Social Drivers of COVID-19 Disease Severity in Pregnant Patients.

OBJECTIVE: While coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has had global impact in all populations, certain groups of patients have experienced disproportionate rates of morbidity and mortality. The purpose of this study was to assess the relationship between COVID-19 disease severity, demographic variables, race and ethnicity, and social determinants of health among pregnant patients in a diverse urban population. STUDY DESIGN: A retrospective analysis was performed of all pregnant patients diagnosed with COVID-19 at two urban tertiary care centers in Houston, TX between March and August 2020. Maternal demographic, COVID-19 illness criteria, and delivery characteristics were collected. The Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and COVID-19 Community Vulnerability Index (CCVI) were obtained based on a patients' census tract of residence. Analyses compared persons with asymptomatic, mild, or severe-critical disease at diagnosis. RESULTS: A total of 317 persons tested positive for COVID-19 during this time period. Asymptomatic persons were more likely to be diagnosed at later gestational ages, but there were no other differences in baseline maternal characteristics. Persons with more severe disease had greater social vulnerability specifically for housing and transportation than those with mild disease (mean SVI [standard error]: 0.72 [0.06] vs. 0.58 [0.2], p = 0.03). Total SVI, total CCVI, and other themed SVI and CCVI indices were not significantly different between groups. CONCLUSION: In this cohort of pregnant persons infected with SARS-CoV-2, an association was shown between disease severity and increased vulnerability in living conditions and transportation. Drivers of the pandemic and COVID-19 outcomes are complex and multifactorial, and likely change over time. However, continued efforts to accurately identify and measure social determinants of health in medicine will likely help identify geographic areas and patient populations that are at risk of higher disease burden. This could facilitate preventative and mitigation measures in these areas in future disaster or pandemic situations. KEY POINTS: · SVI and CCVI estimate social determinants of health.. · COVID-19 is associated with housing and transportation vulnerability.. · Social determinants contribute to disease burden in pregnancy..

Routine Maternal Vaccine Uptake during the COVID-19 Pandemic.

OBJECTIVE: This study examines the impact of the coronavirus disease 2019 (COVID-19) pandemic on influenza and tetanus toxoid, reduced diphtheria toxoid and acellular pertussis (Tdap) vaccine uptake in a pregnant, low-income population. STUDY DESIGN: This retrospective cohort study included women initiating prenatal care before (May-November 2019) or during the COVID-19 pandemic (May-November 2020) at two large Medicaid clinics. All patients entered prenatal care before 20 weeks and delivered full-term. Medical records were reviewed for vaccine uptake and demographic data. Multivariate logistic regression analysis was used to compare vaccination rates prior to and during the COVID-19 pandemic. Additional analysis was performed to identify association of demographic factors with vaccine uptake. IRB approval was obtained for this study. RESULTS: A total of 939 patients met inclusion criteria, with 462 initiating care prior to and 477 initiating care during the COVID-19 pandemic. Influenza vaccination uptake was 78% (362/462) in the prepandemic group, significantly decreasing to 61% (291/477) in the pandemic group (p <0.01, odds ratio [OR] = 0.38, confidence interval [CI]: 0.26-0.53). Tdap vaccination uptake was 85% (392/462) in the prepandemic group, significantly decreasing to 76% (361/477) in the pandemic group (p <0.01, OR = 0.56, CI: 0.40-0.79). The decrease in influenza vaccine uptake was most significant in non-Hispanic Black patients, decreasing from 64% (73/114) in the prepandemic group to 35% (35/101) in the pandemic group (p <0.01, OR = 0.30, CI: 0.17-0.52), while there was no significant difference in age or parity in relation to vaccination status. CONCLUSION: Routine vaccination uptake significantly decreased during the COVID-19 pandemic in a low-income population of pregnant women, with decrease more pronounced on influenza vaccine than on Tdap vaccine uptake, especially in non-Hispanic Black patients. KEY POINTS: · Influenza and Tdap vaccination uptake during pregnancy has decreased during the COVID-19 pandemic.. · Influenza vaccine uptake decreased more than Tdap in pregnancy during the COVID-19 pandemic.. · The greatest decrease was seen in influenza vaccine uptake in non-Hispanic Black patients..

Stress, anxiety and depression levels in pregnancy: outpatient versus inpatient.

