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1.
Telemed J E Health ; 2022 May 02.
Article in English | MEDLINE | ID: covidwho-1820741

ABSTRACT

Objective: To understand how differences in primary care appointment completion rates between Black and non-Black patients changed in 2020 within the context of the COVID-19 pandemic and when telemedicine utilization peaked. Materials and Methods: We conducted a retrospective cohort study using the electronic health record from January 1 to December 31, 2020, among all adults scheduled for a primary care appointment within a large academic medical center. We used mixed-effects logistic regression to estimate adjusted appointment completion rates for Black patients compared with those for non-Black patients in 2020 as compared with those in 2019 within four time periods: (1) prepandemic (January 1, 2020, to March 12, 2020), (2) shutdown (March 13, 2020, to June 3, 2020), (3) reopening (June 4, 2020, to September 30, 2020), and (4) second wave (October 1, 2020, to December 31, 2020). Results: Across 1,947,399 appointments, differences in appointment completion rates between Black and non-Black patients improved in all time periods: +1.4 percentage points prepandemic (95% confidence interval [CI]: +0.8 to +2.0), +11.7 percentage points during shutdown (95% CI: +11.0 to +12.3), +8.2 percentage points during reopening (95% CI: +7.8 to +8.7), and +7.1 percentage points during second wave (95% CI: +6.4 to +7.8) (all p-values <0.001). The types of conditions managed by primary care shifted during the shutdown period, but the remainder of 2020 mirrored those from 2019. Discussion: Racial differences in appointment completion rates narrowed significantly in 2020 even as the mix of disease conditions began to mirror patterns observed in 2019. Conclusions and Relevance: Telemedicine may be an important tool for improving access to primary care for Black patients. These findings should be key considerations as regulators and payors determine telemedicine's future.

2.
Front Digit Health ; 4: 944860, 2022.
Article in English | MEDLINE | ID: covidwho-2099119

ABSTRACT

Objectives: The start of the COVID-19 pandemic led the Los Angeles safety net health system to dramatically reduce in-person visits and transition abruptly to telehealth/telemedicine services to deliver clinical care (remote telephone and video visits). However, safety net patients and the settings that serve them face a "digital divide" that could impact effective implementation of such digital care. The study objective was to examine attitudes and perspectives of leadership and frontline staff regarding telehealth integration in the Los Angeles safety net, with a focus on telemedicine video visits. Methods: This qualitative study took place in the Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net health system in the US. This system disproportionately serves the uninsured, Medicaid, racial/ethnic minority, low-income, and Limited English Proficient (LEP) patient populations of Los Angeles County. Staff and leadership personnel from each of the five major LAC DHS hospital center clinics, and community-based clinics from the LAC DHS Ambulatory Care Network (ACN) were individually interviewed (video or phone calls), and discussions were recorded. Interview guides were based on the Consolidated Framework for Implementation Research (CFIR), and included questions about the video visit technology platform and its usability, staff resources, clinic needs, and facilitators and barriers to general telehealth implementation and use. Interviews were analyzed for summary of major themes. Results: Twenty semi-structured interviews were conducted in August to October 2020. Participants included LAC DHS physicians, nurses, medical assistants, and physical therapists with clinical and/or administrative roles. Narrative themes surrounding telehealth implementation, with video visits as the case study, were identified and then categorized at the patient, clinic (including provider), and health system levels. Conclusions: Patient, clinic, and health system level factors must be considered when disseminating telehealth services across the safety net. Participant discussions illustrated how multilevel facilitators and barriers influenced the feasibility of video visits and other telehealth encounters. Future research should explore proposed solutions from frontline stakeholders as testable interventions towards advancing equity in telehealth implementation: from patient training and support, to standardized workflows that leverage the expertise of multidisciplinary teams.

