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Twiner MJ, Akcasu NN, Foster B, Opara IN, Bauer SJ, Korzeniewski SJ, Brook RD, Levy PD. Origins of a novel mobile health unit program to prevent cardiovascular disease in vulnerable communities. J Clin Hypertens (Greenwich) 2024; 26:448-450. [PMID: 38501742 PMCID: PMC11007797 DOI: 10.1111/jch.14800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Affiliation(s)
- Michael J. Twiner
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
| | - Nora N. Akcasu
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
| | - Bethany Foster
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
| | - Ijeoma Nnodim Opara
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
- Department of Internal MedicineSection of Internal Medicine and PediatricsWayne Health Physician GroupWayne State University School of MedicineDetroitMichiganUSA
| | - Samantha J. Bauer
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
- Department of Family Medicine and Public Health SciencesWayne State UniversityDetroitMichiganUSA
| | - Steven J. Korzeniewski
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
| | - Robert D. Brook
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
- Division of Cardiovascular DiseaseDepartment of Internal MedicineWayne State UniversityDetroitMichiganUSA
| | - Phillip D. Levy
- Department of Emergency MedicineWayne State UniversityDetroitMichiganUSA
- Integrative Biosciences CenterWayne State UniversityDetroitMichiganUSA
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Joshi S, Arshad S, Lindsay A, Heinonen J, Misikir H, Zervos J, Prentiss T, Verkler J, Numi M, Czander B, David RE, Mossing M, Kilgore PE, Rehman N, Zervos M. Control of SARS-CoV-2 infection in skilled nursing facilities in Detroit, Michigan: a model for emerging infectious diseases. Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38505952 DOI: 10.1017/ice.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
An infection prevention bundle that consisted of the development of a response team, public-academic partnership, daily assessment, regular testing, isolation, and environmental controls was implemented in 26 skilled nursing facilities in Detroit, Michigan (March 2020-April 2021). This intervention was associated with sustained control of severe acute respiratory coronavirus virus 2 infection among residents and staff.
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Affiliation(s)
- Seema Joshi
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Samia Arshad
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Abigail Lindsay
- Detroit Health Department, Detroit, MI, USA
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Jessica Heinonen
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Helina Misikir
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - John Zervos
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Tyler Prentiss
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Jelena Verkler
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Mariia Numi
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | | | - Randy E David
- Detroit Health Department, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Michael Mossing
- Detroit Health Department, Detroit, MI, USA
- CDC Foundation, Atlanta, GE, USA
| | - Paul E Kilgore
- School of Medicine, Wayne State University, Detroit, MI, USA
- Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Najibah Rehman
- Detroit Health Department, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
| | - Marcus Zervos
- Division of Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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Arvin M, Bazrafkan S, Beiki P, Sharifi A. A county-level analysis of association between social vulnerability and COVID-19 cases in Khuzestan Province, Iran. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 84:103495. [PMID: 36532873 PMCID: PMC9747688 DOI: 10.1016/j.ijdrr.2022.103495] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 12/11/2022] [Accepted: 12/11/2022] [Indexed: 05/19/2023]
Abstract
Social vulnerability is related to the differential abilities of socio-economic groups to withstand and respond to the adverse impacts of hazards and stressors. COVID-19, as a human risk, is influenced by and contributes to social vulnerability. The purpose of this study was to examine the association between social vulnerability and the prevalence of COVID-19 infection in the counties of Khuzestan province, Iran. To determine the social vulnerability of the counties in the Khuzestan province, decision-making techniques and geographic information systems were employed. Also, the Pearson correlation was used to examine the relationship between the two variables. The findings indicate that Ahvaz county and the province's northeastern counties have the highest levels of social vulnerability. There was no significant link between the social vulnerability index of the counties and the rate of COVID-19 cases (per 1000 persons). We argue that all counties in the province should implement and pursue COVID-19 control programs and policies. This is particularly essential for counties with greater rates of social vulnerability and COVID-19 cases.
