Poverty, inequality and COVID-19: the forgotten vulnerable

The impact of the COVID-19 pandemic on childhood obesity rates, by Health Board area, in Wales, UK

BACKGROUND

The aim of this study was to examine the possible impact of the coronavirus pandemic on rates of children living with obesity and severe obesity, by Health Board area in Wales.

METHODS

The pre-pandemic data consisted of all children included in the Wales Childhood Measurement Programme (2014/15-2018/19). The 2021/22 Child Measurement Programme data were used as the post-pandemic data set. Body mass index for obesity and severe obesity were calculated as 95th and 99.6th centiles, respectively.

RESULTS

Of the 163 277 children measured pre-pandemic (2014/15 to 2018/19), the overall prevalence of children with obesity and severe obesity were 12.1 and 3.2%, respectively. In the post-pandemic year (2021/22), obesity increased to 15.5% and severe obesity increased to 4.8%, with clear deprivation differentials (noting one of the seven Health Boards was unable to submit data post-pandemic). Two Health Boards had significantly higher rates of obesity post-pandemic compared to pre-pandemic. Increased levels of severe obesity were observed in all Health Boards with available data.

CONCLUSION

The post-pandemic rise in obesity and severe obesity in young children living in Wales demonstrates a need for more work on the prevention of obesity and severe obesity, targeting the early years and areas of socio-economic disadvantage.

Public Health Nurses' Proficiencies and Training Needs in an Emergency Response: A Cross-Sectional Observational Study

OBJECTIVE

To address gaps in understanding the public health nursing workforce regarding competencies recognized as critical during an emergency response.

DESIGN, SETTING, AND PARTICIPANTS

A cross-sectional observational study using data with information on local health department staff- and organizational-level characteristics collected from across the United States in 2021. We used logistic regression to estimate the association between 2 binary nurse-specific predictors-(1) whether the staff person was a nurse and (2) whether the staff worked in a local health department that was "nurse-led" (directed by a nurse)-and reported proficiencies important to the COVID-19 response. Models controlled for relevant local health department and community characteristics.

RESULTS

In the sample, 19% were nurses and 37% were at nurse-led health departments. Nurse versus nonnurse staff had higher odds of reporting proficiencies in skills related to Justice, Equity, Diversity, and Inclusion and in the skill "identifying/applying evidence-based approaches to address public health issues." However, nurses, compared with their nonnurse peers, had higher odds of reporting training needs in domains related to community engagement, policy engagement, and cross-sectoral collaboration. Conversely, staff at nurse-led health departments, compared with non-nurse-led staff, had higher odds of reporting proficiencies in many of these same areas, including "collaborating across the public health system" and "influencing policies external to the organization that affect community health." There were no areas in which nurse-led staff had lower odds of reporting proficiencies or higher odds of identifying training needs.

CONCLUSIONS

Findings from this study highlight areas of strength for public health nurses, particularly strengths related to diversity, equity, and inclusion, as well as areas where more training is needed. Such findings can help guide future public health nurse workforce development as well as underscore the value of public health nursing leadership and staff at local health departments for supporting community health.

A methodology for estimating SARS-CoV-2 importation risk by air travel into Canada between July and November 2021

BACKGROUND

Estimating rates of disease importation by travellers is a key activity to assess both the risk to a country from an infectious disease emerging elsewhere in the world and the effectiveness of border measures. We describe a model used to estimate the number of travellers infected with SARS-CoV-2 into Canadian airports in 2021, and assess the impact of pre-departure testing requirements on importation risk.

METHODS

A mathematical model estimated the number of essential and non-essential air travellers infected with SARS-CoV-2, with the latter requiring a negative pre-departure test result. The number of travellers arriving infected (i.e. imported cases) depended on air travel volumes, SARS-CoV-2 exposure risk in the departure country, prior infection or vaccine acquired immunity, and, for non-essential travellers, screening from pre-departure molecular testing. Importation risk was estimated weekly from July to November 2021 as the number of imported cases and percent positivity (PP; i.e. imported cases normalised by travel volume). The impact of pre-departure testing was assessed by comparing three scenarios: baseline (pre-departure testing of all non-essential travellers; most probable importation risk given the pre-departure testing requirements), counterfactual scenario 1 (no pre-departure testing of fully vaccinated non-essential travellers), and counterfactual scenario 2 (no pre-departure testing of non-essential travellers).

