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1.
Annals of Emergency Medicine ; 80(4 Supplement):S65, 2022.
Article in English | EMBASE | ID: covidwho-2176230

ABSTRACT

Study Objectives: Increased rates of suicide and suicidal thoughts amongst Emergency Medical Service (EMS) professionals continue to be reported in literature which has directed attention to potential causative factors. Burnout is one of the factors most discussed as being associated with this increase. There are limited studies of factors that correlate with increased burnout. Our objective was to conduct a survey of a statewide population of emergency services providers to evaluate their rate of burnout in addition to identifying both work and personal factors that may contribute to their burnout level. We also looked at self-reported burnout prior to the Covid 19 pandemic and during. Method(s): A voluntary, anonymous electronic survey was distributed to all registered emergency medical providers in the state of Louisiana through the Louisiana Bureau of EMS and the Louisiana Ambulance Alliance from 5/18/2020 to 7/24/2020. These participants represented paid and volunteer providers from a variety of systems to include;fire based, private, third city and air medical services. Data was analyzed utilizing descriptive statistics. Results/Findings: We received a total of 1,505 responses from the 24,000 EMS providers licensed with the Louisiana Bureau of EMS. The overall response rate when factoring all active Louisiana providers was 6.09% However, the response rate increases with increasing level of provider with more 50% of responses from paramedic and advanced emergency medical technicians (AEMT) The paramedic response rate was 22.39%. The advanced EMT response rate was 28.74% The EMT response rate was much lower at 9.03%. Burnout level increased with number of years of EMS experience, increased years at current EMS provider level and more advanced levels of provider. Shift length of 12-24 hours showed the highest level of burnout (2.8, IQR 2-4). Decreased amounts of sleep correlated with increasing burnout levels. Supervisory positions correlated with higher levels of burnout. Services that did transfers only showed the lowest burnout levels (1, IQR 0-2) and those who did scene calls with and without transfer and special events showed the highest levels of burnout (2.75, IQR 2-3.5). Burnout level for pre-COVID (at 2.1) was statistically lower than burnout during COVID (2.7, p=3.15x10- 24). Burnout level pre-COVID was highest when respondents were contemplating leaving the profession and expected their profession to end within less than 1.75 years (135 individuals fall into this category). Burnout during COVID was highest not only with those two categories influencing it, but also with the perception of unfair compensation, typical shift length and years of experience. Unfair compensation had a greater impact for the COVID burnout measurement than years of expected continued service. Conclusion(s): Pressures resulting in high burnout changed in this time;although contemplating leaving was still the greatest factor contributing to burnout, the second-most important decision changed from predictions about continued employment to concerns regarding fair compensation. Burnout was significantly higher during COVID and was subject to more variables than pre-COVID burnout. [Formula presented] [Formula presented] No, authors do not have interests to disclose Copyright © 2022

2.
Archives of Pathology & Laboratory Medicine ; 146(12):1431, 2022.
Article in English | ProQuest Central | ID: covidwho-2155712
3.
Journal of Sustainable Tourism ; 30(12):2726-2747, 2022.
Article in English | CAB Abstracts | ID: covidwho-2134216

ABSTRACT

Tourism development in the United States and globally is deeply rooted in hypercapitalist strategies and influenced by neoliberal conditions which prioritize economic development often to the detriment of those living and working in tourism destinations. The tourism workforce is a major entity sustaining the day to day operations of the tourism system, yet it remains underexplored. The COVID-19 global pandemic has only strengthened the argument for the need to prioritize the social-or person-aspect of sustainable tourism. Critical qualitative methods such as situational analysis combined with theoretical perspectives like critical race theory can provide methodological tools to expose and re-envision privatized constructions of sustainable tourism. In this article, we describe possibilities for using critical situational analysis to examine a broad range of complex conditions and provide examples of situational mapping from a study focusing on disaster capitalism and the use of tourism development as a strategy in post-Katrina New Orleans. We then offer possibilities for using situational analysis as critical qualitative inquiry moving forward.