3.
Revista Espanola De Sociologia ; JOUR(4), 31.
Article in English | Web of Science | ID: covidwho-2082926

ABSTRACT

The COVID-19 crisis has been characterised by an increased fragility of the labour market, especially in the Southern European countries. Nevertheless, official data do not accurately capture the real upheavals of their labour markets. In this context, this paper compares the labour market performance of vulnerable populations (youth, women and migrants) in three Southern European countries with a cross-analysis of data over time. To this end, we have developed an alternative hidden unemployment indicator that recovers and includes unemployed persons from the categories of involuntary underemployment and inactivity. Our analyses include data from Spain, Portugal, and Italy, and take the European Union-Labour Force Survey (EU-LFS) as their basis. Our results show that the impact of unemployment in the South of Europe is best measured when using an extended indicator, particularly when analysing the cases of vulnerable collectives. This tool shows great analytical potential for unveiling hidden unemployment in the context of the COVID-19 pandemic.

4.
Front Public Health ; 10: 898787, 2022.
Article in English | MEDLINE | ID: covidwho-2080282

ABSTRACT

Background: The continued emergence of new COVID-19 variants highlights the importance of vaccination in the effort to reduce disease transmission and burden. The objective of this study is to evaluate the processes and outcomes associated with a novel in-home COVID-19 vaccination program aimed at vaccinating high-risk populations in New York, USA. Methods: To evaluate program processes, we described the program itself and reflected on some key lessons learned. To evaluate program outcomes, we analyzed data reported by vaccine recipients. These outcomes included the percentage of vaccine recipients that successfully received the full course of vaccinations, and the demographic and health characteristics of vaccine recipients. We additionally assessed demographic differences in motivations for receiving in-home care, using chi-squared tests to assess statistical significance. Data were collected and reported via dynamic online intake forms. Results: The median age of vaccine recipients was 79 ± SD 9.0 years. The oldest vaccine recipient was 107 years old. Of those with non-missing data, more than half of vaccine recipients were female (63%), identified as part of a racial/ethnic minority (66%), reported an annual income of < $25,000 (58%), and received a high school degree or less (68%). Most vaccine recipients reported having one or more health conditions associated with increased risk of severe COVID-19 disease (72%). Vaccine recipients were most likely to report receiving in-home vaccination because they were home-bound due to disability. Motivations for receiving in-home vaccination differed by demographic subgroup. Conclusion: The population receiving vaccinations from this in-home care delivery program comprised seniors who were mostly female and non-white, indicated socioeconomic vulnerability, and reported one or more COVID-related health conditions; this signified that the program met its goal of vaccinating those most at risk for severe COVID-19 disease.


Subject(s)
COVID-19 , Vaccines , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines , Ethnicity , Female , Humans , Male , Minority Groups , SARS-CoV-2 , Vaccination , Vulnerable Populations
5.
J Public Health Dent ; 2022 Oct 18.
Article in English | MEDLINE | ID: covidwho-2078597

ABSTRACT

OBJECTIVES: Teledentistry helped dentistry adapt to pandemic-era challenges; little is known about dental professionals' teledentistry experiences during this time. This analysis sought to understand professionals' pandemic teledentistry experiences and expectations for the modality's future. METHODS: We conducted virtual individual interviews (n = 21) via Zoom to understand how federally qualified health centers (FQHCs) delivered oral care during the first year of the pandemic, including but not limited to the use of teledentistry. We independently coded each transcript, then identified themes and sub-themes. RESULTS: We identified three major themes: (1) Logistical and equity considerations shaped teledentistry's adoption; (2) Team-based factors influenced implementation; and (3) Teledentistry's future is as-yet undetermined. CONCLUSIONS: Experiences with teledentistry during the first year of COVID-19 varied substantially. Future directions should be more deliberate to counter the urgency of pandemic-style implementation and must address appropriate use, reimbursement guidance, patient and provider challenges, and customizability to each clinic's context.

