between number of available responders and racial and demographic characteristics, were examined using Mann-Whitney U Tests due to non-normal distribution of responder counts. Results: The median (IQR) of available PP responders before and after the stay at home order were 67.4125 (116.9375) and 73.05 (127.95), respectively. Fifteen percent of zip codes in the Pittsburgh area have > 30% of African Americans with a median (IQR) of 280 (1488). This compared to 95.6% of zip codes in the Pittsburgh area that have > 30% of Caucasian-Americans with a median (IQR) of 8582 (12538). The median (IQR) for the percent below the poverty level for all zip codes was 9% (10.8%). The p-value of available PP responders before the shutdown for high-income vs. low-income zip codes was 0.493. The p-value of available PP responders after the shutdown for high-income vs. low-income zip codes was 0.197. Lastly, the p-values of available PP after the shutdown to zip codes with > 30% vs. <30% Caucasian-Americans and > 30% vs. <30% African Americans were -0.443 and 1.095, respectively. Conclusion: In summary, SES was associated with the number of PP responders at the zip code level in Allegheny county. Interestingly, the pandemic shifted the distribution of responders to a net increase in available responders which did not entirely differ by race, but by income.