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Objective To explore the sociodemographic and psychological factors influencing the continuity of treatment of patients with chronic kidney disease under the regular epidemic prevention and control of coronavirus disease 2019 (COVID-19). Methods A total of 277 patients with chronic kidney disease who were admitted to Department of Nephrology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. 2020 to Mar. 2021 were enrolled and divided into 3 groups: non-dialysis group (n=102), hemodialysis (HD) group (n=108), and peritoneal dialysis (PD) group (n=67). All patients were investigated by online and offline questionnaires, including self-designed basic situation questionnaire, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). The general sociodemographic data, anxiety and depression of the 3 groups were compared, and the influence of sociodemographic and psychological factors on the interruption or delay of treatment was analyzed by binary logistic regression model. Results There were significant differences in age distribution, marital status, occupation, medical insurance type, caregiver type, whether there was an urgent need for hospitalization and whether treatment was delayed or interrupted among the 3 groups (all P0.05). The average SAS score of 65 PD patients was 38.15+/-15.83, including 53 (81.5%) patients without anxiety, 7 (10.8%) patients with mild anxiety, and 5 (7.7%) patients with moderate to severe anxiety. The average SAS score of 104 patients in the HD group was 36.86+/-14.03, including 81 (77.9%) patients without anxiety, 18 (17.3%) patients with mild anxiety, and 5 (4.8%) patients with moderate to severe anxiety. There were no significant differences in the mean score of SAS or anxiety severity grading between the 2 groups (both P0.05). The mean SDS scores of 65 PD patients were 53.42+/-13.30, including 22 (33.8%) patients without depression, 21 (32.3%) patients with mild depression, and 22 (33.8%) patients with moderate to severe depression. The mean SDS scores of 104 patients in the HD group were 50.79+/-10.76, including 36 (34.6%) patients without depression, 56 (53.8%) patients with mild depression, and 12 (11.6%) patients with moderate to severe depression. There were no significant differences in mean SDS scores or depression severity grading between the 2 groups (both P0.05). The results of intra-group comparison showed that the incidence and severity of depression were higher than those of anxiety in both groups. Multivariate binary logistic regression analysis showed that high school education level (odds ratio OR=5.618, 95% confidence interval CI) 2.136-14.776, P0.01), and unmarried (OR=6.916, 95% CI 1.441-33.185, P=0.016), divorced (OR= 5.588, 95% CI 1.442-21.664, P=0.013), urgent need for hospitalization (OR=8.655, 95% CI 3.847-19.476, P0.01) could positively promote the continuity of treatment in maintenance dialysis patients under the regular epidemic prevention and control of COVID-19. In the non-dialysis group, no sociodemographic and psychological factors were found to be associated with the interruption or delay of treatment (P0.05). Conclusion Education, marital status, and urgent need for hospitalization are correlated with the continuity of treatment in patients with chronic kidney disease on maintenance dialysis.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Objectives: Post-COVID conditions (PCC) are increasingly reported in people who had COVID. Certain racial or socioeconomic groups may be at greater risk for PCC and less likely to seek care. We examined the uptake of the new ICD-10-CM diagnosis code for PCC in routine clinical practice in the United States and how it varied by race and payer group. Method(s): Using the Optum de-identified Electronic Health Record (EHR) dataset, we identified patients with an ICD-10-CM code for PCC (U09.9) between October 1, 2021, through March 31, 2022, with 6 months of prior EHR activity. The earliest diagnosis defined the index date. All concurrent diagnoses were measured on the index date. Prior COVID diagnosis was assessed using all available data before the index date. Result(s): There were 23,647 patients: 9.9% were African American, 12.1% had Medicaid, and 2.4% were uninsured. There was an overrepresentation of white patients among those with PCC (78.6% compared with 69.6% of the overall EHR in 2021). More African American (24.1%), Medicaid (23.1%), and uninsured (27.5%) patients were diagnosed in the inpatient setting or emergency department than whites (14.0%) and commercially insured patients (10.0%). Among racial groups, African Americans had the highest percentage of documented prior COVID diagnosis at 63.6%. Of concurrent diagnoses, shortness of breath and acute respiratory failure with hypoxia were higher among African Americans (13.9% and 6.1%, respectively) than whites (11.5% and 4.3%, respectively). The same pattern was seen when comparing Medicaid and uninsured to commercial payors. Conclusion(s): The PCC code was used differently across racial groups and payor types and captures varying manifestations of PCC. The differences in diagnosis locations underscore the importance of using data capturing all care settings when conducting studies using this code. Subgroup analyses are important for future studies using U09.9 due to variability in code application.Copyright © 2023
