Impact of Race and Socioeconomic Status on Outcomes in Patients Hospitalized with COVID-19.

BACKGROUND: The impact of race and socioeconomic status on clinical outcomes has not been quantified in patients hospitalized with coronavirus disease 2019 (COVID-19). OBJECTIVE: To evaluate the association between patient sociodemographics and neighborhood disadvantage with frequencies of death, invasive mechanical ventilation (IMV), and intensive care unit (ICU) admission in patients hospitalized with COVID-19. DESIGN: Retrospective cohort study. SETTING: Four hospitals in an integrated health system serving southeast Michigan. PARTICIPANTS: Adult patients admitted to the hospital with a COVID-19 diagnosis confirmed by polymerase chain reaction. MAIN MEASURES: Patient sociodemographics, comorbidities, and clinical outcomes were collected. Neighborhood socioeconomic variables were obtained at the census tract level from the 2018 American Community Survey. Relationships between neighborhood median income and clinical outcomes were evaluated using multivariate logistic regression models, controlling for patient age, sex, race, Charlson Comorbidity Index, obesity, smoking status, and living environment. KEY RESULTS: Black patients lived in significantly poorer neighborhoods than White patients (median income: $34,758 (24,531-56,095) vs. $63,317 (49,850-85,776), p < 0.001) and were more likely to have Medicaid insurance (19.4% vs. 11.2%, p < 0.001). Patients from neighborhoods with lower median income were significantly more likely to require IMV (lowest quartile: 25.4%, highest quartile: 16.0%, p < 0.001) and ICU admission (35.2%, 19.9%, p < 0.001). After adjusting for age, sex, race, and comorbidities, higher neighborhood income ($10,000 increase) remained a significant negative predictor for IMV (OR: 0.95 (95% CI 0.91, 0.99), p = 0.02) and ICU admission (OR: 0.92 (95% CI 0.89, 0.96), p < 0.001). CONCLUSIONS: Neighborhood disadvantage, which is closely associated with race, is a predictor of poor clinical outcomes in COVID-19. Measures of neighborhood disadvantage should be used to inform policies that aim to reduce COVID-19 disparities in the Black community.

Neurogenic factor-induced Langerhans cell activation in diabetic mice with mechanical allodynia.

BACKGROUND: Langerhans cells (LCs) are antigen-presenting dendritic cells located in the skin. It has been reported that LC activation is associated with painful diabetic neuropathy (PDN); however, the mechanism of LC activation is still unclear. METHODS: The db/db mouse, a rodent model of PDN, was used to study the roles of LCs in the development of PDN in type 2 diabetes. Hind foot pads from db/db and control db/+ mice from 5 to 24 weeks of age (encompassing the period of mechanical allodynia development and its abatement) were collected and processed for immunohistochemistry studies. LCs were identified with immunohistochemistry using an antibody against CD207 (Langerin). The intraepidermal nerve fibers and subepidermal nerve plexus were identified by immunohistochemistry of protein gene product 9.5 (PGP 9.5) and tropomyosin-receptor kinase (Trk) A, the high affinity nerve growth factor receptor. RESULTS: CD207-positive LCs increased in the db/db mouse during the period of mechanical allodynia, from 8 to 10 weeks of age, in both the epidermis and subepidermal plexus. At 16 weeks of age, when mechanical allodynia diminishes, LC populations were reduced in the epidermis and subepidermal plexus. Epidermal LCs (ELCs) were positive for Trk A. Subepidermal LCs (SLCs) were positive for CD68, suggesting that they are immature LCs. Additionally, these SLCs were positive for the receptor of advanced glycation end products (RAGE) and were in direct contact with TNF-α-positive nerve fibers in the subepidermal nerve plexus during the period of mechanical allodynia. Intrathecal administration of SB203580, a p38 kinase inhibitor, significantly reduced mechanical allodynia, TNF-α expression in the subepidermal plexus, and increased both ELC and SLC populations during the period of mechanical allodynia. CONCLUSIONS: Our data support the hypothesis that increased LC populations in PDN are activated by p38-dependent neurogenic factors and may be involved in the pathogenesis of PDN.

Design of a large scale community-based self-management system for diabetes mellitus.

This paper presents the ongoing development of a community based, self-management system for diabetes mellitus, which incorporates web-based, SMS and mobile-terminal functionalities. SMS represents the first stage of our system development as it is widely available on all mobile phones, convenient and becoming increasingly popular. We discuss past findings and the need for such a system, as well as design, implementation and system architecture. Poor self-management of diabetes is associated with progression into more complex health issues, manifesting as a significant public health burden and impacting negatively on an individual's quality of life. This approach recognizes that telehealth systems will play an increasingly pertinent role in health systems worldwide.

Parental reasons for non-uptake of influenza vaccination in young at-risk groups: a qualitative study.

BACKGROUND: Uptake rates of influenza vaccination in young at-risk groups in primary care (UK) are known to be poor. AIM: To explore parental reasons for non-uptake of influenza vaccination in young at-risk groups. The study hypothesis was that exploration of parental reasons for non-uptake may reveal important barriers to an effective influenza vaccination programme. DESIGN AND SETTING: Thematic analysis of a questionnaire survey with interview follow-up at a single general practice in Inverness, Scotland. METHOD: Parents of children identified as being in an at-risk group for influenza vaccination but who had not received vaccination were sent questionnaires and offered the opportunity to take part in a follow-up interview. RESULTS: Several key themes emerged, including uncertainty about the indication for vaccination, issues of choice, challenges with access, lack of parental priority, and issues relating to health beliefs. CONCLUSION: Any attempt to improve the vaccination rate needs to address the range of decision-making processes undertaken by parents and children. Better and more tailored information and educational delivery to parents, patients, and healthcare providers may lead to an increase in the rates of influenza vaccination uptake in at-risk children. Access is a barrier described by some parents.

Bowel preparation for colonoscopy: a randomized controlled trial comparing polyethylene glycol solution, one dose and two doses of oral sodium phosphate solution.

OBJECTIVES: To compare three bowel preparation regimens for colonoscopy in terms of the quality of preparation, the side effects and patient acceptance. METHODS: A total of 299 patients who underwent colonoscopy were randomized to three bowel preparation regimens: polyethylene glycol solution (n = 106), or a single dose (n = 92) or two doses (n = 101) of sodium phosphate solution. The colonoscopists who recorded the quality of bowel preparation were blind to the preparation regimens. The discomforts associated with bowel preparation and patient acceptance of the preparation were also recorded. RESULTS: Two doses of sodium phosphate solution achieved significantly better bowel preparation than polyethylene solution or a single dose of sodium phosphate solution (p < 0.05). Although two doses of sodium phosphate solution was associated with more dizziness and anal irritation, patients preferred preparation with sodium phosphate solution than with polyethylene glycol solution. Of the 69 patients in the sodium phosphate solution groups who had prior experience of bowel preparation using polyethylene glycol solution, 55 patients (80%) stated that they preferred sodium phosphate solution. CONCLUSION: Two doses of sodium phosphate solution achieved better bowel preparation than polyethylene glycol solution and was more acceptable to patients. A single dose of sodium phosphate did not achieve similar bowel preparation to two doses of the solution.