4.
Ethics, Medicine and Public Health ; : 100860, 2022.
Article in English | ScienceDirect | ID: covidwho-2122582

ABSTRACT

Background and aims. - Healthcare workers (HCW) throughout the world have been exposed to economic and existential stress during the Covid-19 pandemic. The American Medical Association (AMA) has documented that increased healthcare burden correlates with increased HCW stress, burnout, and psychological burden. However, limits on personnel, time, and in person interactions make it challenging to assess mental health outcomes during a pandemic. This pilot test case study used virtual technology to efficiently assess these outcomes. Setting. - Data were collected based on voluntary participation in the Coping with Covid-19 for Caregiver’s survey created by AMA. The survey was sent out to approximately 300 participants who included local physicians, medical residents, medical students, and allied health professionals and students who attended a virtual Mental Health Summit. Methods. - The survey was developed by the AMA, and it included questions about demographics, overall stress, fear of infection and transmission of the virus, perceived anxiety or depression due to Covid, work overload, childcare issues, and sense of meaning and purpose. The AMA allows for up to five additional questions to be added to their survey, therefore five questions regarding support service utilization, perseverance, and resilience during Covid-19, and two items to further understand students’ areas of medical interest. The survey was administered using an online platform through the AMA. The data were analyzed using descriptive statistics. Results. - There were 81 survey respondents. Based on the results of the survey, “high stress” was found in 52 (64%) participants. 66 (81%) were afraid (moderately or to a great extent) of exposure or transmission, 61 (75%) described high levels of anxiety or depression, and 67 (84%) noted work overload. Despite this increase in stress, most respondents (77%) said they were not likely to reduce their devoted hours in clinical care or research in the next 12 months, and 81% answered that they would not leave their practice or research within two years. Conclusion. - Covid-19 has negatively affected the wellbeing of HCW. This is a similar trend seen during other times of healthcare strain. Mental health support, work modulation, and various provisions should be explored as means to reduce Covid-related negative impacts. The use of online an online summit and online data collection methods were appropriate for collecting data on the impact of Covid on mental health. This pilot study supports the larger scale implementation of this technology for health informatics research.

5.
Dissertation Abstracts International: Section B: The Sciences and Engineering ; 84(1-B):No Pagination Specified, 2023.
Article in English | APA PsycInfo | ID: covidwho-2101655

ABSTRACT

Both the HIV pandemic and the COVID-19 pandemic have highlighted underlying racial and socioeconomic health disparities in Louisiana, as well as in the United States. Neighborhood factors, such as community violence and social vulnerability, likely play a significant role in these disparities.The goals of this study were to examine the relationship between community violence exposure and HIV sexual risk behaviors and to examine the impact of neighborhood-level social vulnerability on HIV testing practices and COVID-19 incidence.Data from the National HIV Behavioral Surveillance System, the CDC Social Vulnerability Index (SVI) Database, and the Louisiana Department of Health were analyzed. The CDC SVI was used to measure neighborhood-level social vulnerability, which comprises four related factors: socioeconomic status, household composition and disability, minority and language, and housing characteristics and transportation.First, the relationship between community violence exposure and HIV sexual risk behaviors was examined among an age-diverse population of heterosexually active adults. A positive association was observed between community violence exposure and HIV sexual risk behaviors. Gender did not modify this relationship.Second, the relationship between neighborhood-level social vulnerability and recent HIV testing history was examined. Neighborhood-level socioeconomic status was the only social vulnerability factor observed to be associated with recent HIV testing, where individuals residing in lower socioeconomic neighborhoods had lower odds of receiving a recent HIV test than those residing in higher socioeconomic neighborhoods. This association diminished as age increased.Third, the relationship between social vulnerability and COVID-19 incidence during the first six months of the COVID-19 pandemic within Louisiana census tracts was examined. All four factors measuring social vulnerability were found to be associated with COVID-19 incidence;Louisiana census tracts with higher levels of overall social vulnerability exhibited higher levels of COVID-19 incidences. The results of this study provide further evidence that neighborhood characteristics can influence health behaviors (e.g., sexual risk behaviors), access to healthcare (e.g., HIV testing), and health outcomes (e.g., COVID-19 infections). In conclusion, future public health initiatives should focus on identifying and removing barriers to health within identified vulnerable neighborhoods. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

6.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P36-P37, 2022.
Article in English | EMBASE | ID: covidwho-2064488

ABSTRACT

Introduction: With the relaxation of pandemic-related operative restrictions, there has been an increase in elective facial plastic surgical cases in comparison with 2018, prior to the COVID-19 pandemic. The objective of this study is to compare the surgical volume of pre-COVID-19 pandemic cosmetic facial plastic surgery (FPS) in 2018 with the postpandemic volume in 2021, in both a tertiary care academic practice and community practice. Method(s): This is a retrospective chart review of adult patients undergoing cosmetic FPS at an academic tertiary care center and community practice: Louisiana State University Health Shreveport (LSU) and Kenneth Sanders Facial Plastic Surgery in Louisiana, respectively. Information assessed included demographics, surgical date, and surgical procedure performed during the first 6 months of 2018 and 2021. Categorical variables were compared using 2-proportion z test and Pearson chi2 test. Odds ratio (OR) was used to calculate the likelihood of procedural year predicting subsequent FPS. Result(s): One hundred thirty-nine patients were identified: 58 (41.7%) patients in 2018 and 81 (58.3%) patients in 2021. The number of patients having FPS in the <30-year-old age group increased by 13.6% from 2018 to 2021 (P=.02). The number of septorhinoplasties increased by 20.5% from 2018 to 2021 (P=.01). Furthermore, the odds of one having a septorhinoplasty in 2021 increased 144% compared with 2018 (OR: 2.44 [95% CI, 1.19, 5.11]). The only cosmetic surgery to significantly decrease in volume during the postpandemic time period was rhytidectomy (OR: 0.33 [95% CI, 0.12, 0.82]). Conclusion(s): The COVID-19 pandemic has seen a significant rise in FPS in patients younger than 30 years and those electing to have septorhinoplasty. The etiology of this increase is not clear;however, possible explanations include the following: increased disposable income, "Zoom dysmorphia," and the ability for conspicuous recovery behind a mask.

