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1.
JAMA Netw Open ; 4(12): e2138464, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1567894

ABSTRACT

Importance: Persons experiencing homelessness (PEH) are at higher risk for SARS-CoV-2 infection and severe illness due to COVID-19 because of a limited ability to physically distance and a higher burden of underlying health conditions. Objective: To describe and assess a hotel-based protective housing intervention to reduce incidence of SARS-CoV-2 infection among PEH in Chicago, Illinois, with increased risk of severe illness due to COVID-19. Design, Setting, and Participants: This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID-19 pandemic from April 2 through September 3, 2020. Participants were PEH at increased risk for severe COVID-19, defined as (1) aged at least 60 years regardless of health conditions, (2) aged at least 55 years with any underlying health condition posing increased risk, or (3) aged less than 55 years with any underlying health condition posing substantially increased risk (eg, HIV/AIDS). Exposures: Participants were housed in individual hotel rooms to reduce the risk of SARS-CoV-2 infection; on-site health care workers provided daily symptom monitoring, regular SARS-CoV-2 testing, and care for chronic health conditions. Additional on-site services included treatment of mental health and substance use disorders and social services. Main Outcomes and Measures: The main outcome measured was SARS-CoV-2 incidence, with SARS-Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration. Secondary outcomes were blood pressure control, glycemic control as measured by hemoglobin A1c, and housing placements at departure. Results: Of 259 participants from 16 homeless shelters in Chicago, 104 (40.2%) were aged at least 65 years, 190 (73.4%) were male, 185 (71.4%) were non-Hispanic Black, and 49 (18.9%) were non-Hispanic White. There was an observed reduction in SARS-CoV-2 incidence during the study period among the protective housing cohort (54.7 per 1000 people [95% CI, 22.4-87.1 per 1000 people]) compared with citywide rates for PEH residing in shelters (137.1 per 1000 people [95% CI, 125.1-149.1 per 1000 people]; P = .001). There was also an adjusted change in systolic blood pressure at a rate of -5.7 mm Hg (95% CI, -9.3 to -2.1 mm Hg) and hemoglobin A1c at a rate of -1.4% (95% CI, -2.4% to -0.4%) compared with baseline. More than half of participants (51% [n = 132]) departed from the intervention to housing of some kind (eg, supportive housing). Conclusions and Relevance: This cohort study found that protective housing was associated with a reduction in SARS-CoV-2 infection among high-risk PEH during the first wave of the COVID-19 pandemic in Chicago. These findings suggest that with appropriate wraparound supports (ie, multisector services to address complex needs), such housing interventions may reduce the risk of SARS-CoV-2 infection, improve noncommunicable disease control, and provide a pathway to permanent housing.


Subject(s)
COVID-19 , Delivery of Health Care/methods , Homeless Persons , Housing , Noncommunicable Diseases , Program Evaluation , Adult , Aged , Blood Pressure , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , COVID-19 Testing , Chicago , Chronic Disease , Female , Glycated Hemoglobin A/metabolism , Health Status Disparities , Humans , Incidence , Male , Middle Aged , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/therapy , Retrospective Studies , SARS-CoV-2 , Social Problems
2.
Ann Intern Med ; 174(9): 1325-1326, 2021 09.
Article in English | MEDLINE | ID: covidwho-1526997
4.
J Nerv Ment Dis ; 209(9): 622-627, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1376356

ABSTRACT

ABSTRACT: Nostalgia and homesickness are not currently regarded as mental disorders. The psychic pain associated with longing to return home had been considered a mental disorder for centuries, especially in Europe, where it was a sign of moral weakness between nations. Nostalgia's effects on American Civil War soldiers-anxiety, depression, and sleep and appetite disturbances, for example-were described by clinicians and linked to significant morbidity and mortality. Since then, although these effects of combat have been of interest, focus has shifted to psychic trauma, relegating the concept of nostalgia to an unclassified but commonly encountered condition. Besides wartime trauma, symptomatic conditions related to nostalgia have been described among displaced persons and refugees living in the diaspora longing for their homelands (e.g., social displacement syndrome). More recently, nostalgia has pervaded culture as a benign pastime, with no implications for psychopathology. Finally, the longing for return to an idyllic or imagined lifestyle has returned amid worldwide quarantining and isolation during the COVID-19 pandemic. In this new sense, nostalgia has become a remedy rather than a disease. We identify four major iterations of nostalgia: the medical condition of homesickness, the condition studied in wartime, the application to migration and social displacement, and as a remedy for existential anxiety. We conclude that nostalgia per se is neither pathological nor normative, but a consistent phenomenon in human existence that should not be overlooked in cultural assessment and psychotherapy.


