Retrospective Analysis of the Outcome of Hospitalized COVID-19 Patients with Coexisting Metabolic Syndrome and HIV Using Multinomial Logistic Regression.

Globally, the coexistence of metabolic syndrome (MetS) and HIV has become an important public health problem, putting coronavirus disease 19 (COVID-19) hospitalized patients at risk for severe manifestations and higher mortality. A retrospective cross-sectional analysis was conducted to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients using secondary data from the Department of Health in Limpopo Province, South Africa. The study included 15,151 patient clinical records of laboratory-confirmed COVID-19 cases. Data on MetS was extracted in the form of a cluster of metabolic factors. These included abdominal obesity, high blood pressure, and impaired fasting glucose captured on an information sheet. Spatial distribution of mortality among patients was observed; overall (21-33%), hypertension (32-43%), diabetes (34-47%), and HIV (31-45%). A multinomial logistic regression model was applied to identify factors and determine their relationships with hospitalization outcomes for COVID-19 patients. Mortality among COVID-19 patients was associated with being older (≥50+ years), male, and HIV positive. Having hypertension and diabetes reduced the duration from admission to death. Being transferred from a primary health facility (PHC) to a referral hospital among COVID-19 patients was associated with ventilation and less chance of being transferred to another health facility when having HIV plus MetS. Patients with MetS had a higher mortality rate within seven days of hospitalization, followed by those with obesity as an individual component. MetS and its components such as hypertension, diabetes, and obesity should be considered a composite predictor of COVID-19 fatal outcomes, mostly, increased risk of mortality. The study increases our understanding of the common contributing variables to severe manifestations and a greater mortality risk among COVID-19 hospitalized patients by investigating the influence of MetS, its components, and HIV coexistence. Prevention remains the mainstay for both communicable and non-communicable diseases. The findings underscore the need for improvement of critical care resources across South Africa.

Intervention effects and long-term changes in physical activity and cardiometabolic outcomes among children at risk of noncommunicable diseases in South Africa: a cluster-randomized controlled trial and follow-up analysis.

Introduction: Risk factors for noncommunicable diseases such as insufficient physical activity (PA), overweight or hypertension are becoming increasingly predominant among children globally. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations, is scarce. We aim to assess the short-term effects of the physical and health KaziKidz intervention on cardiometabolic risk factors and the long-term, pre-and post-COVID-19 pandemic changes thereof in high-risk children from marginalized communities. Methods: The intervention was tested in a cluster-randomized controlled trial between January and October 2019 in eight primary schools near Gqeberha, South Africa. Children with overweight, elevated blood pressure, pre-diabetes, and/or borderline dyslipidemia were identified and re-assessed 2 years post-intervention. Study outcomes included accelerometry-measured PA (MVPA), body mass index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC to HDL ratio). We conducted mixed regression analyses to assess intervention effects by cardiometabolic risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation. Results: We found a significant intervention effect on MVPA during school hours for physically inactive children, and among active as well as inactive girls. In contrast, the intervention lowered HbA1c and TC to HDL ratio only in children with glucose or lipid values within the norm, respectively. At follow-up, the intervention effects were not maintained in at-risk children, who showed a decline in MVPA, and an increase in BMI-for-age, MAP, HbA1c and TC to HDL ratio. Conclusion: We conclude that schools are key settings in which to promote PA and improve health; however, structural changes are necessary to ensure that effective interventions reach marginalized school populations and achieve sustainable impact.

Characterization of the COVID-19 Vaccine Uptake in Patients With Chronic Diseases in a Large University-based Family Medicine Clinical Practice.