RESULTS

In the baseline scenario, weekly imported cases and PP varied over time, ranging from 145 to 539 cases and 0.15 to 0.28%, respectively. Most cases arrived from the USA, Mexico, the United Kingdom, and France. While modelling suggested that essential travellers had a higher weekly PP (0.37 - 0.65%) than non-essential travellers (0.12 - 0.24%), they contributed fewer weekly cases (62 - 154) than non-essential travellers (84 - 398 per week) given their lower travel volume. Pre-departure testing was estimated to reduce imported cases by one third (counterfactual scenario 1) to one half (counterfactual scenario 2).

CONCLUSIONS

The model results highlighted the weekly variation in importation by traveller group (e.g., reason for travel and country of departure) and enabled a framework for measuring the impact of pre-departure testing requirements. Quantifying the contributors of importation risk through mathematical simulation can support the design of appropriate public health policy on border measures.

How our longitudinal employment patterns might shape our health as we approach middle adulthood-US NLSY79 cohort

Recent labor market transformations brought on by digital and technological advances, together with the rise of the service economy since the 1980s, have subjected more workers to precarious conditions, such as irregular work hours and low or unpredictable wages, threatening their economic well-being and health. This study advances our understanding of the critical role employment plays in our health by examining how employment patterns throughout our working lives, based on work schedules, may shape our health at age 50, paying particular attention to the moderating role of social position. The National Longitudinal Survey of Youth-1979 (NLSY79), which has collected 30+ years of longitudinal information, was used to examine how employment patterns starting at ages 22 (n ≈ 7,336) might be associated with sleep hours and quality, physical and mental functions, and the likelihood of reporting poor health and depressive symptoms at age 50. Sequence analysis found five dominant employment patterns between ages 22 and 49: "mostly not working" (10%), "early standard hours before transitioning into mostly variable hours" (12%), "early standard hours before transitioning into volatile schedules" (early ST-volatile, 17%), "mostly standard hours with some variable hours" (35%), and "stable standard hours" (26%). The multiple regression analyses indicate that having the "early ST-volatile" schedule pattern between ages 22 and 49 was consistently, significantly associated with the poorest health, including the fewest hours of sleep per day, the lowest sleep quality, the lowest physical and mental functions, and the highest likelihood of reporting poor health and depressive symptoms at age 50. In addition, social position plays a significant role in these adverse health consequences. For example, whereas non-Hispanic White women reported the most hours of sleep and non-Hispanic Black men reported the fewest, the opposite was true for sleep quality. In addition, non-Hispanic Black men with less than a high school education had the highest likelihood of reporting poor health at age 50 if they engaged in an employment pattern of "early ST-volatile" between ages 22 and 49. In comparison, non-Hispanic White men with a college degree or above education had the lowest likelihood of reporting poor health if they engaged in an employment pattern of stable standard hours. This analysis underscores the critical role of employment patterns in shaping our daily routines, which matter to sleep and physical and mental health as we approach middle adulthood. Notably, the groups with relatively disadvantaged social positions are also likely to be subject to nonstandard work schedules, including non-Hispanic Blacks and people with low education; hence, they were more likely than others to shoulder the harmful links between nonstandard work schedules and sleep and health, worsening their probability of maintaining and nurturing their health as they approach middle adulthood.

