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INTRODUCTION: Puerto Rico has endured three major environmental and public health crises (Hurricane Irma, Hurricane Maria, the unprecedented seismic activity of January 2020) and the coronavirus disease 2019 (COVID-19) pandemic during the past 5 years. All these events might lead to an unquestionable deleterious impact in the prevention of cancer and across the cancer continuum, exacerbating cancer health disparities in the future. Cancer screening plays a critical role in early cancer detection. COVID-19 has significantly hampered screening programs in many countries' cancer screening infrastructure and services, affecting adherence. Cancer is the leading cause of morbidity and mortality in Puerto Rico. Limited information is available about the impact the current pandemic on colorectal cancer screening. In this study, we aim to describe the impact of the COVID-19 pandemic on colorectal cancer screening in 2020 and assess if this impact varied by health regions. METHOD(S): This study analyzed administrative data claims from the Public Health System of Puerto Rico which is managed by the Government of Puerto Rico through the Health Insurance Administration. The Current Procedural Terminology (CPT) codes included for this study were (81528, 82270, G0104, G0105, G0121, G0328, G0464). To assess changes in the numbers of colorectal cancer screening claims between the incurred year (2016 and 2020), Poisson regression was used. Initially, we fitted this model with only the incurred year as the predictor and offsetting the model with the annual average of total insured (univariate model). Based on this model, we estimate the magnitude of association between the number of claims and incurred year using the Prevalence Ratio (PR) of claims. Lastly, Poisson univariate regression model were used for each of the seven health regions (Ponce, Bayamon, Caguas, Mayaguez, Metro, Arecibo and Fajardo) to assess potential geographic disparities. RESULT(S): The numbers of colorectal cancer screening claims significantly decreased by 40% (PRcrude: 0.60, 95%CI: 0.59, 0.62) in 2020 when compared to 2016. However, when adjusting for claim incurred month, sex, health region and offsetting the model with the annual average of total insured, the numbers of colorectal cancer screening claims significantly decreased by 34%, (PRadj: 0.66, 95%CI: 0.64, 0.67). The numbers of colorectal cancer screening claims significantly decreased in all health regions in 2020 when compared to 2016 (p<0.05). However, the most impacted region was the Eastern region, Fajardo, with a 64% (PRFajardocrude: 0.36, 95%CI: 0.30, 0.42) significant decrease in numbers of colorectal cancer screening claims. CONCLUSION(S): COVID-19 had a profound negative effect on colorectal screening in Puerto Rico. Moreover, despite the beneficiaries of this governmental health plan sharing similar sociodemographic and socioeconomic background, regional differences were observed.
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Background: COVID-19 vaccine booster uptake remains low and preventable COVID-19 deaths continue to occur, making access to oral antivirals for those most at risk of severe COVID-19 outcomes essential. Method(s): We estimated age and gender adjusted prevalence ratios of oral nirmatrelvir-ritonavir (NMV/r) uptake by sociodemographics, clinical characteristics, and prescription eligibility (based on age, underlying medical conditions, body mass index, physical inactivity, pregnancy, or smokers), among participants in a large U.S. national prospective cohort who were infected with SARS-CoV-2 between December 2021 and October 2022. Among participants who reported NMV/r uptake, we also described the proportion who reported (1) taking NMV/r as directed and (2) NMV/r was helpful for reducing COVID-19 symptoms. Result(s): Among 1,594 participants with a SARS-CoV-2 infection as of October 2022, 1,356 were eligible for NMV/r prescription;of whom 209 (15.4% [95%CI:13.5-17.3]) reported receiving NMV/r. NMV/r uptake increased from 2.2% (95%CI:1.0-3.4) between December 2021 and March 2022 to 16.5% (95% CI:13.0-20.0) between April and July 2022 and 28.6% (95%CI:24.4-32.8) between August and October 2022, respectively. Participants >=65 years of age reported the highest uptake of NMV/r (30.2% [95%CI:22.2-38.2]). Black non-Hispanic participants (7.2% [95%CI:2.4-12.0]) and those in the lowest income group (10.6% [95%CI:7.3-13.8]) had lower uptake than white non-Hispanic (15.8% [95%CI:13.6-18.0]) and high-income individuals (18.4% [95%CI:15.2-21.7]), respectively. Participants with type 2 diabetes had greater uptake (28.8% [95%CI:20.4-37.3]), compared to those without it (12.4% [95%CI:4.8-20.0]). Among a subset of 278 participants who had a prior SARSCoV-2 infection, those who had a history of long COVID reported greater uptake (22.0% [95%CI:13.9-30.1]) for a subsequent SARS-CoV-2 infection than those without a history of long COVID (7.9% [95%CI:3.9-11.8]). Among all participants who were prescribed NMV/r (N=216), 89% (95%CI:85-93) reported that they took NMV/r as directed and 63% (95%CI:57-70) stated NMV/r was helpful for reducing COVID-19 symptoms. Conclusion(s): Uptake of NMV/r increased over time coinciding with national efforts to increase awareness and access. However, most individuals who were eligible for NMV/r did not receive it. Lower NMV/r uptake among racial/ethnic minorities and individuals with lower household income suggests a need to improve awareness and address barriers to uptake in these populations.
