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1.
J Cyst Fibros ; 20 Suppl 3: 49-54, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587337

ABSTRACT

BACKGROUND: Due to the COVID-19 pandemic, there was an uptake of telehealth in cystic fibrosis care. Previous studies show disparities in telehealth use based on socioeconomic status (SES). We aimed to: (1) understand telehealth use and perceptions and (2) identify the facilitators and barriers to telehealth use among people with CF and their families (PwCF) from diverse racial/ethnic and socioeconomic backgrounds. METHODS: We conducted an analysis of the 2020 Cystic Fibrosis State of Care surveys completed by PwCF (PFSoC), CF Care Programs (SoC1) and the CF Foundation Patient Registry (CFFPR). RESULTS: A total of 424 PwCF and 286 programs responded to the PFSoC and SoC1. Among PwCF, 90% self-identified as White, 6% as Hispanic/Latino, and 2% as Black. Racial/ethnic minorities were less likely to have had a telehealth visit (p=.015). This difference was pronounced among the Hispanic/Latino population (p<.01). Telehealth use did not differ by health insurance and was similarly offered independent of financial status. Compared to PwCF who denied financial constraints, those who reported financial difficulties found telehealth more difficult to use (p=.018) and were less likely to think that their concerns (p=.010) or issues that mattered most to them (p=.020) were addressed during telehealth. Programs perceived lack of technology, language barriers, and home conditions as barriers to telehealth in vulnerable populations. CONCLUSION: PFSoC and SoC1 identified differences in telehealth use and care perceptions by ethnicity, race, and socioeconomic characteristics. Further studies are needed to understand how telehealth can change access to CF care in diverse subpopulations.


Subject(s)
COVID-19 , Communication Barriers , Cystic Fibrosis , Minority Health , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Cystic Fibrosis/economics , Cystic Fibrosis/ethnology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Financial Stress/ethnology , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Healthcare Disparities/ethnology , Healthcare Disparities/standards , Humans , Minority Health/ethnology , Minority Health/standards , Minority Health/statistics & numerical data , Needs Assessment , Organizational Innovation , SARS-CoV-2 , Socioeconomic Factors , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology , Vulnerable Populations/statistics & numerical data
2.
BMC Infect Dis ; 21(1): 686, 2021 Jul 16.
Article in English | MEDLINE | ID: covidwho-1571742

ABSTRACT

BACKGROUND: Associations between community-level risk factors and COVID-19 incidence have been used to identify vulnerable subpopulations and target interventions, but the variability of these associations over time remains largely unknown. We evaluated variability in the associations between community-level predictors and COVID-19 case incidence in 351 cities and towns in Massachusetts from March to October 2020. METHODS: Using publicly available sociodemographic, occupational, environmental, and mobility datasets, we developed mixed-effect, adjusted Poisson regression models to depict associations between these variables and town-level COVID-19 case incidence data across five distinct time periods from March to October 2020. We examined town-level demographic variables, including population proportions by race, ethnicity, and age, as well as factors related to occupation, housing density, economic vulnerability, air pollution (PM2.5), and institutional facilities. We calculated incidence rate ratios (IRR) associated with these predictors and compared these values across the multiple time periods to assess variability in the observed associations over time. RESULTS: Associations between key predictor variables and town-level incidence varied across the five time periods. We observed reductions over time in the association with percentage of Black residents (IRR = 1.12 [95%CI: 1.12-1.13]) in early spring, IRR = 1.01 [95%CI: 1.00-1.01] in early fall) and COVID-19 incidence. The association with number of long-term care facility beds per capita also decreased over time (IRR = 1.28 [95%CI: 1.26-1.31] in spring, IRR = 1.07 [95%CI: 1.05-1.09] in fall). Controlling for other factors, towns with higher percentages of essential workers experienced elevated incidences of COVID-19 throughout the pandemic (e.g., IRR = 1.30 [95%CI: 1.27-1.33] in spring, IRR = 1.20 [95%CI: 1.17-1.22] in fall). Towns with higher proportions of Latinx residents also had sustained elevated incidence over time (IRR = 1.19 [95%CI: 1.18-1.21] in spring, IRR = 1.14 [95%CI: 1.13-1.15] in fall). CONCLUSIONS: Town-level COVID-19 risk factors varied with time in this study. In Massachusetts, racial (but not ethnic) disparities in COVID-19 incidence may have decreased across the first 8 months of the pandemic, perhaps indicating greater success in risk mitigation in selected communities. Our approach can be used to evaluate effectiveness of public health interventions and target specific mitigation efforts on the community level.