6.
Hum Vaccin Immunother ; : 2123201, 2022 Sep 28.
Article in English | MEDLINE | ID: covidwho-2068494

ABSTRACT

Adult immunization coverage remains low in the US, particularly for people who use drugs (PWUD), a population that experiences a disproportionate burden of vaccine-preventable diseases. The extent of and characteristics associated with vaccine confidence (VC) held by PWUD is poorly understood. As VC strongly correlates with vaccine uptake, this cross-sectional study identifies mutable factors associated with VC and quantifies its relationship to immunization status within a highly vulnerable, underimmunized population of PWUD. Using a community-engaged research strategy with select partner organizations hosting syringe exchange programs in Atlanta, Los Angeles, and Las Vegas, USA, we surveyed participants ages 18-69 years served by these organizations from 2019 to 2020. Survey measures included sociodemographics, health behavior including immunization receipt, and vaccine confidence in adult vaccinations using a modified Emory Vaccine Confidence Index (EVCI). The findings reflect relatively low VC among the 1,127 recruited participants, with 56% expressing low VC (EVCI 0-12), 35% medium (EVCI 13-20) and 10% high (EVCI 21-24). EVCI varied by city, with lowest confidence in Atlanta and highest in Las Vegas. VC was associated with past receipt of specific vaccines, including hepatitis A, MMR, Tdap, and influenza. VC varied by specific sociodemographic correlates such as housing insecurity (reduced confidence) and receipt of public benefits or disability (increased confidence). This study identified correlates associated with VC based on site and sociodemographic characteristics for this priority population, highlighting the need for specific interventions to raise VC among PWUD, especially among those experiencing housing insecurity and without public benefits.

7.
Interface: Communication, Health, Education ; 26 (no pagination), 2022.
Article in English, Portuguese | EMBASE | ID: covidwho-2065231

ABSTRACT

With the objective of investigate the therapeutic itineraries followed for search the health care by the brazilian population in a situation of social vulnerability during the covid-19 pandemic, a scope review was carried out from July to September 2021, as proposed by the Joanna Briggs Institute, in the BVS, PubMed, EMBASE, Scielo, PsycInfo, Scopus and Web of Science databases within the 2020 and 2021 clippings. 11 articles were analyzed and divided into three categories: strategies care of population;health offerings;difficulties in accessing healthcare. Results explained gaps and potentialities existing on therapeutic itineraries in the search for health care for populations in a situation of social vulnerability and how these aspects became more evident in this pandemic period. There was a movement of this vulnerable populations to overcome the daily difficulties that determine the unfavorable conditions for health care. Copyright © 2022, Fundacao UNI Botucatu/UNESP.

8.
J Infect Dis ; 226(Supplement_3): S327-S334, 2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2062915

ABSTRACT

BACKGROUND: Variable and incomplete reporting of housing status creates challenges in the surveillance of coronavirus disease 2019 (COVID-19) among the homeless population in Los Angeles County (LA County) and nationwide. METHODS: We developed standard investigation procedures to assess the housing status of LA County COVID-19 patients. Using data sharing procedures, we matched COVID-19 patients to Homeless Management Information System (HMIS) client profiles and supplemented with additional data sources for contributory data points and to further housing status ascertainment. RESULTS: We identified 10 586 COVID-19 patients among people experiencing homelessness (PEH) between 30 March 2020 and 30 December 2021; 2801 (26.5%) patients were first identified from HMIS profile matches, 1877 (17.7%) from quarantine/isolation housing intake rosters, 573 (5.4%) from hospital records, 749 (7.1%) from case and contact interviews, 3659 (34.6%) directly from PEH medical and service providers, and 927 (8.8%) had unknown sources. Among COVID-19 patients matched to HMIS profiles, 5351 (42.5%) were confirmed to be PEH at the time of COVID-19 diagnosis. CONCLUSIONS: Interoperability between public health data, HMIS, and external partners have been critical components in evaluating the impact of COVID-19 among the LA County homeless population. No one data source was complete for COVID-19 surveillance in this population.


