The structural drivers of disadvantage and poverty that are antecedents of health inequity in the COVID-19 pandemic are examined. The implementation of proportionately structural changes to how ...health and medical education systems operate is suggested. Heeding this suggestion will advance the health of individuals, communities and their surrounding environments.
Socially vulnerable communities may be at higher risk for COVID-19 outbreaks in the US. However, no prior studies examined temporal trends and differential effects of social vulnerability on COVID-19 ...incidence and death rates. Therefore, we examined temporal trends among counties with high and low social vulnerability to quantify disparities in trends over time.
We conducted a longitudinal analysis examining COVID-19 incidence and death rates from March 15 to December 31, 2020, for each US county using data from USAFacts. We classified counties using the Social Vulnerability Index (SVI), a percentile-based measure from the Centers for Disease Control and Prevention, with higher values indicating more vulnerability. Using a Bayesian hierarchical negative binomial model, we estimated daily risk ratios (RRs) comparing counties in the first (lower) and fourth (upper) SVI quartiles, adjusting for rurality, percentage in poor or fair health, percentage female, percentage of smokers, county average daily fine particulate matter (PM2.5), percentage of primary care physicians per 100,000 residents, daily temperature and precipitation, and proportion tested for COVID-19.
At the outset of the pandemic, the most vulnerable counties had, on average, fewer cases per 100,000 than least vulnerable SVI quartile. However, on March 28, we observed a crossover effect in which the most vulnerable counties experienced higher COVID-19 incidence rates compared to the least vulnerable counties (RR = 1.05, 95% PI: 0.98, 1.12). Vulnerable counties had higher death rates starting on May 21 (RR = 1.08, 95% PI: 1.00,1.16). However, by October, this trend reversed and the most vulnerable counties had lower death rates compared to least vulnerable counties.
The impact of COVID-19 is not static but can migrate from less vulnerable counties to more vulnerable counties and back again over time.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Chasing a dream against all odds Vivian, Eva; Chewning, Betty; Flanagan, Constance
BMC public health,
09/2022, Volume:
22, Issue:
1
Journal Article
Peer reviewed
Open access
Abstract
Background
Youth of color growing up in poverty face many challenges that children from more affluent families never experience. These children often reside in disadvantaged neighborhoods ...with substandard housing, inadequate medical care, and under resourced schools. This places these children at risk for poor academic achievement, school dropout, abuse and neglect, behavioral and socioemotional problems, and physical health problems. In spite of these risks, some children “beat the odds” and overcome the challenges and adversities in their external contexts. The paper reports the findings of a draw-and-write activity designed to learn the processes whereby protective factors promote resilience from a child’s point of view.
Methods
In this qualitative study, a draw-and-write activity was conducted with a convenience sample of 33 children, (23 females and 10 males of which 10 were Hmong, 11 were Middle Eastern, and 12 were African Americans) .The children were asked to make visual representations of resources (persons or things that, in their view, contribute to their wellbeing.) In depth interviews with a subset of 15 of the children was conducted to discuss the meaning of the images in their drawings. A summative content analysis of the visual and narrative data was performed using a resilience framework.
Results
Regardless of racial/ethnic background, parents, and especially mothers, were the main “person or thing” identified by these children living in poverty as helping them “make it thus far in life.” Ninety seven percent of the participants in this study described their parent(s) as nurturing and supportive, enabling them to overcome obstacles and adversities within their environment.
Forty five percent of participants identified their mother as a key anchor in their life Fifty eight percent of the African American children indicated that their parent(s) encouraged education to escape poverty.
Conclusion
The findings support that families, particularly parents have the strongest influence on supporting the resilience process in a child. These findings were consistent across ethnicity and gender. Families, particularly parents, should be the target of future interventions designed to produce resilient behaviors in youth of color living in poverty.
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In humanitarian settings, brief screening instruments for child psychological distress have potential to assist in assessing prevalence, monitoring outcomes, and identifying children and adolescents ...in most need of scarce resources, given few mental health professionals for diagnostic services. Yet, there are few validated screening tools available, particularly in Arabic.
We translated and adapted the Child Psychosocial Distress Screener (CPDS) and the Pediatric Symptom Checklist (PSC) and conducted a validation study with 85 adolescents (aged 10-15) in Lebanon. We assessed internal consistency; test-retest reliability; convergent validity between adolescent- and caregiver-report and between the two measures; ability to distinguish between clinical and non-clinical samples; and concurrent validity against psychiatrist interview using the Kiddie Schedule for Affective Disorders and Schizophrenia.