PURPOSE: To characterize COVID-19 vaccine uptake in patients with chronic conditions at the large university-based Family Medicine practice serving a population with low COVID-19 vaccine acceptance. METHODS: A rolling panel of patients attributed to the practice was submitted monthly to the Chesapeake Regional Health Information Exchange (CRISP) to monitor patients' vaccination status. Chronic conditions were identified using the CMS Chronic Disease Warehouse. An outreach strategy deploying Care Managers was developed and implemented. Associations between vaccination status and patients' characteristics were examined using a multivariable Cox's proportional hazard regression modeling. RESULTS: Among 8469 empaneled adult (18+) patients, 6404 (75.6%) received at least 1 dose of COVID-19 vaccine in December 2020 to March 2022. Patients were relatively young (83.4% <65 years old), predominantly female (72.3%), and non-Hispanic Black (83.0%). Among chronic conditions, hypertension had the highest prevalence (35.7%), followed by diabetes (17.0%). Associations between vaccine status and the presence of chronic conditions varied by age and race. Older patients (45+ years old) with diabetes and/or hypertension showed a statistically significant delay in receiving COVID-19 vaccine, while young Black adults (18-44 years old) with diabetes complicated by hypertension were more likely to be vaccinated compared to patients of the same age and race with no chronic conditions (Hazard ratio 1.45; 95% CI 1.19,1.77; P = .0003). CONCLUSIONS: The practice-specific COVID-19 vaccine CRISP dashboard helped to identify and address delays in receiving COVID-19 vaccine in the most vulnerable, underserved populations. Reasons for age and race-specific delays in patients with diabetes and hypertension should be explored further.

Urinary proteomics combined with home blood pressure telemonitoring for health care reform trial-First progress report.

High blood pressure (BP) and type-2 diabetes (T2DM) are forerunners of chronic kidney disease and left ventricular dysfunction. Home BP telemonitoring (HTM) and urinary peptidomic profiling (UPP) are technologies enabling risk stratification and personalized prevention. UPRIGHT-HTM (NCT04299529) is an investigator-initiated, multicenter, open-label, randomized trial with blinded endpoint evaluation designed to assess the efficacy of HTM plus UPP (experimental group) over HTM alone (control group) in guiding treatment in asymptomatic patients, aged 55-75 years, with ≥5 cardiovascular risk factors. From screening onwards, HTM data can be freely accessed by all patients and their caregivers; UPP results are communicated early during follow-up to patients and caregivers in the intervention group, but at trial closure in the control group. From May 2021 until January 2023, 235 patients were screened, of whom 53 were still progressing through the run-in period and 144 were randomized. Both groups had similar characteristics, including average age (62.0 years) and the proportions of African Blacks (81.9%), White Europeans (16.7%), women 56.2%, home (31.2%), and office (50.0%) hypertension, T2DM (36.4%), micro-albuminuria (29.4%), and ECG (9.7%) and echocardiographic (11.5%) left ventricular hypertrophy. Home and office BP were 128.8/79.2 mm Hg and 137.1/82.7 mm Hg, respectively, resulting in a prevalence of white-coat, masked and sustained hypertension of 40.3%, 11.1%, and 25.7%. HTM persisted after randomization (48 681 readings up to 15 January 2023). In conclusion, results predominantly from low-resource sub-Saharan centers proved the feasibility of this multi-ethnic trial. The COVID-19 pandemic caused delays and differential recruitment rates across centers.

Factors associated with mortality in patients hospitalized for COVID-19 admitted to a tertiary hospital in Lambayeque, Peru, during the first wave of the pandemic.

INTRODUCTION: COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread worldwide, becoming a long-term pandemic. OBJECTIVES: To analyze the factors associated with mortality in patients hospitalized for COVID-19 in a tertiary hospital in the Lambayeque region of Peru. METHODS: A retrospective cohort study of patients with a diagnosis of COVID-19, hospitalized in a hospital in northern Peru, was conducted from March to September 2020. RESULTS: Of the 297 patients studied, 69% were women, the mean age was 63.99 years (SD = ±15.33 years). Hypertension was the most frequent comorbidity (36.67%), followed by diabetes mellitus (24.67%) and obesity (8.33%). The probability of survival at 3 days of ICU stay was 65.3%, at 7 days 24.2%, and 0% on day 14. Risk factors associated with mortality in patients hospitalized for COVID-19 are age, male sex, tachypnea, low systolic blood pressure, low peripheral oxygen saturation, impaired renal function, elevated IL-6 and elevated D-dimer. CONCLUSIONS: Mortality in hospitalized patients with COVID-19 was 51.18 per 100 persons, Mortality was found to be associated with hypertension, type of infiltrating, and sepsis.