7.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S412-S413, 2022.
Article in English | EMBASE | ID: covidwho-2058683

ABSTRACT

Purpose: Inflammatory bowel disease (IBD) is an autoimmune disease that consists of Crohn's Disease (CD) and ulcerative colitis (UC). IBD is thought to result from an environmental trigger, one of which could be diet, in a genetically susceptible host. Food insecurity is defined as limited or uncertain access to enough food. It is estimated that 1 in 7 children in the United States experience food insecurity which is estimated to be about 13 million children. This number has increased since the COVID pandemic to 1 in 4. Louisiana has one of the higher rates of food insecurity in the country with an estimate of over 249,000 children affected. Food insecurity is higher in African American and Hispanic households. Despite nutrition playing a significant role in IBD, there is limited data on food insecurity and IBD. Only one adult study identified that adult IBD patients had 69% higher odds of being food insecure compared to peers without IBD. The purpose of this study is to evaluate if pediatric patients with IBD are food insecure. Our hypothesis is that newly diagnosed pediatric IBD patients who are food insecure have worse clinical outcomes than those who are food secure 6 months after diagnosis. The primary aim will be to assess if food insecurity is associated with escalations in therapy within the first 6 months of diagnosis. Secondary aim of the study is to determine if food insecurity is associated with other clinical outcomes. Food access will also be evaluated to see if patients who are food insecure live in areas defined as a food desert, decrease access to nearby grocery stores, or food swamps, defined as adequate access to food but mostly higher calorie food options over healthy food options. Method(s): This is a prospective study of newly diagnosed pediatric IBD patients seen in the Louisiana State University Health Science Center Pediatric Gastroenterology Division at Children's Hospital New Orleans. Patients were screened for food insecurity using the United States Department of Agriculture's food insecurity screening and the American Academy of Pediatrics' Food Insecurity 2-Question Screen. Data was collected including escalations in medication, hospitalizations, surgeries, emergency room visits and nutritional data over the first 6 months of diagnosis. To determine diet quality, food journals were completed, or comprehensive diet recalls were performed then analyzed by a licensed dietitian. Result(s): There are currently 13 patients enrolled in this ongoing study. All patients have Crohn's Disease and receive maintenance therapy with TNF alpha antagonist (infliximab or biosimilar). Most patients are female (69%), Medicaid insurer (54%), with approximately half identifying as white race (46%) and half identifying as African American (46%). The average age at diagnosis was 14.4 years (+/- 2.7 years). Nine of the patients (69%) have no grocery stores within 1 mile of their home. Three patients lived in a food swamp (23%), 1 of which also had low food security. There was one patient who did not live in a food desert or food swamp but identified as having low food security. The average BMI was 19.4 and 3 had a BMI z-score less than -1 at diagnosis. Two parents were identified as having low food security and 2 patients screened positive for low food security. Only one survey matched low food security for both parent and child. For transportation, many traveled to appointments by automobile but were not owners of the automobile. At one month after diagnosis, there was 1 medication change due to the development of antibodies, 2 courses of oral steroids, 2 patients had an additional medication added (methotrexate for both), 3 hospitalizations, 1 surgery;however, none of the patients fit criteria for low food security. There were 2 emergency room visits, 1 of 2 were food insecure. Weight gain in one month ranged from 0.3 to 10.4 kilograms. One food insecure patient lost 0.8 kilograms at 1 month. Conclusion(s): While there were few patients identified as food insecure, each patient had relatively poor access to healthy food options. Every patient in the study either fell into the category of having no grocery stores within a mile of their home, living in a food swamp or having low food security. Establishment of additional surrogates for food insecurity may be warranted to better assess the association of food insecurity with IBD. The significance of food insecurity in pediatric IBD remains unclear. However, longer follow-up is planned to further assess the relationship between food insecurity and clinical and nutritional outcomes. Additional studies are forthcoming to evaluate the impact food quality within the diet of pediatric IBD patients has on short-term and long-term health outcomes.

