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1.
BMC Public Health ; 22(1): 81, 2022 01 13.
Article in English | MEDLINE | ID: covidwho-1622224

ABSTRACT

BACKGROUND: Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known. METHODS: We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population. RESULTS: Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90th and 10th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties. CONCLUSIONS: County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level.


Subject(s)
COVID-19 , Humans , Risk Factors , Rural Population , SARS-CoV-2 , Social Vulnerability , United States/epidemiology
2.
Sci Rep ; 12(1): 273, 2022 01 07.
Article in English | MEDLINE | ID: covidwho-1612208

ABSTRACT

The coronavirus pandemic has disproportionally impacted racial and ethnic minority communities in the United States. Patterns of these disparities may be changing over time as outbreaks occur in different communities. Utilizing electronic health record data from the US Department of Veterans Affairs (VA), we estimated odds ratios, stratified by time period and region, for testing positive among 1,313,402 individuals tested for SARS-CoV-2 between February 12, 2020 and August 16, 2021 at VA medical facilities. We adjusted for personal characteristics (sex, age, rural/urban residence, VA facility) and a wide range of clinical characteristics that have been evaluated in prior SARS-CoV-2 reports and could potentially explain racial/ethnic disparities in SARS-CoV-2. Our study found racial and ethnic disparities for testing positive were most pronounced at the beginning of the pandemic and decreased over time. A key finding was that the disparity among Hispanic individuals attenuated but remained elevated, while disparities among Asian individuals reversed by March 1, 2021. The variation in racial and ethnic disparities in SARS-CoV-2 positivity by time and region, independent of underlying health status and other demographic characteristics in a nationwide cohort, provides important insight for strategies to prevent further outbreaks.


Subject(s)
COVID-19/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Female , Humans , Male , Middle Aged , Risk Factors , Rural Population , SARS-CoV-2/isolation & purification , United States/epidemiology , Urban Population , Young Adult
3.
J Glob Health ; 11: 05029, 2021.
Article in English | MEDLINE | ID: covidwho-1614230

ABSTRACT

Background: The COVID-19 pandemic prompted movement restrictions in countries worldwide, impacting on physical activity (PA), a major non-communicable disease risk factor, and thus may have unintentional long-term health implications. In semi-rural areas of low-middle-income-countries (LMICs), where occupational activity is the main source of PA, changes in PA associated with COVID-19 restrictions are unknown. We investigated the impact of Movement Control Order (MCO) restrictions in a semi-rural region of Malaysia. Methods: The South East Asia Community Observatory (SEACO) is a dynamic prospective community cohort. We contacted a random sample of 1007 adults (18+) who had previously provided PA data in 2018. We asked about PA during the MCO (March-May 2020) and at the time of interview (June 2020). Results: During the MCO, PA reduced by a mean of 6.7 hours/week (95% confidence interval (CI) = 5.3, 8.0) compared to 2018, with the largest reductions among those in employment. By June, PA was 3.4 hours/week (95% CI = 2.0, 4.8) less than 2018, leaving 34% of adults currently inactive (20% in 2018). Reductions in occupational PA were not replaced with active travel or activity at home. Despite these observed reductions, most participants did not think the MCO had affected their PA. Conclusions: Movement restrictions are associated with lower PA lasting beyond the period of strict restrictions; such longer-term reductions in PA may have a detrimental impact on health. Future MCOs should encourage people to be active, but may additionally need targeted messaging for those who don't necessarily realise they are at risk. In particular, policies developed in more affluent countries may not easily translate to LMICs.