Impact of free hypertension pharmacy program and social distancing policy on stroke: A longitudinal study.

Background: The estimated lifetime risk of stroke was the highest in East Asia worldwide, especially in China. Antihypertensive therapy can significantly reduce stroke mortality. However, blood pressure control is poor. Medication adherence is a barrier as patients' out-of-pocket costs have risen. We aimed to take advantage of a free hypertension pharmacy intervention and quantified the impact on stroke mortality. Methods: A free pharmaceutical intervention program was implemented in Deqing, Zhejiang province in April 2018. Another non-pharmaceutical intervention, social distancing due to the pandemic of Coronavirus disease 2019 (COVID-19), was also key to affecting stroke mortality. We retrospectively collected the routine surveillance data of stroke deaths from Huzhou Municipal Center for Disease Prevention and Control in 2013-2020 and obtained within-city mobility data from Baidu Migration in 2019-2020, then we quantified the effects of both pharmaceutical intervention and social distancing using Serfling regression model. Results: Compared to the predicted number, the actual number of stroke deaths was significantly lower by 10% (95% CI, 6-15%; p < 0.001) from April 2018 to December 2020 in Deqing. Specifically, there was a reduction of 19% (95% CI, 10-28%; p < 0.001) in 2018. Moreover, we observed a 5% (95% CI, -4 - 14%; p = 0.28) increase in stroke mortality due to the adverse effect of COVID-19 but it wasn't statistically significant. Conclusion: Free hypertension pharmacy program has great potential to prevent considerable stroke deaths. In the future, the free supply of low-cost, essential medications that target patients with hypertension at increased risk of stroke could be taken into account in formulating public health policies and guiding allocations of health care resources.

Outcomes of the Indonesian Chronic Disease Management Program (PROLANIS) in Patients with Hypertension During the COVID-19 Pandemic in Rural Areas: A Preliminary Evaluation Study.

BACKGROUND The Indonesian Chronic Disease Management Program (PROLANIS) is a government program that aims to improve the health outcomes of patients with chronic diseases, including hypertension. This preliminary study aimed to evaluate the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the health outcomes of hypertension patients in rural areas who were enrolled in PROLANIS. MATERIAL AND METHODS This study used data from 4 PROLANIS groups in East Java province. The data were collected from participants' 6-month evaluations at 3 time points: before the COVID-19 pandemic in December 2019 (T0), during the COVID-19 pandemic in June 2020 (T1), and in December 2020 (T2). Evaluated parameters were body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), low-density lipid (LDL), high-density lipid (HDL), triglyceride (TG), and estimated glomerular filtration rate (eGFR). RESULTS There were 91 patients included in the analyses. Compared to T0, BMI, blood pressure, eGFR, and TC had significantly deteriorated at T1, but LDL, HDL, and TG showed no marked changes. At T2, BMI, DBP, and TC were similar to T0. On the other hand, SBP and eGFR did not improve, while HDL significantly deteriorated. Stratified based on age, worsening of DBP, TC, and LDL at T1 and eGFR at T1 and T2 was only observed in those aged 60 years and older. CONCLUSIONS This preliminary study showed that the health outcomes of hypertension patients in rural areas who were enrolled in PROLANIS were negatively impacted during the COVID-19 pandemic, with the elderly being the most affected.

Occurrence of comorbid diseases in patients after COVID-19.