8.
ASAIO Journal ; 68(Supplement 3):68, 2022.
Article in English | EMBASE | ID: covidwho-2058158

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is a life-saving treatment modality for patients with severe respiratory and cardiac failure. During the COVID-19 pandemic, the ability to utilize this service worldwide was limited by the number of facilities capable of providing ECMO support and their patient capacity. We describe an institution rapidly deploying an ECMO transport program to improve access to this service and optimize its capacity. As the only ELSO Center of Excellence in the state of Louisiana, and one of the few facilities that can provide this service in the state, our center had an obligation to expand our ability to provide access to ECMO support in our region. However, as we had not performed ECMO transport before the pandemic, we were faced with challenges in developing the infrastructure for a transport program. Due to limited resources and our emphasis on treating the maximum number of patients, we had to create and implement protocols simultaneously, refining them as we went. We relied on programs that had previously developed transport protocols and procedures for guidance, adapting their templates for our program's specific characteristics. Less than one month after obtaining our first CardiohelpTM system we performed our first ECMO transport by air. Over the next twelve months, we performed more than ten transports by air and ground successfully with no mortalities or complications during transport. Despite various obstacles, we succeeded in creating a transport service and improved our ability to provide ECMO support to patients throughout the state of Louisiana.

9.
Institute of Transportation Engineers. ITE Journal ; 92(10):9, 2022.
Article in English | ProQuest Central | ID: covidwho-2057509

ABSTRACT

Louisiana Department of Transportation (DOT) Secretary Dr. Shawn Wilson joins the ITE Talks Transportation podcast for a dynamic conversation on the state of the industry and why he feels it's "the most exciting time" ever to work in transportation. He shares his perspectives on the Bipartisan Infrastructure Law and how the funding can help state DOTs address safety, especially for vulnerable users. He also addresses the myriad of challenges brought on by COVID-19 for DOTs, and discusses how agencies can gain a competitive edge among the current workforce.

10.
Louisiana Agriculture ; 65:2, 2022.
Article in English | CAB Abstracts | ID: covidwho-2045537

ABSTRACT

This article reports on the inclusion of wild-caught shrimp in the USDA Agricultural Marketing Service (AMS) program to help Louisiana's shrimp industry during the COVID-19 pandemic. As a result of a quick Sea Grant mobilization, $50 million in cash from USDA was infused into the shrimping industry, and 7.6 million pounds of Louisiana shrimp were taken out of inventory and distributed nationwide.

11.
Louisiana Agriculture ; 65:2, 2022.
Article in English | CAB Abstracts | ID: covidwho-2044964

ABSTRACT

This article presents an overview of the growth of the Louisiana nursery industry and the labour challenges the industry is facing. Labour issues in the nursery industry are not easily solved, considering the nature and seasonality of employment and competition from other industries. Despite the benefits associated with the H-2A guest worker program, particularly securing seasonal workers in times of need, which allows nurseries to cope with labour shortages, few Louisiana nurseries rely on the H-2A program. Moreover, prolonged impact of the COVID-19 pandemic also raises concerns on ways the industry needs may change and how it will affect securing labour.

12.
Transplantation ; 106(8):121-122, 2022.
Article in English | EMBASE | ID: covidwho-2040847

ABSTRACT

Background: This study aimed to assess the impact of the recently (02/2020) implemented Acuity Circles (AC) liver allograft allocation policy on MELD at transplant and Donation after Circulatory Death (DCD) rates. Methods: Study period: 01/2016- 08/2021. Data retrieved from SRTR database. Inclusion criteria: All DCD liver transplants (LT). The cohort was dichotomized into a pre- and post-AC era. DCD rate (defined as DCD/ 50k population/year) was calculated for each State. The change (Δ) on the DCD rate (ΔDCD) and the MELD (ΔMELD) between the two periods was also calculated. Results: 1. Total LT increased in the post-AC era (26%/50k vs. 15%/50k, p=0.0567). 2. DCD LT increased in the post-AC era (15%/50k vs.10%/50k, p=0.0885). 3. MELD increased in the post-AC era in nearly all States (ΔMELD, fig.1, 2 & 3). 4. Uneven distribution of pre- & post-AC DCD activity, with a few States driving DCD LT in the US (fig.4 & 5). 5. Arizona and Louisiana had the highest pre-AC DCD rates (58%/50k & 31%/50k, respectively;fig.3). 6. The top post-AC DCD rate was reached in Arizona (78%/50k, fig.5). 7. Top post-AC ΔDCD was noted in Arkansas & Arizona (fig.6). 8. The highest ΔMELD was noted in low DCD/ negative ΔDCD areas (fig.7). 9. The lowest ΔMELD was noted in areas with the highest DCD rate (fig.7) 10. The State with the highest DCD rates pre-AC had the highest ΔDCD (fig.5). 11. 10/11 States with negative ΔDCD were located North of the 35o. Conclusions: AC implementation coincided with an increase in the overall LT & DCD LT activity. However, causation remains to be clarified, given the concurrent opioid crisis and SARS-CoV-2 pandemic. There was remarkable DCD rate variation. States with high DCD rates/ΔDCD demonstrated greater adaptability in the allocation change, maintaining low ΔMELD across eras. (Figure Presented).