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Objective. To describe the clinical and epidemical characteristics of a new coronavirus disease 2019 (COVID-19) in people living with HIV, for HIV infection implies the development of an immunosuppressive condition that may exacerbate the course of COVID-19. Material and methods. The research is based on retrospective and current epidemiological situation of HIV and SARS-CoV-2 infections in the Southern Russia regions during 2020 and survey of the patients with the co-infections concerning epidemiological, clinical, and laboratory diagnostic information. We collected all data from 15 regional centers for AIDS prevention and control in the Southern and North Caucasus Federal Districts. The survey sample consists of 121 patients. Statistical computation is done with Microsoft Office Excel 2010. Results and discussion. HIV patients of various age and social characteristics are involved in the COVID-19 epidemic process. Within registered HIV and SARS-CoV-2 co-infections all patients have apparent clinical symptoms. Asymptomatic cases are not presented. Mild cases prevail in the sample (48.8%). The frequency of severe and extremely severe was significantly higher in people living with HIV/AIDS on ART more than 2 months against naive PLHIV or using ART up two one month (p<0.05).Copyright © 2022 by the authors.
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The aim - to assess some medical and social aspects of the epidemic process during the first wave of a new coronavirus infectious disease - COVID-19 in the Republic of Tajikistan. Material and methods. The retrospective study was conducted on the basis of an epidemiological analysis of official statistics as part of the epidemiological surveillance of COVID-19 from April 2020 to April 2021. Results and discussion. At the beginning of April 2021, a total of 13 308 cases of COVID-19 were registered, of which the proportion of recovered was 99.3% (13 218 cases), and the number of cases with a fatal outcome was 0.68% (90 cases;the average age of the deceased was 62.3+/-0.07 years). The peak of infection during the first wave occurred in May and June 2020, when the average daily increase was 97 people. For 2 months of the epidemic in the republic, 44.6% of the total number of patients with COVID-19 became infected, and the number of deaths reached 52 people or 57.7%. Among the patients, men prevailed (65%). The largest number of deaths (76.7%;n=69) was among older people with comorbidities (diabetes mellitus, cardiovascular disease, chronic lung disease, metabolic syndrome, etc.). An analysis of the age structure showed that the main proportion of cases fell on the age group of 40-60 years (42.6%). It was found that a significant proportion of patients with COVID-19 was detected in the Sughd region (33.0%) and Dushanbe (30.1%). Conclusion. The COVID-19 pandemic showed that the national healthcare system of the Republic of Tajikistan was not sufficiently prepared for such a development of the COVID-19 epidemic process. There was an acute shortage of medical and preventive specialists in the republic. Given the current situation in the Republic of Tajikistan, within the framework of epidemiological surveillance, the features of the course of the COVID-19 epidemic process were analyzed, adequate emergency measures were developed and proposed to limit the spread of the virus and reduce the negative impact of COVID-19 on public health. The number of beds has been reasonably expanded, the capacity of the laboratory service has been increased, mass vaccination of the population has been started according to epidemic indications.Copyright © 2022 Geotar Media Publishing Group
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Although it has been almost three years since the World Health Organization (WHO) declared a pandemic, COVID-19 is still an unsolved problem, thereby attracting great scientific interest. The disease has a heterogeneous clinical picture with multiple manifestations from different organs and systems. Currently, COVID-19 is perceived as a polysyndromic inflammatory disease involving not only the respiratory system, but also the musculoskeletal system, the cardiovascular system, the skin, the excretory and the nervous system, and is accompanied by a number of hematological, gastrohepatoenterological and endocrine disorders. Various pain phenomena also appear in the clinical presentation of the disease, often as a single manifestation or in combination with symptoms from different organs and systems. The pathogenesis of pain is complex and there is still no consensus on the exact driving mechanisms. Several different signaling pathways play an important role in the generation of pain impulses and perception. They are different for different types of pain. At this stage, the role of angiotensin-converting enzyme 2 (ACE), the renin-angiotensin system (RAC), angiotensin 2 receptors (AT2R), direct neuronal invasion of the virus, the involvement of pro-inflammatory cytokines, hypoxia, the involvement of macrophages, is discussed. as well as the role of overactivity of the immune system, causing the so-called "cytokine storm". Pain is the result of complex biochemical processes influenced to varying degrees by biological, physiological and social factors. Our knowledge at this stage remains scarce and is the subject of many studies on the key pathogenic mechanisms. Therefore, the purpose of this review is to describe the known mechanisms for the occurrence and persistence of pain in patients with COVID-19, as well as to classify the pain phenomena and present its most common localizations. The diagnosis and treatment of COVID-19 and associated pain should be carried out by a multidisciplinary team of specialists, given the heterogeneous clinical presentation of the disease.Copyright © 2023 Medical Information Center. All rights reserved.