The COVID-19 pandemic has highlighted the potential impact of this disease on cardiovascular morbidity and mortality. Patients with established cardiovascular (CV) disease are at increased risk of severe infection and hospital-acquired adverse outcomes. This study aimed to investigate the prevalence and characteristics of comorbidities in COVID-19 patients. We analyzed data from 220 patients who previously contracted COVID-19. Statistical analysis was performed using SPSS software. The average age of the patients was 54.6 ± 11.4 years, and arterial hypertension (AH) was the most common comorbidity, affecting 55% of patients. Obesity was observed in one-third of patients, while coronary heart disease (CHD) and coronary heart failure (CHF) were reported in 17.7% and 11.8% of patients, respectively. Chronic kidney disease (CKD), atrial fibrillation (AF), and obstructive pulmonary disease (COPD) were less common. Cardiovascular diseases, particularly AH, were the most frequent comorbidities in COVID-19 patients. Understanding the prevalence and characteristics of comorbidities in COVID-19 patients is crucial for developing appropriate management strategies and improving clinical outcomes. Our findings highlight the importance of identifying and managing comorbidities in COVID-19 patients to reduce the risk of severe COVID-19 and improve clinical outcomes.

Risk of Incident New-Onset Arterial Hypertension After COVID-19 Recovery: A Systematic Review and Meta-analysis.

INTRODUCTION: Arterial Hypertension (HT) has been described as a common comorbidity and independent risk factor of short-term outcome in COVID-19 patients. However, data regarding the risk of new-onset HT during the post-acute phase of COVID-19 are scant. AIM: We assess the risk of new-onset HT in COVID-19 survivors within one year from the index infection by a systematic review and meta-analysis of the available data. METHODS: Data were obtained searching MEDLINE and Scopus for all studies published at any time up to February 11, 2023, and reporting the long-term risk of new-onset HT in COVID-19 survivors. Risk data were pooled using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI). Heterogeneity among studies was assessed using I2 statistic. RESULTS: Overall, 19,293,346 patients (mean age 54.6 years, 54.6% males) were included in this analysis. Of them, 758,698 survived to COVID-19 infection. Over a mean follow-up of 6.8 months, new-onset HT occurred to 12.7 [95% CI 11.4-13.5] out of 1000 patients survived to COVID-19 infection compared to 8.17 [95% CI 7.34-8.53] out of 1000 control subjects. Pooled analysis revealed that recovered COVID-19 patients presented an increased risk of new-onset HT (HR 1.70, 95% CI 1.46-1.97, p < 0.0001, I2 = 78.9%) within seven months. This risk was directly influenced by age (p = 0.001), female sex (p = 0.03) and cancer (p < 0.0001) while an indirect association was observed using the follow-up length as moderator (p < 0.0001). CONCLUSIONS: Our findings suggest that new-onset HT represents an important post-acute COVID-19 sequelae.

The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi.

Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5-8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.

Clinical profile and severity predictors of coronavirus disease 19 infection in a reference center from southern Brazil: a cross-sectional study.

