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1.
Cadernos de Saude Publica ; 36(12), 2021.
Article in English | EMBASE | ID: covidwho-1883749
2.
Circ Cardiovasc Qual Outcomes ; 14(2): e007643, 2021 02.
Article in English | MEDLINE | ID: covidwho-1883362

ABSTRACT

Following decades of decline, maternal mortality began to rise in the United States around 1990-a significant departure from the world's other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable-a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights-the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality.


Subject(s)
Cardiologists , Maternal Health , African Americans , Female , Humans , Maternal Mortality , Mothers , United States/epidemiology
3.
Health Secur ; 20(3): 238-245, 2022.
Article in English | MEDLINE | ID: covidwho-1882965

ABSTRACT

During the COVID-19 pandemic, academic health centers suspended clinical clerkships for students. A need emerged for innovative virtual curricula to continue fostering professional competencies. In March 2020, a multidisciplinary team from the University of Nebraska Medical Center had 2 weeks to create a course on the impact of infectious diseases that addressed the COVID-19 pandemic in real time for upper-level medical and physician assistant students. Content addressing social determinants of health, medical ethics, population health, service learning, health security, and emergency preparedness were interwoven throughout the course to emphasize critical roles during a pandemic. In total, 320 students were invited to complete the survey on knowledge gained and attitudes about the course objectives and materials and 139 responded (response rate 43%). Students documented over 8,000 total hours of service learning; many created nonprofit organizations, aligned their initiatives with health systems efforts, and partnered with community-based organizations. Thematic analysis of qualitative evaluations revealed that learners found the greatest value in the emphasis on social determinants of health, bioethics, and service learning. The use of predeveloped, asynchronous e-modules were widely noted as the least effective aspect of the course. The COVID-19 pandemic introduced substantial challenges in medical education but also provided trainees with an unprecedented opportunity to learn from real-world emergency preparedness and public health responses. The University of Nebraska Medical Center plans to create a health security elective that includes traditional competencies for emergency preparedness and interrogates the social and structural vulnerabilities that drive disproportionately worse outcomes among marginalized communities. With further evaluation, many components of the curriculum could be broadly scaled to meet the increasing need for more public health and health security medical education.


Subject(s)
COVID-19 , Civil Defense , Communicable Diseases , Curriculum , Humans , Pandemics/prevention & control
4.
Vaccine ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1882609

ABSTRACT

INTRODUCTION: Vaccinating children against COVID-19 protects children's health and can mitigate the spread of the virus to other community members. OBJECTIVE: The primary objective of this study was to use a socio-ecological perspective to identify multi-level factors associated with US parents' intention to vaccinate their children. METHODS: This study used a longitudinal online cohort. Multinomial logistic regression models assessed socio-ecological predictors of negative and uncertain child COVID-19 vaccination intentions compared to positive intentions. RESULTS: In June 2021, 297 parents were surveyed and 44% reported that they intended to vaccinate their children while 25% expressed uncertainty and 31% did not intend to vaccinate their children. The likelihood of reporting uncertain or negative intention, compared to positive intention to vaccinate their children was higher among parents who had not received a COVID-19 vaccination and those who did not have trusted information sources. Parents who talked to others at least weekly about the COVID-19 vaccine were less likely to endorse uncertain compared to positive vaccine intentions (aRRR: 0.44; 95% CI: 0.20-0.93). A sub-analysis identified that parents had significantly higher odds of intending to vaccinate older children compared to younger children (children ages 16-17 years v. 0-4 years OR: 2.01, 95% CI: 1.05-3.84). An additional sub-analysis assessed the stability of parents' intention to vaccinate their children between March 2021 and June 2021 (N=166). There was transition within each intention group between the study periods; however, symmetry and marginal homogeneity test results indicated that the shift was not statistically significant. Parents expressing uncertainty in March 2021 were the most likely to change their intention, with 24% transitioning to positive intention and 23% to negative intention in June 2021. CONCLUSION: Study findings suggest that programs to promote vaccination uptake should be dyadic and work to promote child and parent vaccination. Peer diffusion strategies may be particularly effective at promoting child vaccination uptake among parents expressing uncertainty.

5.
Topics in Antiviral Medicine ; 30(1 SUPPL):380-381, 2022.
Article in English | EMBASE | ID: covidwho-1880503

ABSTRACT

Background: The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. Methods: From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. Results: Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. Conclusion: Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.