Subject(s)
COVID-19 , Adult , Exercise , Humans , Longitudinal Studies , Malaysia , Pandemics , Prospective Studies , Rural Population , SARS-CoV-2
6.
JAMA Netw Open ; 5(1): e2142046, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1605268

ABSTRACT

Importance: The COVID-19 pandemic has had a distinct spatiotemporal pattern in the United States. Patients with cancer are at higher risk of severe complications from COVID-19, but it is not well known whether COVID-19 outcomes in this patient population were associated with geography. Objective: To quantify spatiotemporal variation in COVID-19 outcomes among patients with cancer. Design, Setting, and Participants: This registry-based retrospective cohort study included patients with a historical diagnosis of invasive malignant neoplasm and laboratory-confirmed SARS-CoV-2 infection between March and November 2020. Data were collected from cancer care delivery centers in the United States. Exposures: Patient residence was categorized into 9 US census divisions. Cancer center characteristics included academic or community classification, rural-urban continuum code (RUCC), and social vulnerability index. Main Outcomes and Measures: The primary outcome was 30-day all-cause mortality. The secondary composite outcome consisted of receipt of mechanical ventilation, intensive care unit admission, and all-cause death. Multilevel mixed-effects models estimated associations of center-level and census division-level exposures with outcomes after adjustment for patient-level risk factors and quantified variation in adjusted outcomes across centers, census divisions, and calendar time. Results: Data for 4749 patients (median [IQR] age, 66 [56-76] years; 2439 [51.4%] female individuals, 1079 [22.7%] non-Hispanic Black individuals, and 690 [14.5%] Hispanic individuals) were reported from 83 centers in the Northeast (1564 patients [32.9%]), Midwest (1638 [34.5%]), South (894 [18.8%]), and West (653 [13.8%]). After adjustment for patient characteristics, including month of COVID-19 diagnosis, estimated 30-day mortality rates ranged from 5.2% to 26.6% across centers. Patients from centers located in metropolitan areas with population less than 250 000 (RUCC 3) had lower odds of 30-day mortality compared with patients from centers in metropolitan areas with population at least 1 million (RUCC 1) (adjusted odds ratio [aOR], 0.31; 95% CI, 0.11-0.84). The type of center was not significantly associated with primary or secondary outcomes. There were no statistically significant differences in outcome rates across the 9 census divisions, but adjusted mortality rates significantly improved over time (eg, September to November vs March to May: aOR, 0.32; 95% CI, 0.17-0.58). Conclusions and Relevance: In this registry-based cohort study, significant differences in COVID-19 outcomes across US census divisions were not observed. However, substantial heterogeneity in COVID-19 outcomes across cancer care delivery centers was found. Attention to implementing standardized guidelines for the care of patients with cancer and COVID-19 could improve outcomes for these vulnerable patients.


Subject(s)
COVID-19/epidemiology , Neoplasms/epidemiology , Pandemics , Rural Population , Social Vulnerability , Urban Population , Aged , Cause of Death , Censuses , Female , Health Facilities , Humans , Intensive Care Units , Male , Middle Aged , Odds Ratio , Registries , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Spatial Analysis , United States/epidemiology
7.
Ann Agric Environ Med ; 28(4): 667-675, 2021 Dec 29.
Article in English | MEDLINE | ID: covidwho-1591762

ABSTRACT

INTRODUCTION AND OBJECTIVE: A change in the body mass may be one of the health consequence of the COVID-19 pandemic, and may affect the health condition measured in many dimensions. The paper aims at assessment of the level and determinants of the body mass changes and stress level in the initial months of the COVID-19 pandemic, and the interrelation of these two factors. MATERIAL AND METHODS: Data were collected in June 2020, as a cross-sectional on-line survey. The representative sample of 2,535 Poles aged 18-65 was analysed. The main outcome is the Cohen's stress index PSS-4. Among thirteen independent variables, five were related to the change observed during the pandemic (including the body mass change and satisfaction with sexual life). RESULTS: Increase of the body mass within the period of the pandemic was declared by 33.9% of the respondents, including 36.1% in urban and 30.9% in rural areas (p=0.026). The average increase of body mass was 5.11 kg. The increase of body mass was related to the existing overweight and obesity, occurrence of chronic diseases, episodes of physical and mental crisis, and decrease of interest in sexual activity. The average index of stress in the initial months of the pandemic was 6.38±2.94. Multivariate regression analysis showed eight independent predictors of stress in the whole group, seven in towns and five in rural areas. The significance of the relationship with the body mass increase was proved only among residents of rural areas. CONCLUSIONS: The initial months of the COVID-19 pandemic were reflected, to a different extent, among residents of urban and rural areas. Body mass change and sexual health indicators remained significant predictors of stress level, even after analyses were corrected for other covariates.


