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1.
J Appl Psychol ; 106(1): 1-3, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1593023

ABSTRACT

It is impossible to write this editorial without recognizing that we are living in challenging times. Unprecedented changes in how, when, where, and with whom we work have occurred in response to the COVID-19 pandemic. In addition to the threat to human life, the pandemic is expected to increase poverty and deepen preexisting inequalities for vulnerable groups such as women (United Nations, 2020) and individuals living in poorer countries (United Nations Development Programme, 2020). In the United States, the pandemic has disproportionately negatively affected racial and ethnic minority group members (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html). For example, in the United States infection and mortality rates are especially high among African Americans (Yancy, 2020). These sobering realities, along with the recent deaths of George Floyd, Ahmaud Arbery, and Breonna Taylor, and so many others, are vivid and wrenching reminders of longstanding social injustice and systematic racism, both in the United States and around the globe. When preparing my candidate statement and vision for the journal, a global pandemic and widespread social protest were the furthest thing from my mind. However, several aspects of my vision for JAP are highly relevant to the current context. This includes increasing representation and supporting diversity, as well as improving the translation of our science for the public good. Other elements of my vision for the journal include enhancing the review process and promoting open science. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Subject(s)
COVID-19/psychology , Poverty/psychology , Psychology, Applied/methods , Racism/psychology , Social Justice/psychology , /psychology , Humans , Minority Groups/psychology , Pandemics , SARS-CoV-2 , Socioeconomic Factors , United States
2.
Front Public Health ; 9: 590458, 2021.
Article in English | MEDLINE | ID: covidwho-1591317

ABSTRACT

Background: Low-income earners are particularly vulnerable to mental health, consequence of the coronavirus disease 2019 (COVID-19) lockdown restrictions, due to a temporary or permanent loss of income and livelihood, coupled with government-enforced measures of social distancing. This study evaluates the mental health status among low-income earners in southwestern Uganda during the first total COVID-19 lockdown in Uganda. Methods: A cross-sectional descriptive study was undertaken amongst earners whose income falls below the poverty threshold. Two hundred and fifty-three (n = 253) male and female low-income earners between the ages of 18 and 60 years of age were recruited to the study. Modified generalized anxiety disorder (GAD-7), Spielberger's State-Trait Anger Expression Inventory-2 (STAXI-2), and Beck Depression Inventory (BDI) tools as appropriate were used to assess anxiety, anger, and depression respectively among our respondents. Results: Severe anxiety (68.8%) followed by moderate depression (60.5%) and moderate anger (56.9%) were the most common mental health challenges experienced by low-income earners in Bushenyi district. Awareness of mental healthcare increased with the age of respondents in both males and females. A linear relationship was observed with age and depression (r = 0.154, P = 0.014) while positive correlations were observed between anxiety and anger (r = 0.254, P < 0.001); anxiety and depression (r = 0.153, P = 0.015) and anger and depression (r = 0.153, P = 0.015). Conclusion: The study shows the importance of mental health awareness in low resource settings during the current COVID-19 pandemic. Females were identified as persons at risk to mental depression, while anger was highest amongst young males.


Subject(s)
COVID-19 , Pandemics , Adolescent , Adult , Anger , Anxiety/epidemiology , Anxiety Disorders/epidemiology , Communicable Disease Control , Cross-Sectional Studies , Depression/epidemiology , Female , Humans , Male , Middle Aged , Poverty , SARS-CoV-2 , Uganda/epidemiology , Young Adult
3.
J Med Internet Res ; 23(12): e26381, 2021 12 14.
Article in English | MEDLINE | ID: covidwho-1572234