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Background: We sought to assess the anxiety and depression scores of pregnant women in Hong Kong during the COVID-19 pandemic and to evaluate the impact of demographic, economic and social factors on these scores. Method(s): This was part of an ongoing worldwide cross-sectional study conducted from 22 May 2020 to 28 February 2021. Data were collected through an anonymous web-based survey. The severity of depression and anxiety was assessed using the Patient Health Questionnaire-9 (PHQ-9) score and the General Anxiety Disorder-7 (GAD-7) score, respectively. Result(s): A total of 361 participants completed both the GAD-7 and PHQ-9 questionnaires. Participants with psychiatric illness reported a significant higher median GAD-7 score (6.00, interquartile range [IQR] 3.00-7.75 vs. 2.00, IQR 0.00-6.00, p = 0.001), while the median PHQ-9 score was also higher but was not statistically significant (6.50, IQR 3.00-11.00 vs. 5.00, IQR 3.00-8.00, p = 0.066). A higher proportion of participants with psychiatric illness reported moderate-severe depression and anxiety (35.7% vs. 16.5%, p = 0.002, 17.8% vs. 3.6%, p < 0.001 respectively). Multivariate regression analysis demonstrated that financial difficulty, in education and pregnancy by in-vitro fertilization were associated with a higher PHQ-9 score in pregnant women during the COVID-19 pandemic, while underlying psychiatric illness was associated with a higher GAD-7 score. Support from a partner was demonstrated to be associated with a reduced level of depression and anxiety in pregnancy. Conclusion(s): Pregnant women with underlying psychiatric illness were more vulnerable during the COVID-19 pandemics than the non-psychiatric counterparts. Partner support is important for alleviating depression and anxiety in pregnancy during the COVID-19 pandemic. Clinical Trial Registration: The study was registered at http://www.clinicaltrials.gov, registration number NCT04377412.Copyright © 2023 The Author(s).
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In the 21st century, global supply chains have experienced severe risks due to disruptions caused by crises and serious diseases, such as the great tsunami, SARS, and, more recently, COVID-19. Building a resilient supply chain is necessary for business survival and growth. Similarly, there is increasing regulatory and social pressure for managers to continuously design and implement sustainable supply chain networks, encompassing economic, social, and environmental components. Hence, a panacea approach is required to establish a compromise position between resiliency concerns and sustainability responsibilities. To address this, this work presents a hybrid integrated BWM-CoCoSo-multi-objective programming model (BC-MOPM) formulated to deliver a compromise between resilience and sustainability supply chain network design (RS-SCND). First, a thorough literature review analysis is conducted to explore the relationship and correlation between resilience and sustainability to develop a framework for the resiliency and sustainability criteria, in a supply chain context. Second, four objectives were formulated, including the minimisation of total cost and environmental impact and the maximisation of social and resilience paradigms. A real two-tier supply chain network is deployed to evaluate the applicability of the developed BC-MOPM. Furthermore, sensitivity analysis is conducted to establish the relative importance of the identified criteria to prove the model's robustness. Results demonstrate the capability of the BC-MOPM in revealing trade-offs between the resiliency and sustainability aspects. © 2023 Elsevier B.V.