6.
Fertility and Sterility ; 116(3 SUPPL):e299, 2021.
Article in English | EMBASE | ID: covidwho-1880076

ABSTRACT

OBJECTIVE: The COVID-19 pandemic has created many uncertainties for those pursuing fertility care and assisted reproductive technology (ART) procedures, due to ever-changing healthcare restrictions. There is a lack of research on large-scale data for ART procedures during the pandemic. The objective of our study is to evaluate ART procedures, specifically oocyte retrieval and in vitro fertilization (IVF) cycles, prior to and during the pandemic. MATERIALS AND METHODS: Claims data from Symphony Health, one of thelargest databases of patient-level data on morethan 280 million patientsin the US, was examined from May 1, 2019 to February 28, 2021. Reproductiveaged women were included in the analysis. March - April 2020 was used as a threshold for when healthcare restrictions became widespread. We compared 10 months prior to the pandemic (May 2019 - Feb 2020) and the same time period after the start of the pandemic (May 2020 - Feb 2021). ART procedures were identified using CPT codes (58970 for oocyte retrieval, and S4011, S4015, and S4016 for IVF) under ICD-10. Data analysis was conducted in Stata, version 16.1, using 2-sided t-tests with significance set at P < 0.05. RESULTS: Our search yielded 39,087 oocyte retrievals and 14,365 IVF cycles. The average age of patients who started an IVF cycle (36±4.2 vs 35±4.4 years) as well as the age of those who had an oocyte retrieval (36.2±4.6 vs 35.3±4.7 years) prior to and during the pandemic was statistically different. Time series plots show that, after a substantial drop in focal variables in March - April 2020, ART procedures quickly recovered to pre-pandemic baseline by June 2020. Afterwards, oocyte retrievals increased from 1,703 per month pre-pandemic to 2,010 per month during the pandemic, and this difference approached significance (P=0.06). There was not a significant difference in IVF cycles (677 per month pre-pandemic vs 686 per month during the pandemic, P=0.88). CONCLUSIONS: Despite concerns regarding suspension of ART and delivery of infertility care during the pandemic, our study shows no significant difference in oocyte retrievals and IVF cycles prior to and during the COVID-19 pandemic. IMPACT STATEMENT: These results suggest reassuring outcomes despite a health crisis in the US. There was no significant delay or interruption of fertility care and ART procedures in the US. Further research should examine how other social determinants such as ethnicity, income and geographic location affected access to and utilization of infertility care.

9.
mSystems ; : e0008922, 2022 May 31.
Article in English | MEDLINE | ID: covidwho-1874511

ABSTRACT

Obesity has been linked to higher morbidity and mortality in those that contract novel viruses, such as H1N1 and SARS-CoV-2. Loss of life and the high cost of obesity highlight the need to focus on preventative measures. The state of Maine (United States) is profiled as a rural state with high rates of obesity and low health literacy that benefits from programs to improve health. However, more multidirectional efforts are needed. Four recommendations for building a healthier, more resilient patient population are discussed here: (i) state incentives and subsidies, (ii) employers to incentivize healthy living, (iii) federal incentives and initiatives, and (iv) personal responsibility for health and wellness.

10.
AIDS Behav ; 26(7): 2242-2255, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1872567

ABSTRACT

COVID-19 vaccination is recommended for people living with HIV (PLWH), among whom social inequities and co-morbidities may drive risks of COVID-19 infection and outcome severity. Among a provincial (British Columbia) sample, we determined the prevalence of COVID-19 vaccine intention by HIV status and assessed socio-demographic, vaccine hesitancy, and psychological predictors of vaccine intention. Individuals (25-69 years) recruited from province-wide research cohorts and the general public completed an online survey examining COVID-19 impacts (August/2020-March/2021). In an analysis restricted to women and gender diverse participants (n = 5588), we compared intention to receive a recommended COVID-19 vaccine (Very likely/Likely vs Neutral/Unlikely/Very Unlikely) by self-reported HIV status. Logistic regression models assessed the independent effect of HIV status and other factors on COVID-19 vaccine intention. Of 5588 participants, 69 (1.2%) were living with HIV, of whom 79.7% were on antiretroviral therapy. In bivariate analyses, intention to vaccinate was significantly lower among PLWH compared to participants not living with HIV (65.2% vs 79.6%; OR 0.44; 95%CI 0.32-0.60). However, this association was not statistically significant after adjustment for ethnicity, income, education, and essential worker status (aOR 0.85; 95%CI 0.48-1.55). Among PLWH, those with greater vaccine confidence, positive attitudes towards the COVID-19 vaccine, and more strongly influenced by direct and indirect social norms to vaccinate had significantly higher odds of vaccine intention. Tailored messaging is needed to build vaccine confidence, address questions about vaccine benefits, and support informed vaccination decision-making to promote COVID-19 vaccine uptake among women and gender diverse people living with HIV.