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Background: People who inject drugs (PWID) may be at a greater risk of SARS-CoV-2 infection and COVID-19 due to socio-structural inequities, high-risk behaviors and comorbidities;however, PWID have been underrepresented in case-based surveillance due to lower access to testing. We characterize temporal trends and correlates of SARS-CoV-2 seroprevalence among a community-based sample of current and former PWID. Method(s): A cross-sectional study was conducted among participants in the AIDS Linked to the IntraVenous Experience (ALIVE) study-a community-based cohort of adults with a history of injection drug use in Baltimore, Maryland. Participants' first serum sample collected at routine study visits between December 2020 and July 2022 was assayed for antibodies to the nucleocapsid (N) (past infection) and spike-1 (S) (past infection and/or vaccination) proteins using the MSD V-Plex Panel 2 IgG SARS-CoV-2 assay. For each correlate, we estimated adjusted prevalence ratios (PR) via separate Poisson regression models adjusted for calendar time, age, sex and race. Result(s): Of 561 participants, the median age was 59 years (range=28-77), 35% were female, 84% were Black, 36% were living with HIV (97% on ART), and 55% had received >=1 COVID-19 vaccine dose. Overall, anti-N and anti-S prevalence was 26% and 63%, respectively. Prevalence of anti-N increased from 23% to 40% between December 2020-May 2021 and December 2021-July 2022, with greater increases in the prevalence of anti-S from 34% to 86% over the same period (Figure). Being employed (PR=1.53 [95%CI=1.11-2.11]) and never being married (PR=1.40 [0.99-1.99]) were associated with a higher prevalence of anti-N, while female sex (PR=0.75 [0.55-1.02]) and a history of cancer (PR=0.40 [0.17-0.90]) were associated with a lower prevalence of anti-N. Younger age, female sex (PR=0.90 [0.80-1.02]), and homelessness (PR=0.78 [0.60-0.99]) were associated with a lower prevalence of anti-S. Although HIV infection was not associated with anti-N, it was associated with a higher prevalence of anti-S (PR=1.13 [1.02-1.27]). Substance use was not associated with anti-N or anti-S. Conclusion(s): Anti-N and anti-S levels increased over time, suggesting cumulative increases in SARS-CoV-2 incidence of infection and vaccination among PWID;however, disparities in seroprevalence remain. Younger and female PWID and those experiencing homelessness were less likely to be anti-S positive, suggesting programs should aim to improve vaccination coverage in such vulnerable populations.
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Background: The COVID-19 pandemic disrupted HIV prevention and treatment services, especially for structurally vulnerable individuals like many people who inject drugs (PWID). We sought to compare present levels of access to these services to their levels before the pandemic. Method(s): We used data from 2018 and 2022 collected through the National HIV Behavioral Surveillance (NHBS) survey among PWID in Philadelphia. Using generalized linear regression models, we estimated the associations between our exposure (year) and self-reported HIV testing, medical care, SSP access, PrEP use, and drug treatment in the year prior to interview. We calculated adjusted prevalence ratios (aPR) using multivariable models adjusted for age, race/ ethnicity, housing stability, and primary injecting drug. Result(s): There were 620 participants in 2018 and 604 in 2022 included in analyses. Compared to the 2018 sample, the 2022 sample was significantly older, non-Hispanic Black, and primarily injected drugs other than heroin. A significantly smaller proportion of participants in 2022 had a recent HIV test (57% vs. 71%), visited a health care provider (77% vs 82%), received sterile needles from an SSP (69% vs 75%), or participated in a drug treatment program (47% vs 54%). Between 2018 and 2022, PrEP awareness increased significantly (39% vs 54%) but PrEP use did not (3% vs 3%). In adjusted models, an 18% decrease in recent HIV testing was observed between 2018 and 2022 (aPR: 0.82;95% CI: 0.70-0.96). Among those who reported a recent HIV test, there was an 18% increase in testing in clinical settings observed between 2018 and 2022 (aPR: 1.18;95% CI: 1.10-1.26). Recent medical care, SSP access, PrEP use, and drug treatment were not associated with year in adjusted models. Conclusion(s): Access to a full range of social services is necessary for Ending the HIV Epidemic. These findings indicate that HIV prevention services, particularly HIV testing, among PWID have not rebound fully from the pandemic. Considering this and ongoing outbreaks of HIV among PWID, public health practitioners should closely monitor HIV testing frequency among PWID and prioritize expanding access to low-barrier HIV prevention and care services, especially in non-clinical settings.