Subject(s)
COVID-19/epidemiology , Occupations/statistics & numerical data , Social Environment , Transportation/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/ethnology , Female , Health Status Disparities , Humans , Incidence , Income/statistics & numerical data , Male , Massachusetts/epidemiology , Middle Aged , Movement/physiology , Pandemics , Residence Characteristics/statistics & numerical data , Risk Factors , SARS-CoV-2/physiology , Socioeconomic Factors , Time Factors , Vulnerable Populations/ethnology , Vulnerable Populations/statistics & numerical data , Young Adult
8.
Sci Rep ; 11(1): 18117, 2021 09 13.
Article in English | MEDLINE | ID: covidwho-1406408

ABSTRACT

COVID-19 vaccination is being rapidly rolled out in the US and many other countries, and it is crucial to provide fast and accurate assessment of vaccination coverage and vaccination gaps to make strategic adjustments promoting vaccine coverage. We reported the effective use of real-time geospatial analysis to identify barriers and gaps in COVID-19 vaccination in a minority population living in South Texas on the US-Mexico Border, to inform vaccination campaign strategies. We developed 4 rank-based approaches to evaluate the vaccination gap at the census tract level, which considered both population vulnerability and vaccination priority and eligibility. We identified areas with the highest vaccination gaps using different assessment approaches. Real-time geospatial analysis to identify vaccination gaps is critical to rapidly increase vaccination uptake, and to reach herd immunity in the vulnerable and the vaccine hesitant groups. Our results assisted the City of Brownsville Public Health Department in adjusting real-time targeting of vaccination, gathering coverage assessment, and deploying services to areas identified as high vaccination gap. The analyses and responses can be adopted in other locations.


Subject(s)
COVID-19 Vaccines/immunology , COVID-19/immunology , Immunization Programs/statistics & numerical data , SARS-CoV-2/immunology , Vaccination Coverage/statistics & numerical data , Vaccination/statistics & numerical data , COVID-19/prevention & control , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Geography , Humans , Immunization Programs/methods , Mexico/ethnology , Minority Groups/statistics & numerical data , Minority Health/statistics & numerical data , SARS-CoV-2/physiology , Socioeconomic Factors , Texas/ethnology , Vaccination/methods , Vaccination Coverage/methods , Vulnerable Populations/ethnology , Vulnerable Populations/statistics & numerical data
9.
J Infect Dev Ctries ; 15(8): 1066-1073, 2021 08 31.
Article in English | MEDLINE | ID: covidwho-1405471

ABSTRACT

INTRODUCTION: COVID-19 is a severe respiratory syndrome caused by the SARS-CoV-2 virus. In Brazil the highest infection rates are associated with socially vulnerable populations. This study therefore sought to analyze the spatial distribution of the disease and its relation with geographic, socioeconomic and public health policy characteristics associated with quilombola communities in Salvaterra municipality, state of Pará, for the period of March to September, 2020. METHODOLOGY: This cross-sectional and ecological study used data from the Disease Notification System and the National Registry of Health Establishments of the Ministry of Health, the Income Transfer Registry of the Ministry of Citizenship and the 2010 census of the Brazilian Institute of Geography and Statistics. Statistical and spatial analysis of the data was done through percentages of cases and Flow and Kernel map techniques. RESULTS: Seventy-five notified cases of COVID-19 distributed among 7 quilombola communities in the municipality were analyzed. The epidemiological profile followed a national trend, with a higher percentage of cases among persons who were female, adults with low schooling levels, working as family farmers and with an outcome ending in recovery. The spatial distribution of the disease was not homogenous and showed clusters of cases and high incidence rates, especially in communities close to the municipal seat or to highways. CONCLUSIONS: The use of data analysis techniques was satisfactory for providing an understanding of the socioeconomic production of the disease in the areas studied. Accordingly, the need for intensifying epidemiological survey actions in the quilombola communities of the municipality is emphasized.