Subject(s)
COVID-19 , Homeless Persons , Management Information Systems , COVID-19/epidemiology , COVID-19 Testing , Housing , Humans
9.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-344335

ABSTRACT

Background: There is growing evidence that the COVID-19 pandemic disproportionately affected minority and lower socioeconomic groups. These groups have limited access to healthcare and social security, work in high-risk jobs, and have higher rates of comorbidities associated with poor outcomes from COVID-19. This study quantifies the effect of individual demographics, socioeconomic factors, and public health measures on COVID-19 health outcomes in a large population. Method: Demographics, socioeconomic factors, and COVID-19 outcomes for all 600,000 residents of the Sydney Local Health District from June 2021 to February 2022 were identified from the state’s Notifiable Conditions Information Management System (NCIMS) and linked to Australian Census data. Logistic regression and Cox proportional hazards models were generated for the outcomes of testing, infection, hospitalisation, and death for different periods of public health restrictions. Findings: Overall, public health interventions were effective in protecting the entire population from COVID-19 infection, hospitalisation, and death.During strict public health measures, older individuals had a lower risk of infection, with those aged 80 years and over having half the risk of infection compared to the reference group of 30 to 39 years old (hazards ratio 0.47, 95%CI 0.45-0.49);and those living in areas of lower socioeconomic status (SES) had a higher risk of infection, with the lowest areas having seven times the risk compared to the highest areas (HR 7.15, 6.24-8.19). The risk of infection was also higher for males (HR 1.34 1.27-1.40);those living in areas with higher household sizes (HR 1.56, 1.36-1.78);and individuals who were born in South Asia (HR 1.18, 1.07-1.29), South East Asia (HR 1.20, 1.07-1.36) and the Middle East and North Africa (HR 1.67, 1.47-1.90). During relaxed restrictions, differences between sexes, age groups, regions of birth and household sizes attenuated, but remained significant. Individuals with lower SES had lower rates of COVID-19 testing (odds ratio 0.31, 0.30-0.33), and higher odds of hospitalisation (OR 2.02, 1.71-2.38) and death (OR 4.11, 2.66-6.37) due to COVID-19. Individuals born outside of Australia had lower odds of testing, but no difference in the odds of hospitalisation or death. Importantly, vaccines were preferentially given to at-risk people, and these were protective of hospitalisation (OR 0.67, 0.61-0.73) and death (OR 0.70, 0.58-0.85). The Delta variant of COVID-19 was associated with higher odds of hospitalisation (OR 5.00, 0.56-4.76) and death (OR 4.17, 4.76-3.45). Interpretation: Policies adopted during the height of the COVID-19 pandemic were insufficient to maintain social equity. Policy and decision-makers should enhance efforts to achieve equity in relation to public health measures adopted for disease control. The challenge is to strengthen, scale, and sustain community engagement and relationships initiated during COVID-19 outbreaks. This can be part of a broader agenda that aims at enhancing clinical governance and community capacity to address the health and social inequalities of priority communities.

10.
miniren iryo ; - (583):24-25, 2021.
Article in Japanese | Ichushi | ID: covidwho-2058284
11.
Can J Public Health ; 2022 Sep 26.
Article in English | MEDLINE | ID: covidwho-2056601

ABSTRACT

SETTING: Toronto (Ontario, Canada) is a large urban centre with a significant population of underhoused residents and several dozen shelters for this population with known medical and social vulnerabilities. A sizeable men's homeless shelter piloted a facility-level SARS-CoV-2 wastewater surveillance program. INTERVENTION: Wastewater surveillance was initiated at the shelter in January 2021. One-hour composite wastewater samples were collected twice weekly from a terminal sanitary clean-out pipe. The genetic material of the SARS-CoV-2 virus was extracted from the solid phase of each sample and analyzed using real-time qPCR to estimate the viral level. Wastewater results were reported to facility managers and Toronto Public Health within 4 days. OUTCOMES: There were 169 clients on-site at the time of the investigation. Wastewater surveillance alerted to the presence of COVID-19 activity at the site, prior to clinical detection. This notification acted as an early warning signal, which allowed for timely symptom screening and case finding for shelter managers and the local health unit, in preparation for the declaration of an outbreak. IMPLICATIONS: Wastewater surveillance acted as an advanced notification leading to the timely deployment of enhanced testing prior to clinical presentation in a population with known vulnerabilities. Wastewater surveillance at the facility level is beneficial, particularly in high-risk congregate living settings such as shelters that house transient populations where clinical testing and vaccination can be challenging. Open communication, established individual facility response plans, and a balanced threshold for action are essential to an effective wastewater surveillance program.