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Background: Myocarditis (MC) is an inflammatory condition of the myocardium often caused by a virus and can lead to hospitalization, heart failure, or death. Although rare, data suggest an increased incidence associated with the COVID-19 virus. However, the risk for COVID-19-induced MC remains poorly understood and debated. We sought to evaluate the prevalence of pandemic MC-related inpatient encounters during 2020 through a descriptive approach and compare it to the pre-pandemic era. Given that the first COVID-19 vaccine doses were administered on December 14, 2020, a significant increase in MC prevalence could be attributable to COVID-19 exposure. Method(s): Data were obtained from the PearlDiver database (PearlDiver Technologies, Fort Wayne, IN). The database provides all-payers administrative claims data on the patient level. Using ICD-10-CM codes, a cohort of patients who had their first inpatient encounter with MC was identified and divided into pre-pandemic (January- October 2019) and pandemic (January-October 2020) groups and classified by age, gender, and month of hospitalization. We described these patients' demographics, calculated the prevalence ratio (PR) and 95% CI of MC-related encounters during the pandemic, and compared it with the same period in the pre-pandemic period. A p-value <0.05 was deemed significant. Result(s): The median age, length of stay in previous hospitalizations, mean gender and Elixhauser Comorbidity Index were similar between groups. The prevalence of MC was 22/100,000 cases in 2019 and 25/100,000 in 2020. The overall PR of hospitalization due to MC was 13% higher in 2020 than it was in 2019 (PR=1.13, p<0.0001), with a significantly higher risk in age groups 5-9 (PR=1.41 p=0.02), 60-64 (PR=1.24 p<0.0001), 65-69 (PR=1.14 p=0.01), 70-74 (PR=1.28 P<0.0001), and 80-85 (PR=1.36 p<0.0001). The risk was significantly higher in March (PR=1.27 p<0.0001), July (PR=1.41 p<0.0001, and September (PR=1.52 p<0.0001) in 2020. In 2020, the risk of MC in males with respect to females decreased by 3% compared to 2019. Discussion(s): Our results suggest a temporal correlation between increased prevalence of inpatient encounters for MC since COVID-19's inception. The risk was significantly higher in older adults and during months with a higher COVID-19 incidence. These findings do not demonstrate causation between the COVID-19 virus and MC and are limited by the typical biases associated with retrospective studies. Conclusion(s): Although MC is a less common hospitalization condition, our data supports a significantly increased prevalence of MC-related encounters during the initial year of the COVID-19 pandemic. We found risk variations according to age, gender, and month.Copyright © 2022
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Prior to the COVID-19 pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. Yet, widespread misleading information about the COVID19 vaccine might negatively impact HPV vaccine attitudes. This study aims to assess and compare HPV and COVID-19 vaccines attitudes toward school-entry policies among adults living in PR. A convenience sample of 222 adults (>=21 years old) living in PR were recruited through social media and completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID-19 vaccines knowledge (ranging from 0=none to 3=high knowledge), attitudes toward vaccination policies for school-entry, and perceptions of trusted and untrusted sources of information. Descriptive statistics were computed to identify the demographics characteristics of the participants. We also estimated the prevalence ratio (PRadjusted) using a logistic regression model to assess the magnitude of association between COVID-19 vaccination for the school-entry policy and HPV vaccination for school-entry policy agreement, adjusting for different confounders. The mean age of the study sample was 36.73 +/- 11.18 years. The majority of the sample were female (87%, n=194), with at least some college of education (92%;n=205) and employed (61%;n=165). One-fifth of the participants reported having children between ages 11 and 16 (n=46). Participants' perceived knowledge about the HPV vaccine was moderate (mean=1.72;SD=1.12), while for COVID-19 vaccine was moderately high (mean=2.47;SD=.68). The most trusted form of information for HPV and COVID-19 vaccines were health care providers (42% and 17%, respectively), the Centers for Disease Control and Prevention (35% and 55%, respectively), and the Department of Health (15% and 19%, respectively). The least trusted source of information included social media (40% and 39%, respectively), friends and family (23% n=47, and 17% n=33, respectively), and the Department of Health (15% n=30, and 18% n=36, respectively). More than half of the participants agreed that HPV (76% n=156) and COVID vaccines (69% n=136) should be required for school-entry. Agreement with COVID-19 vaccination for the school-entry policy was significantly associated with HPV vaccination for school-entry policy agreement (PRadjusted:1.96;95% CI:1.48-2.61) after controlling for age, sex, education, and having children between age 11 and 16. Findings suggest that adults living in PR have an overall positive attitude about mandatory HPV and COVID-19 vaccination school-entry policies, and these attitudes are interrelated. Yet, it is concerning that the Department of Health is identified as one of the least trusted sources of information, as it has a prominent role in implementing HPV and COVID-19 vaccine policies in PR. Further research should elucidate why the Department of Health is considered an untrusted source of information among adults living in PR and evaluate the implications of the COVID-19 pandemic on HPV vaccine attitudes and adherence rates.
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Background: The COVID-19 pandemic impacted on health service access, due to lockdowns and isolation measures. To address this access to telehealth items were expanded. Aim/Objectives: Explore use and satisfaction with telehealth during the COVID-19 pandemic in metropolitan Sydney using a cohort of older Australians. Method(s): Data from Wave 3 (2020) of the 45 and Up Study were used. Participants in metropolitan Sydney who answered the telehealth question were included. Satisfaction was measured using a question on likelihood of recommending telehealth. Factors influencing telehealth use and satisfaction were then analysed using Poisson modelling to calculate prevalence ratios (PRs). In addition, associations between telehealth use, satisfaction and delaying GP/specialist healthcare during COVID-19 were modelled. Finding(s): The cohort consisted of 17,190 participants (mean age=70.3 years, 55.1% female). 7,585 (44.1%) participants reported using telehealth in the last 12 months. 83.1% received services via telephone, 3.4% via video and 5.3% via both. Health conditions such as cancer (adjPR=0.18, 95CI=0.11-0.24) or anxiety (adjPR=0.16, 95CI=0.08-0.25) were associated with higher telehealth use. People who report delayed or missed GP or specialist visits due to COVID-19 (adjPR=0.15, 95CI=0.07-0.23, and adjPR=0.17, 95CI=0.08- 0.25 respectively) were more likely to use telehealth. 4185 (55%) reported they 'probably will' or 'definitely will' recommend telehealth. Satisfaction varied with demographics, with self-reported good quality of life having the highest impact (adjPR=0.11, 95CI=-0.06-0.28). Implications: Just under half of the participants used telehealth, with the majority being via telephone. Participants who used telehealth were more likely to have had physical and mental ill health. However, we did not have data on overall health service use for comparison. Having good health was associated with less telehealth use and higher satisfaction with telehealth. We plan to investigate the influence of telehealth on GP access, using MBS items before and after additional telehealth items were introduced.