Subject(s)
COVID-19 , HIV Infections , Vaccines , British Columbia/epidemiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Female , HIV Infections/epidemiology , HIV Infections/prevention & control , Humans , Intention , SARS-CoV-2 , Vaccination
11.
Vaccines (Basel) ; 10(6)2022 May 26.
Article in English | MEDLINE | ID: covidwho-1869859

ABSTRACT

(1) Background: By summer 2021, overseas France turned COVID-19 vaccine and immunity certificates into passports to open travel bubbles. Subsequently, its territories set French records for both COVID-19 and 6-month excess all-cause mortality. (2) Methods: Official time series were collected to compare time correlations between air traffic and COVID-19 transmission and mortality in overseas France, before and after the implementation of immunity passports. (3) Results: Air traffic initially had a reversed relationship with COVID-19, which transitioned into a leader-follower relationship with the introduction of immunity passports. Essentially, air traffic increased 16 days before COVID-19 cases increased (r = 0.61) and 26 days before deaths increased (r = 0.31) in Martinique, 26 days (r = 0.72) and 40 days (r = 0.82) before in Guadeloupe, and 29 days (r = 0.60) and 31 days (r = 0.41) before in Réunion upon introduction of immunity passports. Moreover, air traffic became as correlated as community transmission to COVID-19 mortality in Guadeloupe. (4) Conclusions: Since the introduction of immunity passports, air traffic has been pacesetting COVID-19 within one month for transmission, and within an additional two weeks for mortality in overseas France. Responding to WHO's call for real-world evidence, this study suggests that COVID-19 passports are not commensurate with health system goals.

12.
Med Sci (Basel) ; 10(2)2022 May 28.
Article in English | MEDLINE | ID: covidwho-1869709

ABSTRACT

Evidence continues to emerge that the social determinants of health play a role in adverse outcomes related to COVID-19, including increased morbidity and mortality, increased risk of long COVID, and vaccine adverse effects. Therefore, a more nuanced understanding of the biochemical and cellular pathways of illnesses commonly associated with adverse social determinants of health is urgently needed. We contend that a commitment to understanding adverse outcomes in historically marginalized communities will increase community-level confidence in public health measures. Here, we synthesize emerging literature on mast cell disease, and the role of mast cells in chronic illness, alongside emerging research on mechanisms of COVID illness and vaccines. We propose that a focus on aberrant and/or hyperactive mast cell behavior associated with chronic underlying health conditions can elucidate adverse COVID-related outcomes and contribute to the pandemic recovery. Standards of care for mast cell activation syndrome (MCAS), as well as clinical reviews, experimental research, and case reports, suggest that effective and cost-efficient remedies are available, including antihistamines, vitamin C, and quercetin, among others. Primary care physicians, specialists, and public health workers should consider new and emerging evidence from the biomedical literature in tackling COVID-19. Specialists and researchers note that MCAS is likely grossly under-diagnosed; therefore, public health agencies and policy makers should urgently attend to community-based experiences of adverse COVID outcomes. It is essential that we extract and examine experiential evidence of marginalized communities from the broader political-ideological discourse.

13.
BMC Public Health ; 22(1): 1067, 2022 May 29.
Article in English | MEDLINE | ID: covidwho-1869075

ABSTRACT

BACKGROUND: Preliminary evidence suggests that individuals living in lower income neighbourhoods are at higher risk of COVID-19 infection. The relationship between sociodemographic characteristics and COVID-19 risk warrants further study. METHODS: We explored the association between COVID-19 test positivity and patients' socio-demographic variables, using neighborhood sociodemographic data collected retrospectively from two COVID-19 Assessment Centres in Toronto, ON. RESULTS: Eighty-three thousand four hundred forty three COVID-19 tests completed between April 5-September 30, 2020, were analyzed. Individuals living in neighbourhoods with the lowest income or highest concentration of immigrants were 3.4 (95% CI: 2.7 to 4.9) and 2.5 (95% CI: 1.8 to 3.7) times more likely to test positive for COVID-19 than those in highest income or lowest immigrant neighbourhoods, respectively. Testing was higher among individuals from higher income neighbourhoods, at lowest COVID-19 risk, compared with those from low-income neighbourhoods. CONCLUSIONS: Targeted efforts are needed to improve testing availability in high-risk regions. These same strategies may also ensure equitable COVID-19 vaccine delivery.


