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1.
Int J Environ Res Public Health ; 20(10)2023 05 12.
Article in English | MEDLINE | ID: covidwho-20234935

ABSTRACT

People released from prison experience high health needs and face barriers to health care in the community. During the COVID-19 pandemic, people released early from California state prisons to under-resourced communities. Historically, there has been minimal care coordination between prisons and community primary care. The Transitions Clinic Network (TCN), a community-based non-profit organization, supports a network of California primary care clinics in adopting an evidence-based model of care for returning community members. In 2020, TCN linked the California Department of Corrections and Rehabilitation (CDCR) and 21 TCN-affiliated clinics to create the Reentry Health Care Hub, supporting patient linkages to care post-release. From April 2020-August 2022, the Hub received 8420 referrals from CDCR to facilitate linkages to clinics offering medical, behavioral health, and substance use disorder services, as well as community health workers with histories of incarceration. This program description identifies care continuity components critical for reentry, including data sharing between carceral and community health systems, time and patient access for pre-release care planning, and investments in primary care resources. This collaboration is a model for other states, especially after the Medicaid Reentry Act and amid initiatives to improve care continuity for returning community members, like California's Medicaid waiver (CalAIM).


Subject(s)
COVID-19 , Prisoners , United States , Humans , Prisons , Pandemics , COVID-19/epidemiology , Delivery of Health Care , Continuity of Patient Care , California , Chronic Disease , Referral and Consultation
2.
J Emerg Manag ; 21(2): 165-171, 2023.
Article in English | MEDLINE | ID: covidwho-20232804

ABSTRACT

This study examined the results of an electronic survey of residential care facilities for the elderly (RCFE) in California in 2021 to provide insight on key elements of emergency plans and facility preparedness for the COVID-19 pandemic and future emergencies. Surveys were distributed to RCFE administrators using publicly available emails found on the California Health and Human Services Open Data Portal. Responses from 150 facility administrators included data on their perception of current and future facility preparedness for COVID-19 and other emergency scenarios, items included in facility evacuation/shelter-in-place plans, and hazard vulnerability analyses and training practices of facility staff. Descriptive analyses were performed on collected data. The majority of results were from small facilities serving less than seven residents (70.7 percent). Prior to COVID-19, more than 90 percent of respondents included disaster drills, evacuation plans, and emergency transportation in their emergency preparedness plan. The majority of facilities added pandemic planning, vaccine distribution, and quarantine guidelines elements into their plans during COVID-19. Approximately half of facilities reported conducting proactive hazard vulnerability analyses. Around 75 percent of RCFEs felt well prepared for fires and infectious disease outbreaks, had mixed preparedness levels for earthquakes and floods, and felt least prepared for landslides and active shooter emergencies. During the pandemic, perceptions of preparedness rose, with 92 percent stating they felt very prepared currently and almost 70 percent felt very prepared for future pandemics. Preparedness of these essential facilities and their residents can continue to improve by conducting regular proactive hazard vulnerability analyses, improving communication lines and mutual aid agreements with local and state organizations, and preparing for critical emergencies such as landslides and active shooter scenarios. This can help to ensure adequate resources and investments are provided to care for older adults during emergencies.


Subject(s)
COVID-19 , Civil Defense , Disaster Planning , Humans , Aged , Emergencies , Pandemics , COVID-19/epidemiology , Surveys and Questionnaires , California
3.
Microb Genom ; 9(6)2023 06.
Article in English | MEDLINE | ID: covidwho-20243083

ABSTRACT

The capacity for pathogen genomics in public health expanded rapidly during the coronavirus disease 2019 (COVID-19) pandemic, but many public health laboratories did not have the infrastructure in place to handle the vast amount of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequence data generated. The California Department of Public Health, in partnership with Theiagen Genomics, was an early adopter of cloud-based resources for bioinformatics and genomic epidemiology, resulting in the creation of a SARS-CoV-2 genomic surveillance system that combined the efforts of more than 40 sequencing laboratories across government, academia and industry to form California COVIDNet, California's SARS-CoV-2 Whole-Genome Sequencing Initiative. Open-source bioinformatics workflows, ongoing training sessions for the public health workforce, and automated data transfer to visualization tools all contributed to the success of California COVIDNet. While challenges remain for public health genomic surveillance worldwide, California COVIDNet serves as a framework for a scaled and successful bioinformatics infrastructure that has expanded beyond SARS-CoV-2 to other pathogens of public health importance.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , SARS-CoV-2/genetics , COVID-19/epidemiology , Public Health , Laboratories , Genomics , California/epidemiology
4.
Front Public Health ; 11: 1148200, 2023.
Article in English | MEDLINE | ID: covidwho-2327695