13.
The Journal of Gemmology ; 38(3):284-287, 2022.
Article in English | ProQuest Central | ID: covidwho-2040464

ABSTRACT

First he examined the interactions between the lingering effects of the COVID-19 pandemic and current economic and social transformations. In light of the session in his honour, Dr George Harlow (American Museum of Natural History, New York, USA) chronicled the history of his career, in which he built collections, organised exhibitions and performed geological fieldwork around the world while researching jade, ruby, etc. Pamir rubies formed at unusually low pressures (minimum of 1–1.2 kbar) and a temperature of approximately 760°C. Wim Vertriest (Gemological Institute of America [GIA], Bangkok, Thailand) and co-authors reviewed the identification of low-temperature heat treatment of gem corundum (i.e. up to about 1200°C, which starts causing damage to rutile ‘silk’ inclusions). In another presentation, Dr Dutrow and co-authors investigated the origin determination of Cu-bearing tourmaline using statistical analyses of LIBS and electron microprobe data.

14.
J Racial Ethn Health Disparities ; 2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-2035482

ABSTRACT

Early COVID-19 pandemic data suggested racial/ethnic minority and low-income earning people bore the greatest burden of infection. Structural racism, the reinforcement of racial and ethnic discrimination via policy, provides a framework for understanding disparities in health outcomes like COVID-19 infection. Residential racial and economic segregation is one indicator of structural racism. Little attention has been paid to the relationship of infection to relative overall concentrations of risk (i.e., segregation of the most privileged from the most disadvantaged). We used ordinary least squares and geographically weighted regression models to evaluate the relationship between racial and economic segregation, measured by the Index of Concentration at the Extremes, and COVID-19 cases in Louisiana. We found a significant global association between racial segregation and cumulative COVID-19 case rate in Louisiana and variation across the state during the study period. The northwest and central regions exhibited a strong negative relationship indicating greater risk in areas with high concentrations of Black residents. On the other hand, the southeastern part of the state exhibited more neutral or positive relationships indicating greater risk in areas with high concentrations of White residents. Our findings that the relationship between racial segregation and COVID-19 cases varied within a state further support evidence that social and political determinants, not biological, drive racial disparities. Small area measures and measures of polarization provide localized information better suited to tailoring public health policy according to the dynamics of communities at the census tract level, which may lead to better health outcomes.

15.
American Journal of Pharmaceutical Education ; 86(6):759-775, 2022.
Article in English | ProQuest Central | ID: covidwho-2033922