Subject(s)
COVID-19/epidemiology , Public Health/statistics & numerical data , Socioeconomic Factors , Vulnerable Populations/statistics & numerical data , Brazil/epidemiology , Cross-Sectional Studies , Female , Humans , Incidence , Male , Public Health/legislation & jurisprudence , Qualitative Research , Risk Factors , Spatial Analysis
12.
Psychiatriki ; 32(3): 219-223, 2021 Sep 20.
Article in English | MEDLINE | ID: covidwho-1357715

ABSTRACT

People with mental illness are known to have poorer physical health outcomes. Among them, patients with schizophrenia spectrum disorders are disproportionately burdened. A number of recent studies have highlighted that patients with schizophrenia are particularly at risk from COVID-19. The aim of this systematic review is to clarify whether patients with schizophrenia spectrum disorders are at greater risk for poor COVID-19 outcomes. We conducted a systematic review of the literature following the PRISMA guidelines, using PubMed, PsycINFO (via Ovid) and Scopus as databases, to identify all studies which investigated infection and/or mortality rate from SARS-CoV-2 in patients with schizophrenia spectrum disorders. Following a formal screening process, seven studies met our inclusion criteria. The results of these seven studies were reported using odds ratios or adjusted odds ratios. The collective results indicated a moderate, but statistically significant effect for higher infection rates, and a strong statistically significant effect for higher mortality rates in patients with schizophrenia. Our findings indicate that people with schizophrenia have a high risk of being infected by the new coronavirus and have a significantly higher mortality rate than the general population. There are contradictory findings concerning other outcomes, including the frequency of intensive care unit admissions for this group. Collectively, these results indicate that people with schizophrenia spectrum disorders may be more vulnerable to being infected and more likely to die due to COVID-19, and yet their access to Intensive Care Units does not seem to be higher. We conclude that patients with schizophrenia constitute a vulnerable group for COVID-19 related infection and mortality, consequently there is a necessity for this vulnerable group of people to have better access to healthcare, including priority in nationwide COVID-19 vaccination programs and expedited intensive care treatment. Our conclusion adds to the ongoing debate arguing for equitable access to healthcare for people with schizophrenia spectrum disorders.


Subject(s)
COVID-19 , Schizophrenia , Vulnerable Populations , COVID-19/mortality , COVID-19/prevention & control , COVID-19/psychology , COVID-19/therapy , Causality , Healthcare Disparities , Humans , Intensive Care Units/statistics & numerical data , Mortality , SARS-CoV-2 , Schizophrenia/epidemiology , Schizophrenia/physiopathology , Vulnerable Populations/psychology , Vulnerable Populations/statistics & numerical data
13.
Public Health Rep ; 136(6): 765-773, 2021.
Article in English | MEDLINE | ID: covidwho-1354647

ABSTRACT

OBJECTIVES: Widespread SARS-CoV-2 testing is critical to identify infected people and implement public health action to interrupt transmission. With SARS-CoV-2 testing supplies and laboratory capacity now widely available in the United States, understanding the spatial heterogeneity of associations between social determinants and the use of SARS-CoV-2 testing is essential to improve testing availability in populations disproportionately affected by SARS-CoV-2. METHODS: We assessed positive and negative results of SARS-CoV-2 molecular tests conducted from February 1 through June 17, 2020, from the Massachusetts Virtual Epidemiologic Network, an integrated web-based surveillance and case management system in Massachusetts. Using geographically weighted regression and Moran's I spatial autocorrelation tests, we quantified the associations between SARS-CoV-2 testing rates and 11 metrics of the Social Vulnerability Index in all 351 towns in Massachusetts. RESULTS: Median SARS-CoV-2 testing rates decreased with increasing percentages of residents with limited English proficiency (median relative risk [interquartile range] = 0.96 [0.95-0.99]), residents aged ≥65 (0.97 [0.87-0.98]), residents without health insurance (0.96 [0.95-1.04], and people residing in crowded housing conditions (0.89 [0.80-0.94]). These associations differed spatially across Massachusetts, and localized models improved the explainable variation in SARS-CoV-2 testing rates by 8% to 12%. CONCLUSION: Indicators of social vulnerability are associated with variations in SARS-CoV-2 testing rates. Accounting for the spatial heterogeneity in these associations may improve the ability to explain and address the SARS-CoV-2 pandemic at substate levels.