Subject(s)
Body Mass Index , COVID-19 , Health Status , Mental Health , Sexual Health , Adult , Cross-Sectional Studies , Humans , Pandemics , Poland , Rural Population , Urban Population
8.
Rural Remote Health ; 21(3): 6596, 2021 07.
Article in English | MEDLINE | ID: covidwho-1579427

ABSTRACT

INTRODUCTION: Face masks are widely recommended as a COVID-19 prevention strategy. State mask mandates have generally reduced the spread of the disease, but decisions to wear a mask depend on many factors. Recent increases in case rates in rural areas following initial outbreaks in more densely populated areas highlight the need to focus on prevention and education. Messaging about disease risk has faced challenges in rural areas in the past. While surges in cases within some communities are likely an impetus for behavior change, rising case rates likely explain only part of mask-wearing decisions. The current study examined the relationship between county-level indicators of rurality and mask wearing in the USA. METHODS: National data from the New York Times' COVID-19 cross-sectional mask survey was used to identify the percentage of a county's residents who reported always/frequently wearing a mask (2-14 July 2020). The New York Times' COVID-19 data repository was used to calculate county-level daily case rates for the 2 weeks preceding the mask survey (15 June - 1 July 2020), and defined county rurality using the Index of Relative Rurality (n=3103 counties). Multivariate linear regression was used to predict mask wearing across levels of rurality. The model was adjusted for daily case rates and other relevant county-level confounders, including county-level indicators of age, race/ethnicity, gender, political partisanship, income inequality, and whether each county was subject to a statewide mask mandate. RESULTS: Large clusters of counties with high rurality and low mask wearing were observed in the Midwest, upper Midwest, and mountainous West. Holding daily case rates and other county characteristics constant, the predicted probability of wearing a mask decreased significantly as counties became more rural (β=-0.560; p<0.0001). CONCLUSION: Upticks in COVID-19 cases and deaths in rural areas are expected to continue, and localized outbreaks will likely occur indefinitely. The present findings highlight the need to better understand the mechanisms underlying perceptions of COVID-19 risk in rural areas. Dissemination of scientifically correct and consistent information is critical during national emergencies.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Health Status Disparities , Masks/trends , Rural Population/trends , Cross-Sectional Studies , Female , Humans , Linear Models , Male , Severity of Illness Index , Socioeconomic Factors
10.
Nutrients ; 13(2)2021 Jan 22.
Article in English | MEDLINE | ID: covidwho-1574048

ABSTRACT

North of Italy was severely hit by the COVID-19 (Coronavirus disease 19) pandemic. This induced the government to adopt severely restrictive measures to reduce the contagion risk, forcing most of the population to stop working and from leisure activities, and to remain at home for several weeks. Our study aimed to evaluate the effect of COVID-related quarantine on smoking and dietary habits of a well-characterized northern Italian rural population. For this purpose, while lockdown restrictions were in place (February-April 2020), 359 subjects from the Brisighella Heart Study cohort underwent a phone interview about their lifestyle habit changes during COVID-19-related quarantine. Quarantine did not significantly modify smoking habit nor body mass index. Subjects significantly increased daily carbohydrates consumption, all fresh vegetables, healthy vegetable oils, milk and yogurt, alcoholic drinks, sugars and sweets, and coffee. The weekly consumption of low-fat meat, cured meat other than ham, cheeses, eggs, nuts and mixed seed oils significantly increased, while the weekly intake of fish, mussels, and legumes significantly decreased during lockdown. The Dietary Quality Index was reduced from 42.4 ± 4.1 to 37.8 ± 4.7 (p < 0.03). In accordance with our findings, COVID-19-related quarantine might worsen the quality of diet, also leading to an increased intake of almost all food categories.