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Background: The global pandemic respiratory infection COVID-19 has had a high mortality rate since early 2020 with a broad spectrum of symptoms and giving a high burden. This study used the chest X-ray radiologic severity index method to radiologically assess the degree of lung lesions and the CURB-65 score to clinically assess COVID-19 pneumonia patients associated with the incidence of death in hospitalized patients. Results: The research data were carried out from March 2020 to April 2021 based on patient medical records and chest X-rays at Doctor Kariadi General Hospital Semarang Indonesia. One hundred and five subjects were collected that fulfilled the inclusion and exclusion criteria. The CURB-65 score ≥ 2 had a significant relationship to the death event with a prevalence interval of 2.98 (95% CI, p = 0.000). The radiologic severity index ≥ 22.5 in initial chest X-ray signified a prevalence ratio of 2.24 (CI 95%, p = 0.004) and the radiologic severity index ≥ 29.5 in the second chest X-ray signified a prevalence ratio of 4.53 for the incidence of death (95% CI, p = 0.000). The combination of CURB-65 and the first chest X-ray radiologic severity index resulted in a prevalence ratio of 27.44, and the combination of CURB-65 and the second chest X-ray radiologic severity index resulted in a prevalence ratio of 60.2 which were significant for the mortality of hospitalized COVID-19 pneumonia patients. Conclusions: Chest X-ray radiologic severity index and CURB-65 score have a significant relevance with the death event in hospitalized patients with COVID-19 pneumonia and can thus be used as a predictor of mortality.
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Background: The ongoing coronavirus disease 2019 (COVID-19) pandemic and subsequent waves still represent a healthcare issue. Their impact on the treat-to-target (T2T) strategy in rheumatoid arthritis (RA) patients has been seldom investigated. Difficult access to rheumatology outpatient clinic, laboratory and imaging investigations as well as nationwide containment measures could potentially affect disease activity and tight-control strategy. Recently, we reported how a telephone-based tight control strategy ensured satisfactory management of RA treated with targeted therapies during the frst wave of the pandemic [1]. However, the performance of our different patterns of healthcare delivery across different pandemic waves has not been studied yet. Objectives: To analyze the impact of different patterns of healthcare delivery on remission of RA patients treated with targeted therapies during the frst wave (2020) and second/third waves (2021) of pandemic compared to the pre-pan-demic period (2019). Methods: In this observational real-life study, data of our cohort of RA patients treated with biologic or targeted synthetic drugs were extracted from a longitudinal registry. Clinical Disease Activity Index (CDAI) was analyzed in the same period from 22nd of February to 18th of May for three consecutive years: before the pandemic (2019), during the frst wave (2020), and during the second/third waves (2021). During the frst wave, patients could choose whether to receive home drug delivery or to maintain their face-to-face visits, in the other periods only in-person visits were delivered. A generalized linear model with the binomial error was ftted to evaluate the difference in the proportion of patients in CDAI remission. Quantile regression was used to compare the median of CDAI in difficult-to-treat (D2T) patients [2]. In both models, the correlation of different measurements on the same patient was considered. Results: In the pre-pandemic period (2019), 407 RA patients were included in this study. During the frst wave (2020) we analyzed 450 patients, of whom 359 patients chose in-person visits, while 91 patients home drug delivery and virtual visit. Finally, 540 patients were included in 2021 (second/third wave). The percentages of patients in CDAI remission were similar in the three periods (prevalence ratio 1.07, p-value 0.423 between 2020 and 2019, and 1.01, p-value 0.934 between 2021 and 2019). The CDAI remission rate was 40.55% (N=163), 43.18% (N=155) and 40.82% (N=220) in 2019, 2020 and 2021, respectively. The disease activity profile during the three periods is reported in detail in the Table 1 below. Among our cohort of D2T patients, the median value of CDAI before (2019), during the frst wave (2020), and during the second/third wave (2021) changed signifcantly (p= 0.053 between 2020 and 2019 and p=0.006 between 2021 and 2019). Conclusion: Although the pandemic has imposed changes in our healthcare delivery, these different strategies seem to be effective in ensuring satisfactory management of RA treated with targeted therapies. The approaches modulated in the context of the different periods have been a feasible compensation for ensuring disease control even in D2T patients.