Identification of key gene expression associated with quality of life after recovery from COVID-19

Post-acute sequelae of COVID-19 (PASC) is a persistent complication of severe acute respiratory syndrome coronavirus 2 infection that includes symptoms, such as fatigue, cognitive impairment, and respiratory distress. These symptoms severely affect the quality of life of patients after their recovery from COVID-19. In this study, a group of machine learning algorithms analyzed the whole blood RNA-seq data from patients with different PASC levels. The purpose of this analysis was to identify the gene markers associated with PASC and the special expression patterns for different PASC levels. By comparing the quality of life of patients after the acute phase of COVID-19 and before the disease, samples in the dataset were divided into three groups, namely, "Better," "The Same," and "Worse." Each patient was represented by the expression levels of 58,929 genes. The machine learning-based workflow included six feature-ranking algorithms, incremental feature selection (IFS), and four classification algorithms. The feature ranking algorithms were in charge of assessing feature importance, whereas IFS with classification algorithms were used to extract essential genes and to construct efficient classifiers and classification rules. The expression of top genes in the results was associated with the immune response to viral infection, which is supported by the published literature. For example, patients with low CCDC18 expression and high CPED1 expression had good quality of life, whereas those with low CDC16 expression had poor quality of life.

Socioeconomic and Demographic Risk Factors for SARS-CoV-2 Seropositivity Among Healthcare Workers in a UK Hospital: A Prospective Cohort Study

BACKGROUND

To protect healthcare workers (HCWs) from the consequences of disease due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it is necessary to understand the risk factors that drive exposure and infection within hospitals. Insufficient consideration of key socioeconomic variables is a limitation of existing studies that can lead to bias and residual confounding of proposed risk factors for infection.

METHODS

The Co-STARs study prospectively enrolled 3679 HCWs between April 2020 and September 2020. We used multivariate logistic regression to comprehensively characterize the demographic, occupational, socioeconomic, and environmental risk factors for SARS-CoV-2 seropositivity.

RESULTS

After adjusting for key confounders, relative household overcrowding (odds ratio [OR], 1.4 [95% confidence interval {CI}, 1.1-1.9]; P = .006), Black, Black British, Caribbean, or African ethnicity (OR, 1.7 [95% CI, 1.2-2.3]; P = .003), increasing age (ages 50-60 years: OR, 1.8 [95% CI, 1.3-2.4]; P < .001), lack of access to sick pay (OR, 1.8 [95% CI, 1.3-2.4]; P < .001).

CONCLUSIONS

Socioeconomic and demographic factors outside the hospital were the main drivers of infection and exposure to SARS-CoV-2 during the first wave of the pandemic in an urban pediatric referral hospital. Overcrowding and out-of-hospital SARS-CoV-2 contact are less amenable to intervention. However, lack of access to sick pay among externally contracted staff is more easily rectifiable. Our findings suggest that providing easier access to sick pay would lead to a decrease in SARS-CoV-2 transmission and potentially that of other infectious diseases in hospital settings.

CLINICAL TRIALS REGISTRATION

NCT04380896.

Differences in Perceptions of COVID-19 Risks in a Fishing Community in Alaska, 2020-2021

Bristol Bay in Alaska is home to the world's largest commercial salmon fishery. During an average fishing season, the population of the Bristol Bay region more than doubles as thousands of workers from out of state converge on the fishery. In the months leading up to the 2020 commercial fishery opening, as the COVID-19 pandemic exploded worldwide, great uncertainty existed about the health risks of opening the fishery. Bristol Bay residents had not yet experienced any cases of COVID-19, yet the livelihoods of most were closely tied to the commercial fishery opening. To better understand how COVID-19 risk perceptions affected decisions to participate in the fishery, we administered an online survey to community members and fishery participants. We collected standard socioeconomic data and posed questions to gauge risk perceptions related to COVID-19. We find that COVID-19 risk perceptions vary across race/ethnic groups by residency and income. People with below median income who are members of minority groups-notably, non-resident Hispanic workers and resident Alaska Native respondents-reported the highest risk perceptions related to COVID-19. This study highlights the important linkages among risk perceptions, socioeconomic characteristics, and employment decisions during an infectious disease outbreak.