Subject(s)
COVID-19 , Feeding Behavior , Life Style , Quarantine , Rural Population , SARS-CoV-2 , Adult , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/prevention & control , Female , Humans , Italy , Longitudinal Studies , Male , Middle Aged
11.
CMAJ Open ; 9(4): E1149-E1158, 2021.
Article in English | MEDLINE | ID: covidwho-1575519

ABSTRACT

BACKGROUND: There were large disruptions to health care services after the onset of the COVID-19 pandemic. We sought to describe the extent to which pandemic-related changes in service delivery and access affected use of primary care for children overall and by equity strata in the 9 months after pandemic onset in Manitoba and Ontario. METHODS: We performed a population-based study of children aged 17 years or less with provincial health insurance in Ontario or Manitoba before and during the COVID-19 pandemic (Jan. 1, 2017-Nov. 28, 2020). We calculated the weekly rates of in-person and virtual primary care well-child and sick visits, overall and by age group, neighbourhood material deprivation level, rurality and immigrant status, and assessed changes in visit rates after COVID-19 restrictions were imposed compared to expected baseline rates calculated for the 3 years before pandemic onset. RESULTS: Among almost 3 million children in Ontario and more than 300 000 children in Manitoba, primary care visit rates declined to 0.80 (95% confidence interval [CI] 0.77-0.82) of expected in Ontario and 0.82 (95% CI 0.79-0.84) of expected in Manitoba in the 9 months after the onset of the pandemic. Virtual visits accounted for 53% and 29% of visits in Ontario and Manitoba, respectively. The largest monthly decreases in visits occurred in April 2020. Although visit rates increased slowly after April 2020, they had not returned to prerestriction levels by November 2020 in either province. Children aged more than 1 year to 12 years experienced the greatest decrease in visits, especially for well-child care. Compared to prepandemic levels, visit rates were lowest among rural Manitobans, urban Ontarians and Ontarians in low-income neighbourhoods. INTERPRETATION: During the study period, the pandemic contributed to rapid, immediate and inequitable decreases in primary care use, with some recovery and a substantial shift to virtual care. Postpandemic planning must consider the need for catch-up visits, and the long-term impacts warrant further study.


Subject(s)
COVID-19/epidemiology , Pediatrics/statistics & numerical data , Primary Health Care/statistics & numerical data , Adolescent , Age Distribution , Ambulatory Care/statistics & numerical data , COVID-19/virology , Child , Child, Preschool , Cross-Sectional Studies , Databases, Factual , Emigrants and Immigrants , Female , Humans , Infant , Infant, Newborn , Male , Manitoba/epidemiology , Ontario/epidemiology , Outcome Assessment, Health Care , Pandemics , Population Surveillance , Rural Population
12.
Addict Sci Clin Pract ; 16(1): 72, 2021 12 11.
Article in English | MEDLINE | ID: covidwho-1571935

ABSTRACT

BACKGROUND: In the United States, methadone for opioid use disorder (OUD) is highly regulated. Federal agencies announced guidelines in March 2020 allowing for relaxation of take-home methadone dispensing at opioid treatment programs (OTPs) to improve treatment access and reduce COVID-19 transmission risk during the public health emergency. We explored patient perspectives at three OTPs serving rural communities on how take-home policy changes were received and implemented and how these changes impacted their addiction treatment and recovery. METHODS: We completed semi-structured individual qualitative interviews in 2 phases: (1) August-October 2020 and (2) November 2020-January 2021 (total n = 46), anticipating possible policy changes as the pandemic progressed. We interviewed patients with OUD enrolled at 3 rural OTPs in Oregon. Participants received varying take-home methadone allowances following the COVID-19-related policy changes. All interviews were conducted via phone, audio-recorded, and transcribed. We conducted a thematic analysis, iteratively coding transcripts, and deductively and inductively generating codes. RESULTS: The 46 participants included 50% women and 89% had Medicaid insurance. Three main themes emerged in the analysis, with no differences between study phases: (1) Adapting to changing OTP policies throughout the pandemic; (2) Recognizing the benefits, and occasional struggles, with increased take-home methadone dosing; and (3) Continuing policies and procedures post-pandemic. Participants described fears and anxieties around ongoing methadone access and safety concerns prior to OTP policy changes, but quickly adapted as protocols soon seemed "natural." The majority of participants acknowledged significant benefits to increased take-homes independent of reducing COVID-19 infection risk including feeling "more like a normal person," improved recovery support, reduced time traveling, and having more time with family and for work. Looking to a post-pandemic future, participants thought some COVID-19-related safety protocols should continue that would reduce risk of other infections, make OTP settings less stressful, and result in more individualized care. CONCLUSIONS: As the pandemic progressed, study participants adapted to rapidly changing OTP policies. Participants noted many unanticipated benefits to increased take-home methadone and other COVID-19 protocols including strengthened self-efficacy and recovery and reduced interpersonal conflict, with limited evidence of diversion. Patient perspectives should inform future policies to better address the ongoing overdose epidemic.