ABSTRACT

BACKGROUND: The predominant implementation paradigm of electronic health record (EHR) systems in low- and middle-income countries (LMICs) relies on standalone system installations at facilities. This implementation approach exacerbates the digital divide, with facilities in areas with inadequate electrical and network infrastructure often left behind. Mobile health (mHealth) technologies have been implemented to extend the reach of digital health, but these systems largely add to the problem of siloed patient data, with few seamlessly interoperating with the EHR systems that are now scaled nationally in many LMICs. Robust mHealth applications that effectively extend EHR systems are needed to improve access, improve quality of care, and ameliorate the digital divide. OBJECTIVE: We report on the development and scaled implementation of mUzima, an mHealth extension of the most broadly deployed EHR system in LMICs (OpenMRS). METHODS: The "Guidelines for reporting of health interventions using mobile phones: mobile (mHealth) evidence reporting assessment (mERA)" checklist was employed to report on the mUzima application. The World Health Organization (WHO) Principles for Digital Development framework was used as a secondary reference framework. Details of mUzima's architecture, core features, functionalities, and its implementation status are provided to highlight elements that can be adapted in other systems. RESULTS: mUzima is an open-source, highly configurable Android application with robust features including offline management, deduplication, relationship management, security, cohort management, and error resolution, among many others. mUzima allows providers with lower-end Android smartphones (version 4.4 and above) who work remotely to access historical patient data, collect new data, view media, leverage decision support, conduct store-and-forward teleconsultation, and geolocate clients. The application is supported by an active community of developers and users, with feature priorities vetted by the community. mUzima has been implemented nationally in Kenya, is widely used in Rwanda, and is gaining scale in Uganda and Mozambique. It is disease-agnostic, with current use cases in HIV, cancer, chronic disease, and COVID-19 management, among other conditions. mUzima meets all WHO's Principles of Digital Development, and its scaled implementation success has led to its recognition as a digital global public good and its listing in the WHO Digital Health Atlas. CONCLUSIONS: Greater emphasis should be placed on mHealth applications that robustly extend reach of EHR systems within resource-limited settings, as opposed to siloed mHealth applications. This is particularly important given that health information exchange infrastructure is yet to mature in many LMICs. The mUzima application demonstrates how this can be done at scale, as evidenced by its adoption across multiple countries and for numerous care domains.


Subject(s)
COVID-19 , Electronic Health Records , Humans , Poverty , SARS-CoV-2 , Uganda
4.
J Infect Dev Ctries ; 15(11): 1603-1606, 2021 11 30.
Article in English | MEDLINE | ID: covidwho-1572701

ABSTRACT

During phase 2 of the COVID-19 pandemic in a Mexican City, informal street vendors (cases) and formal employees (controls) were interviewed. A total of 82.6% of street vendors preferred to expose themselves to the coronavirus than to stop working, compared with 18.4% of formal employees (adjusted OR = 19.4, 95%CI: 4.6-81.7, p < 0.001). Street vendors had 7 times less fear of dying from coronavirus (adjusted OR = 0.14, 95% CI: 0.03-0.5, p = 0.005) and showed a 16-times greater lack of real concern for the increase in cases in their community than the formal employees (adjusted OR = 0.06, 95% CI: 0.01-0.3, p = 0.002). Street vendors were the group with the poorest adherence to household and work area containment measures that continued to be in contact with others. The corresponding authorities must plan specific strategies that allow street vendors to survive economically, while at the same time, protecting community health.


Subject(s)
COVID-19/epidemiology , Health Behavior , Occupational Diseases/epidemiology , SARS-CoV-2 , Workplace , Adult , COVID-19/transmission , Female , Humans , Interviews as Topic , Male , Mexico/epidemiology , Middle Aged , Pandemics , Poverty
5.
Lancet Digit Health ; 3(11): e716-e722, 2021 11.
Article in English | MEDLINE | ID: covidwho-1557380