ABSTRACT

President - John Clay Kirtley, PharmD, Executive Director, Arkansas State Board of Pharmacy (National Associate of Boards of Pharmacy (NABP));Vice-President - Reza Karimi, RPh, PhD, Dean & Professor, Pacific University School of Pharmacy (American Association of Colleges of Pharmacy, AACP);Secretary/ Treasurer - Amy L. Seybert, BS, PharmD, FASHP, FCCP, CHSE, Associate Professor and Chair of the Department of Pharmacy and Therapeutics at the University of Pittsburgh School of Pharmacy (American Pharmacists Association, APhA) Board Members. Marie A. Chisholm-Burns, PharmD, MPH, MBA, FCCP, FASHP, Dean at the University of Tennessee Health Science Center College of Pharmacy and Professor of Surgery in the College of Medicine (AACP);Gregory Gruener, MD, MBA, MHPE, Vice Dean for Education, Stritch School of Medicine, Loyola University Chicago, Ralph P. Leischner Jr., MD, Department of Medical Education, Professor, Neurology (American Council on Education, ACE);Kimberly S. Croley, PharmD, BCGP, FASCP, FAPhA, Director of Pharmacy and Clinical Pharmacist for Laurel Senior Living Communities (APhA);Winnie A. Landis, BS Pharm, CDE, FAPhA, Community Pharmacist, CVS Health (APhA);LuGina Mendez-Harper, PharmD, Director, Professional Practices, at Prime Therapeutics (NABP);Michael A. Mone, RPh, JD, FAPhA, Senior Legal Counsel, CVS Health (NABP);Sharon L. Youmans, PharmD, MPH, FAPhA, Vice Dean at the University of California San Francisco and Professor of Clinical Pharmacy (AACP) Continuing Pharmacy Education (CPE) Commission The CPE Commission met virtually, due to the COVID-19 pandemic, on May 11-13, 2021, and November 16-18, 2021. Crystal Carter, MPA, Louisiana Pharmacists Association;JoAnn Francis, BS Pharm, MBA, CHCP, American Society of Health System Pharmacists;Peter J. (P.J.) Hughes, PharmD, MSEd, BCPS, Samford University;Barbara Jolly, RPh, MPA, LDE, Sullivan University College of Pharmacy;Lindsay Kaster, PharmD, BCOP, Boise VA Medical Center;Nicholas Lehman, PharmD, BCACP, Drake University College of Pharmacy and Health Sciences and UnityPoint West Des Moines Family Medicine & Internal Medicine Clinics;Jennifer Pauley, PharmD, BCPS, BCOP, St. Jude Children's Research Hospital;Ginger Scott, RPh, MS, PhD, West Virginia University School of Pharmacy;Kathy Schott, PhD, CEimpact;Barbara Ellen Maguire Vick, JD, PharmD, BCSCP, North Carolina Board of Pharmacy;Diane Yoon, EdD, USC School of Pharmacy, Health Sciences Campus. For Purposes of Considering Continued Accreditation Status Creighton University School of Pharmacy and Health Professions·;Duquesne University School of Pharmacy;Florida Agricultural & Mechanical University College of Pharmacy and Pharmaceutical Sciences·;Howard University College of Pharmacy;Long Island University Arnold and Marie Schwartz College of Pharmacy and Health Sciences·;Mercer University College of Pharmacy Doctor of Pharmacy;Midwestern University College of Pharmacy·;Rosalind Franklin University of Medicine and Science College of Pharmacy;South College School of Pharmacy;University of Arkansas for Medical Sciences College of Pharmacy;University of California, San Francisco School of Pharmacy;University of Cincinnati James L. Winkle College of Pharmacy;University of Connecticut School of Pharmacy;University of Kansas School of Pharmacy;University of Louisiana at Monroe College of Health and Pharmaceutical Sciences School of Pharmacy;University of Utah College of Pharmacy Accredited with Probation Status Chicago State University College of Pharmacy For Purposes of Considering Advancement from Precandidate to Candidate Status American University of Health Sciences School of Pharmacy Removal of Accredited with Probation Status: None For Purposes of Considering: Application for Precandidate Status: California Health Sciences University College of Pharmacy (three year) (precandidate status denied) For Purposes of Considering: Continued Candidate Status None For Purposes of Considering: Continued Accredited Status (after initial two-year term) University of Texas at Tyler Ben and Maytee Fisch College of Pharmacy For Purposes of Considering: Advancement from Candidate to Accredited Status Larkin University College of Pharmacy (advancement denied;held at candidate status);SUNY Binghamton University School of Pharmacy and Pharmaceutical Sciences;University of Texas at El Paso College of Pharmacy;William Carey University School of Pharmacy Focused On-site Evaluation Visits Albany College of Pharmacy and Health Sciences School of Pharmacy and Pharmaceutical Sciences;D'Youville College School of Pharmacy;St. John Fisher Wegmans School of Pharmacy;Touro New York College of Pharmacy;University at Buffalo The State University of New York School of Pharmacy and Pharmaceutical Sciences;University of the Pacific Thomas J. Long School of Pharmacy;University of Tennessee Health Science

16.
Public Health Rep ; : 333549221120676, 2022 Sep 05.
Article in English | MEDLINE | ID: covidwho-2020755

ABSTRACT

OBJECTIVE: On June 17, 2021, Louisiana launched a lottery campaign to reward residents who received a COVID-19 vaccination. We investigated the association between the lottery and vaccination uptake by characteristics of parishes. METHODS: We constructed an interrupted time series based on daily parish-level data on COVID-19 vaccinations to analyze the association with the lottery. We used recursive partitioning to separate vaccination uptake due to the Delta variant from vaccination uptake due to the lottery and limited our study period to May 25 through July 20, 2021. We performed subanalyses that grouped parishes by political affiliation, hesitancy toward COVID-19 vaccines, race and ethnicity, and socioeconomic status to detect heterogeneous responses to the lottery by these characteristics. We ran models separately for parishes in the top and bottom tertiles of each sociodemographic indicator and used a z test to check for differences. RESULTS: The lottery was associated with an additional 1.03 (95% CI, 0.61-1.45; P < .001) first doses per parish per day. Comparing lottery impacts between top and bottom tertiles, we found significantly larger associations in parishes with lower vaccine hesitancy rates, higher percentage of Hispanic population, higher median annual household income, and more people with a college degree. CONCLUSIONS: Results suggest that the lottery was associated with increased COVID-19 vaccination uptake in Louisiana. However, larger associations were observed in parishes with an already higher likelihood of accepting vaccines, which raises equity issues about the opportunity created by the lottery and its effectiveness as a long-term behavioral incentive.