ABSTRACT

Introduction: COVID-19 vaccine inequities have been widespread across California, the United States, and globally. As COVID-19 vaccine inequities have not been fully understood in the youth population, it is vital to determine possible factors that drive inequities to enable actionable change that promotes vaccine equity among vulnerable minor populations. Methods: The present study used the social vulnerability index (SVI) and daily vaccination numbers within the age groups of 12-17, 5-11, and under 5 years old across all 58 California counties to model the growth velocity and the anticipated maximum proportion of population vaccinated. Results: Overall, highly vulnerable counties, when compared to low and moderately vulnerable counties, experienced a lower vaccination rate in the 12-17 and 5-11 year-old age groups. For age groups 5-11 and under 5 years old, highly vulnerable counties are expected to achieve a lower overall total proportion of residents vaccinated. In highly vulnerable counties in terms of socioeconomic status and household composition and disability, the 12-17 and 5-11 year-old age groups experienced lower vaccination rates. Additionally, in the 12-17 age group, high vulnerability counties are expected to achieve a higher proportion of residents vaccinated compared to less vulnerable counterparts. Discussion: These findings elucidate shortcomings in vaccine uptake in certain pediatric populations across California and may help guide health policies and future allocation of vaccines, with special emphasis placed on vulnerable populations, especially with respect to socioeconomic status and household composition and disability.


Subject(s)
COVID-19 Vaccines , COVID-19 , Child , Adolescent , Humans , Child, Preschool , Conservation of Natural Resources , COVID-19/epidemiology , COVID-19/prevention & control , Vaccination , Demography , California/epidemiology
5.
JAMA Health Forum ; 4(5): e231018, 2023 05 05.
Article in English | MEDLINE | ID: covidwho-2325405

ABSTRACT

Importance: Addiction treatment rapidly transitioned to a primarily telehealth modality (telephone and video) during the COVID-19 pandemic, raising concerns about disparities in utilization. Objective: To examine whether there were differences in overall and telehealth addiction treatment utilization after telehealth policy changes during the COVID-19 pandemic by age, race, ethnicity, and socioeconomic status. Design, Setting, and Participants: This cohort study examined electronic health record and claims data from Kaiser Permanente Northern California for adults (age ≥18 years) with drug use problems before the COVID-19 pandemic (from March 1, 2019, to December 31, 2019) and during the early phase of the COVID-19 pandemic (March 1, 2020, to December 31, 2020; hereafter referred to as COVID-19 onset). Analyses were conducted between March 2021 and March 2023. Exposure: The expansion of telehealth services during COVID-19 onset. Main Outcomes and Measures: Generalized estimating equation models were fit to compare addiction treatment utilization during COVID-19 onset with that before the COVID-19 pandemic. Utilization measures included the Healthcare Effectiveness Data and Information Set of treatment initiation and engagement (including inpatient, outpatient, and telehealth encounters or receipt of medication for opioid use disorder [OUD]), 12-week retention (days in treatment), and OUD pharmacotherapy retention. Telehealth treatment initiation and engagement were also examined. Differences in changes in utilization by age group, race, ethnicity, and socioeconomic status (SES) were examined. Results: Among the 19 648 participants in the pre-COVID-19 cohort (58.5% male; mean [SD] age, 41.0 [17.5] years), 1.6% were American Indian or Alaska Native; 7.5%, Asian or Pacific Islander; 14.3%, Black; 20.8%, Latino or Hispanic; 53.4%, White; and 2.5%, unknown race. Among the 16 959 participants in the COVID-19 onset cohort (56.5% male; mean [SD] age, 38.9 [16.3] years), 1.6% were American Indian or Alaska Native; 7.4%, Asian or Pacific Islander; 14.6%, Black; 22.2%, Latino or Hispanic; 51.0%, White; and 3.2%, unknown race. Odds of overall treatment initiation increased from before the COVID-19 pandemic to COVID-19 onset for all age, race, ethnicity, and SES subgroups except for patients aged 50 years or older; patients aged 18 to 34 years had the greatest increases (adjusted odds ratio [aOR], 1.31; 95% CI, 1.22-1.40). Odds of telehealth treatment initiation increased for all patient subgroups without variation by race, ethnicity, or SES, although increases were greater for patients aged 18 to 34 years (aOR, 7.17; 95% CI, 6.24-8.24). Odds of overall treatment engagement increased (aOR, 1.13; 95% CI, 1.03-1.24) without variation by patient subgroups. Retention increased by 1.4 days (95% CI, 0.6-2.2 days), and OUD pharmacotherapy retention did not change (adjusted mean difference, -5.2 days; 95% CI, -12.7 to 2.4 days). Conclusions: In this cohort study of insured adults with drug use problems, there were increases in overall and telehealth addiction treatment utilization after telehealth policies changed during the COVID-19 pandemic. There was no evidence that disparities were exacerbated, and younger adults may have particularly benefited from the transition to telehealth.