ABSTRACT

BACKGROUND: Little is known about the effect of changes in mobility at the subcity level on subsequent COVID-19 incidence, which is particularly relevant in Latin America, where substantial barriers prevent COVID-19 vaccine access and non-pharmaceutical interventions are essential to mitigation efforts. We aimed to examine the longitudinal associations between population mobility and COVID-19 incidence at the subcity level across a large number of Latin American cities. METHODS: In this longitudinal ecological study, we compiled aggregated mobile phone location data, daily confirmed COVID-19 cases, and features of urban and social environments to analyse population mobility and COVID-19 incidence at the subcity level among cities with more than 100 000 inhabitants in Argentina, Brazil, Colombia, Guatemala, and Mexico, from March 2 to Aug 29, 2020. Spatially aggregated mobile phone data were provided by the UN Development Programme in Latin America and the Caribbean and Grandata; confirmed COVID-19 cases were from national government reports and population and socioeconomic factors were from the latest national census in each country. We used mixed-effects negative binomial regression for a time-series analysis, to examine longitudinal associations between weekly mobility changes from baseline (prepandemic week of March 2-9, 2020) and subsequent COVID-19 incidence (lagged by 1-6 weeks) at the subcity level, adjusting for urban environmental and socioeconomic factors (time-invariant educational attainment, residential overcrowding, population density [all at the subcity level], and country). FINDINGS: We included 1031 subcity areas, representing 314 Latin American cities, in Argentina (107 subcity areas), Brazil (416), Colombia (82), Guatemala (20), and Mexico (406). In the main adjusted model, we observed an incidence rate ratio (IRR) of 2·35 (95% CI 2·12-2·60) for COVID-19 incidence per log unit increase in the mobility ratio (vs baseline) during the previous week. Thus, 10% lower weekly mobility was associated with 8·6% (95% CI 7·6-9·6) lower incidence of COVID-19 in the following week. This association gradually weakened as the lag between mobility and COVID-19 incidence increased and was not different from null at a 6-week lag. INTERPRETATION: Reduced population movement within a subcity area is associated with a subsequent decrease in COVID-19 incidence among residents of that subcity area. Policies that reduce population mobility at the subcity level might be an effective COVID-19 mitigation strategy, although they should be combined with strategies that mitigate any adverse social and economic consequences of reduced mobility for the most vulnerable groups. FUNDING: Wellcome Trust. TRANSLATION: For the Spanish translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19/epidemiology , Population Dynamics , Poverty , COVID-19/therapy , COVID-19 Vaccines , Cell Phone , Cities , Health Services Accessibility , Humans , Incidence , Latin America/epidemiology , Longitudinal Studies , Pandemics , SARS-CoV-2
6.
Pan Afr Med J ; 38: 348, 2021.
Article in French | MEDLINE | ID: covidwho-1547772

ABSTRACT

Introduction: since its appearance, the COVID-19 has exhausted global health systems. It was predictable that countries with weak health systems will be severly wiped out by the pandemic. Countries across Europe faced severe human loses and it was foreseable that Africa will experience an even worse tragedy. Suprisingly, since the evolution of the pandemic, there has been remarkable resistance from African countries, including Cameroon. Method: the study was phenomenographic. The data were collected successively from media observations (in particular the WHO site, national TV (CRTV) programs 'Parlons COVID'), social networks - Facebook and Whatsapp) and direct observations of some quarters of Garoua (Roumdé-Adjia, Foulbéré, Kakataré) and Mora for the Far North and the southern zone of Yaoundé (Ngoa-Ekelé, Nkolondom, Mokolo). These observations were associated with individual interview, reviews and note-taking around places of public circulation (places of worship, markets and discussion sites (Faada). The theory of functionalism was mobilized in this study. Results: the results show that Cameroonians perceive the pandemic as an eminently metasocial phenomenon which explains their tendency to use prayers, nature to counter this attack. Conclusion: the study suggests that a multidimensional approach is capable of offering avenues of « liberation ¼. Also, the study once again raises the place of traditional medecine in health systems and shows the close link that exists between traditional medicine and spirituality.


Subject(s)
Attitude to Health , COVID-19/epidemiology , Anthropology, Cultural , Cameroon/epidemiology , Humans , Poverty , Religion , Sociological Factors , Urban Health
7.
J Health Care Poor Underserved ; 32(4): 1978-1994, 2021.
Article in English | MEDLINE | ID: covidwho-1528709

ABSTRACT

Objectives . We investigated the association of pre-existing economic variables with COVID-19 infections and mortality in New York City. Methods . We combined ZIP code-level data from New York City's Department of Health with five-year American Community Survey data. We estimated ordinary least squares models of the prevalence of positive COVID-19 test results and deaths per 100,000 population. Results . We found ZIP codes with higher concentrations of residents living in crowded living quarters, employees in high-risk occupations, and employees commuting more than half an hour were positively and significantly associated with higher infection rates. Higher rates of crowded housing were also significantly and positively related to mortality rates, though the positive point estimates for the other two economic variables were not statistically significant. Conclusions . Economic factors such as working and living conditions beyond common measures such as poverty generate significant public health effects. Policymakers should consider these associations while designing and modifying public health policies.