Subject(s)
Analgesics, Opioid , COVID-19 , Humans , Methadone/therapeutic use , Policy , Rural Population , SARS-CoV-2 , United States
13.
Emerg Infect Dis ; 27(12): 3020-3029, 2021 12.
Article in English | MEDLINE | ID: covidwho-1556378

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections may be underestimated because of limited access to testing. We measured SARS-CoV-2 seroprevalence in South Africa every 2 months during July 2020-March 2021 in randomly selected household cohorts in 2 communities. We compared seroprevalence to reported laboratory-confirmed infections, hospitalizations, and deaths to calculate infection-case, infection-hospitalization, and infection-fatality ratios in 2 waves of infection. Post-second wave seroprevalence ranged from 18% in the rural community children <5 years of age, to 59% in urban community adults 35-59 years of age. The second wave saw a shift in age distribution of case-patients in the urban community (from persons 35-59 years of age to persons at the extremes of age), higher attack rates in the rural community, and a higher infection-fatality ratio in the urban community. Approximately 95% of SARS-CoV-2 infections were not reported to national surveillance.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Child , Humans , Middle Aged , Rural Population , Seroepidemiologic Studies , South Africa/epidemiology
14.
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
15.
J Infect Dev Ctries ; 15(10): 1388-1395, 2021 10 31.
Article in English | MEDLINE | ID: covidwho-1518654

ABSTRACT

INTRODUCTION: Immunization, as a process of fighting against the COVID-19, has gained important research appeal, but very limited endeavor has been paid for vaccine behavioral studies in underdeveloped and developing countries. This study explores the vaccine demand, hesitancy, and nationalism as well as vaccine acceptance and domestic vaccine preference among young adults in Bangladesh. METHODOLOGY: This quantitative study followed the snowball sampling technique and collected responses from 1,018 individuals from various social media platforms. The analysis covered both descriptive and inferential statistics including chi-square, F-statistic, and logistic regression. RESULTS: The findings of the fully-adjusted regression model suggest that the individuals who had more vaccine demand were 3.29 times (95% confidence interval = 2.39-4.54; p < 0.001) higher to accept vaccine compared to those who had no vaccine demand. Conversely, vaccine hesitancy was negatively associated with vaccine acceptance. Here, the odds ratio was found 0.70 (95% confidence interval = 0.62-0.80; p < 0.001), which means that those who had higher vaccine hesitancy were about 30% less likely to accept vaccines than those who had no hesitancy. In addition, the persons who had vaccine nationalism were 1.75 times (95% confidence interval = 1.62-1.88; p < 0.001) more prone to prefer domestic vaccine. CONCLUSIONS: This study suggests that policymakers may take initiatives for making people aware and knowledgeable about the severity and vulnerability to specific health threats. In this concern, perception and efficacy-increasing programs may take part in increasing protection motivation behaviors like vaccine acceptance and (domestic) vaccine preference.