Subject(s)
COVID-19 Testing , COVID-19 , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Vaccines , Cross-Sectional Studies , Emigration and Immigration , Humans , Ontario/epidemiology , Poverty , Retrospective Studies
14.
Journal of Clinical and Translational Science ; 2022.
Article in English | EMBASE | ID: covidwho-1867966

ABSTRACT

The African American population of Buffalo, New York experiences striking race-based health disparities due to adverse social determinants of health. A team of community leaders and university faculty determined that a community dialogue was needed to focus research and advocacy on the root causes of these disparities. In response, we organized the annual Igniting Hope conference series that has become the premier conference on health disparities in the region. The series, now supported by an R13 conference grant from NCATS, has been held four times (2018-2021) and has attracted community members, community leaders, university faculty and trainees. The agenda includes talks by national leaders and breakout/working groups that led to a new state law that has reduced disproportionate traffic-ticketing and driver’s license suspensions in Black neighborhoods;mitigation of the disproportionate COVID-19 fatalities in Black communities;and the launching of a university-supported institute. We describe the key elements of success for a conference series designed by a community-university partnership to catalyze initiatives that are having an impact on social determinants of health in Buffalo.

15.
Prev Med Rep ; 28: 101833, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1867678

ABSTRACT

While the first wave of COVID-19 primarily impacted urban areas, subsequent waves were more widespread. Most analysis of Covid-19 rates examine state or metropolitan areas, ignoring potential heterogeneity within states and metro areas, over time, and between populations with differing contextual and compositional features. In this study, we compare spatial and temporal trends in Covid-19 cases and deaths in Louisiana, USA, over time and across populations and geographies (New Orleans, other urban areas, suburban, rural) and parish-level political lean. We employ publicly available longitudinal census tract and parish-level Covid-19 data reported from February 27th, 2020 to October 27th, 2021. We find that incidence and mortality rates were initially highest in New Orleans and Democratic areas and higher in other geographies and more conservative areas during subsequent waves. We also find wide relative disparities during the first wave, where increased social vulnerability was associated with increased positivity and incidence across geographies and political contexts. However, relative disparities diverged by geography and political lean and outcome across the remaining waves. This work draws attention to the differential rates of Covid-19 cases and deaths by geography, time, and population throughout the pandemic, and importance of political and geographic boundaries for rates of Covid-19.

16.
J Pediatr Health Care ; 2022 Jun 01.
Article in English | MEDLINE | ID: covidwho-1867656

ABSTRACT

INTRODUCTION: This study sought to identify social determinants of health (SDH) patterns associated with severe pediatric injuries. METHOD: We used cross-sectional data from children (≤18 years) admitted to a pediatric trauma center between March and November 2021 (n = 360). We used association rule mining (ARM) to explore SDH patterns associated with severe injury. We then used ARM-identified SDH patterns in multivariable logistic regressions of severe injury, controlling for patient and caregiver demographics. Finally, we compared results to naive hierarchical logistic regressions that considered SDH types as primary exposures rather than SDH patterns. RESULTS: We identified three SDH patterns associated with severe injury: (1) having child care needs in combination with neighborhood violence, (2) caregiver lacking health insurance, and (3) caregiver lacking social support. In the ARM-informed logistic regression models, the presence of a child care need in combination with neighborhood violence was associated with an increased odds of severe injury (aOR, 2.77; 95% CI, 1.01-7.62), as was caregiver lacking health insurance (aOR, 2.29; 95% CI, 1.02-5.16). In the naive hierarchical logistic regressions, no SDH type in isolation was associated with severe injury. DISCUSSION: Our exploratory analyses suggest that considering the co-occurrence of negative SDH that families experience rather than isolated SDH may provide greater insights into prevention strategies for severe pediatric injury.

17.
Contemp Clin Trials ; 118: 106808, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1866942

ABSTRACT

Asthma-related deaths, hospitalizations, and emergency visits are more numerous among low-income patients, yet management guidelines do not address this high-risk group's special needs. We recently demonstrated feasibility, acceptability, and preliminary evidence of effectiveness of two interventions to improve access to care, patient-provider communication, and asthma outcomes: 1) Clinic Intervention (CI): study staff facilitated patient preparations for office visits, attended visits, and afterwards confirmed patient understanding of physician recommendations, and 2) Home Visit (HV) by community health workers for care coordination and informing clinicians of home barriers to managing asthma. The current project, denominated "HAP3," combines these interventions for greater effectiveness, delivery of guideline-based asthma care, and asthma control for low-income patients recruited from 6 primary care and 3 asthma specialty practices. We assess whether patients of clinicians receiving guideline-relevant, real-time feedback on patient health and home status have better asthma outcomes. In a pragmatic factorial longitudinal trial, HAP3 enrolls 400 adults with uncontrolled asthma living in low-income urban neighborhoods. 100 participants will be randomized to each of four interventions: (1) CI, (2) CI with HVs, (3) CI and real-time feedback to asthma clinician of guideline-relevant elements of patients' current care, or (4) both (2) and (3). The outcomes are asthma control, quality of life, ED visits, hospitalizations, prednisone bursts, and intervention costs. The COVID-19 pandemic struck 6.5 months into recruitment. We describe study development, design, methodology, planned analysis, baseline findings and adaptions to achieve the original aims of improving patient-clinician communication and asthma outcomes despite the markedly changed pandemic environment.