Subject(s)
COVID-19 , Housing , Humans , New York City/epidemiology , Poverty , SARS-CoV-2
8.
J Gerontol B Psychol Sci Soc Sci ; 76(7): e268-e274, 2021 08 13.
Article in English | MEDLINE | ID: covidwho-1526159

ABSTRACT

OBJECTIVES: Mexico is among the countries in Latin America hit hardest by coronavirus disease 2019 (COVID-19). A large proportion of older adults in Mexico have high prevalence of multimorbidity and live in poverty with limited access to health care services. These statistics are even higher among adults living in rural areas, which suggest that older adults in rural communities may be more susceptible to COVID-19. The objectives of the article were to compare clinical and demographic characteristics for people diagnosed with COVID-19 by age group, and to describe cases and mortality in rural and urban communities. METHOD: We linked publicly available data from the Mexican Ministry of Health and the Census. Municipalities were classified based on population as rural (<2,500), semirural (≥2,500 and <15,000), semiurban (≥15,000 and <100,000), and urban (≥100,000). Zero-inflated negative binomial models were performed to calculate the total number of COVID-19 cases, and deaths per 1,000,000 persons using the population of each municipality as a denominator. RESULTS: Older adults were more likely to be hospitalized and reported severe cases, with higher mortality rates. In addition, rural municipalities reported a higher number of COVID-19 cases and mortality related to COVID-19 per million than urban municipalities. The adjusted absolute difference in COVID-19 cases was 912.7 per million (95% confidence interval [CI]: 79.0-1746.4) and mortality related to COVID-19 was 390.6 per million (95% CI: 204.5-576.7). DISCUSSION: Urgent policy efforts are needed to mandate the use of face masks, encourage handwashing, and improve specialty care for Mexicans in rural areas.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility/statistics & numerical data , Health Status Disparities , Poverty/statistics & numerical data , Rural Population/statistics & numerical data , Urban Population/statistics & numerical data , Age Factors , Aged , COVID-19/therapy , Female , Humans , Male , Mexico/epidemiology , Rural Health Services/organization & administration , Urban Health Services/organization & administration
9.
Int J Obes (Lond) ; 45(12): 2577-2584, 2021 12.
Article in English | MEDLINE | ID: covidwho-1526062

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has disproportionally affected communities of color. We aimed to determine what factors are associated with COVID-19 testing and test positivity in an underrepresented, understudied, and underreported (U3) population of mothers. METHODS: This study included 2996 middle-aged mothers of the Boston Birth Cohort (a sample of predominantly urban, low-income, Black and Hispanic mothers) who were enrolled shortly after they gave birth and followed onward at the Boston Medical Center. COVID-19 testing and test positivity were defined by the SARS-CoV-2 nucleic acid test. Two-probit Heckman selection models were performed to identify factors associated with test positivity while accounting for potential selection associated with COVID testing. RESULTS: The mean (SD) age of study mothers was 41.9 (±7.7) years. In the sample, 1741 (58.1%) and 667 (22.3%) mothers were self-identified as Black and Hispanic, respectively. A total of 396 mothers had COVID-19 testing and of those, 95 mothers tested positive from March 2020 to February 2021. Among a multitude of factors examined, factors associated with the probability of being tested were obesity (RR = 1.27; 95% confidence interval (CI): 1.08-1.49); and presence of preexisting chronic medical conditions including hypertension, asthma, stroke, and other comorbidities (coronary heart disease, chronic kidney disease, and sickle cell disease) with a corresponding RR = 1.40 (95% CI: 1.23-1.60); 1.29 (95% CI: 1.11-1.50); 1.44 (95% CI: 1.23-1.68); and 1.37 (95% CI: 1.12-1.67), respectively. Factors associated with higher incident risk of a positive COVID-19 test were body mass index, birthplace outside of the USA, and being without a college-level education. CONCLUSIONS: This study demonstrated the intersectionality of obesity and social factors in modulating incident risk of COVID-19 in this sample of US Black and Hispanic middle-aged mothers. Methodologically, our findings underscore the importance of accounting for potential selection bias in COVID-19 testing in order to obtain unbiased estimates of COVID-19 infection.