OBJECTIVES: The coronavirus disease pandemic has become a major global health crisis since 2019. Recent data show the association of diabetes, hypertension, and obesity with poor related outcomes in coronavirus disease infection. This descriptive study aimed to identify the clinical and laboratory parameters in patients with acute respiratory syndrome and confirmed severe acute respiratory syndrome coronavirus 2 infection. METHODS: In this cross-sectional study, we analyzed data of 409 patients admitted to a referral hospital in Rio Grande do Sul, Brazil, with coronavirus disease infection confirmed by reverse transcription polymerase chain reaction. Clinical, laboratory, and imaging data were collected retrospectively from electronic medical records using a template with the variables of interest. RESULTS: The average age was 64 years (52-73), and the body mass index was 27 kg/m² (22.1-31.2). Hypertension, diabetes, and obesity were observed in 58, 33, and 32% of the patients, respectively. Patients admitted to an intensive care unit were older [66 years (53-74) vs. 59 years (42.2-71.7)], with significantly higher impairment on chest computed tomography [75% (50-75) vs. 50% (25-60)] and received higher doses of corticosteroid therapy [39.4 mg (14.3-70.3) vs. 6 mg (6-14.7)]. Hematological parameters were lower in critically ill patients, with greater differences observed on the fifth day of hospitalization [hemoglobin 11.5 g/dL (9.5-13.1) vs. 12.8 g/dL (11.5-14.2), platelets 235,000 µL (143,000-357,000) vs. 270,000 µL (192,000-377,000), and lymphocytes 900 µL (555-1,500) vs. 1,629 µL (1,141-2,329)]. C-reactive protein levels and kidney function were also worse in intensive care unit patients. The mortality rate was significantly higher in the intensive care unit compared to the basic care unit (62.8 vs. 12.2%). CONCLUSION: Our findings suggest that metabolic and cardiovascular comorbidities, as well as abnormal hematological parameters, are common findings among patients with severe respiratory syndrome related to coronavirus disease.

Eliminating hypertension disparities in U.S. non-Hispanic black adults: current and emerging interventions.

PURPOSE OF REVIEW: Hypertension in non-Hispanic black (NHB) adults in the United States has an earlier onset, higher prevalence, and increased severity compared with other racial/ethnic populations. Uncontrolled hypertension is responsible for the increased burden of cardiovascular disease (CVD) morbidity and mortality and decreased longevity in NHB adults. Unfortunately, eliminating the persistent hypertension-associated disparities and the white/black mortality gap, worsened by the COVID-19 pandemic, has been challenging. Overcoming the social determinants of health (SDOH), implementing therapeutic lifestyle changes (TLC), and using intensive guideline-directed medical therapy are required. Moreover, novel approaches, including community-based interventions and self-measured blood pressure (SMBP) monitoring, may mitigate U.S. disparities in hypertension. RECENT FINDINGS: In this review, we discuss recent data regarding the U.S. NHB adult disparate hypertension control and CVD morbidity and mortality. We note current approaches to address disparities, such as TLC, evidence-based pharmacotherapy, community-based interventions and SMBP. Finally, we explore future research and initiatives to seek hypertension-related health equity. SUMMARY: In the final analysis, longstanding, unacceptable hypertension and CVD morbidity and mortality in U.S. NHB adults must be addressed. Appropriate TLC and evidence-based pharmacotherapy benefit all populations, especially NHB adults. Ultimately, novel community-based interventions and SMBP may help overcome the SDOH that cause hypertension disparities.

Global prevalence and effect of comorbidities and smoking status on severity and mortality of COVID-19 in association with age and gender: a systematic review, meta-analysis and meta-regression.