Subject(s)
Attitude to Health , COVID-19 Vaccines/administration & dosage , Health Knowledge, Attitudes, Practice , Motivation , Patient Acceptance of Health Care , Vaccination/psychology , Adolescent , Bangladesh , Cross-Sectional Studies , Female , Humans , Male , Rural Population/statistics & numerical data , SARS-CoV-2/pathogenicity , Surveys and Questionnaires , Urban Population/statistics & numerical data , Vaccination Refusal/psychology , Young Adult
16.
JAMA Netw Open ; 4(11): e2133167, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1516697
17.
JAMA Netw Open ; 4(11): e2132777, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1516694

ABSTRACT

Importance: A slow or incomplete civil registry makes it impossible to determine excess mortality due to COVID-19 and difficult to inform policy. Objective: To quantify the association of the COVID-19 pandemic with excess mortality and household income in rural Bangladesh in 2020. Design, Setting, and Participants: This repeated survey study is based on an in-person census followed by 2 rounds of telephone calls. Data were collected from a sample of 135 villages within a densely populated 350-km2 rural area of Bangladesh. Household data were obtained first in person and subsequently over the telephone. For the analysis, mortality data were stratified by month, age, sex, and household education. Mortality rates were modeled by bayesian multilevel regression, and the strata were aggregated to the population by poststratification. Data analysis was performed from February to April 2021. Exposures: Date and cause of any changes in household composition, as well as changes in income and food availability. Main Outcomes and Measures: Mortality rates were compared for 2019 and 2020, both without adjustment and after adjustment for nonresponse and differences in demographic variables between surveys. Income and food availability reported for January, May, and November 2020 were also compared. Results: Enumerators collected data from an initial 16 054 households in January 2020; 14 551 households (91%) responded when contacted again by telephone in May 2020, and 11 933 households (74%)responded when reached again over the telephone in November 2020, for a total of 58 806 individuals (29 726 female participants [50.5%]; mean [SD] age, 26.4 [19.8] years). A total of 276 deaths were reported between February and the end of October 2020 for the subset of the population that could be contacted twice over the telephone, slightly below the 289 deaths reported for the same population over the same period in 2019. After adjustment for survey nonresponse and poststratification, 2020 mortality changed by -8% (95% CI, -21% to 7%) compared with an annualized mortality of 6.1 deaths per 1000 individuals in 2019. However, in May 2020, salaried primary income earners reported a 40% decrease in monthly income (from 17 485 to 10 835 Bangladeshi Taka), and self-employed earners reported a 60% decrease in monthly income (23 083 to 8521 Bangladeshi Taka), with only a small recovery observed by November 2020. Conclusions and Relevance: In this study of households in rural Bangladesh, all-cause mortality was lower in 2020 compared with 2019. Restrictions imposed by the government may have limited the scale of the COVID-19 pandemic in rural areas, although economic data suggest that these restrictions need to be accompanied by expanded welfare programs.


Subject(s)
COVID-19 , Cause of Death , Family Characteristics , Income , Pandemics , Rural Population , Adolescent , Adult , Bangladesh , Bayes Theorem , COVID-19/mortality , Child , Educational Status , Employment , Female , Humans , Male , Middle Aged , SARS-CoV-2 , Socioeconomic Factors , Young Adult
18.
Rural Remote Health ; 21(4): 6770, 2021 11.
Article in English | MEDLINE | ID: covidwho-1513371

ABSTRACT

CONTEXT: The COVID-19 pandemic led to several changes to methadone treatment protocols at federal opioid treatment programs in the USA. ISSUE: Protocol changes were designed to reduce transmission of COVID-19 while allowing for continuity of care, but those changes also demonstrated that many policies surrounding opioid use disorder care in the USA cause unnecessary burdens to patients. In this commentary, we describe how current policies create and maintain fatal barriers to methadone treatment for people in rural communities who have opioid use disorder, and highlight how COVID-19 adaptations and more flexible methadone models in other countries can better allow for effective and accessible care. Reasons and ways to address these issues to create lasting solutions for rural communities are discussed. LESSONS LEARNED: We focus on three lessons: (1) methadone dispensing and take-home schedules during COVID-19, (2) telehealth services during COVID-19, and (3) international models in use prior to COVID-19. We then outline recommendations for each lesson to improve access to methadone treatment long term for rural communities in the USA. There is an urgent need to implement recommendations that maintain flexible approaches and address methadone treatment barriers in the rural USA. To achieve lasting health policy change and combat stigma about addiction and methadone treatment, there is a need for advocacy efforts that give voice to rural residents impacted by inequitable access to methadone treatment and rural-tailored educational initiatives that promote the evidence base for methadone. We hope opioid treatment program directors, regulatory authorities, and health policymakers consider our recommendations.