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BACKGROUND: Vaccination uptake is a crucial component of public health and primary care, particularly amid the Covid-19 pandemic. The Centers for Disease Control and Prevention (CDC) recommends nearly universal yearly influenza vaccinations for all persons older than 6 months old, but uptake remains suboptimal. We sought to determine if individuals who report more frequent risk-taking behaviors, including excessive alcohol use, smoking, and driving without wearing a seatbelt, would be less likely to report recent influenza vaccination. METHODS: We used data from the BRFSS, a nationally representative telephone survey of community-dwelling adults conducted by the CDC, from 2011, 2015, and 2019. Risky behaviors queried and defined by the BRFSS included: 1) heavy alcohol use (>14 drinks per week for men or >7 drinks per week for women in the past 30 days);2) binge drinking (>5 drinks in one setting for men or >4 drinks for women in the past 30 days);3) current smoking (someday or everyday smoker);and 4) not wearing a seatbelt nearly always. Seatbelt data was only available for 2011 and 2015. We present weighted prevalence ratios (PR) derived from generalized linear models adjusted for age, race, sex, census region, year, and having a personal physician. We defined current influenza vaccination as receipt of a nasal or injected vaccine within the last year. RESULTS: Across the three included years, 1,217,271 people had data available for our variables of interest. A total of 40.1% (95% confidence interval [CI] 39.9% - 40.3%) of respondents reported influenza vaccination within the past year. All four of the risky behaviors were individually and independently associated with lower rates of vaccination (Heavy alcohol use: PR 0.94, 95% CI 0.91 - 0.97;Binge drinking: PR 0.91, 95% CI 0.89 - 0.93;Current smoking: PR 0.79, 95% CI 0.77 - 0.80;Seatbelt: PR 0.76, 95% CI 0.74 - 0.78), and the presence of multiple risk factors further lowered rates of influenza vaccination. When restricted to the smoking and alcohol risk factors for all three years, the likelihood of influenza vaccination was 14% lower (PR 0.86, 95% CI 0.85 - 0.87) for each additional risk factor present. We observed a statisically significant dose-dependent decrease in likelihood of vaccination from 0.76 (PR 95% CI 0.74 - 0.77) with any one risk factor present to 0.65 (PR 95% CI 0.63 - 0.68) with any two risk factors present, down to 0.50 (PR 95% CI 0.47 - 0.53) if all three risk factors were present. When we examined all four risk factors across the two years where data was available, the likelihood of influenza vaccination dropped by an average of 15% (PR 0.85, 95% CI 0.84 - 0.86) with each additional risk factor present. CONCLUSIONS: In this contemporary, nationally-representative analysis of American adults, risk-taking behavior was associated with lower rates of influenza vaccination. This analysis may provide a useful framework for physician counseling and public health efforts to expand vaccination.
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Background: Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a disabling multisystem complex disorder with prevalence of 875 per 100,000 (up to 3.4 million people) in the United States. There are no known etiologic or risk factors and no approved treatments for ME/CFS. We conducted a molecular epidemiologic study to test the hypothesis that ME/CFS may be an autoimmune disease (AID) and explore the link between ME/CFS and cancer, specifically hematologic malignancies. Methods: Our clinic-based study involved carefully selected cases with confirmed diagnosis of ME/CFS (n=59) and healthy controls (n=54) frequency matched to cases on age, gender and ethnicity. During structured interviews, detailed multi-generation pedigrees, epidemiologic and medical questionnaires, and biospecimen were obtained on all subjects. Statistical analysis of pedigree data involved comparison of cases and controls with respect to the prevalence and cumulative incidence of AID and cancer among their first-degree relatives. For unadjusted analysis, risk ratios, 95% confidence intervals (CI), and p-values were calculated. For age-adjusted analyses, cumulative incidence estimates were compared using the log-rank test. Results: The prevalence of AID was significantly higher among the first-degree relatives of cases compared to those of controls (OR=5.30;95%CI: 1.83-15.38;p=0.001). The prevalence of AID among mothers was 14% for cases and 1.9% for controls (p=0.03). 11.2% of the first-degree relatives of cases had an AID compared to 3.1% of the relatives of controls (prevalence ratio=3.71;95% CI: 1.74-7.88;p=0.0007). The cumulative incidence of AID among the first-degree relatives of ME/CFS cases was 9.4% compared to 2.7% for those of the controls (p=0.0025). First-degree relatives of ME/CFS cases had a significantly higher prevalence of any cancer compared to the relatives of unrelated controls (OR=4.06, 95%CI: 1.84-8.96, p=0.0005). Age-adjusted analysis revealed significantly higher (p=0.03) cumulative incidence of any cancer among the first-degree relatives of cases (20%) compared to the relatives of controls (15.4%). The cumulative incidence of hematologic cancers was also significantly higher among the relatives of cases (p<0.05). Conclusions: We found statistically significant increased risks of AID and cancer among the firstdegree relatives of ME/CFS cases. Our findings implicate immune dysregulation as an underlying mechanism, providing etiologic clues and leads for prevention. Given symptomatic similarities between 'long COVID' and ME/CFS, it is predicted that there will be a significant increase in incidence of ME/CFS as the result of COVID-19 pandemic. Our findings may enable defining a subset of COVID-19 patients who could be at risk of developing ME/CFS, and who may benefit from treatments used for certain AIDs.