A COVID-19 patient often presents with multiple comorbidities and is associated with adverse outcomes. A comprehensive assessment of the prevalence of comorbidities in patients with COVID-19 is essential. This study aimed to assess the prevalence of comorbidities, severity and mortality with regard to geographic region, age, gender and smoking status in patients with COVID-19. A systematic review and multistage meta-analyses were reported using PRISMA guidelines. PubMed/MEDLINE, SCOPUS, Google Scholar and EMBASE were searched from January 2020 to October 2022. Cross-sectional studies, cohort studies, case series studies, and case-control studies on comorbidities reporting among the COVID-19 populations that were published in English were included. The pooled prevalence of various medical conditions in COVID-19 patients was calculated based on regional population size weights. Stratified analyses were performed to understand the variations in the medical conditions based on age, gender, and geographic region. A total of 190 studies comprising 105 million COVID-19 patients were included. Statistical analyses were performed using STATA software, version 16 MP (StataCorp, College Station, TX). Meta-analysis of proportion was performed to obtain pooled values of the prevalence of medical comorbidities: hypertension (39%, 95% CI 36-42, n = 170 studies), obesity (27%, 95% CI 25-30%, n = 169 studies), diabetes (27%, 95% CI 25-30%, n = 175), and asthma (8%, 95% CI 7-9%, n = 112). Moreover, the prevalence of hospitalization was 35% (95% CI 29-41%, n = 61), intensive care admissions 17% (95% CI 14-21, n = 106), and mortality 18% (95% CI 16-21%, n = 145). The prevalence of hypertension was highest in Europe at 44% (95% CI 39-47%, n = 68), obesity and diabetes at 30% (95% CI, 26-34, n = 79) and 27% (95%CI, 24-30, n = 80) in North America, and asthma in Europe at 9% (95% CI 8-11, n = 41). Obesity was high among the ≥ 50 years (30%, n = 112) age group, diabetes among Men (26%, n = 124) and observational studies reported higher mortality than case-control studies (19% vs. 14%). Random effects meta-regression found a significant association between age and diabetes (p < 0.001), hypertension (p < 0.001), asthma (p < 0.05), ICU admission (p < 0.05) and mortality (p < 0.001). Overall, a higher global prevalence of hypertension (39%) and a lower prevalence of asthma (8%), and 18% of mortality were found in patients with COVID-19. Hence, geographical regions with respective chronic medical comorbidities should accelerate regular booster dose vaccination, preferably to those patients with chronic comorbidities, to prevent and lower the severity and mortality of COVID-19 disease with novel SARS-CoV-2 variants of concern (VOC).

Estimating Older Adult Mortality From COVID-19.

OBJECTIVES: The purpose of this study was to employ simulations to model the probability of mortality from COVID-19 (i.e., coronavirus) for older adults in the United States given at best and at worst cases. METHODS: This study first examined current epidemiological reports to better understand the risk of mortality from COVID-19. Past epidemiological studies from severe acute respiratory syndrome were also examined given similar virology. Next, at best and at worst mortality cases were considered with the goal of estimating the probability of mortality. To accomplish this for the general population, microdata from the National Health Interview Survey pooled sample (2016, 2017, and 2018 public-use NHIS with a sample of 34,881 adults at least 60 years of age) were utilized. Primary measures included age and health status (diabetes, body mass index, and hypertension). A logit regression with 100,000 simulations was employed to derive the estimates and probabilities. RESULTS: Age exhibited a positive association for the probability of death with an odds ratio (OR) of 1.22 (p < .05, 95% confidence interval [CI]: 1.05-1.42). A positive association was also found for body mass index (BMI) (OR 1.03, p < .01, 95% CI: 1.02-1.04) and hypertension (OR 1.36, p < .01, 95% CI: 1.09-1.66) for the at best case. Diabetes was significant but only for the at best case. DISCUSSION: This study found mortality increased with age and was notable for the 74-79 age group for the at best case and the 70-79 age group of the at worst case. Obesity was also important and suggested a higher risk for mortality. Hypertension also exhibited greater risk but the increase was minimal. Given the volume of information and misinformation, these findings can be applied by health professionals, gerontologists, social workers, and local policymakers to better inform older adults about mortality risks and, in the process, reestablish public trust.

Associations of Physical Inactivity and COVID-19 Outcomes Among Subgroups.