17.
American Journal of Kidney Diseases ; 79(4):S2-S3, 2022.
Article in English | EMBASE | ID: covidwho-1996877

ABSTRACT

Inheritance of the APOL1 G1 or G2 risk alleles in the homozygous or compound heterozygous state, are associated with a ~7-30X increased risk of development of chronic kidney disease (CKD), and with collapsing glomerulopathies in individuals with viral infections including COVID-19 or HIV. Identification of APOL1 high risk genotypes (HRG) can impact patient treatment, prognosis and kidney donor selection. Approximately 13% of African Americans (AA) have an APOL1 HRG, indicating genetic testing in this population can identify those at-risk for CKD development, leading to appropriate patient counseling and management. Here we sought to understand the clinical presentation and variability among patients with APOL1 HRGs, following the implementation of genetic testing for kidney disease with a broad panel at a Louisiana Nephrology clinic. Clinical genetic testing of patient samples was performed using a >380 kidney gene panel (the RenasightTM test, Natera, Inc.) A retrospective review of clinical data for individuals positive for an APOL1 HRG (G1/G1, G2/G2, G1/G2) was performed. We identified 12 patients that were positive for an APOL1 HRG, with all genotypes represented: G1/G1 (n=8), G1/G2 (n=3), and G2/G2 (n=1). Among this cohort, 100% (12/12) were of AA descent. At the time of testing 91% (11/12) of the patients were diagnosed with CKD or ESRD with proteinuria. Biopsy confirmed focal segmental glomerulosclerosis (FSGS) in two patients and collapsing glomerulopathy in one patient. The most common comorbidities among this cohort were hypertension (9/12) and diabetes mellitus (2/12). Four patients had a history of infection with COVID-19 (n=3) or HIV (n=1), three of whom had renal involvement (acute kidney injury or CKD and proteinuria). Use of a broad kidney gene panel enabled the identification of APOL1 HRGs in individuals for which hypertension or diabetes may have otherwise been attributed as the primary cause of CKD. APOL1 HRGs could also provide context for the renal involvement seen in the patients with COVID-19 or HIV infection. Broad panel genetic testing provides an accessible tool for nephrology clinics to help identify individuals at risk for positivity for an APOL1 HRG, including those of AA descent with hypertensive, proteinuric CKD.

18.
Journal of General Internal Medicine ; 37:S284-S285, 2022.
Article in English | EMBASE | ID: covidwho-1995782

ABSTRACT

BACKGROUND: The COVID-19 pandemic magnified the digital health divide among marginalized populations when health systems scaled back inperson visits as a public health precaution. We conducted this qualitative study during the pandemic to solicit patient and provider perceptions of use of digital health programs (patient portals, telemedicine, remote hypertension/diabetes monitoring) and to inform strategies to surmount barriers to accessing remote care. METHODS: We conducted semi-structured interviews with 40 patients and 29 primary care providers (PCPs) from northern and southeastern Louisiana who were recruited within an integrated delivery health system and an FQHC between May and July 2021. We used constant comparative method of grounded theory to identify themes. Commonalities/differences in perspectives between patients and PCPs were analyzed. RESULTS:Most patients recruited to the study self-identified as Black (68%), female (73%), mean age 51, lived in an urban area (77%), and had Medicaid (58%). Most PCPs were White (79%), male (52%), mean age 39, and reported Medicaid as the predominant insurer (59%). Most patients reported using smartphones for accessing the internet for health and non-health activities. Some participants used apps to track their health but noted internet/data/storage limits. PCPs noted increased uptake of misinformation on the internet prompting them to proactively recommend websites and apps. Most patients had used a patient portal and reported convenience of messaging their PCP, getting refills, scheduling appointments, and reviewing test results. PCPs noted a concurrent increase in their in-basket workload with a particular concern for frequent messaging like cellphone texting. Most patients had telemedicine video visits using their smartphones - some of which converted to audio when technology problems arose. Patients and PCPs noted telemedicine is appropriate for routine follow-up but preferred in-person visits. PCPs noted additional workflow disruption when moving from in-person to video visits in the same clinic session. Few patients were enrolled in a digital health program for remote monitoring;however, patients and PCPs agreed these programs provide valuable adjuncts to chronic care. PCPs reported patient limitations in accessing such programs due to the need for smartphones/internet/WiFi and select insurance coverage which can lead to further disparities in access to care. CONCLUSIONS: Health policies that support broadband/internet/ smartphone service as a standard utility and insurance coverage for digital health programming are paramount for surmounting major patient barriers. Clinical practice procedures which optimize technical support for patients and providers are also needed. RESULTS: Of the 236 women in the study, there was a mean age of 66.5 years ± 7.1;67 self-identified as Black, 93 as White, 49 as Hispanic and 16 as Other. Median CA anxiety score was 3 while DM anxiety score was 2.5 (p<0.001). For the anxiety groups, 67 (28%) were in the high CA/high DM group, 52 (22%) in the high CA/low DM group, 15 (6%) in the low CA/high DM group, and 94 (39%) in the low CA/low DM group. Participants in the high CA/low DMand low CA/low DMgroups were more likely to adhere to a healthy diet (73% and 71% compared with 51% for high CA/high DM and 53% for low CA/high DM, p= 0.02). They also had an increased likelihood of consuming at least 5 servings of fruits and veggies daily (69% and 57% vs. 45% for high CA/high DM and 40% for low CA/high DM, p= 0.03) and adhering to oral DM medications (62% and 75% vs. 52% for high CA/high DM and 20% for low CA/high DM, p= 0.05). CONCLUSIONS: Older breast cancer survivors with DM have different levels of anxiety about CA versus DM and those with high DM anxiety are less likely to adhere to DMSMBs. Our findings suggest that increased anxiety might hinder one's ability to achieve disease control, making anxiety management vital to supporting patient adherence and health.