Subject(s)
COVID-19/psychology , Loneliness/psychology , Social Behavior , Humans , Mental Disorders/diagnosis , Social Problems
5.
Int J Environ Res Public Health ; 18(14)2021 07 08.
Article in English | MEDLINE | ID: covidwho-1332157

ABSTRACT

(1) Background: The aim of this study was (i) to analyze problems faced by informal caregivers in three areas of their life: health, work and finances, and family and social relationships, (ii) to investigate the main determinants of these problems, and (iii) to explore differences between men and women. (2) Methods: The study population consisted of people aged ≥18 years living in a family home who were providing unpaid care to a dependent person in the same or another home and who were registered as caregivers with the Primary Health Care District of Granada or the Provincial Council of Gipuzkoa. Several logistic regression models were built to analyze the likelihood of caregivers experiencing health, work-related, or social problems as a result of their caregiving responsibilities. (3) Results: Informal female caregivers were more likely to experience problems attributed to caregiving than their male counterparts, particularly in the areas of health and work. Additional factors associated with an increased likelihood of problems were low perceived social support, performance of ungratifying tasks, and fewer years as a caregiver. (4) Conclusions: Informal caregivers in Spain face significant problems as a result of their caregiving duties, and the impact on men and women is different. Policies and interventions to mitigate the negative effects of unpaid caregiving should incorporate differential strategies to meet the specific needs of male and female caregivers in different caregiving contexts.


Subject(s)
Caregivers , Social Support , Adolescent , Adult , Female , Gender Identity , Humans , Male , Social Problems , Spain
6.
Dermatol Clin ; 39(4): 619-625, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1252648

ABSTRACT

In this article, we discuss the impact of the COVID-19 pandemic on various areas of global health dermatology, including patient care, neglected tropical diseases, education, and collaborations. Information was collected from literature review and informal interviews with more than 20 dermatologists from around the world. Many of the setbacks and hardships experienced by the global health community in the last year highlight long-standing global interdependencies and systems that perpetuate ethnic, economic, and social inequalities on local and global scales. The pandemic has brought discussions on global health colonialism and domestic health inequality to the forefront.


Subject(s)
COVID-19/epidemiology , Dermatology/trends , Global Health , Health Status Disparities , Practice Patterns, Physicians'/statistics & numerical data , Humans , Skin Diseases/therapy , Social Problems , Socioeconomic Factors
7.
Hist. ciênc. saúde-Manguinhos ; 28(2): 581-585, abr.-jun. 2021.
Article in Spanish | LILACS (Americas) | ID: covidwho-1216979

ABSTRACT

Resumen A pesar de los esfuerzos del Estado por contener la llegada y propagación de la covid-19, que comprendió una cuarentena estricta a nivel nacional por más de cien días, el Perú fue uno de los países en el mundo con más casos y número de muertes por la pandemia. La pandemia hizo visible la precariedad del sistema de salud, del empleo, de las condiciones de vivienda y transporte. Demostró además que mientras no se resuelvan problemas de fondo en el sistema social y económico del país, es poco lo que se puede hacer desde el sector salud para confrontar una crisis sanitaria. Este artículo analiza las respuestas estatales y sociales a la pandemia entre febrero y agosto del 2020.


Abstract Despite efforts by the Peruvian state to contain the outbreak and spread of covid-19, including a strict nationwide quarantine for more than one hundred days, Peru had one of the highest numbers of cases and deaths in the world due to the pandemic. The pandemic highlighted the precariousness of the health care system, work, living conditions and transport. The pandemic also demonstrated that until underlying problems in the country's social and economic system are solved (such as inequality and poverty), the health sector can do little to combat a health care crisis. This article analyzes state and societal responses to the pandemic between February and August 2020.


Subject(s)
Humans , COVID-19/prevention & control , COVID-19/epidemiology , Peru/epidemiology , Social Problems , Socioeconomic Factors , Quarantine , Government
8.
Psychiatr Serv ; 72(4): 485-486, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1215033
9.
10.
Bull Hist Med ; 94(4): 658-669, 2020.
Article in English | MEDLINE | ID: covidwho-1156070

ABSTRACT

Writing in the late 1980s in the midst of the AIDS crisis in the United States, historian Charles Rosenberg suggested that epidemics furnished "useful sampling devices" for examining "fundamental patterns of social value and institutional practice." This paper reconsiders Rosenberg's seminal essay and the central question it addresses-what is an epidemic?-from the vantage of a historian in Hong Kong working on colonial and postcolonial Asia in the midst of the COVID-19 pandemic. The paper begins by setting Rosenberg's essay in its historical context and then considers whether explanatory models developed in a Northern American context may be applicable (or not) to other non-Western settings. The paper makes the case for a re-interrogation of the "epidemic" as an epidemiological and social category, and it concludes by suggesting that COVID-19 is challenging underlying assumptions about what a "crisis" is to the extent that the pandemic may be understood as a crisis of crisis itself.