RéSUMé: LIEU: Toronto (Ontario, Canada) est un grand centre urbain qui compte une importante population de résidents mal logés et plusieurs douzaines de refuges pour cette population aux vulnérabilités médicales et sociales connues. Un assez gros refuge pour hommes sans-abri a mis à l'essai dans ses installations un programme de surveillance des eaux usées pour le SRAS-CoV-2. INTERVENTION: La surveillance des eaux usées du refuge a commencé en janvier 2021. Des échantillons composites d'une heure ont été prélevés deux fois par semaine à partir d'un regard de nettoyage à l'extrémité du drain sanitaire. Le matériel génétique du virus du SRAS-CoV-2 a été extrait du support solide de chaque échantillon et analysé par PCR quantitative en temps réel pour estimer le niveau du virus. Les résultats des eaux usées ont été déclarés aux gestionnaires du refuge et à Santé publique Toronto dans un délai de quatre jours. RéSULTATS: Il y avait 169 usagers sur place au moment de l'enquête. La surveillance des eaux usées a averti de la présence d'une activité de la COVID-19 sur les lieux avant sa détection clinique. Cet avertissement a servi de signal d'alerte précoce, ce qui a permis aux gestionnaires du refuge et au bureau de santé local de procéder au dépistage rapide des symptômes et à la recherche des cas en préparation pour la déclaration d'une éclosion. CONSéQUENCES: La surveillance des eaux usées a servi de notification préalable et entraîné le déploiement opportun d'un dépistage complémentaire avant la manifestation clinique dans une population qui présente des vulnérabilités connues. La surveillance des eaux usées d'une installation est avantageuse, surtout dans des milieux d'hébergement collectif à risque élevé comme les refuges qui hébergent des populations de passage, où le dépistage clinique et la vaccination peuvent être difficiles. Une communication ouverte, des plans d'intervention établis pour chaque installation et un seuil d'intervention équilibré sont essentiels à l'efficacité d'un programme de surveillance des eaux usées.

12.
Front Psychiatry ; 13: 897276, 2022.
Article in English | MEDLINE | ID: covidwho-2055084

ABSTRACT

During the COVID-19 pandemic, Brazilian urban peripheries have been severely affected both by the spread of the virus and by social, political, and economical dynamics, raising concerns about the psychological wellbeing and mental health of the population living in these areas. The pandemic broke out in a context of reduced public spending in social and health policies as well as in a process of erosion of social rights, fostering processes of exclusion and highlighting the association between austerity, the increase in poverty and inequality as well as in health and mental health problems indicators. This article presents the results of a qualitative participatory research that investigated subjective experiences in a peripheral neighborhood of São Paulo, Brazil, aiming to understand how contextual dynamics played a role in shaping mental health experiences during the COVID-19 pandemic. A multidisciplinary team of researchers worked closely with local volunteers trained to provide emotional support calls to neighbors of the community who signed up for the project. This article presents three ethnographic cases of women who had their routines strongly affected by the suspension of public and social protection services for the containment of the SARS-CoV-2 pandemic, leading to psychological suffering due to the increased demand of "domestic circuits of care". We argue that within a context of austerity, the pandemic was remarkably harsh in urban peripheries and, specifically, for women with caring responsibilities. In addition to highlighting the pervasive "social protection gap", the cases presented in this paper also reveals the unequal dynamics of the social reproduction work in several layers, which falls mainly on women's shoulders. The "crisis of care", proposed by gender and feminist scholars, can contribute to understanding the psychological outcomes of the COVID-19 pandemic for these women.