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This study aimed to determine the relationship between ABO blood groups and mortality in patients hospitalized for severe SARS-CoV-2 infection. An observational and retrospective research was conducted in a tertiary care hospital in Lima, Peru. A total of 203 patients with a mean age of 62.58 ± 16.45 years were included in the research, out of whom 71.92 % were males. The frequency of O, A and B blood groups were 75.37 %, 17.24 % and 7.39 %, respectively. An association with mortality from severe COVID-19 infection was found with non-A blood groups (O group or B group), with a PR (prevalence ratio) of 2.25 and 95% CI (confidence interval) of 1.07 – 4.71. When adjusting the main variables, the association with PR remained in 2.78 and 95% CI in 1.06 – 7.24. In conclusion, patients hospitalized for severe SARS-CoV-2 infection with O and B blood groups seem to be associated with higher mortality rates than those with A blood group.
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Introduction: In the United States (US), health and financial consequences of COVID-19 have disproportionately impacted minoritized groups. Yet, few US studies have investigated COVIDrelated financial loss/consequences and sleep health disparities. Methods: To investigate differences by sex/gender and race/ethnicity in cross-sectional associations between both job/business loss and substantial financial hardship (SFH) with sleep health, we used data collected from 12/2020 to 2/2021 among 4,726 men and women in the nationally representative COVID-19 Unequal Racial Burden (CURB) Study (N=5,500 American Indian/Alaska Native (AI/AN), Asian, Black, Hispanic/Latino, Multiracial, Native Hawaiian/Pacific Islander (NH/PI), and non-Hispanic (NH)-White adults). Participants reported job/business loss since the start of the pandemic (yes, no) and SFH (e.g., unable to pay for housing costs). Poor sleep health was defined as concurrence of self-reported fair/poor sleep quality, non-restorative sleep, sleep problems, and difficulty falling asleep in the past week. Adjusting for sociodemographic and health characteristics and receipt of financial assistance, weighted Poisson regression with robust variance estimated prevalence ratios (PRs) for poor sleep overall, by sex/gender, and by race/ethnicity. Results: Men and women equally reported both job/business loss (20%) and SFH (11% men and 12% women). Minoritized racial/ ethnic groups except Asians most frequently reported job/business loss (20%-25% vs. 16% Asian, 13% NH-White) and SFH (11%-15% vs. 9% NH-White, 5% Asian). Poor sleep health was more prevalent among women (21%) than men (14%) and among AI/AN, NH/PI, and Multiracial adults (each 22% vs. 11%-19% remaining racial/ethnic groups). Both job/business loss and SFH were associated with a higher prevalence of poor sleep health, overall. Compared to women, men had stronger associations for both job/ business loss (PRmen=1.80 [95% CI:1.39,2.33], PRwomen=1.23 [1.01,1.50];pinteraction=0.01) and SFH (PRmen=4.46 [3.18,6.26]), PRwomen= 1.82 [1.45,2.30];pinteraction=0.01). For job/business loss, associations were strongest among Asians (PR=2.07 [1.32,3.23] vs. PR range=0.88-1.89;pinteraction=0.09). Conclusion: COVID-19 related job/business loss and financial hardship were both associated with poorer sleep health, and associations for job/business loss were strongest among men and Asian adults.
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Background: The impact of COVID-19 mitigation measures on STI transmission and racial disparities remains unknown. The objectives were to examine trends in sex and drug risk behaviors, access to sexual health services and STI positivity overall and by race during-compared to pre-pandemic among urban sexual minorities (MSM). Methods: Sexually-active MSM aged 18-45 years were administered a behavioral survey and STI testing at three-month intervals. Participants completing > one during-pandemic (April-December 2020) and one pre-pandemic study visit (before March 13, 2020) occurring < six months apart were included. Generalized estimating equations with modified Poisson regression models compared outcomes during-compared to pre-pandemic visits. Results: Among 231 MSM, reports of > three sex partners declined [adjusted Prevalence Ratio (aPR): pandemic-1(p1) 0.68, 95% CI (0.54-0.86);pandemic-2(p2) 0.65 (0.51-0.84);pandemic-3(p3) 0.57 (0.43-0.75)];similar findings were observed among Black and non-Black MSM. Black, but not non-Black MSM, reported sustained decreases in substance use (aPR: p1 0.90 (0.79-1.03);p2 0.74 (0.62-0.89);p3 0.82 (0.67-0.99)], and increased HIV/PrEP care engagement [aPR: p1 1.20 (1.07-1.34);p2 1.24 (1.11-1.39);p3 1.30 (1.16-1.47)]. Reported STI testing (overall and by race) decreased [aPR: p1 0.68 (0.57-0.81);p2 0.78 (0.67-0.92)], then rebounded [aPR: p3 1.01 (0.87-1.18)]. Overall, neither chlamydia [aPR: p2 1.62 (0.75-3.46);p3 1.13 (0.24-1.27)] nor gonorrhea [aPR: p2 0.87 (0.46-1.62) p3 0.56 (0.24-1.27)] positivity significantly changed during vs. pre-pandemic. Conclusion: We observed sustained decreases in STI risk behaviors but minimal change in STI positivity during compared to pre-pandemic. Findings underscore the urgent need for novel strategies to deliver STI prevention services without in-person interactions among MSM.