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One of the global crises that people are dealing with today is the COVID-19 pandemic. The outbreak of this disease as a social phenomenon has affected all aspects of life. This study aimed to identify adult people's experiences during the COVID-19 outbreak. This qualitative research was performed with a conventional qualitative content analysis approach in Mashhad, Iran, from April to November 2020. twenty-five participants were selected through a purposeful sampling method with maximum diversity until data saturation was reached. Data were collected using semi-structured face-to-face interviews with open-end questions and analyzed with MAXQDA10 software. Two main categories were extracted (1) difficulties in multiple domains (psychological and informational problems, social challenges, spiritual and religious challenges, and economic problems), (2) adaptation to the epidemic (purposive self-care, ignoring the disease and health instructions, faith in God and optimism). The participants faced extensive challenges, which were made worse by the confusion and ambiguity about the information, quarantine, and social isolation. To continue living, the participants tried to adapt to situations. These results provide a guiding framework for policymaking and intervention.Copyright © 2023 Tehran University of Medical Sciences. All rights reserved.
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Introduction Kidney transplantation is often seen as the optimal form of kidney replacement therapy for children and young people (CYP) with stage 5 Chronic Kidney Disease (CKD5). Psychosocial factors have been cited to delay their access to a kidney transplant, however it is unclear what these factors are. We undertook a multi-centre qualitative study that explored the range of psychological and social factors that CYP, their carers and their paediatric nephrology multi-disciplinary team (MDT) perceived to influence how soon a CYP with CKD5 accesses a kidney transplant. This included factors that were perceived to influence kidney transplantation outcomes or deemed important to patients and their families in terms of their quality of life (QoL). Material and methods Semi-structured interviews were conducted with CYP, their carers and their paediatric nephrology MDT across 7 tertiary paediatric nephrology units in the United Kingdom. These interviews were reviewed for pertinent themes using Thematic Analysis following the approach of Braun and Clarke. Results A total of 36 interviews were conducted with 13 families and 16 members of the paediatric nephrology MDT. The majority of participating families identified as White (57%), followed by Black (22%) or Asian (21%). The following themes were deemed important to accessing kidney transplantation and post-transplant outcomes: health beliefs;relationship with and trust in healthcare;support networks;family relationships;socioeconomic circumstances;culture and race;and mental health and coping strategies. Specific challenges from living with CKD5 and living through the COVID-19 pandemic were also discussed due to their impact on QoL and accessing a kidney transplant. Conclusions There are a wide range of psychosocial factors that are perceived to influence a CYP's access to kidney transplantation. Longitudinal and prospective studies are needed to fully assess the relationship between these psychosocial factors and a CYP's access to, and outcomes of, kidney transplantation.
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Introduction: The COVID-19 pandemic forced many established processes to be assessed and changed, prompting new ways of working to overcome obstacles. This opened the door to a new patient referral pathway, with a nurse led screening clinic a viable option for patients as well as a development opportunity for nursing staff. Method(s): All outpatient clinics were cancelled in March 2020, with consultant slots reinstated as telephone only from April. Referrals were previously booked into a new patient consultant clinic followed by investigative blood work, before a second appointment for results. It became impractical for new referrals to be processed due to the impossibility of remote investigative blood tests, and the lack of an initial face to face review. Referrals are now screened by the attending consultant who ascertains urgency and which blood tests are required, before the patient is booked into a nurse appointment within the following month. This is a first face to face consultation where a full history is taken including medical diagnoses, family and bleed history, medications, allergies, social factors and surgical challenges. The consultation is documented electronically and blood samples are taken. The results are monitored by the nurses and repeat samples +/- further investigations are obtained, to ensure all results are available for the 1st consultant clinic appointment. Result(s): This new process enables us to safely manage urgency of appointments with clear, relevant history taking and extensive and accurate blood work being completed. This ensures all referrals into the consultant clinic are relevant and appropriate with the focus on diagnosis and discharge, as the doctor will be equipped with a full set of blood work and appropriate results. The number of patients reviewed has been steadily increasing, with 30 adults and 13 children in the past 12 months. Discussion/Conclusion: This approach enables safe screening for new patients whilst actively managing valuable consultant clinic appointment slots. It is important to be aware of the time requirement for the reviewing nurse to complete this appointment, and ensure staffing is sufficient to enable a thorough nurse led consultation to take place. Going forward we plan to formalise appointments in an official nurse screening clinic, and will also look to audit patients already seen, to ensure this approach is received as intended and to continue to obtain best practice.