OBJECTIVE: To compare stress, anxiety and depression levels among 3 groups of pregnant women: 1) low-risk outpatient (LRO), 2) high-risk outpatient (HRO), and 3) inpatient (IP). METHODS: This was a cross-sectional study using validated instruments. Inclusion criteria were pregnancies 23-37 weeks and maternal age > 18 years. The primary outcome was mean/median scores of Perceived Stress Scale (PSS), State Trait Anxiety Inventory (STAI), and Edinburgh Depression Scale (EDS). Secondary outcome was rate of abnormal scores. RESULTS: Among 190 women approached, 180 (95%) participated, with 60 (33%) in each group. Mean PSS scores (range 0-40) significantly increased from LRO (12.0, standard deviation [SD] 7.8) to HRO (14.7, SD 7.9) to IP (15.6, SD 8.2); p = .04. Mean STAI scores (range 20-80) also significantly increased from LRO (32.0, SD 11.1) to HRO (35.8, SD 11.9) to IP (40.9, SD 13.1); p < .01. Abnormal anxiety (STAI ≥ 40) was present in 40% of women and significantly higher among IP compared to LRO (56% vs 25%; RR 2.24, 95% CI 1.36-3.67; aRR 2.24, 95% CI 1.34-3.74). CONCLUSION: Stress and anxiety scores significantly differ in LRO, HRO, and IP women. While depression screening is common postpartum, screening for stress, anxiety and depression prenatally may be beneficial.

Genomic identification, annotation, and comparative analysis of Vacuolar-type ATP synthase subunits in Diaphorina citri.

The hemipteran insect Diaphorina citri, or Asian citrus psyllid, is a vector for Candidatus Liberibacter asiaticus (CLas), the bacterium causing citrus greening disease, or Huanglongbing (HLB). Millions of citrus trees have been destroyed, and every grove in Florida, USA, has been directly affected by this disease. In eukaryotes, vacuolar-type ATP synthase (V-ATPase) is an abundant heterodimeric enzyme that serves the cell with essential compartment acidification through the active processes that transport protons across the membrane. Fifteen putative V-ATPase genes in the D. citri genome were manually curated. Comparative genomic analysis revealed that D. citri V-ATPase subunits share domains and motifs with other insects, including the V-ATPase-A superfamily domain. Phylogenetic analysis separates D. citri V-ATPase subunits into expected clades with orthologous sequences. Annotation of the D. citri genome is a critical step towards developing directed pest management strategies to reduce the spread of HLB throughout the citrus industry.

Mental Health Screening and Differences in Access to Care among Prisoners.

OBJECTIVE: Disparities in mental health care exist between regional and demographic groups. While screening is recommended as part of a correctional mental health strategy, little work has been done to explore whether it can narrow regional and demographic disparities in access to care. We compared treatment access rates by sex, race, age, and region in relation to screening results. METHODS: We conducted a retrospective cohort study using administrative data. All 7965 admissions to the prison system were followed for a median of 14 months. RESULTS: Males and non-Indigenous minority racial groups had lower rates of treatment regardless of screening results; they were less likely both to self-report needs and to receive treatment if these needs were reported. Regional differences revealed higher treatment rates in Atlantic Canada and Ontario, as well as higher rates of inmates self-reporting needs on screening who did not receive treatment in the Atlantic, Québec, and Pacific regions. There were minimal differences between inmates of different age groups. CONCLUSIONS: Findings suggest potential resource gaps and/or differences in the performance of screening to detect mental health needs across demographic and regional groups. Screening did not narrow, and may have widened, differences between groups.

Mental health treatment patterns following screening at intake to prison.

OBJECTIVE: While there is general consensus about the need to increase access to mental health treatment, it is debated whether screening is an effective solution. We examined treatment use by inmates in a prison system that offers universal mental health screening. METHOD: We conducted an observational study of 7,965 consecutive admissions to Canadian prisons. We described patterns of mental health treatment from admission until first release, death, or March, 2015 (median 14-month follow-up). We explored the association between screening results and time of first treatment contact duration of first treatment episode, and total number of treatment episodes. RESULTS: Forty-three percent of inmates received at least some treatment, although this was often of short duration; 8% received treatment for at least half of their incarceration. Screening results were predictive of initiation of treatment and recurrent episodes, with stronger associations among those who did not report a history prior to incarceration. Half of all inmates with a known mental health need prior to incarceration had at least 1 interruption in care, and only 46% of inmates with a diagnosable mental illness received treatment for more than 10% of their incarceration. CONCLUSION: Screening results were associated with treatment use during incarceration. However, mental health screening may have diverted resources from the already known highest need cases toward newly identified cases who often received brief treatment suggestive of lower needs. Further work is needed to determine the most cost-effective responses to positive screens, or alternatives to screening that increase uptake of services. (PsycINFO Database Record