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Affiliation(s)
- Mahmoud Arvin
- Department of Human Geography, Faculty of Geography, University of Tehran, Iran
| | - Shahram Bazrafkan
- Department of Human Geography and Spatial Planning, Faculty of Earth Sciences, Shahid Beheshti University, Tehran, Iran
| | - Parisa Beiki
- Department of Geography, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Ayyoob Sharifi
- Hiroshima University, ،The IDEC Institute, the Graduate School of Humanities and Social Science, and the Network for Education and Research on Peace and Sustainability (NERPS), Japan
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Al-Otaiby M, Almutairi KM, Vinluan JM, Al Seraihi A, Alonazi WB, Qahtani MH, Aljeri T, Alhumud MA, Alobaidi N, Alhurishi SA. Demographic Characteristics, Comorbidities, and Length of Stay of COVID-19 Patients Admitted Into Intensive Care Units in Saudi Arabia: A Nationwide Retrospective Study. Front Med (Lausanne) 2022; 9:893954. [PMID: 35911421 PMCID: PMC9325959 DOI: 10.3389/fmed.2022.893954] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to describe the demographic characteristics and determine the risk factors associated with disease severity and length of hospital and intensive care unit (ICU) stay in a cohort of COVID-19 patients admitted into ICU in Saudi Arabia. Methods This was a national, multi-center, retrospective cross-sectional study of all COVID-19 cases admitted into different ICUs in Saudi Arabia between March 2020 and September 202l. Demographic, clinical features, comorbidities, and length of stay (LOS) data were retrieved from the national Health Electronic Surveillance Network (HESN) and Taqassi databases at the Saudi Ministry of Health (MOH) for subsequent analyses. We used multiple linear regression models to determine risk factors associated with critical outcomes (including LOS in ICU) among COVID-19 cases. Results A total of 12,436 COVID-19 patients were included in this study, with a mean age of 59.57 ± 18.30 years and 7,679 (62%) were <65 years old. COVID-19 was more common in males (N = 7,686, 61.9%) and Saudi nationals (N = 8,516, 68.5%). The clinical characteristic findings showed that 36.3% of patients required invasive ventilation whilst 65.4% received tracheostomies for ventilation, and 4% were on dialysis. Our analysis revealed that 2,978 (23.9%) patients had one comorbidity, 4,977 (47.4%) had two or more comorbidities, and diabetes (48.2%) was the most prevalent comorbidity, followed by hypertension (44.2%), and chronic cardiovascular disease (10.5%). Thirteen variables emerged as significant predictors of LOS in ICU using multiple linear regression analyses, with invasive ventilation as the strongest predictor of LOS in the ICU (beta = −0.68, p = 0.001) and hospital admission (beta = −0.65, p = 0.001). Conclusions COVID-19 continues to affect millions of people around the world, with a mortality rate of about 2–3% of all infected patients. Our analysis revealed that comorbidities such as chronic kidney disease, cardiovascular disease, diabetes, and older age were significant risk factors associated with a poorer prognosis and longer duration of stay in hospitals and ICU.
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Affiliation(s)
- Maram Al-Otaiby
- The Saudi Ministry of Health, Riyadh, Saudi Arabia
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- *Correspondence: Maram Al-Otaiby
| | - Khalid M. Almutairi
- Department of Community Health Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Jason M. Vinluan
- Department of Community Health Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Wadi B. Alonazi
- College of Business Administration, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Manal A. Alhumud
- Department of Community Health Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Sultana A. Alhurishi
- Department of Community Health Science, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Matthews S, Levy PD. A sociogenomic paradigm to replace the racial paradigm. Per Med 2022; 19:377-382. [PMID: 35758011 DOI: 10.2217/pme-2021-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Sajith Matthews
- Department of Internal Medicine, Division of General Medicine, Wayne State University, 4201 St Antoine Street, UHC 5C, Detroit, MI 48201, USA
| | - Phillip D Levy
- Department of Emergency Medicine & Integrative Biosciences Center, Wayne State University, Detroit, MI 48201, USA
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Bukstein DA, Friedman A, Gonzalez Reyes E, Hart M, Jones BL, Winders T. Impact of Social Determinants on the Burden of Asthma and Eczema: Results from a US Patient Survey. Adv Ther 2022; 39:1341-1358. [PMID: 35072886 PMCID: PMC8784588 DOI: 10.1007/s12325-021-02021-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
Introduction Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care. Methods An online survey was completed by market research panelists in the USA between March 24, 2020 and April 6, 2020. Eligible participants were at least 18 years of age and endorsed a diagnosis of asthma and/or eczema. Survey responses are described for all participants, by designated racial/ethnic groups, and by income level. Results In all, 841 participants completed the survey (asthma, n = 554; eczema, n = 398; both, n = 111; White, n = 421; Black, n = 252; Hispanic, n = 95; low income [less than $15,000/year], n = 99; higher income [at least $15,000/year], n = 713). More Black and Hispanic participants than White participants, and more participants with low income than higher income, endorsed health literacy as a barrier (e.g., filling out official documents, understanding written materials). Participants with low income were less likely than participants with higher income to have an asthma action plan (42% vs 53%, respectively) and to discuss asthma control with their healthcare provider (54% vs 69%). Black and Hispanic participants were more likely than White participants to have an emergency department visit (52% and 49% vs 31%, respectively) or hospitalization (31% and 39% vs 16%) for asthma within the last 12 months. Participants reporting low income indicated that they experienced eczema symptoms more frequently than participants with higher income; 35% of low-income participants vs 15% of higher-income participants reported that they had not tried any eczema treatments. Participants in all racial/ethnic and income-level groups reported that their asthma or eczema impacted their lifestyle and daily activities. Conclusion More effective and culturally informed communication and education strategies to improve health information uptake and shared decision-making are needed to reduce the burdens of disease and treatment in highly impacted populations. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-02021-0. Disparities in asthma and eczema outcomes have been described in various populations. However, little is known about how these patient populations perceive their disease management or disease burden. A survey of 841 adults across diverse demographic groups in the USA with asthma and/or eczema was conducted to evaluate overall perceived disease burden and to specifically understand burden experiences by marginalized populations. In general, all participants indicated that asthma and eczema have a negative physical, emotional, and social impact on their lives. Some participants who identified as Black or Hispanic, and those with low income (less than $15,000/year), indicated greater difficulties in filling out paperwork or understanding written materials related to their condition than White participants or those with higher incomes. Black and Hispanic participants tended to receive asthma care in the emergency department or urgent care more than White participants and had more emergency department visits and hospitalizations than White Participants. Participants with low income were less likely to discuss their asthma management with their doctor than those with higher incomes and also indicated potential undertreatment of eczema. These results indicate that Black, Hispanic, or low-income patients may experience barriers to health equity. These barriers include lack of effective communication methods and materials to meet the needs of all patients, as well as the overall lack of quality healthcare access. These challenges must be addressed to overcome social disparities in health.