19.
Cancer Research ; 82(12), 2022.
Article in English | EMBASE | ID: covidwho-1986489

ABSTRACT

Background. Research has reported that African American (AA) cancer patients with COVID-19 had a higher hospitalization rate than their white counterparts. Because the severity of COVID-19 is partly related to existing chronic diseases, one of the speculations is that racial differences in COVID-19 severity are attributable to AA cancer patients having a higher prevalence of chronic illnesses. Our study aimed to assess the impact of existing chronic diseases on the racial differences in hospitalization and length of hospitalization in COVID-19 cancer patients in Louisiana. Methods. We linked cancer cases diagnosed in 2015-2019 from the Louisiana Tumor Registry (LTR) with the statewide COVID-19 data to identify COVID-19 patients who had been previously diagnosed with cancer. We also identified chronic illnesses (i.e., heart disease, peripheral vascular and cerebrovascular diseases, pulmonary disease, renal disease, liver disease, diabetes, and others) from 2012-2020 hospital discharge data and LTR data. Age and census tract level poverty were at the time of COVID-19 diagnosis. Bivariate and multivariable logistic regressions were used to exam the association of race with hospitalization after adjusting for socio-demographic and chronic illnesses. The multivariable Poisson model was used to assess the racial disparity in length (in days) of hospitalization. Results. Of 6,518 COVID-19 cancer patients, there were 30.8% AA, 68.4% whites, and 0.8% other races. AA, male, older, residing in high poverty, and patients with chronic illnesses were more likely (P<0.05) to be hospitalized. The odds of hospitalization was 87.2% higher among AA patients than white patients in bivariate analysis. After adjusting for age, gender, poverty, obesity, smoking status, and chronic illnesses, the odds of hospitalization was still higher for AA than white patients (OR=1.81;95% CI: 1.55-2.09). The length of hospital stay for AA was more (P<0.05) than whites After adjusting for the same covariates. Conclusion. Sociodemographic factors and chronic illnesses are associated with the severity of COVID-19 among cancer patients. However, AA COVID-19 cancer patients have significantly higher odds of hospitalization and longer hospital stays even when controlling these factors. More research is warranted to determine underlying factors of the observed racial disparities.

20.
Cancer Research ; 82(12), 2022.
Article in English | EMBASE | ID: covidwho-1986486

ABSTRACT

Introduction: The COVID-19 pandemic continues to be a major socioeconomic disruptor worldwide. The intervention that has a far-reaching impact is the adoption of an efficient nationwide vaccination campaign with the effective COVID-19 vaccines. The success of this strategy is dependent on the capacity of the existing healthcare systems and the public vaccine acceptance. Vaccine hesitancy is considered among the top global health threats. Its patterns and intensity vary by geosocial contexts. Due to the roll-out of the vaccine which was followed by the booster dose, we explored the demographic pattern and reasons behind the primary and secondary COVID-19 vaccine hesitancy among our ArkLATX cancer patients. Methods: Two cohorts were used to conduct this study (cohort 1 for primary and Cohort 2 for secondary vaccine hesitancy). An in-person survey of a random sample was conducted across 5 Hematology-Oncology clinics asking the veterans whether they are interested in receiving the initial COVID-19 vaccine and later the booster dose. If the veterans declined, they were asked to state the reason behind their decision. Age, sex, race, and state of residence were captured for each participant. Descriptive statistics were calculated and X2 and logistic regression were carried out to determine the impact of demographic factors on COVID-19 vaccine hesitancy. Results: Cohorts 1&2 consisted of 240 and 303 veterans, respectively. The median age was 71 years. The participants were around 92% male vs 8% female and around 41% Black vs 59% White. In cohort-1, 21% declined due to concerns about safety (33%), not wanting to be the first (33%), anti-vaxxer stance (14%), and inadequate information (8%). Among other reasons (12%), 3 saw no reason for the vaccination, 2 cited severe reactions to prior vaccines, and 1 cited mistrust of the government. In cohort-2, 14% declined booster dose due to concerns about the need (55%) and safety (14%), anti-vax (19%), suspicious (5%), and medical reason and timing (7%). There were no statistical differences between veterans that approved of or declined receiving the vaccine with respect to demographic characteristics. Conclusions: Our survey indicates that the majority of ArkLATX high-risk veterans with cancer are willing to be vaccinated against COVID-19. The major reasons behind vaccine primary and secondary hesitancy seem to be categorized as information issues consisting of questions about safety and the need for the vaccine. For primary hesitancy another major group consisted of a diffusion of innovation late majority that are open to COVID-19 vaccination, but they do not want to be the first to take it. Such barriers can be potentially circumvented by providing the appropriate targeted information campaigns and provider counseling.

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