Unmasking the long-term effects: unravelling neuropsychiatric and neurological consequences of COVID-19

The COVID-19 pandemic has not only burdened healthcare systems but has also led to a new emerging medical enigma that is post-COVID-19 syndrome or "long COVID." Characterized by persistent symptoms that extend beyond the acute phase of the illness, long COVID has rapidly become a public health concern with ambiguous neurological and neuropsychiatric dimensions. This narrative review aims at synthesizing available research to decode the long-term impacts of COVID-19 on neurological and mental health. Drawing from a multitude of studies, this review synthesizes evidence on various neuropsychiatric and neurological symptoms, including cognitive deficits, mood disorders, and more. The narrative delves into potential pathogenic mechanisms, hoping to fill existing research gaps and offering directions for future inquiry. The objective is not just academic; it has immediate real-world implications. Understanding these long-term effects is crucial for developing effective treatments and interventions, thereby better serving the millions of individuals living with these lingering symptoms. As healthcare systems continue to grapple with the fallout from the pandemic, this review provides much-needed context and insights into an area that demands urgent research and action.

Human biology and the study of precarity: How the intersection of uncertainty and inequality is taking us to new extremes

Inequality represents an extreme environment to which humans must respond. One phenomenon that contributes to this growing extreme is precarity or the intersection of uncertainty and some form of inequality. While precarity has an important intellectual history in the fields of sociology and sociocultural anthropology, it has not been well studied in the field of human biology. Rather human biologists have engaged with the study of closely related concepts such as uncertainty and resource insecurity. In this article, we propose that human biology take on the study of precarity as a novel way of investigating inequality. We first provide a brief intellectual history of precarity which is followed by a review of research on uncertainty and resource security in human biology which, while not exhaustive, illustrates some key gaps that precarity may aid us in addressing. We then review some of the pathways through which precarity comes to affect human biology and health and some of the evidence for why the unpredictable nature of precarity may make it a unique physiological stress. A case study based on research in Nuñoa, Peru provides an important example of how precarity can elucidate the influences of health in an extreme setting, albeit with insights that apply more broadly. We conclude that precarity holds important potential for the study of human biology, including helping us more effectively operationalize and study uncertainty, encouraging us to explore the predictability of resources and stressors, and reminding us to think about the intersectional nature of stressors.

Examining associations between social vulnerability indices and COVID-19 incidence and mortality with spatial-temporal Bayesian modeling

This study compares two social vulnerability indices, the U.S. CDC SVI and SoVI (the Social Vulnerability Index developed at the Hazards Vulnerability & Resilience Institute at the University of South Carolina), on their ability to predict the risk of COVID-19 cases and deaths. We utilize COVID-19 cases and deaths data for the state of Indiana from the Regenstrief Institute in Indianapolis, Indiana, from March 1, 2020, to March 31, 2021. We then aggregate the COVID-19 data to the census tract level, obtain the input variables, domains (components), and composite measures of both CDC SVI and SoVI data to create a Bayesian spatial-temporal ecological regression model. We compare the resulting spatial-temporal patterns and relative risk (RR) of SARS-CoV-2 infection (COVID-19 cases) and associated death. Results show there are discernable spatial-temporal patterns for SARS-CoV-2 infections and deaths with the largest contiguous hotspot for SARS-CoV-2 infections found in the southwest of the Indianapolis metropolitan area. We also observed one large contiguous hotspot for deaths that stretches across Indiana from the Cincinnati area in the southeast to just east and north of Terre Haute (southeast to west central). The spatial-temporal Bayesian model shows that a 1-percentile increase in CDC SVI was significantly (p ≤ 0.05) associated with an increased risk of SARS-CoV-2 infection by 6 % (RR = 1.06, 95 %CI = 1.04 -1.08). Whereas a 1-percentile increase in SoVI was significantly predicted to increase the risk of COVID-19 death by 45 % (RR = 1.45, 95 %CI =1.38 - 1.53). Domain-specific variables related to socioeconomic status, age, and race/ethnicity were shown to increase the risk of SARS-CoV-2 infections and deaths. There were notable differences in the relative risk estimates for SARS-CoV-2 infections and deaths when each of the two indices were incorporated in the model. Observed differences between the two social vulnerability indices and infection and death are likely due to alternative methodologies of formation and differences in input variables. The findings add to the growing literature on the relationship between social vulnerability and COVID-19 and further the development of COVID-19-specific vulnerability indices by illustrating the utility of local spatial-temporal analysis.

