ABSTRACT
Background: Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood. Methods: Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 - May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes. Results: Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts. Discussion: Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.
ABSTRACT
Universal screenings for social determinants of health (SDOH) are feasible at the health system level and enable institutions to identify unmet social needs that would otherwise go undiscovered. NewYork-Presbyterian Hospital implemented SDOH screenings together with clinical screenings in four outpatient primary care sites. Aligning SDOH screening with clinical screening was crucial for establishing provider buy-in and ensuring sustainability of screening for SDOH. Despite some challenges, universal screening for SDOH has allowed NewYork-Presbyterian Hospital to identify unmet needs to improve population health.
Subject(s)
Mass Screening/organization & administration , Primary Health Care/organization & administration , Social Determinants of Health/statistics & numerical data , Academic Medical Centers , Ambulatory Care Facilities/organization & administration , Electronic Health Records , Female , Health Literacy , Humans , Male , Minority Groups , New York City , Primary Health Care/methodsABSTRACT
BACKGROUND: A strong association between the number of adverse childhood experiences (ACEs) and the risk of maternal depression has been demonstrated; however, this association has not been examined with regards to changes in depression across the perinatal period. The objectives of this longitudinal study were to: (1) determine whether ACEs predict depressive symptomology in pregnancy and the postpartum period; (2) test the relative contribution of ACEs, with other established risks of depression, including social support, and (3) examine whether the association between ACEs and depression across the perinatal period vary as a function of social support. METHODS: Data from 1994 women were collected from a prospective pregnancy cohort. Women completed questionnaires related to ACEs prior to the age of 18. In pregnancy and at 4 months postpartum, social support was measured using the Medical Outcomes Study Social Support Survey and clinical cut-off scores for depression were assessed using the Edinburgh Postnatal Depression Scale. RESULTS: Logistic regression demonstrated that after accounting for sociodemographic factors and social support, ACEs predicted depressive symptoms in pregnancy (AOR = =1.26, CI = =1.12-1.43), the postpartum period (AOR = =1.34, CI = =1.17-1.52), and across the perinatal period (AOR = =1.31, CI = =1.12-1.54). Social support did not moderate the association between maternal ACEs and depression for any time point. LIMITATIONS: retrospective and self-report nature of the data. CONCLUSION: ACEs and low social support are both risk factors for depression, however low social support predicted the highest odds of depression, indicating the importance of asking about social support in pregnant and postpartum women.
Subject(s)
Adverse Childhood Experiences , Depression, Postpartum , Child , Depression , Depression, Postpartum/epidemiology , Female , Humans , Longitudinal Studies , Pregnancy , Prospective Studies , Retrospective Studies , Risk Factors , Social SupportABSTRACT
The insula has been implicated in playing important roles in various brain functions including consciousness, homeostasis, perception, self-awareness, language processing, and interpersonal experience. Abnormalities of the insula have been observed in patients suffering from addiction, deteriorating language function, anorexia, and emotional dysregulation. We analyzed typical development of insular connections in a large-scale pediatric population using 642 magnetic resonance imaging examinations. Interpreting large quantities of acquired data is one of the major challenges in connectomics. This article focuses its analysis on the connectivity observed between the insula and many other regions throughout the brain and performs a hemispheric asymmetry analysis comparing localized connectome measurements. Results demonstrate asymmetries in the pathways connecting the insula to the superior temporal region, pars opercularis, etc. that may be representative of language lateralization in the brain. Results also demonstrate multiple fiber pathways that exhibit hemispheric dominance in tract length and an inverted hemispheric dominance in tract counts, implying the presence of asymmetric lateralization of some of the brain's insular pathways. This study illustrates the investigative potential of performing connectomics-style analyses in a clinical context across a large population of children as part of routine imaging, demonstrating the feasibility of using current technologies to perform regionally focused clinical connectivity studies.