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Background: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and the challenges in implementing infection prevention and control measures;however, seroprevalence studies are lacking in correctional settings. We examined the seroprevalence of SARS-CoV-2 and associated modifiable risk factors among incarcerated adult men in Quebec, Canada. Methods: We conducted a cross-sectional seroprevalence study in three provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity, detected by the Roche Elecsys® anti-SARS-CoV-2 serology test. Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard error. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated. Results: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15-27%). Of these, 192 (78%) reported having at least one previous SARS-CoV-2 PCR test, with 122 (64%) testing positive and 70 (36%) testing negative;73 (30%) individuals with a positive serology test were asymptomatic. Seropositivity increased with time spent in prison since March 2020 (aPR 2.17, 95%CI 1.53-3.07 for all vs. little), employment during incarceration (aPR 1.64, 95%CI 1.28-2.11 vs. not), shared meal consumption during incarceration (with cellmates: aPR 1.46, 95%CI 1.08-1.97 vs. alone;with sector: aPR 1.34, 95%CI 1.03-1.74 vs. alone), and incarceration post-prison outbreak (aPR 2.32, 95% CI 1.69-3.18 vs. pre-outbreak) (see Table). Shared (vs. single) cells were not associated with increased seropositivity. Conclusion: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several modifiable carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.
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Background: We aimed to examine concerns surrounding COVID-19 infection and healthcare access among South African young people (YP) living with HIV (YPLWH) and HIV-uninfected YP with the goal of identifying differences between groups. Methods: We examined cross-sectional data from the baseline procedures of the BUDDY study conducted among YP (13-24 years) living with and without HIV in Cape Town, South Africa from February-September 2021. YPLWH were recruited from an HIV clinic and HIV-uninfected YP were recruited through community outreach. Adjusted prevalence ratios (aPRs) were computed to estimate associations between HIV cohort and COVID-19 testing, vaccine acceptance, and access to healthcare services since March 2020 controlling for participant age and gender. Results: A total of 535 participants were enrolled into the study, including 217 YPLWH and 318 HIV-uninfected YP. The median age, 19.1 years (IQR=16.6-21.5), was similar between groups. YPLWH were 58% female and HIV-uninfected YP were 78% female (p<.001). YPLWH were less than half as likely than HIV-uninfected YP to have received a COVID-19 test (6% vs 12%, aPR=0.48, 95% CI 0.26-0.89), to be willing to accept a COVID-19 vaccine (49% vs 59%, aPR=0.84, 95% CI 0.71-0.99), and to be concerned about becoming severely ill from COVID-19 (60% vs 76%, aPR=0.79, 95% CI 0.69-0.89). Perceived risk of becoming infected with COVID-19 in the next month was similar between YPLWH and HIV-uninfected YP (32% vs 36%). YPLWH were more likely than HIV-uninfected YP to report being unable to attend a healthcare appointment (27% vs 20%, aPR=1.39, 95% CI 1.01-1.90). Further, a greater proportion of YPLWH attempted to access condoms (aPR=1.51, 95% CI 1.32-1.74) and HIV/STI testing services (aPR=1.58, 95% CI 1.38-1.80) than HIV-uninfected YP and, among females who attempted to access contraceptives services, YPLYW reported significantly lower access than HIV-uninfected YP (aPR=0.82, 95% CI 0.71-0.94) (Table 1). Last, among YPLWH, 28% reported missing an HIV care appointment, 14% reported running out of their HIV medication, and 34% reported they were worried about running out of their medication since March 2020. Conclusion: Experiences living with HIV may shape concerns around COVID-19 infection among YP. YPLWH reported greater health-seeking behavior than HIV-uninfected YP and a significant proportion reported missing an appointment and running out of their HIV medication. Services should devise strategies to prevent interruptions in healthcare access among YP.
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Background: Older adults with frailty may struggle to adapt to prolonged periods of infection prevention measures during COVID- 19. However, few studies have explored how frailty has shaped experiences of living through the COVID-19 pandemic. We aimed to 1) investigate quantitative associations between frailty and each of physical isolation, worry about COVID-19, and loneliness;and 2) qualitatively explore older adults' lived experiences of frailty during the pandemic. Methods: We used a cross-sectional sequential explanatory mixed-methods design. Data were from online questionnaires in the nationwide United States COVID-19 Coping Study from December 2020 through January 2021 (N = 2,451 adults aged ≥55). Frailty was assessed by the 5-item FRAIL scale. We used adjusted population- weighted modified Poisson regression to estimate prevalence ratios for associations between frailty and physical isolation (not leaving home except for essential purposes);worry about COVID-19 (moderate/extremely worried vs. not at all/slightly/somewhat worried);and loneliness (UCLA Loneliness scale, ≥6/9 vs. <6/9). We performed qualitative thematic analysis on open-ended written responses to the question, “How does your health status affect your everyday activities during the pandemic?”. Results: Frailty was associated with increased prevalence of all outcomes in dose-response fashions. Key qualitative themes among pre-frail and frail aging adults included concerns about infection, adherence to COVID-19 prevention measures, changes in social interaction, physical challenges, and changes in exercise and activities. Conclusion: Experiences of aging with frailty during the pandemic have been diverse and encompass isolation, worry, loneliness, and frailty progression, as well as coping strategies and resilience. Individualized strategies that consider the factors influencing frailty are needed to support well-being among aging adults during the pandemic.