Subject(s)
COVID-19 , Opioid-Related Disorders , Telemedicine , Adult , Humans , Male , Middle Aged , Female , Ethnicity , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Pandemics , Opioid-Related Disorders/drug therapy , California/epidemiology , Social Class
6.
BMC Public Health ; 23(1): 905, 2023 05 18.
Article in English | MEDLINE | ID: covidwho-2326135

ABSTRACT

BACKGROUND: Policies to restrict population mobility are a commonly used strategy to limit the transmission of contagious diseases. Among measures implemented during the COVID-19 pandemic were dynamic stay-at-home orders informed by real-time, regional-level data. California was the first state in the U.S. to implement this novel approach; however, the effectiveness of California's four-tier system on population mobility has not been quantified. METHODS: Utilizing data from mobile devices and county-level demographic data, we evaluated the impact of policy changes on population mobility and explored whether demographic characteristics explained variability in responsiveness to policy changes. For each California county, we calculated the proportion of people staying home and the average number of daily trips taken per 100 persons, across different trip distances and compared this to pre-COVID-19 levels. RESULTS: We found that overall mobility decreased when counties moved to a more restrictive tier and increased when moving to a less restrictive tier, as the policy intended. When placed in a more restrictive tier, the greatest decrease in mobility was observed for shorter and medium-range trips, while there was an unexpected increase in the longer trips. The mobility response varied by geographic region, as well as county-level median income, gross domestic product, economic, social, and educational contexts, the prevalence of farms, and recent election results. CONCLUSIONS: This analysis provides evidence of the effectiveness of the tier-based system in decreasing overall population mobility to ultimately reduce COVID-19 transmission. Results demonstrate that socio-political demographic indicators drive important variability in such patterns across counties.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Pandemics/prevention & control , Income , California/epidemiology , Computers, Handheld
7.
Emerg Infect Dis ; 29(5): 1011-1014, 2023 05.
Article in English | MEDLINE | ID: covidwho-2318749

ABSTRACT

Infection with Borrelia miyamotoi in California, USA, has been suggested by serologic studies. We diagnosed B. miyamotoi infection in an immunocompromised man in California. Diagnosis was aided by plasma microbial cell-free DNA sequencing. We conclude that the infection was acquired in California.


Subject(s)
Borrelia Infections , Borrelia , Ixodes , Animals , Humans , Male , Borrelia/genetics , Borrelia/isolation & purification , Borrelia Infections/diagnosis , California/epidemiology , Immunocompromised Host
8.
Am J Public Health ; 111(4): 582-583, 2021 04.
Article in English | MEDLINE | ID: covidwho-2289313
9.
JAMA Pediatr ; 177(6): 644-646, 2023 06 01.
Article in English | MEDLINE | ID: covidwho-2295597

ABSTRACT

This diagnostic study describes a dog screening program used to identify COVID-19 infections among schoolchildren.