Subject(s)
Asthma , House Calls , Pandemics , Adult , Asthma/therapy , COVID-19/epidemiology , Humans , Poverty , Randomized Controlled Trials as Topic
18.
Stud Health Technol Inform ; 294: 701-702, 2022 May 25.
Article in English | MEDLINE | ID: covidwho-1865435

ABSTRACT

In this study we examined the correlation of COVID-19 positivity with area deprivation index (ADI), social determinants of health (SDOH) factors based on a consumer and electronic medical record (EMR) data and population density in a patient population from a tertiary healthcare system in Arkansas. COVID-19 positivity was significantly associated with population density, age, race, and household size. Understanding health disparities and SDOH data can add value to health and the creation of trustable AI.


Subject(s)
COVID-19 , COVID-19/epidemiology , Delivery of Health Care , Hospitals, State , Humans , Population Density , Rural Population , Social Determinants of Health
19.
Nurs Forum ; 2022 May 26.
Article in English | MEDLINE | ID: covidwho-1865116

ABSTRACT

The COVID-19 pandemic has further limited access to treatment for opioid use disorder (OUD). Advanced practice registered nurses can reduce opioid related complications and overdose by obtaining a Drug Enforcement Administration (DEA) regulated X-waiver that allows for prescription of medications for OUD (MOUD) in general medical settings. Graduate nursing education, where advanced practice nurse practitioner (NP) students are educated, has not incorporated this content into standard curricula. We describe an innovative approach to incorporate DEA X-waiver training in a required community health NP in partnership with addiction medicine clinicians. Advanced practice NP students (N = 114) either completed fully online or hybrid (virtual didactic and online) X-waiver training on MOUD. We describe how an interprofessional partnership to incorporate MOUD education into graduate nursing curricula is a feasible method for training students to treat OUD in the context of the pandemic. This approach is responsive to the crucial need for more health care providers to address the opioid overdose crisis.

20.
Popul Health Manag ; 25(2): 186-191, 2022 04.
Article in English | MEDLINE | ID: covidwho-1864947

ABSTRACT

In March 2020, at the start of the COVID-19 pandemic, New York City instituted a shelter-in-place order, dramatically affecting the area's social and economic landscape. Pediatric primary care practices universally screen for social determinants of health (SDOH) and mental health (MH) needs, providing an opportunity to assess changes in the population's needs during COVID-19. To assess changes in SDOH and MH needs of pediatric families before and during COVID-19, the authors conducted a prospective cohort study of patients seen in the hospital's pediatric primary care practices. Baseline data were collected during well visits from March 1, 2019 to March 1, 2020, and included the following outcome measures: Patient Health Questionnaire (PHQ2) score >0, PHQ9 scores ≥5, pediatric symptom checklist (PSC17) scores ≥15, and SDOH needs. Follow-up pandemic data were collected from June to August 2020. A total of 423 patients (215 [51%] female, 279 [66%] Hispanic, and 248 [59%] primary English speakers) were enrolled in the study. The following SDOH needs significantly increased during COVID-19: food (17%-32%; P < 0.001), legal (19%-30%; P = 0.003), public benefits (4%-13.8%; P < 0.001), and housing (17.2%-26%; P = 0.002). There was no significant change in MH screening results during COVID-19 compared with baseline: positive PHQ2 depression screen (27.9% vs. 34.3%, P = 0.39), positive PHQ9 depression screen (45.5% vs. 64.1%, P = 0.32), or positive PSC17 measuring emotional and behavioral concerns (4.9% vs. 8.2%, P = 0.13). During COVID-19, patients with food, housing, or legal needs had a significantly higher likelihood of having emotional or behavioral difficulties (P < 0.01). Further research is needed to evaluate outcomes in the following months.


Subject(s)
COVID-19 , Pediatrics , COVID-19/epidemiology , Child , Female , Humans , Male , Mental Health , New York City/epidemiology , Pandemics , Primary Health Care , Prospective Studies , Social Determinants of Health
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