Subject(s)
COVID-19/epidemiology , Chronic Disease/epidemiology , Obesity/epidemiology , Social Factors , Adult , African Americans , Boston/epidemiology , COVID-19/ethnology , COVID-19 Testing , Chronic Disease/ethnology , Comorbidity , Female , Health Knowledge, Attitudes, Practice , Humans , Middle Aged , Mothers , Obesity/ethnology , Poverty , Risk Factors
10.
J Dev Behav Pediatr ; 42(8): 672-676, 2021.
Article in English | MEDLINE | ID: covidwho-1517916

ABSTRACT

OBJECTIVE: This study examines the media use of children from low-income homes during school closings during the COVID-19 pandemic. METHODS: Caregivers of 151 kindergarteners from low-income homes completed questionnaires as part of a larger study. Caregivers reported how much time children spent watching television/videos and using apps on the most recent weekday and weekend days. Caregivers also reported how their child's current use of media for several different purposes compared with how much the child usually uses media for that purpose. RESULTS: Weekly average media use was 46.3 hours or 6.6 hours per day. Counter to previous research, weekday media use was higher than weekend media use, suggesting that media was likely used as a replacement for time usually spent in school. Caregivers reported increased child media use for positive purposes, such as education and maintaining relationships with family and friends outside of the home, and potentially useful but less socially valued purposes, such as occupying the child's time while caregivers were completing other tasks. Having more children in the household was related to higher media use, and girls used media for maintaining remote relationships more than boys. CONCLUSION: These findings provide reason for both concern and optimism for the impacts of pandemic closures on low-income children. High levels of media use seem to be prevalent in this population. However, the diverse purposes for media use suggest that caregivers relied on media to supplement children's academic and social growth at a time when school and socializing were not safe in their typical forms.


Subject(s)
COVID-19 , Poverty , Television , Caregivers , Child, Preschool , Family Characteristics , Female , Humans , Male , Ohio , Pandemics , Television/statistics & numerical data
12.
PLoS One ; 16(11): e0259257, 2021.
Article in English | MEDLINE | ID: covidwho-1504723

ABSTRACT

Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.


Subject(s)
COVID-19 Testing , COVID-19 Vaccines , COVID-19/epidemiology , COVID-19/prevention & control , Hand Disinfection , Masks , Adolescent , Adult , Aged , Communicable Disease Control , Cross-Sectional Studies , Female , Geography , Health Behavior , Humans , Infectious Disease Medicine/methods , Internet , Male , Middle Aged , Multivariate Analysis , Poverty , Probability , SARS-CoV-2 , Surveys and Questionnaires , United States/epidemiology , Young Adult
13.
BMJ Glob Health ; 6(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1504243

ABSTRACT

INTRODUCTION: This paper presented qualitative and quantitative data collected on the research capacity of global health institutions in China and aimed to provide a landscaping review of the development of global health as a new discipline in the largest emerging economy of the world. METHODS: Mixed methods were used and they included a bibliometric analysis, a standardised survey and indepth interviews with top officials of 11 selected global health research and educational institutions in mainland China. RESULTS: The bibliometric analysis revealed that each institution had its own focus areas, some with a balanced focus among chronic illness, infectious disease and health systems, while others only focused on one of these areas. Interviews of key staff from each institution showed common themes: recognition that the current research capacity in global health is relatively weak, optimism towards the future, as well as an emphasis on mutual beneficial networking with other countries. Specific obstacles raised and the solutions applied by each institution were listed and discussed. CONCLUSION: Global health institutions in China are going through a transition from learning and following established protocols to taking a more leading role in setting up China's own footprint in this area. Gaps still remain, both in comparison with international institutions, as well as between the leading Chinese institutions and those that have just started. More investment needs to be made, from both public and private domains, to improve the overall capacity as well as the mutual learning and communication within the academic community in China.