INTRODUCTION: Physical activity before COVID-19 infection is associated with less severe outcomes. The study determined whether a dose‒response association was observed and whether the associations were consistent across demographic subgroups and chronic conditions. METHODS: A retrospective cohort study of Kaiser Permanente Southern California adult patients who had a positive COVID-19 diagnosis between January 1, 2020 and May 31, 2021 was created. The exposure was the median of at least 3 physical activity self-reports before diagnosis. Patients were categorized as follows: always inactive, all assessments at 10 minutes/week or less; mostly inactive, median of 0-60 minutes per week; some activity, median of 60-150 minutes per week; consistently active, median>150 minutes per week; and always active, all assessments>150 minutes per week. Outcomes were hospitalization, deterioration event, or death 90 days after a COVID-19 diagnosis. Data were analyzed in 2022. RESULTS: Of 194,191 adults with COVID-19 infection, 6.3% were hospitalized, 3.1% experienced a deterioration event, and 2.8% died within 90 days. Dose‒response effects were strong; for example, patients in the some activity category had higher odds of hospitalization (OR=1.43; 95% CI=1.26, 1.63), deterioration (OR=1.83; 95% CI=1.49, 2.25), and death (OR=1.92; 95% CI=1.48, 2.49) than those in the always active category. Results were generally consistent across sex, race and ethnicity, age, and BMI categories and for patients with cardiovascular disease or hypertension. CONCLUSIONS: There were protective associations of physical activity for adverse COVID-19 outcomes across demographic and clinical characteristics. Public health leaders should add physical activity to pandemic control strategies.

Noncompliance with Hypertension Treatment and Related Factors among Kumamoto Earthquake Victims Who Experienced the COVID-19 Pandemic during Postearthquake Recovery Period.

Survivors of the Kumamoto earthquake of 2016 experienced the coronavirus disease (COVID-19) outbreak while carrying additional burdens that might bring inadequate coping. This cross-sectional survey aimed to identify untreated and interrupted consultations among those with hypertension and related factors and to identify the disaster's long-term effects. Of the 19,212 earthquake survivors who had moved to permanent housing, 7367 (4196 women and 3171 men, mean age 61.8 ± 17.3 years) completed a self-administered questionnaire. The prevalence of hypertension was 41.4%. The results of the logistic regression analysis with the significant independent variables in the bivariate analysis were: reduced income due to COVID-19 (AOR = 3.23, 95%CI = 2.27-4.58) and poor self-rated health (AOR = 2.49, 95%CI = 1.72-3.61) were associated with a risk of untreated or discontinued treatment. Moreover, living in rental, public or restoration public housing was also significantly associated with a higher risk of hypertension noncompliance (AOR = 1.92, 95%CI = 1.20-3.07; AOR = 2.47, 95%CI = 1.38-4.42; AOR = 4.12, 95%CI = 1.14-14.90). These results suggest that changes due to COVID-19, the extent of self-rated health and the type of permanent housing influence the hypertension consulting behaviour of earthquake survivors during recovery. It is crucial to implement long-term public support for the mental health, income and housing concerns of the survivors.

[Frequency of clinical characteristics and factors associated with mortality in patients hospitalized for COVID-19 in Puebla, Mexico]. / Frecuencia de características clínicas y factores asociados con mortalidad en pacientes hospitalizados por COVID-19 en Puebla, México.

BACKGROUND: Mexico has a very high mortality rate from COVID19, risk factors, clinical manifestations of our population are unknown. OBJECTIVE: To know risk factors for mortality from COVID19 in hospitalized patients of the Secretary of Health (SSA) Puebla, and clinical characteristics. MATERIAL AND METHODS: Case-control, observational, retrospective, cross-sectional study in COVID-19 patients. 2 groups: COVID-19 patients who died and those who did not die. RESULTS: 502  patients,  314  men  (62.5%  CI95%  58-66%),  188  women  (37.5%  CI95%  33-42%),  mean  age  54.14  +13.8,  interquartile  range  (IQR)  45-63, age interval 19 and 90 years, hospital stay (DEIH) 1-43 days, mean 9.8+7.8 days, median 8, IQR 4-13 days. Symptoms associated with mortality: dyspnea, chest pain, MR>1. Variables associated with mortality: age = or > 65 years, greater IHD, having > 2 comorbidities (OR 1.453), diabetes (OR 1.759), hypertension (OR 6.29) and chronic kidney failure (CRF) (OR 3.16) , (p<0.05). Ferritin >500ng/ml (OR 5.1799), DHL >400 IU/L (OR 3.313) and D-dimer >2000 m/ml (OR 2.868). CONCLUSIONS: Age > or = 65 years, greater IHD, > 2 comorbidities, diabetes, hypertension or CRF, increased ferritin, D-dimer or DHL, are risk factors for mortality from COVID-19.