13.
Disaster Med Public Health Prep ; : 1-4, 2022 Sep 29.
Article in English | MEDLINE | ID: covidwho-2050173

ABSTRACT

The COVID-19 Pandemic has exacerbated the already worsening opioid epidemic within the United States. With a continuing increase in opioid overdose deaths, measures are needed to halt the needless number of deaths and begin on a path of recovery to address all the factors that impact the epidemic. The CDC has provided various recommendations to combat the increases in opioid overdose deaths. These recommendations have included expanded distribution and use of naloxone and overdose prevention education as essential services for people most at risk of overdose. While strategies should include the increase in community resources for those with opioid disorder and shifting the perspectives of healthcare to view opioid disorder as a chronic illness that can be treated with medication such as buprenorphine, these methods are not immediate enough to stop the trend in deaths. The United States must take immediate action to expand access to and use of Naloxone for the public and first responders. Naloxone alone cannot address the magnitude of this epidemic, but it is an essential first step in preventing immediate death while a multimodal strategy is enacted to fully protect those most at risk.

14.
J Community Psychol ; 50(6): 2537-2541, 2022 08.
Article in English | MEDLINE | ID: covidwho-2047664

ABSTRACT

At the time of this special issue, coronavirus disease 2019 (COVID-19) is the leading cause of death in the United States and has contributed to millions of deaths worldwide. The world had no idea how the pandemic was going to impact our lives. COVID-19 exposed the inequities in our world and the individuals that were most impacted by it: vulnerable populations. Vulnerable populations may be defined as those living in poverty, living with disability, and racial, ethnic, sexual, and gender minorities. Additionally, as community psychologists we understand that the impact of inequities do not appear singlehandedly since as human beings we do not exist in a vacuum and there are multiple factors that create our level of health and well-being. Therefore, the idea of examining COVID-19 in a syndemic framework allows us to explore how a synergistic epidemic (i.e., the aggregation of two or more concurrent or sequential epidemics or disease clusters in a population with biological interactions) exacerbates the prognosis and burden of disease, which can impact vulnerable populations simultaneously. The main goal of this special issue concentrates on how COVID-19 had a synergistic impact on vulnerable populations and how these populations reacted and coped with these events.


Subject(s)
COVID-19 , Humans , Pandemics , Racial Groups , SARS-CoV-2 , United States/epidemiology , Vulnerable Populations
15.
Cureus ; 14(8): e27805, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2040374

ABSTRACT

Peripartum depression is a common complication of pregnancy with the potential for dangerous consequences to maternal and infant health if left untreated. The disorder was previously classified as a global public health issue due to the high prevalence of the disorder and the mismatch between available treatment options and successful completion of those options. The coronavirus disease 2019 (COVID-19) pandemic increased the incidence of mental health disorders globally, with an even greater effect on peripartum mothers. A preliminary study on fetal implications suggests the resulting increased maternal stress and depressive mood symptoms correlates to worsened fetal brain development. The pandemic highlighted existing barriers to the treatment of peripartum mood disorders. The drastic increase in the use of telemedicine as a modality of treatment in response to the public health crisis has the potential to address some of these barriers. Future global disasters are inevitable with peripartum mothers highly susceptible to worsened mental health outcomes. We are thus highlighting the responsibility of clinicians, professional organizations, and policymakers to support, identify, and facilitate the treatment of postpartum depression for this vulnerable population to prevent short-term and long-term repercussions.