Subject(s)
Developing Countries , Global Health , China , Government Programs , Humans , Poverty
14.
BMJ Open ; 11(10): e049981, 2021 10 19.
Article in English | MEDLINE | ID: covidwho-1504158

ABSTRACT

OBJECTIVE: Our study aims to describe differences or similarities in the scope, participant characteristics and methods used in core outcome sets (COS) development when only participants from high-income countries (HICs) were involved compared with when participants from low-income and middle-income countries (LMICs) were also involved. DESIGN: Systematic review. DATA SOURCES: Annual Core Outcome Measures in Effectiveness Trials systematic reviews of COS which are updated based on SCOPUS and MEDLINE, searches. The latest systematic review included studies published up to the end of 2019. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies reporting development of a COS for use in research regardless of age, health condition or setting. Studies reporting the development of a COS for patient-reported outcomes or adverse events or complications were also included. DATA EXTRACTION AND SYNTHESIS: Data were extracted in relation to scope of the COS study, participant categories and the methods used in outcome selection. RESULTS: Studies describing 370 COS were identified in the database. Of these, 75 (20%) included participants from LMICs. Only four COS were initiated from an LMIC setting. More than half of COS with LMIC participants were developed in the last 5 years. Cancer and rheumatology were the dominant disease domains. Overall, over 259 (70%) of COS explicitly reported including clinical experts; this was higher where LMIC participants were also included 340 (92%). Most LMIC participants were from China, Brazil and South Africa. Mixed methods for consensus building were used across the two settings. CONCLUSION: Progress has been made in including LMIC participants in the development of COS, however, there is a need to explore how to enable initiation of COS development from a range of LMIC settings, how to ensure prioritisation of COS that better reflects the burden of disease in these contexts and how to improve public participation from LMICs.


Subject(s)
Developing Countries , Poverty , Consensus , Databases, Factual , Humans , Outcome Assessment, Health Care
16.
Sci Rep ; 11(1): 21174, 2021 10 27.
Article in English | MEDLINE | ID: covidwho-1493227

ABSTRACT

Lockdowns implemented to address the COVID-19 pandemic have disrupted human mobility flows around the globe to an unprecedented extent and with economic consequences which are unevenly distributed across territories, firms and individuals. Here we study socioeconomic determinants of mobility disruption during both the lockdown and the recovery phases in Italy. For this purpose, we analyze a massive data set on Italian mobility from February to October 2020 and we combine it with detailed data on pre-existing local socioeconomic features of Italian administrative units. Using a set of unsupervised and supervised learning techniques, we reliably show that the least and the most affected areas persistently belong to two different clusters. Notably, the former cluster features significantly higher income per capita and lower income inequality than the latter. This distinction persists once the lockdown is lifted. The least affected areas display a swift (V-shaped) recovery in mobility patterns, while poorer, most affected areas experience a much slower (U-shaped) recovery: as of October 2020, their mobility was still significantly lower than pre-lockdown levels. These results are then detailed and confirmed with a quantile regression analysis. Our findings show that economic segregation has, thus, strengthened during the pandemic.


Subject(s)
COVID-19/epidemiology , Pandemics , SARS-CoV-2 , COVID-19/economics , Communicable Disease Control/economics , Communicable Disease Control/methods , Humans , Income , Italy/epidemiology , Machine Learning , Pandemics/economics , Poverty , Quarantine/economics , Regression Analysis , Socioeconomic Factors , Travel
17.
Acad Pediatr ; 21(8S): S134-S139, 2021.
Article in English | MEDLINE | ID: covidwho-1487557

ABSTRACT

One in three American Indian/Alaska Native (AI/AN) children live in poverty. This rate is higher in some reservation communities. The alarming rates of physical, mental, and social health inequities (eg, poverty) experienced by AI/AN children are symptoms of genocide, a legacy of inhumane Federal Indian policy, and ongoing structural violence. The chronically underfunded Indian Health Service (IHS) is just one example where AI/AN children are not universally guaranteed equitable health care or opportunity to thrive. Poverty is highly predictive of educational achievement, employment opportunities, violence, and ultimately health outcomes. COVID-19 has not only exacerbated physical and mental health inequities experienced by AI/AN communities, but has also intensified the economic consequences of inequity. Thus, it is vital to advocate for programs and policies that are evidence based, incorporate cultural ways of knowing, and dismantle structurally racist policies.