Subject(s)
COVID-19/diagnosis , COVID-19/epidemiology , Vulnerable Populations/statistics & numerical data , Age Factors , COVID-19 Testing , Housing , Humans , Language , Massachusetts/epidemiology , Pandemics , Public Health , SARS-CoV-2 , Socioeconomic Factors , Spatial Analysis
15.
Am J Public Health ; 111(7): 1223-1226, 2021 07.
Article in English | MEDLINE | ID: covidwho-1348405

ABSTRACT

Emergency Medical Services (EMS) in Israel was called on to vaccinate the most vulnerable population-the elderly in assisted living facilities and their caregivers. Two parameters led the operation: (1) maximum use of the scarce COVID-19 vaccine, and (2) minimizing the time it took to reach this entire population. We present the process of vaccinating 126 245 people in two weeks at 756 locations countrywide, focusing on the planning and logistics of this operation. Resilience, flexible logistics, and dedicated personnel provided an efficient public health operation.


Subject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Emergency Medical Services/statistics & numerical data , Vaccination/statistics & numerical data , Vulnerable Populations/statistics & numerical data , Aged , COVID-19/epidemiology , COVID-19/transmission , Humans , Israel
16.
Am J Public Health ; 111(7): 1227-1230, 2021 07.
Article in English | MEDLINE | ID: covidwho-1348403

ABSTRACT

Cook County Health partnered with the Chicago Departments of Public Health and Family & Support Services and several dozen community-based organizations to rapidly establish a temporary medical respite shelter during the spring 2020 COVID-19 peak for individuals experiencing homelessness in Chicago and Cook County, Illinois. This program provided low-barrier isolation housing to medically complex adults until their safe return to congregate settings. We describe strategies used by the health care agency, which is not a Health Resource and Services Administration Health Care for the Homeless grantee, to provide medical services and care coordination.


Subject(s)
COVID-19/rehabilitation , Community Networks/organization & administration , Homeless Persons/statistics & numerical data , Interinstitutional Relations , Social Work/organization & administration , COVID-19/epidemiology , Chicago , Communicable Diseases, Emerging/prevention & control , Humans , Illinois , Interdisciplinary Communication , Public Housing/statistics & numerical data , Vulnerable Populations/statistics & numerical data
17.
PLoS One ; 16(8): e0255680, 2021.
Article in English | MEDLINE | ID: covidwho-1341508

ABSTRACT

New emerging infectious diseases are identified every year, a subset of which become global pandemics like COVID-19. In the case of COVID-19, many governments have responded to the ongoing pandemic by imposing social policies that restrict contacts outside of the home, resulting in a large fraction of the workforce either working from home or not working. To ensure essential services, however, a substantial number of workers are not subject to these limitations, and maintain many of their pre-intervention contacts. To explore how contacts among such "essential" workers, and between essential workers and the rest of the population, impact disease risk and the effectiveness of pandemic control, we evaluated several mathematical models of essential worker contacts within a standard epidemiology framework. The models were designed to correspond to key characteristics of cashiers, factory employees, and healthcare workers. We find in all three models that essential workers are at substantially elevated risk of infection compared to the rest of the population, as has been documented, and that increasing the numbers of essential workers necessitates the imposition of more stringent controls on contacts among the rest of the population to manage the pandemic. Importantly, however, different archetypes of essential workers differ in both their individual probability of infection and impact on the broader pandemic dynamics, highlighting the need to understand and target intervention for the specific risks faced by different groups of essential workers. These findings, especially in light of the massive human costs of the current COVID-19 pandemic, indicate that contingency plans for future epidemics should account for the impacts of essential workers on disease spread.