Subject(s)
Epidemics , Social Problems , COVID-19/psychology , History, 20th Century , Hong Kong , Humans , Writing/history
12.
Can J Public Health ; 111(6): 967-970, 2020 12.
Article in English | MEDLINE | ID: covidwho-1083809

ABSTRACT

Addressing the vulnerability and unique needs of homeless populations during pandemics has been a major component of the Canadian federal response to the COVID-19 crisis. Rural and remote communities, however, have received little to no funding to aid in their care of homeless people during the pandemic. Similarly, there has been little to no research on rural communities' pandemic preparedness in the context of homelessness. There are large numbers of homeless individuals in rural and remote Canada, including Indigenous peoples who are over-represented in homeless populations. Rural communities, including rural and remote Indigenous communities, are often isolated and more limited than urban areas in their capacity to respond to pandemics. They are particularly vulnerable due to fewer healthcare and social service resources-the lack of which has been particularly evident during the COVID-19 pandemic. In this commentary, we suggest that policy-makers need to take seriously the situation of rural homelessness in Canada, its implications for individual and community health, and consequences in the context of pandemics. Policy- and decision-makers can address these concerns through increased homelessness funding and support for rural and remote communities, policy change to recognize the unique challenges associated with rural pandemic planning and homelessness, and more research that can be translated into policy, programs, and supports for rural homelessness and pandemic planning response.


Subject(s)
COVID-19/epidemiology , Homeless Persons , Pandemics , Public Health , Rural Population , Canada/epidemiology , Decision Making , Health Policy , Humans , Social Problems , Vulnerable Populations
13.
J Psychiatr Res ; 133: 113-118, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065384

ABSTRACT

Firearm sales have surged during COVID-19, raising concerns about a coming wave of suicide deaths. Little is known, however, about the individuals considering acquiring firearms during the pandemic. Recent research has highlighted that individuals considering acquiring firearms may be motivated by exaggerated threat expectancies. In a sample of 3,500 Americans matched to 2010 United States Census data, we compared individuals intending to buy firearms in the coming 12 months (assessed in late June and early July 2020) to those undecided or not planning to acquire firearms on a range of demographic, anxiety, and firearm ownership variables. Our results indicated that those intending to acquire a firearm in the next twelve months are less tolerant of uncertainty, endorse exaggerated threat expectancies, and are experiencing more severe COVID-19 specific fears. Individuals intending to purchase firearms were also more likely to have experienced suicidal ideation in the past year, to have worked in law enforcement, and to have been considered essential workers during COVID-19. Furthermore, such individuals were more likely to already own firearms and to have purchased firearms during the opening months of the COVID-19 pandemic. Those intending to purchase firearms did not endorse lower perceived neighborhood safety, however, indicating that their intent to purchase firearms is unlikely to be driven by tangible threats in their immediate environment. These findings highlight that exaggerated fears may be motivating individuals to purchase firearms to diminish anxiety and that this trend may be particularly common among individuals who already own firearms.


Subject(s)
COVID-19/psychology , Culture , Fear , Firearms , Intention , Ownership , Pandemics , Social Perception/psychology , Social Problems , Suicide/prevention & control , Suicide/psychology , Anxiety/psychology , COVID-19/prevention & control , Decision Making , Humans , Residence Characteristics , Safety
15.
J Bioeth Inq ; 17(4): 649-656, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-917148

ABSTRACT

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population.


Subject(s)
COVID-19/prevention & control , Healthcare Disparities , Pandemics/ethics , Poverty Areas , Public Health Practice/ethics , Rural Health/ethics , Social Problems/ethics , COVID-19/epidemiology , Humans , SARS-CoV-2 , United States/epidemiology
16.
J Urol ; 204(2): 206-207, 2020 08.
Article in English | MEDLINE | ID: covidwho-793536
19.
Int J Health Serv ; 51(1): 50-54, 2021 01.
Article in English | MEDLINE | ID: covidwho-693766

ABSTRACT

COVID-19 not only constitutes a serious public health problem and a global major threat to the poorest and most vulnerable social groups and neighborhoods of the world, creating a potential pandemic of inequality, but also poses an enormous challenge from the perspective of public health, ethics, economy, environment, and politics. However, many of the deep and complex systemic interrelationships created and developed by this pandemic are largely hidden, unknown, or neglected, both by the hegemonic media and by a highly specialized and fragmented academic world. However, when all the available knowledge is critically integrated, the origins and effects underlying this pandemic are likely to be found in the development of neoliberal capitalism and its inherent logic of ceaseless accumulation, economic growth, large inequalities, and ecological devastation. This commentary reflects on these issues, drawing out some of the most important lessons to be learned and challenges to be faced in the COVID-19 pandemic and its aftermath, advocating for a radical social change to deal with these challenges.


Subject(s)
COVID-19/epidemiology , Global Health , Healthcare Disparities , Pandemics , Social Change , Social Problems , Capitalism , Health Policy , Humans , Politics , Public Health , SARS-CoV-2 , Socioeconomic Factors
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