Subject(s)
Alaskan Natives , COVID-19 , Indians, North American , Child , Child Health , Humans , Poverty , SARS-CoV-2 , United States
18.
Acad Pediatr ; 21(8S): S177-S183, 2021.
Article in English | MEDLINE | ID: covidwho-1487556

ABSTRACT

Children are the poorest age group in our country, with 1 in 6, or 12 million, living in poverty. This sobering statistic became even more appalling in spring 2020 when COVID-19 magnified existing inequities. These inequities are particularly important to pediatricians, because poverty, along with racism and other interrelated social factors, significantly impact overall child health and well-being. It is imperative that pediatric educators redouble their efforts to train learners to recognize and address health inequities related to poverty and all of its counterparts. In this paper, we describe the current state of poverty-related training in pediatric undergraduate, graduate, and continuing medical education as well as opportunities for growth. We highlight gaps in the current curricula, particularly around the intersectionality between poverty and racism, as well as the need for robust evaluation. Using a logic model framework, we outline content, learning strategies, and outcomes for poverty-related education. We include opportunities for the deployment of best practice learning strategies and the incorporation of newer technologies to deliver the content. We assert that collaboration with community partners is critical to shape the depth and breadth of education. Finally, we emphasize the paramount need for high-quality faculty development and accessible career paths to create the cadre of role models and mentors necessary to lead this work. We conclude with a call for collaboration between institutions, accrediting bodies, and policymakers to promote meaningful, outcome-oriented, poverty-related education, and training throughout the medical education continuum.


Subject(s)
COVID-19 , Pediatrics , Child , Education, Medical, Continuing , Humans , Poverty , SARS-CoV-2
19.
Int J Environ Res Public Health ; 18(20)2021 10 15.
Article in English | MEDLINE | ID: covidwho-1480727

ABSTRACT

Food insecurity and limited healthy food access are complex public health issues and warrant multi-level evaluations. The purpose of this paper was to present the overall study design and baseline results of the multi-pronged evaluation of a healthy food access (i.e., Fresh for Less (FFL)) initiative in Central Texas. The 2018-2021 FRESH-Austin study was a natural experiment that utilized a cluster random sampling strategy to recruit three groups of participants (total n = 400): (1) customers at FFL assets, (2) residents that lived within 1.5 miles of an FFL asset, and (3) residents from a comparison community. Evaluation measures included annual cohort surveys, accelerometers and GPS devices, store-level audits, and built environment assessments. Data are being used to inform and validate an agent-based model (ABM) to predict food shopping and consumption behaviors. Sociodemographic factors and food shopping and consumption behaviors were similar across the three groups; however, customers recruited at FFL assets were lower income and had a higher prevalence of food insecurity. The baseline findings demonstrate the need for multi-level food access interventions, such as FFL, in low-income communities. In the future, ABM can be used as a cost-effective way to determine potential impacts of future large-scale food environment programs and policies.


Subject(s)
Food Supply , Poverty , Food , Humans , Income , Texas
20.
Rural Remote Health ; 21(4): 6691, 2021 10.
Article in English | MEDLINE | ID: covidwho-1478861

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has had serious health and socioeconomic impacts on people all over the world. It was expected that Africa would be the hardest hit; consequently, Nigeria and other African nations worked with non-government organisations to institute a framework for controlling the spread of the disease and the resultant economic woes. The measures, however, largely focused on urban centres, whereas the spread of the virus and the disease transcended imported urban cases to spread through the rural community. This study explored the experiences of traditional rulers, who are closest to rural people, in the fight against COVID-19. METHODS: A qualitative research design was adopted and data were collected from eight Nigerian traditional rulers through interviews. The collected data were coded inductively using NVivo v12 and were then analysed thematically. RESULTS: Findings showed that the traditional rulers adopted measures such as the use of town criers to raise awareness among rural people about COVID-19. Findings also revealed that the protection measures led to increased economic hardship for rural people in Nigeria. Doubt about the existence of the virus and widespread poverty were found to be the major hindrances in the fight against the pandemic. CONCLUSION: It is recommended that traditional rulers collaborate with the government to make free protective equipment available for poor rural people, and collaborate with youths and religious leaders to properly fight the 'infodemic' through continuous community education and awareness-raising.


Subject(s)
COVID-19 , Health Knowledge, Attitudes, Practice , Pandemics , Rural Population , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Hunger , Nigeria/epidemiology , Poverty , Qualitative Research
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