Subject(s)
COVID-19 , Humans , Dogs , Animals , COVID-19/diagnosis , Schools , California/epidemiology , Pilot Projects
10.
BMC Public Health ; 23(1): 782, 2023 04 28.
Article in English | MEDLINE | ID: covidwho-2305654

ABSTRACT

BACKGROUND: The COVID-19 pandemic has highlighted the role of infectious disease forecasting in informing public policy. However, significant barriers remain for effectively linking infectious disease forecasts to public health decision making, including a lack of model validation. Forecasting model performance and accuracy should be evaluated retrospectively to understand under which conditions models were reliable and could be improved in the future. METHODS: Using archived forecasts from the California Department of Public Health's California COVID Assessment Tool ( https://calcat.covid19.ca.gov/cacovidmodels/ ), we compared how well different forecasting models predicted COVID-19 hospitalization census across California counties and regions during periods of Alpha, Delta, and Omicron variant predominance. RESULTS: Based on mean absolute error estimates, forecasting models had variable performance across counties and through time. When accounting for model availability across counties and dates, some individual models performed consistently better than the ensemble model, but model rankings still differed across counties. Local transmission trends, variant prevalence, and county population size were informative predictors for determining which model performed best for a given county based on a random forest classification analysis. Overall, the ensemble model performed worse in less populous counties, in part because of fewer model contributors in these locations. CONCLUSIONS: Ensemble model predictions could be improved by incorporating geographic heterogeneity in model coverage and performance. Consistency in model reporting and improved model validation can strengthen the role of infectious disease forecasting in real-time public health decision making.


Subject(s)
COVID-19 , Communicable Diseases , Humans , Pandemics , Retrospective Studies , COVID-19/epidemiology , SARS-CoV-2 , Communicable Diseases/epidemiology , California/epidemiology , Public Policy , Decision Making , Hospitalization , Forecasting
11.
Disaster Med Public Health Prep ; 17: e375, 2023 04 13.
Article in English | MEDLINE | ID: covidwho-2302856

ABSTRACT

The California Medical Assistance Team (CAL-MAT) program is coordinated by the California Emergency Medical Services Authority (EMSA). The program was developed to deploy and support medical personnel for disaster medical response. During the coronavirus disease (COVID-19) pandemic, the program and missions grew rapidly in response to medical surge, programs for testing and vaccination, and other concurrent disasters. CAL-MAT enrollment increased 10-fold from approximately 200 members at the beginning of 2020, to an estimated 2200 members by June 2021. This article describes the flexible use of a state-managed disaster medical response program within California and some of the challenges associated with rapid expansion and varied demands during the COVID-19 surges of March 2020-March 2022. CAL-MAT may serve as a model for development of similar state-sponsored or other disaster medical response teams.


Subject(s)
COVID-19 , Disaster Planning , Disasters , Emergency Medical Services , Humans , COVID-19/epidemiology , California/epidemiology , Medical Assistance
12.
Matern Child Health J ; 27(7): 1254-1263, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-2301799

ABSTRACT

INTRODUCTION: Pregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century. METHODS: We conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health. RESULTS: Many of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week. DISCUSSION: Pregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.


Subject(s)
COVID-19 , Pandemics , Female , Pregnancy , Humans , Cross-Sectional Studies , COVID-19/epidemiology , Health Behavior , California/epidemiology , Anxiety/epidemiology , Depression/epidemiology
13.
Am J Epidemiol ; 190(6): 1075-1080, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-2254014

ABSTRACT

Increasing hospitalizations for COVID-19 in the United States and elsewhere have ignited debate over whether to reinstate shelter-in-place policies adopted early in the pandemic to slow the spread of infection. The debate includes claims that sheltering in place influences deaths unrelated to infection or other natural causes. Testing this claim should improve the benefit/cost accounting that informs choice on reimposing sheltering in place. We used time-series methods to compare weekly nonnatural deaths in California with those in Florida. California was the first state to begin, and among the last to end, sheltering in place, while sheltering began later and ended earlier in Florida. During weeks when California had shelter-in-place orders in effect, but Florida did not, the odds that a nonnatural death occurred in California rather than Florida were 14.4% below expected levels. Sheltering-in-place policies likely reduce mortality from mechanisms unrelated to infection or other natural causes of death.


Subject(s)
COVID-19/prevention & control , Cause of Death/trends , Quarantine/statistics & numerical data , COVID-19/mortality , California/epidemiology , Florida/epidemiology , Humans , Likelihood Functions , SARS-CoV-2 , United States
15.
Public Health Nurs ; 40(3): 394-403, 2023.
Article in English | MEDLINE | ID: covidwho-2252026