OBJECTIVO: Identificar los factores de riesgo y las manifestaciones clínicas asociadas con mortalidad por COVID-19 en pacientes internados en hospitales de la Secretaria de Salud (SSA) del estado de Puebla, México. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y transversal, llevado a cabo en pacientes con COVID-19, internados en hospitales de la Secretaria de Salud (SSA) del estado de Puebla, México. Los pacientes se dividieron en dos grupos: 1) fallecidos por COVID-19 y 2) supervivientes de COVID-19. RESULTADOS: Se registraron 502 pacientes: 314 hombres (62.5 % IC95% 58-66 %) y 188 mujeres (37.5% IC95% 33-42%), con edad promedio de 54.14 ± 13.8 años (rango intercuartil de 45-63, intervalo de edad de 19 y 90 años); estancia hospitalaria de 1 a 43 días (media 9.8 ± 7.8 días, me-diana 8, rango intercuartil 4-13 días). Los síntomas asociados con mortalidad por COVID-19 fueron: disnea y dolor torácico (RM >1). Las variables asociadas con mortalidad: edad igual o mayor de 65 años, estancia hospitalaria prolongada, coexistencia de dos o más comorbilidades (RM: 1.453), diabetes (RM: 1.759), hipertensión (RM: 6.29) e insuficiencia renal crónica (RM: 3.16; p<0.05); ferritina >500 ng/mL (RM: 5.1799), DHL >400 IU/L (RM: 3.313) y Dimero D >2000 m/ml (RM: 2.868). CONCLUSIONES: Este estudio demuestra que los principales factores de riesgo asociados con mortalidad por COVID-19 son: edad igual o mayor de 65 años, estancia hospitalaria prolongada, coexistencia de dos o más enfermedades, diabetes, hipertensión e insuficiencia renal crónica; además de concentraciones elevadas de ferritina, Dimero D y DHL.

Decision makers perceptions and experiences of developing population-level interventions targeting risk factors for hypertension and diabetes in South Africa: a qualitative study.

BACKGROUND: People in low- and middle-income countries are disproportionately affected by Noncommunicable diseases (NCDs). NCD's such as heart disease, cancer, chronic respiratory disease, and diabetes, are the leading cause of premature death worldwide and represent an emerging global health threat. The purpose of this qualitative study was to explore decision makers perceptions of developing population-level interventions (policies and programmes), targeting risk factors for hypertension and diabetes, in South Africa. METHODS: Using purposive sampling we recruited fifteen participants, who were well informed about the policies, programs or supportive environment for prevention and management of diabetes and hypertension in South Africa. We conducted 12 individual interviews and 1 group interview (consisting of 3 participants). Data was analysed thematically in NVivo. The results were shared and discussed in two consultative stakeholder workshops, with participants, as part of a member validation process in qualitative research. All communication with participants was done virtually using MS Teams or ZOOM. RESULTS: For development of population-level interventions, key enablers included, stakeholders' engagement and collaboration, contextualization of policies and programs, and evaluation and organic growth. Challenges for supportive policy and program formulation, and to enable supportive environments, included the lack of time and resources, lack of consultation with stakeholders, regulations and competing priorities, and ineffective monitoring and evaluation. The main drivers of population-level interventions for diabetes and hypertension were perceived as the current contextual realities, costs, organizational reasons, and communication between various stakeholders. CONCLUSION: To address the risk factors for hypertension and diabetes in South Africa, policies and programs must account for the needs of the public and the historical and socio-economic climate. Feasibility and sustainability of programs can only be ensured when the resources are provided, and environments enabled to promote behavior change on a population-level. A holistic public health approach, which is contextually relevant, and evidence informed, is considered best practice in the formulation of population-level interventions.