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Affiliation(s)
| | - Adam Friedman
- Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, DC, USA
| | - Erika Gonzalez Reyes
- Department of Internal Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Mary Hart
- Allergy & Asthma Network, Vienna, VA, USA
| | - Bridgette L Jones
- Children's Mercy Kansas City & University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
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Giovanatti A, Elassar H, Karabon P, Wunderlich-Barillas T, Halalau A. Social Determinants of Health Correlating with Mechanical Ventilation of COVID-19 Patients: A Multi-Center Observational Study. Int J Gen Med 2021; 14:8521-8526. [PMID: 34848998 PMCID: PMC8612671 DOI: 10.2147/ijgm.s334593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/29/2021] [Indexed: 01/30/2023] Open
Abstract
Importance Several studies have relayed the disproportionate impact of COVID-19 on marginalized communities; however, few have specifically examined the association between social determinants of health and mechanical ventilation (MV). Objective To determine which demographics impact MV rates among COVID-19 patients. Design This observational study included COVID-19 patient data from eight hospitals’ electronic medical records (EMR) between February 25, 2020, to December 31, 2020. Associations between demographic data and MV rates were evaluated using uni- and multivariate analyses. Setting Multicenter (eight hospitals), largest health system in Southeast Michigan. Participants Inpatients with a positive RT-PCR for SARS-CoV-2 on nasopharyngeal swab. Exclusion criteria were missing demographic data or non-permanent Michigan residents. Exposure Patients were divided into two groups: MV and non-MV. Main Outcome and Measures The primary outcome was MV rate per demographic. A multivariate model then predicted the odds of MV per demographic descriptor. Hypotheses were formulated prior to data collection. Results Among 11,304 COVID-19 inpatients investigated, 1621 (14.34%) were MV, and 49.96% were male with a mean age of 63.37 years (17.79). Significant social determinants for MV included Black race (40.19% MV vs 31.31% non-MV, p<0.01), poverty (14.60% vs. 13.21%, p<0.01), and disability (12.65% vs 9.14%; p<0.01). Black race (AOR 1.61 (CI 1.41–1.83; p<0.01)), median income (AOR 0.99 (CI 0.99–0.99; p<0.01)), disability (AOR 1.55 (CI 1.26, 1.90; p<0.01)), and non-English-speaking status (AOR 1.26 (CI 1.05, 1.53)) had significantly higher odds of MV. Conclusions and Relevance Black race, low socioeconomic status, disability, and non-English-speaking status were significant risk factors for MV from COVID-19. An urgent need remains for a pandemic response program that strategizes care for marginalized communities.