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British and European public attitudes towards hand hygiene have evolved over time. Early examples of soap-like products date from Babylon around 5000 years ago, later probably passing along the silk route to Europe. A mixture of fats boiled with ashes were found in clay cylinders. In the fourth century BC, Hippocrates propagated ancient Chinese and Greek theories that epidemics spread via noxious 'miasma' particles. In the Roman Empire, Galen advocated health by balancing four humours (blood, yellow bile, black bile and phlegm). The Romans brought public bathhouses to Britain after invading in 55BC adding a social aspect to cleanliness, also bringing fresh water in aqueducts. Emily Cockayne's book Hubbub: Filth, Noise & Stench in England documents daily life in England from 1600 to 1770. Diarist Samuel Pepys reportedly rubbed himself 'clean' using a cloth. King Louis XIV of France reportedly took two baths during his reign, the first during his recovery from a convulsive episode. In the Middle Ages, 'cleanliness' focused on keeping up appearances. It was believed that white linen garments absorbed the body's impurities and cleaned the skin. People wore visible starched white collars and cuffs, to signal cleanliness and social superiority. British public attitudes changed during the nineteenth century, driven by discoveries showing a relationship between hygiene and health. Bulwer- Lytton disparagingly referred to the 'great unwashed' lower classes in his 1830 novel Paul Clifford. However, in 1837, Buckingham Palace did not have a bathroom. Bathing was mostly inaccessible, labourers would usually bath in sweat and were cleaned only on admission to hospitals or poor houses. In 1845, English dermatologist Sir Erasmus Wilson published a lay handbook called Healthy Skin. This was wildly popular and disseminated the health benefits of sanitation and clean skin. Public washhouses proliferated. By the 1920s handwashing was common practice in Western countries. Soap manufactures Lever Brothers launched a 'clean hands' campaign advising children to wash their hands 'before breakfast, before dinner and after school'. After the Second World War, bathrooms became widespread and home plumbing made village washhouses redundant and unappealing. Handwashing practices among healthcare workers have remained low, averaging 39%. Hand hygiene was at the forefront in tackling the COVID-19 pandemic. The public were advised to wash their hands frequently, for at least 20 s each time. Will this be a landmark in handwashing history.
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As President Biden's administration works towards a 'fair and humane' immigration overhaul, it becomes critical to examine the implications of immigration policies/laws under the Trump administration on the well-being of undocumented residents to inform equitable reformations. We investigate challenges faced by undocumented Latinx immigrants in accessing health care services in the sociopolitical climate under the Trump administration. This study, which follows a similar study among frontline service providers, presents key findings from 23 in-depth interviews with Latinx individuals. Understanding their experiences is necessary to advance access to health-promoting services and uphold the human right to health. Our study participants' narratives document multiple barriers to health care services, many notably exacerbated by increasingly restrictive immigration policies/laws and heightened punitive interior enforcement practices under the Trump administration. As the nation awaits equitable immigration reform, health care organizations should immediately incorporate, amplify, or alter programs/practices to facilitate access among their undocumented clients. Focused organizational changes have the potential to reduce unmet health needs, minimize financial burdens for families, and curtail potential public health threats, the latter a particularly imperative goal within the current COVID-19 pandemic. We also distill conclusions drawn from our interviews with clients and their convergence with and divergence from conclusions drawn from our related research with providers. While providers recognize the negative impact of sociopolitical factors on their clients' access to health care services, client experiences illuminate potential gaps in their understanding. Bridging understanding between providers and clients can improve access, utilization, and retention in health care services.Copyright © 2022 The Authors
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Background: Neurodivergence has been established as associated with a significant number of co-occurring physical conditions, particularly for autistic individuals who are at risk for increased pain, hypermobility (including Ehlers-Danlos Syndrome) and gastrointestinal problems. However, data, so far, has been focused on adults and generally limited to discussions of condition prevalence alone. Method(s): The following article will present a topical review of the literature considering evidence for increased physical health concerns within neurodivergent populations, particularly autistic individuals, with a focus on the impact that these physical health concerns may have in an educational setting. Results and discussion: The impact of physical health concerns within neurodivergent populations in an educational setting may be concerning. Such populations may face a range of challenges in obtaining appropriate support for physical conditions. We discuss a number of said challenges including;communication challenges, misattributing physical health symptoms as a part of neurodivergence, and a history of not being believed, which limits symptomatic reporting. We further consider the potential impact these physical health concerns may have on scholastic and social development, such as impacts for attainment and attendance. Furthermore, we provide recommendations for teachers, parents/carers and other allied professionals in young people's lives, on supporting young neurodivergent people with physical health concerns.