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INTRODUCTION: Uncontrolled blood pressure contributes a huge contribution to many hypertension-related complications and it is one of the unbeaten problems for patients taking antihypertensive drugs. The association of social support and other factors with uncontrolled blood pressure during the covid-19 pandemic is not well investigated. Therefore, this study explored the determinants of blood pressure control status during the COVID-19 pandemic among patients with hypertension who were on an antihypertensive treatment. METHOD: A cross-sectional study was done from March to May 2021 among adults aged 18 or more patients with hypertension for three months or more on treatment in Dessie City. An interview-administered questionnaire was done using simple random sampling from hypertension follow-up register for 380 patients with hypertension. Blood pressure measurement was taken from their arm using a stethoscope and mercury sphygmomanometer at a sitting position with 90-degree back support. Uncontrolled blood pressure was also computed either the systolic or diastolic blood pressure greater than or less than the limit of uncontrolled blood pressure with regarding the age and diabetic status of patients. The perceived social support-related questionnaire was adopted from the Multidimensional Scale of Perceived Social Support (MSPSS) -12 item checklist. It was sum-up and transformed into three categories using tertile of their computed raw scores. The adjusted prevalence ratio with a 95 percent confidence interval (CI) was used to calculate the strength of the association between uncontrolled blood pressure and independent predictors using log-binomial regression analysis. A P-value less than 0.05 was declared as statistically significant in multivariable log-binomial regression analysis. RESULT: A total of 360 study participants were included in this study. The prevalence of uncontrolled blood measures in patients with hypertension with a 95% CI was 55.8(50.7, 61.0). In a multivariable analysis adjusted prevalence ratio with 95% CI for poor medication adherence 1.86(1.59,2.19), being male 1.35(1.11,1.64), secondary education 0.52(0.35,0.77), and low social support 1.24(1.01, 1.54) were the predictors of uncontrolled blood pressure. CONCLUSION: Uncontrolled blood pressure for patients with hypertension on treatment is higher during the COVID-19 pandemic. Being male, poor medication adherence, educational status and low social support are factors that contribute to uncontrolled blood pressure.
Subject(s)
COVID-19 , Hypertension , Adult , Antihypertensive Agents/therapeutic use , Blood Pressure , COVID-19/epidemiology , Cross-Sectional Studies , Ethiopia/epidemiology , Female , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Male , Medication Adherence , PandemicsABSTRACT
Introduction: The university population may be vulnerable to self-medication due to COVID-19 due to their greater exposure to social networks and their tendency to imitate self-medication practices of their social environment. Objective: Assess the characteristics and factors associated with self-medication due to COVID-19 in undergraduate university students of a Peruvian university. Methods: An analytical cross-sectional study (October 1st to November 14, 2020) in which 166 surveys were analyzed among students of the National University of Central Peru selected through a probabilistic sampling stratified by faculties. The factors associated with self-medication were evaluated by Poisson regression of robust variances, in this way the prevalence ratios and corresponding confidence intervals were obtained. Results: 14.5% of the students self-medicated due to COVID-19 and the main reasons were sore throat (45.8%), fever (37.5%) and disease prevention (29.2%). The most commonly used drugs were paracetamol (70.8%), aspirin (62.5%) and influenza drugs (62.5%). Some participants (20.8%) reported experiencing side effects after taking medications such as aspirin, ivermectin, dexamethasone, and chlorine dioxide. The perception that self-medication is harmful to health (PR: 0.41;CI: 0.20-0.84) and having doctors as a source of drug information (PR: 0.46;CI: 0.21-0.99) were associated with self-medication due to COVID-19. Approximately 15 out of every 100 students in the studied population self-medicated due to COVID-19. Likewise, those who perceived self-medication as harmful to health and who had doctors as a source of drug information self-medicated less. Conclusions: The results allow us to characterize the problem of self-medication due to COVID-19 in university students, while offering information for the approach of strategies that reduce its negative impact.
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Background: Despite using biosafety protocols, dentists fear contracting COVID-19 and face economic uncertainties about their professional future caused by the pandemic. Objective: This study aimed at determining the prevalence of anxiety and identifying factors associated with it among dentists during the COVID-19 pandemic in Brazil. Methods: A cross-sectional study involving 408 Brazilian dental surgeons selected by snowball technique who filled an electronic questionnaire about sex, race, dental specialty, health habits, health-related quality of life, anxiety, and COVID-19-related aspects. Symptoms of anxiety were measured by the Beck anxiety inventory, and health-related quality of life was assessed by the World Health Organization Quality of Life questionnaire. Poisson regression was used to obtain estimates of adjusted prevalence ratios. Results: The prevalence rate of anxiety was found to be 27.5% and it was significantly higher among dentists who were afraid of catching COVID-19 (Prevalence Ratio=PR=2.52), and among those who reported sweating, wheezing, and increased heart rate during work (PR=3.67). Afro-American dentists were 48% more anxious than dentists belonging to the white/yellow race. The mean value of the quality of life of anxious dentists compared to non-anxious dentists was 13% lower in the physical domain, 12% lower in the psychological domain, and 7% higher in the social relationship domain. Conclusion: The prevalence of anxiety among Brazilian dentists, in the context of economic uncertainty and social distance imposed by the COVID-19 pandemic, is high and associated with the fear of contracting the disease, physical symptomatology of stress, being Afro-American, and altered quality of life in the physical, psychological, and social relationships domains.