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Affiliation(s)
- Alexa Giovanatti
- Internal Medicine Department, Beaumont Health, Royal Oak, MI, USA
| | - Heba Elassar
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Patrick Karabon
- Office of Research, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | | | - Alexandra Halalau
- Internal Medicine Department, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Levy P, McGlynn E, Hill AB, Zhang L, Korzeniewski SJ, Foster B, Criswell J, O’Brien C, Dawood K, Baird L, Shanley CJ. From pandemic response to portable population health: A formative evaluation of the Detroit mobile health unit program. PLoS One 2021; 16:e0256908. [PMID: 34847164 PMCID: PMC8631611 DOI: 10.1371/journal.pone.0256908] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/20/2021] [Indexed: 11/20/2022] Open
Abstract
This article describes our experience developing a novel mobile health unit (MHU) program in the Detroit, Michigan, metropolitan area. Our main objectives were to improve healthcare accessibility, quality and equity in our community during the novel coronavirus pandemic. While initially focused on SARS-CoV-2 testing, our program quickly evolved to include preventive health services. The MHU program began as a location-based SARS-CoV-2 testing strategy coordinated with local and state public health agencies. Community needs motivated further program expansion to include additional preventive healthcare and social services. MHU deployment was targeted to disease "hotspots" based on publicly available SARS-CoV-2 testing data and community-level information about social vulnerability. This formative evaluation explores whether our MHU deployment strategy enabled us to reach patients from communities with heightened social vulnerability as intended. From 3/20/20-3/24/21, the Detroit MHU program reached a total of 32,523 people. The proportion of patients who resided in communities with top quartile Centers for Disease Control and Prevention Social Vulnerability Index rankings increased from 25% during location-based "drive-through" SARS-CoV-2 testing (3/20/20-4/13/20) to 27% after pivoting to a mobile platform (4/13/20-to-8/31/20; p = 0.01). The adoption of a data-driven deployment strategy resulted in further improvement; 41% of the patients who sought MHU services from 9/1/20-to-3/24/21 lived in vulnerable communities (Cochrane Armitage test for trend, p<0.001). Since 10/1/21, 1,837 people received social service referrals and, as of 3/15/21, 4,603 were administered at least one dose of COVID-19 vaccine. Our MHU program demonstrates the capacity to provide needed healthcare and social services to difficult-to-reach populations from areas with heightened social vulnerability. This model can be expanded to meet emerging pandemic needs, but it is also uniquely capable of improving health equity by addressing longstanding gaps in primary care and social services in vulnerable communities.
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Affiliation(s)
- Phillip Levy
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Erin McGlynn
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Alex B. Hill
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Liying Zhang
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Steven J. Korzeniewski
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Bethany Foster
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jasmine Criswell
- Wayne Health, Wayne State University, Detroit, Michigan, United States of America
| | - Caitlin O’Brien
- Wayne Health, Wayne State University, Detroit, Michigan, United States of America
| | - Katee Dawood
- Wayne Health, Wayne State University, Detroit, Michigan, United States of America
| | - Lauren Baird
- Wayne Health, Wayne State University, Detroit, Michigan, United States of America
| | - Charles J. Shanley
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, United States of America
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Lamb LE, Timar R, Wills M, Dhar S, Lucas SM, Komnenov D, Chancellor MB, Dhar N. Long COVID and COVID-19-associated cystitis (CAC). Int Urol Nephrol 2021; 54:17-21. [PMID: 34787782 PMCID: PMC8597545 DOI: 10.1007/s11255-021-03030-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/08/2021] [Indexed: 12/20/2022]
Abstract
Purpose There is scarce literature regarding genitourinary symptoms in COVID-19, especially post-acute disease otherwise known as Long COVID. We identified recovered COVID-19 patients presenting with new or worsening overactive bladder symptoms, known as COVID-19-associated cystitis (CAC). Methods We used the American Urological Association Urology Care Foundation Overactive Bladder (OAB) Assessment Tool to screen COVID-19 recovered patients presenting with urological complaints at our urban-located institution from 5/22/2020 to 12/31/2020. Patients 10–14 weeks post-discharge responded to 5 symptom and 4 quality-of-life (QoL) questions. We reported median symptom scores, as well as QoL scores, based on new or worsening urinary symptoms, and by sex. Results We identified 350 patients with de novo or worsening OAB symptoms 10–14 weeks after hospitalization with COVID-19. The median total OAB symptom score in both men and women was 18. The median total QoL score for both men and women was 19. Patients with worsening OAB symptoms had a median pre-COVID-19 symptom score of 8 (4–10) compared to post-COVID-19 median symptom score of 19 (17–21). Median age was 64.5 (range 47–82). Median hospital length-of-stay was 10 days (range 5–30). Conclusion We report survey-based results of patients suffering from new or worsening OAB symptoms months after their hospitalization from COVID-19. Future studies with larger sample sizes and more extensive testing will hopefully elucidate the specific pathophysiology of OAB symptoms in the context of long COVID so urologists can timely and appropriately treat their patients. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-021-03030-2.
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Affiliation(s)
- Laura E Lamb
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Ryan Timar
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Melissa Wills
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Sorabh Dhar
- Wayne State University School of Medicine, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
- John D. Dingell VA Medical Center, Detroit, MI, USA
| | - Steve M Lucas
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Dragana Komnenov
- Wayne State University School of Medicine, Detroit, MI, USA
- Detroit Medical Center, Detroit, MI, USA
| | - Michael B Chancellor
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester Hills, MI, USA
| | - Nivedita Dhar
- Detroit Medical Center, Detroit, MI, USA.
- John D. Dingell VA Medical Center, Detroit, MI, USA.
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