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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COVID-19 has highlighted a brutal reality known for decades, that Black, Indigenous, and People of Color bear a disproportionate burden of US annual sepsis cases. While plentiful research funds have been spent investigating genetic reasons for racial disparities in sepsis, an abundance of research shows that sepsis incidence and mortality maps to indicators of colonial practices including residential segregation, economic and marginalization sepsis, and denial of care. Here we argue that sepsis risk is an immunological embodiment of racism in colonial states, that the factors contributing to sepsis disparities are insidious and systemic. We show that regardless of causative pathogen, or host ancestry, racialized people get and die of sepsis most frequently in a pattern repeatedly reiterated worldwide. Lastly, we argue that while alleviation of sepsis disparities requires radical, multiscale intervention, biological anthropologists have a responsibility in this crisis. While some of us can harness our expertise to take on the ground action in sepsis prevention, all of us can leverage our positions as the first point of contact for in depth human biology instruction on most college campuses. As a leading cause of death worldwide, and a syndrome that exhibits the interplay between human physiology, race and environment, sepsis is at the nexus of major themes in biological anthropology and is a natural fit for the field's curriculum. In adopting a discussion of race and sepsis in our courses, we not only develop new research areas but increase public awareness of both sepsis and the factors contributing to uneven sepsis burden.Copyright © 2022 The Authors. American Journal of Biological Anthropology published by Wiley Periodicals LLC.
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Morbidity surveys in certain regions during the COVID-19 pandemic have established that the infection spreads in a wave-like manner characterised with peaks and troughs in incidence. According to the analysis of COVID-19 epidemic development in Russia, surges in COVID-19 infections are mainly driven by seasonal factors, insufficient herd immunity, and emerging SARS-CoV-2 variants with increased transmissibility. The aim of the study was to analyse environmental, biological and social factors contributing to new rises in COVID-19 cases in Russia. The study covers the global epidemiological situation as of mid-2022 and the role of environmental, biological, and social factors in the spread of COVID-19 in the Russian Federation. The results suggest that new highly contagious SARS-CoV-2 variants and seasonality are the principal factors driving new rises in morbidity. The authors assume that the sixth and the seventh COVID-19 waves in Russia will be in line with the best case scenario, which predicts the spread of a SARS-CoV-2 variant with increased transmissibility and reduced virulence.Copyright © 2023 Safety and Risk of Pharmacotherapy. All rights reserved.
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BACKGROUND: The state and prospects of the healthcare industry of a country are among its top priorities because the quality of life and health of its citizens are indicators of its success and competitiveness. The aim of this study is to conduct a theoretical analysis and qualitative and quantitative assessments of indicators by developing an integral indicator in the context of behavioral, social, demographic, and economic factors that characterize the level of healthcare system development in European countries using multivariate statistical modeling methods. METHODS: The study was implemented using Statistica 10 and Statistica Portable statistical packages. The statistical base of the study was formed using descriptive analysis; a group of 10 European countries was identified using a cluster analysis based on the application of an iterative divisive k-means method. The degree and significance of the interrelations between the components characterizing the studied groups of indicators were determined using canonical correlations by conducting a canonical analysis. Factor modeling is conducted by applying the analysis of the main components to determine the relevant indicators for assessing the level of healthcare system development to build integral indicators of the level of healthcare system development in European countries. RESULTS: The need to improve the level of healthcare system development in European countries was confirmed. Shortcomings and possible reserves for potential improvement of the healthcare system were identified. CONCLUSIONS: The results can help public authorities, officials and employees of the healthcare sector organize and conduct effective, timely, high-quality regulation and adjustment of the regulatory and legislative framework to improve healthcare system development.