Subject(s)
COVID-19/psychology , Delivery of Health Care/organization & administration , Health Services Accessibility , Methadone/therapeutic use , Opiate Substitution Treatment/statistics & numerical data , Opioid-Related Disorders/rehabilitation , Rural Population , COVID-19/epidemiology , Humans , Opiate Substitution Treatment/methods , Opioid-Related Disorders/psychology , Pandemics , SARS-CoV-2 , United States
19.
Int J Environ Res Public Health ; 18(20)2021 10 11.
Article in English | MEDLINE | ID: covidwho-1512263

ABSTRACT

Romanian rural villages are struggling to survive present times when youngsters leave for a better life in the city while elders work the land like a hundred years ago. Our paper integrates human environments research with public health preparedness, presenting the Țigani (Gypsy/Roma) ethnic group from rural Romania as an example to the world. The future security of mankind will require a new understanding of the human place in its environment. That will lead to a new society, not the most powerful or intelligent, but the one that is more adaptable to changes, with sensitive and interconnected community members. Therefore, the Țigani ethnic group that fought for its rights and flourished despite unfavorable odds, including the recent COVID-19 pandemic, represents the best example for a new world that prioritizes humans, promotes health and wellbeing, facilitating innovation and transformative networks environmental integration. This research attempts to quantify the Țigani's unique attributes that helped their communities survive and made them more adaptive to change. Always marginalized, they identified the other ethnic groups' weaknesses to penetrate the villages and learned to use the smartphone apps to communicate, for their trades, coppersmith, metal roof tiles and drainage systems. Our research was based on Geographical Information System, Microsoft Power Bi analytics data visualization tools and statistical analysis with SPSS V20 to demonstrate what enables their flourishing and what resistance they face locally. We argue that the Țigani's intense social cooperation, strong sense of family, community and mutual assistance helped them to fight COVID-19, generating their significant adaptability to the societal changes and their power to keep intact their cultural identity. The results show how the constant growing Țigani population changed and may change Romania's rural environments in the future.


Subject(s)
COVID-19 , Pandemics , Aged , Humans , Romania , Rural Population , SARS-CoV-2
20.
BMJ Glob Health ; 6(Suppl 5)2021 09.
Article in English | MEDLINE | ID: covidwho-1504733

ABSTRACT

INTRODUCTION: India has one of the highest gender gaps in mobile phone access in the world. As employment opportunities, health messaging (mHealth), access to government entitlements, banking, civic participation and social engagement increasingly take place in the digital sphere, this gender gap risks further exacerbating women's disadvantage in Indian society. This study identifies the factors driving women's unequal use of phones in rural Madhya Pradesh, India. METHODS: We interviewed mothers of 1-year-old children (n=29) who reported that they had at least some access to a mobile phone. Whenever possible, we also spoke to their husbands (n=23) and extended family members (n=34) through interviews or family group discussions about the use of phones in their households, as well as their perspectives on gender and phone use more broadly. Our analysis involved comparing wife-husband pairs to assess differences in phone access and use, and thematic coding on the determinants of women's phone use using an iteratively developed conceptual framework. RESULTS: While respondents reported that women could use the phone without needing permission, this apparent 'freedom' existed in a context that severely constrained women's actual use, most directly through: (1) narrow expectations and desires around how women would use phones, (2) women's dependence on men for phone ownership and lower proximity to phones, (3) the poorer functionality of women's phones; (4) women's limited digital skills, and (5) time allocation constraints, wherein women had less leisure time and were subject to social norms that discouraged using a phone for leisure. CONCLUSION: Our framework, presenting the distal and proximate determinants of women's phone use, enables more nuanced understanding of India's digital divide. Addressing these determinants is vital to shift from re-entrenching unequal gender relations to transforming them through digital technology.


Subject(s)
Cell Phone , Telemedicine , Child , Female , Freedom , Humans , India/epidemiology , Infant , Male , Rural Population
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