Subject(s)
COVID-19/transmission , Infection Control , Physical Distancing , Workforce , COVID-19/epidemiology , Epidemics/prevention & control , Health Personnel/statistics & numerical data , Humans , Infection Control/methods , Infection Control/standards , Infection Control/statistics & numerical data , Models, Statistical , New York City/epidemiology , Occupations/statistics & numerical data , Pandemics , Quarantine/statistics & numerical data , Risk Factors , Vulnerable Populations/statistics & numerical data , Workforce/organization & administration , Workforce/statistics & numerical data
18.
PLoS One ; 16(8): e0254821, 2021.
Article in English | MEDLINE | ID: covidwho-1341500

ABSTRACT

INTRODUCTION: Although most countries and healthcare systems worldwide have been affected by the COVID-19 pandemic, some groups of the population may be more vulnerable to detrimental effects of the pandemic on mental health than others. The aim of this systematic review was to synthesise evidence currently available from systematic reviews on the impact of COVID-19 and other coronavirus outbreaks on mental health for groups of the population thought to be at increased risk of detrimental mental health impacts. MATERIALS AND METHODS: We conducted a systematic review of reviews on adults and children residing in a country affected by a coronavirus outbreak and belonging to a group considered to be at risk of experiencing mental health inequalities. Data were collected on symptoms or diagnoses of any mental health condition, quality of life, suicide or attempted suicide. The protocol for this systematic review was registered in the online PROSPERO database prior to commencing the review (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=194264). RESULTS: We included 25 systematic reviews. Most reviews included primary studies of hospital workers from multiple countries. Reviews reported variable estimates for the burden of symptoms of mental health problems among acute healthcare workers, COVID-19 patients with physical comorbidities, and children and adolescents. No evaluations of interventions were identified. Risk- and protective factors, mostly for healthcare workers, showed the importance of personal factors, the work environment, and social networks for mental health. CONCLUSIONS: This review of reviews based on primary studies conducted in the early months of the COVID-19 pandemic shows a lack of evidence on mental health interventions and mental health impacts on vulnerable groups in the population.


Subject(s)
COVID-19/epidemiology , Coronavirus Infections/epidemiology , Health Personnel , Mental Health/statistics & numerical data , Vulnerable Populations , Adolescent , Adult , COVID-19/psychology , Child , Coronavirus Infections/psychology , Disease Outbreaks , Health Personnel/psychology , Health Personnel/statistics & numerical data , Humans , Mental Disorders/epidemiology , Mental Disorders/etiology , Pandemics , SARS-CoV-2/physiology , Socioeconomic Factors , Vulnerable Populations/psychology , Vulnerable Populations/statistics & numerical data
20.
PLoS One ; 16(7): e0254954, 2021.
Article in English | MEDLINE | ID: covidwho-1319521

ABSTRACT

BACKGROUND: Food insecurity is a serious social and public health problem which is exacerbated by the COVID-19 pandemic especially in resource-poor countries such as Nepal. However, there is a paucity of evidence at local levels. This study aims to explore food insecurity among people from the disadvantaged community and low-income families during the COVID-19 pandemic in Province-2 of Nepal. METHODS: The semi-structured qualitative interviews were conducted virtually among purposively selected participants (n = 41) from both urban and rural areas in eight districts of Province 2 in Nepal. All the interviews were conducted in the local language between July and August 2020. The data analysis was performed using thematic network analysis in Nvivo 12 Pro software. RESULTS: The results of this study are grouped into four global themes: i) Impact of COVID-19 on food security; ii) Food insecurity and coping strategies during the COVID-19 pandemic, iii) Food relief and emergency support during the COVID-19 pandemic, and iv) Impact of COVID-19 and food insecurity on health and wellbeing. Most participants in the study expressed that families from low socioeconomic backgrounds and disadvantaged communities such as those working on daily wages and who rely on remittance had experienced increased food insecurity during the COVID-19 pandemic. Participants used different forms of coping strategies to meet their food requirements during the pandemic. Community members experienced favouritism, nepotism, and partiality from local politicians and authorities during the distribution of food relief. The food insecurity among low-income and disadvantaged families has affected their health and wellbeing making them increasingly vulnerable to the COVID-19 infection. CONCLUSION: Food insecurity among low-income and disadvantaged families was found to be a serious problem during the COVID-19 pandemic. The study suggests that the relief support plan and policies should be focused on the implementation of immediate sustainable food security strategies to prevent hunger, malnutrition, and mental health problems among the most vulnerable groups in the community.


Subject(s)
COVID-19/epidemiology , Food Insecurity , Income/statistics & numerical data , Pandemics/economics , Vulnerable Populations/statistics & numerical data , Adult , Aged , Female , Housing/statistics & numerical data , Humans , Male , Middle Aged , Nepal/epidemiology , Surveys and Questionnaires , Young Adult
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