16.
BMC Infect Dis ; 22(1): 743, 2022 Sep 20.
Article in English | MEDLINE | ID: covidwho-2038667

ABSTRACT

BACKGROUND: Lockdowns imposed throughout the US to control the COVID-19 pandemic led to a decline in all routine immunizations rates, including the MMR (measles, mumps, rubella) vaccine. It is feared that post-lockdown, these reduced MMR rates will lead to a resurgence of measles. METHODS: To measure the potential impact of reduced MMR vaccination rates on measles outbreak, this research examines several counterfactual scenarios in pre-COVID-19 and post-COVID-19 era. An agent-based modeling framework is used to simulate the spread of measles on a synthetic yet realistic social network of Virginia. The change in vulnerability of various communities to measles due to reduced MMR rate is analyzed. RESULTS: Results show that a decrease in vaccination rate [Formula: see text] has a highly non-linear effect on the number of measles cases and this effect grows exponentially beyond a threshold [Formula: see text]. At low vaccination rates, faster isolation of cases and higher compliance to home-isolation are not enough to control the outbreak. The overall impact on urban and rural counties is proportional to their population size but the younger children, African Americans and American Indians are disproportionately infected and hence are more vulnerable to the reduction in the vaccination rate. CONCLUSIONS: At low vaccination rates, broader interventions are needed to control the outbreak. Identifying the cause of the decline in vaccination rates (e.g., low income) can help design targeted interventions which can dampen the disproportional impact on more vulnerable populations and reduce disparities in health. Per capita burden of the potential measles resurgence is equivalent in the rural and the urban communities and hence proportionally equitable public health resources should be allocated to rural regions.


Subject(s)
COVID-19 , Measles , COVID-19/epidemiology , Child , Communicable Disease Control , Humans , Measles/epidemiology , Measles/prevention & control , Measles-Mumps-Rubella Vaccine , Pandemics , United States/epidemiology
17.
Front Public Health ; 10: 857033, 2022.
Article in English | MEDLINE | ID: covidwho-2022926

ABSTRACT

Background: Infection control policy affected people's wellbeing during the COVID-19 pandemic, especially those vulnerable populations. This study aimed to compare the health-related quality of life (HRQoL) of the Hong Kong (HK) Chinese population under the pandemic with the normative profiles and explore its influencing factors, including socio-demographic characteristics, loneliness, and the interaction between them. Methods: A cross-sectional questionnaire survey (301 online and 202 in-person) was conducted between June and December 2020 among the adult Chinese population during the 2nd wave of COVID-19 in HK. HRQoL was measured by a Hong Kong validated EQ-5D-5L instrument (EQ-5D-5L HK). Loneliness was measured by a single-item question regarding the frequency of the participants reporting feeling lonely and their subjective social status was measured by the MacArthur Scale of Subjective Social Status. A series of Tobit regressions was conducted. The interaction terms between socio-demographics and loneliness were also examined to decide their association with HRQoL. Results: A total of 503 responses were collected. The level of HRQoL of the respondents was significantly lower than the referred norms profile among the local general population. The findings identified that younger age, single, a higher subjective social status, and a lower level of loneliness were significantly associated with better HRQoL. Moreover, age and marital status were significant moderators in the relationship between loneliness and HRQoL. Conclusion: The present study found that some population groups face additional vulnerabilities during the pandemic in terms of declined HRQoL. In addition, reducing loneliness can protect the HRQoL during the pandemic, especially among older people. This article provides useful information for policy-makers to design and promote effective services or provide education to improve the connection of people and recover from the global pandemic.


Subject(s)
COVID-19 , Quality of Life , Adult , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Health Status , Hong Kong/epidemiology , Humans , Loneliness , Pandemics , Vulnerable Populations
18.
J Transcult Nurs ; 33(6): 732-741, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2020943

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has an amplified impact on vulnerable populations. Also, aspects related to health inequalities are insufficiently taught in higher education. This study aims to promote reflection in nursing students on the impact of the COVID-19 pandemic on vulnerable populations affected by health inequities. METHODOLOGY: A photovoice method was used. Undergraduate nursing students (Spain and United Kingdom) took and explained photographs using SHOWED models. RESULTS: 108 students participated. Two-domain summary themes were created: The COVID-19 pandemic has impacted ethnic minorities and socioeconomically vulnerable groups, and Proposals to respond to the negative impact on ethnic minorities and socioeconomically vulnerable groups. DISCUSSION: The students identified negative health scenarios by linking COVID-19 with aspects of work, salary, and housing of these two specific populations. Holistic actions were also proposed to protect their health. As future health professionals, they must recognize these communities and work to eliminate inequalities.