ABSTRACT

OBJECTIVE: To explore in a sample of school nurses (SN) in California the impact of the COVID-19 pandemic on school nurse health services, how school nurses mitigated the impact of COVID-19, and moral distress levels among school nurses. DESIGN AND METHODS: Nineteen (N = 19) school nurses who work in K-12 schools in California, USA participated in a mixed-methods approach involving qualitative descriptive design, inductive content analysis, and descriptive statistics. Interviews were conducted in August and September 2021. RESULTS: Five themes emerged: (1) role of the SN during the COVID-19 pandemic, (2) coordination with school administration, (3) COVID-19 related challenges and disruptions to care, (4) moral distress, and (5) coping during the pandemic. CONCLUSION: The pandemic had a profound impact on school nurses. This study provides school nurse perspectives of the impact of COVID-19 on services they delivered, the unique skills of school nurses essential to mitigation strategies, and moral distress school nurses encountered during the pandemic. Understanding the important role school nurses had during the pandemic is paramount to fully contextualize the contributions they made within public health nursing practice and inform preparedness for future pandemics.


Subject(s)
COVID-19 , Nurses , Humans , Pandemics , Adaptation, Psychological , California/epidemiology , Public Health Nursing
16.
Perm J ; 27(1): 103-112, 2023 03 15.
Article in English | MEDLINE | ID: covidwho-2283177

ABSTRACT

Objective To address the challenges of inequitable access to the COVID-19 vaccines, Kaiser Permanente Southern California developed a community-oriented and geographic vaccine strategy combining clinical data, community data, and predictive models to identify ZIP codes requiring increased resources to achieve equitable vaccine receipt. Study Design This is a quality-improvement implementation study. Methods The authors developed hot-spot maps for southern California service areas to assist clinicians in identifying specific ZIP codes to increase vaccination efforts. Data inputs for these hot spots included COVID-19 incidence, hospitalization, ecologic variables of social determinants of health, and predictive models of vaccine penetrance. Partnering with community organizations, vaccine penetrance was improved by targeting hot spots with pop-up clinics, mobile health vehicle visits, extending facility hours, and sending tailored text messages. Results By the end of 2021, Kaiser Permanente Southern California achieved a 70% vaccination rate in 83% of 670 ZIP codes it serves, resulting in a total vaccination rate of 81% in 2021. Further, more than 2 out of 3 individuals receiving a vaccine through the hot-spot guided mobile health vehicle were Hispanic or Black. The hot-spotting approach produced a refreshed monthly dashboard of hot spots in 7 counties covering over 670 ZIP codes to help decision makers better understand and improve vaccination in targeted communities. Conclusion The hot-spot methodology produced monthly lists of ZIP codes requiring additional health-care resources and vaccination strategies. This was a feasible place-based approach to mitigating disparities in vaccine uptake in historically disinvested communities that may be readily applied to other areas of care.


Subject(s)
COVID-19 Vaccines , COVID-19 , Health Services Accessibility , Humans , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Hispanic or Latino , Hospitalization , Vaccination , Black or African American , California
17.
Am J Prev Med ; 64(4): 492-502, 2023 04.
Article in English | MEDLINE | ID: covidwho-2287982

ABSTRACT

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.


Subject(s)
COVID-19 , Exercise , Exercise/physiology , COVID-19/classification , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , Humans , Male , Female , Middle Aged , Aged , Hospitalization/statistics & numerical data , California , Retrospective Studies , Disease Progression , Sedentary Behavior , Time Factors , Racial Groups/statistics & numerical data , Ethnicity/statistics & numerical data , Body Mass Index , Cardiovascular Diseases/epidemiology , Hypertension/epidemiology
18.
JAMA Netw Open ; 6(3): e231471, 2023 03 01.
Article in English | MEDLINE | ID: covidwho-2286922