The translated and adapted child-reported PSC-17 and PSC-35, and caregiver-reported PSC-35 all showed adequate internal consistency and test-retest reliability and high concurrent validity with psychiatrist interview and were able to distinguish between clinical and non-clinical samples. However, the caregiver-reported PSC-17 did not demonstrate adequate performance in this setting. Child-reported versions of the PSC outperformed caregiver-reported versions and the 35-item PSC scales showed stronger performance than 17-item scales. The CPDS showed adequate convergent validity with the PSC, ability to distinguish between clinical and non-clinical samples, and concurrent validity with psychiatrist interview. Internal consistency was low for the CPDS, likely due to the nature of the brief risk-screening tool. There were discrepancies between caregiver and child-reports, worthy of future investigation. For indication of any diagnosis requiring treatment, we recommend cut-offs of 5 for CPDS, 12 for child-reported PSC-17, 21 for child-reported PSC-35, and 26 for caregiver-reported PSC-35.
The Arabic PSC and CPDS are reliable and valid instruments for use as primary screening tools in Lebanon. Further research is needed to understand discrepancies between adolescent and caregiver reports, and optimal methods of using multiple informants.
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Context: Neighborhood characteristics play an important role in health outcomes, especially for people who access care in community health centers (CHCs). Objective: This study evaluates rates of ...patient-level multimorbidity (greater than or equal to 2 chronic diseases) among CHC patients living in different areas of community-level social deprivation. Study Design and Analysis: Retrospective cohort study using Poisson mixed effects regression of the rates of morbidities by patient- and community- level characteristics including the social deprivation index (SDI). SDI is a composite measure of community-level income, education, employment, housing, household characteristics, transportation, and demographics. Morbidities included 22 chronic diseases recommended by the Department of Health and Human Services Multiple Chronic Conditions framework. Setting or Dataset: 1,412,038 patients from 9,362 Zip Code Tabulation Areas (ZCTAs) living in 27 states. Population Studied: Patients, greater than or equal to 45 years from the OCHIN and HCN practice-based research networks. Intervention/Instrument: SDI (0-100) was categorized into quartiles using the patient's ZCTA at last known address. Higher SDI quartiles denote more deprivation. Outcome Measures: Rates of morbidities at date of last known address. Results: Overall, patients averaged 2.50 morbidities (standard deviation SD = 2.20). Most patients were 45-54 years of age (38.2%), female (56.0%), non-Hispanic White (37.4%), spoke English (69.8%), continuously <138% of the federal poverty line (FPL) (36.5%), and continuously insured (28.8%). In analytic models, patients in SDI quartiles 3 and 4 had a 7% and 10% higher rate of morbidities compared with SDI quartile 1. Older age groups had a higher rate of morbidities than 45-54 year age group (Incident Rate Ratio IRR 55-64: 1.26, IRR 65+: 1.48). Patients inconsistently over or under the 138% FPL threshold had a 10% higher rate of morbidities compared with those <138% of the FPL (IRR = 1.10). Patients who were continuously or discontinuously insured experienced a 54% and 97% higher rate in morbidities (IRRs = 1.54 and 1.97), respectively, compared with continuously uninsured patients. Conclusions: Patients residing in more socially-deprived areas experienced a higher rate of morbidity burden than those in less socially-deprived areas. Community health centers should target preventive care interventions to avert further morbidity development among safety-net populations.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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BFBNIB, DOBA, IZUM, KILJ, NMLJ, NUK, ODKLJ, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
28.
Presidential Powers and Response to COVID-19 Gostin, Lawrence O; Hodge, James G; Wiley, Lindsay F
JAMA : the journal of the American Medical Association,
04/2020, Volume:
323, Issue:
16
Journal Article
Peer reviewed
Open access
The legal powers the US president and state governors have to implement travel and other restrictions to control the spread of coronavirus are examined. In light of these powers, there is a need to ...balance rights to privacy and liberty with public health in ways that do not disadvantage already vulnerable populations.
Physicians with the highest proportion of patients dually eligible for Medicare and Medicaid may have significantly lower Merit-based Incentive Payment System (MIPS) scores compared with other ...physicians. In 284,544 physicians, the mean MIPS score for physicians in the highest risk quintile (64.7) was lower relative to scores for physicians in the middle 3 (75.4) and lowest (75.9) risk quintiles.
The possible role of neutralizing monoclonal antibodies (MAbs) as a treatment for COVID-19 and as a means of prevention in high-risk populations is examined. For most viral diseases, neutralizing ...MAbs are a key component of protective immunity. Some limitations of the approach that need to be disproven or addressed for the strategy to be effective are also discussed.
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