Subject(s)
COVID-19 , Education, Nursing, Baccalaureate , Students, Nursing , Education, Nursing, Baccalaureate/methods , Health Inequities , Humans , Pandemics
19.
Addict Sci Clin Pract ; 17(1): 48, 2022 Sep 05.
Article in English | MEDLINE | ID: covidwho-2009468

ABSTRACT

BACKGROUND: People who inject drugs (PWID) have low rates of COVID-19 testing and vaccination and are vulnerable to severe disease. We partnered with a local, community-based syringe service program (SSP) in San Diego County, CA, to develop the single-session theory- and evidence-informed "LinkUP" intervention to increase COVID-19 testing and vaccination. This paper details the protocol for a pilot randomized controlled trial (RCT) of the LinkUP intervention. METHODS: With significant community input into study design considerations, including through our Community and Scientific Advisory Board, the LinkUP pilot RCT leverages an ongoing cohort study with adult (≥ 18 years) PWID in San Diego County to recruit participants who have not recently undergone voluntary COVID-19 testing and are unvaccinated. Eligible participants are referred to SSP locations randomized to offer the active intervention (involving tailored education, motivational interviewing, and problem-solving strategies) or a didactic attention-control condition (information sharing only). Both conditions are delivered by trained peer counselors hired by the SSP and were designed to be delivered at mobile (outdoor) SSP sites in ~ 30 min. Intake data assesses COVID-19 testing and vaccination history, health status, and harm reduction needs (to facilitate SSP referrals). At the end of either intervention condition, peer counselors offer onsite rapid COVID-19 antigen testing and COVID-19 vaccination referrals. Out-take and follow-up data (via SSP and state health department record linkages) confirms whether participants received the intervention, COVID-19 testing (and results) onsite or within six months, and vaccination referrals (and uptake) within six months. Planned analyses, which are not powered to assess efficacy, will provide adequate precision for effect size estimates for primary (COVID-19 testing) and secondary (vaccination) intervention outcomes. Findings will be disseminated widely including to local health authorities, collaborating agencies, and community members. DISCUSSION: Lessons from this community-based pilot study include the importance of gathering community input into study design, cultivating research-community partnerships based on mutual respect and trust, and maintaining frequent communication regarding unexpected events (e.g., police sweeps, neighborhood opposition). Findings may support the adoption of COVID-19 testing and vaccination initiatives implemented through SSPs and other community-based organizations serving vulnerable populations of people impacted by substance use and addiction. Trial registration This trial was registered prospectively at ClinicalTrials.gov (identifier NCT05181657).


Subject(s)
COVID-19 , Drug Users , Substance Abuse, Intravenous , Adult , COVID-19/prevention & control , COVID-19 Testing , Humans , Pilot Projects , Randomized Controlled Trials as Topic , SARS-CoV-2 , Substance Abuse, Intravenous/epidemiology , Vaccination
20.
Clin Infect Dis ; 75(Supplement_1): S30-S36, 2022 Aug 15.
Article in English | MEDLINE | ID: covidwho-2001238

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused significant mortality, especially among older adults whose distinct immune system reflects immunosenescence. Multiple SARS-CoV-2 vaccines have received emergency use authorization and/or licensure from the US Food and Drug Administration and throughout the world. However, their deployment has heighted significant limitations, such by age-dependent immunogenicity, requirements for multiple vaccine doses, refrigeration infrastructure that is not universally available, as well as waning immunity. Thus, there was, and continues to be a need for continued innovation during the pandemic given the desire for dose-sparing, formulations stable at more readily achievable temperatures, need for robust immunogenicity in vulnerable populations, and development of safe and effective pediatric vaccines. In this context, optimal SARS-CoV-2 vaccines may ultimately rely on inclusion of adjuvants as they can potentially enhance protection of vulnerable populations and provide dose-sparing effects enabling single shot protection.


Subject(s)
COVID-19 , Viral Vaccines , Adjuvants, Immunologic , Aged , Antibodies, Viral , COVID-19/prevention & control , COVID-19 Vaccines , Child , Humans , SARS-CoV-2 , Vulnerable Populations
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