ABSTRACT

Importance: Despite complexities of racial and ethnic residential segregation (hereinafter referred to as segregation) and neighborhood socioeconomic deprivation, public health studies, including those on COVID-19 racial and ethnic disparities, often rely on composite neighborhood indices that do not account for residential segregation. Objective: To examine the associations by race and ethnicity among California's Healthy Places Index (HPI), Black and Hispanic segregation, Social Vulnerability Index (SVI), and COVID-19-related hospitalization. Design, Setting, and Participants: This cohort study included veterans with positive test results for COVID-19 living in California who used Veterans Health Administration services between March 1, 2020, and October 31, 2021. Main Outcomes and Measures: Rates of COVID-19-related hospitalization among veterans with COVID-19. Results: The sample available for analysis included 19 495 veterans with COVID-19 (mean [SD] age, 57.21 [17.68] years), of whom 91.0% were men, 27.7% were Hispanic, 16.1% were non-Hispanic Black, and 45.0% were non-Hispanic White. For Black veterans, living in lower-HPI (ie, less healthy) neighborhoods was associated with higher rates of hospitalization (odds ratio [OR], 1.07 [95% CI, 1.03-1.12]), even after accounting for Black segregation (OR, 1.06 [95% CI, 1.02-1.11]). Among Hispanic veterans, living in lower-HPI neighborhoods was not associated with hospitalization with (OR, 1.04 [95% CI, 0.99-1.09]) and without (OR, 1.03 [95% CI, 1.00-1.08]) Hispanic segregation adjustment. For non-Hispanic White veterans, lower HPI was associated with more frequent hospitalization (OR, 1.03 [95% CI, 1.00-1.06]). The HPI was no longer associated with hospitalization after accounting for Black (OR, 1.02 [95% CI, 0.99-1.05]) or Hispanic (OR, 0.98 [95% CI, 0.95-1.02]) segregation. Hospitalization was higher for White (OR, 4.42 [95% CI, 1.62-12.08]) and Hispanic (OR, 2.90 [95% CI, 1.02-8.23]) veterans living in neighborhoods with greater Black segregation and for White veterans in more Hispanic-segregated neighborhoods (OR, 2.81 [95% CI, 1.96-4.03]), adjusting for HPI. Living in higher SVI (ie, more vulnerable) neighborhoods was associated with greater hospitalization for Black (OR, 1.06 [95% CI, 1.02-1.10]) and non-Hispanic White (OR, 1.04 [95% CI, 1.01-1.06]) veterans. Conclusions and Relevance: In this cohort study of US veterans with COVID-19, HPI captured neighborhood-level risk for COVID-19-related hospitalization for Black, Hispanic, and White veterans comparably with SVI. These findings have implications for the use of HPI and other composite neighborhood deprivation indices that do not explicitly account for segregation. Understanding associations between place and health requires ensuring composite measures accurately account for multiple aspects of neighborhood deprivation and, importantly, variation by race and ethnicity.


Subject(s)
COVID-19 , Ethnicity , Male , Humans , Middle Aged , Female , Cohort Studies , Veterans Health , California , Hospitalization , Socioeconomic Factors
19.
Addict Behav ; 143: 107707, 2023 08.
Article in English | MEDLINE | ID: covidwho-2267286

ABSTRACT

INTRODUCTION: This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. MATERIALS AND METHODS: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol use among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one's own home, another's home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. RESULTS: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR = 0.72, CI = 0.56-0.93, p < 0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreases in frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other's home and outdoors. CONCLUSIONS: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.


Subject(s)
COVID-19 , Underage Drinking , Adolescent , Humans , Alcohol Drinking/epidemiology , Emergency Shelter , Pandemics , COVID-19/prevention & control , California/epidemiology
20.
Optom Vis Sci ; 100(4): 276-280, 2023 04 01.
Article in English | MEDLINE | ID: covidwho-2265369

ABSTRACT

SIGNIFICANCE: Acute infectious conjunctivitis poses significant challenges to eye care providers. It can be highly transmissible, and because etiology is often presumed, correct treatment and management can be difficult. This study uses unbiased deep sequencing to identify causative pathogens of infectious conjunctivitis, potentially allowing for improved approaches to diagnosis and management. PURPOSES: This study aimed to identify associated pathogens of acute infectious conjunctivitis in a single ambulatory eye care center. CASE REPORTS: This study included patients who presented to the University of California Berkeley eye center with signs and symptoms suggestive of infectious conjunctivitis. From December 2021 to July 2021, samples were collected from seven subjects (ages ranging from 18 to 38). Deep sequencing identified associated pathogens in five of seven samples, including human adenovirus D, Haemophilus influenzae , Chlamydia trachomatis , and human coronavirus 229E. CONCLUSIONS: Unbiased deep sequencing identified some unexpected pathogens in subjects with acute infectious conjunctivitis. Human adenovirus D was recovered from only one patient in this series. Although all samples were obtained during the COVID-19 pandemic, only one case of human coronavirus 229E and no SARS-CoV-2 were identified.


Subject(s)
COVID-19 , Conjunctivitis , Humans , Acute Disease , California/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , High-Throughput Nucleotide Sequencing , Pandemics
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