Nursing Students' Experience of a Poverty Simulation and Its Impact on Empathy and Social Justice Awareness: A Descriptive Qualitative Study

Holistic nursing practice requires an understanding of the constraints of poverty as one of the social determinants of health. Future nurses need to be change agents for social justice. A descriptive, qualitative study was conducted to explore students' experience of the Missouri Association for Community Action Poverty Simulation© (CAPS) and its impact on empathy and social justice awareness among a purposive sample of 56 sophomore baccalaureate nursing students at a public university in the Northeastern United States. Inductive thematic analysis was applied to data collected from a postparticipation reflection paper. Five themes emerged: (a) emotions, (b) personal history of poverty, (c) empathy, (d) rising advocacy, and (e) lessons learned. The results support that the CAPS simulation provides an experiential opportunity which impacts empathy and foundational attitudes to be a change agent for social justice. Recommendations include structured education about social determinants of health prior to the CAPS simulation, continued education throughout nursing curricula, and experiential opportunities to apply social justice skills before graduation.

Risk evaluation of venue types and human behaviors of COVID-19 outbreaks in public indoor environments: A systematic review and meta-analysis

Despite increasing vaccination rates, the incidence of breakthrough infections with COVID-19 has increased due to the continued emergence of new variants of the SARS-CoV-2 coronavirus. Therefore, Non-pharmaceutical interventions remain the most effective measures for coping with the ever-changing pandemic. The lifting of compulsory interventions has made individuals primary responsibility for their own health, which highlights the importance of increasing awareness of the infection risk from the environment in which they live and their individual behaviors. We systematically searched PubMed, Web of Science, ScienceDirect, and Scopus on April 17, 2023, for all studies reporting COVID-19 outbreaks in public indoor venues. The study outcome was the attack rate. A total of 42 studies, which included cross-sectional studies, cohort studies, and case studies, reporting data on 1951 confirmed cases in 64 COVID-19 outbreaks satisfied the meta-analysis and were included in the review. A random-effect model was used in the meta-analysis, and subgroup analyses were conducted to investigate factors affecting attack rates. We found a strong level of evidence (p < 0.01) supporting a higher pooled attack rate in recreation-related venues (0.44, 95% CI: 0.30 to 0.60) than in work-related venues (0.21, 95% CI: 0.16 to 0.27). Compared to those outbreaks without that, outbreaks with high-intensity exercise, vocalization, contact behavior, or close body proximity had a higher attack rate of 0.51, 0.55, 0.33, and 0.39, respectively. Further studies suggest that different attack rates across different types of settings may be the result of heterogeneity in exposed people's behaviors. There were significant heterogeneities that may limit the interpretation of connections between influencing factors and outbreak outcomes. The identification of key behaviors that may contribute to transmission risk, and their correlation with venue type, has important implications for the development of future public health interventions and individual prevention strategies for respiratory infectious diseases such as COVID-19.

Risk factors for COVID-19 in-hospital mortality in Argentina: A competing risk survival analysis

COVID-19 poses dire threats for low and middle-income countries (LMICs). Yet, there remains limited rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs, and often the evidence was based on small samples and/or unicentric. The objective of this study was to examine risk factors of COVID-19 mortality in Argentina, a hard-hit middle-income Latin American country. We analyze data on 5,146 COVID-19 patients from 11 centers across 10 cities in Argentina, making this one of the largest multi-centric retrospective observational descriptive studies in the LMICs. Information on demographics and co-morbidities was extracted from medical records. Outcomes of relevance consisted of whether the patient was discharged or deceased (as established in medical records), along with date of each event. We use survival models that account for competing risks. Median age was 60 years (IQR: 48-72), there were fewer women (40.8%) hospitalized than men (59.2%), and the most prevalent comorbidities were hypertension (40.9%), diabetes (20.0%) and obesity (19.1%). Patients were hospitalized for a median duration of 8 days (IQR: 5-13), and in-hospital mortality was 18.1%, though it varied substantially across health centers (95%CI: 17.1%-19.2%). Baseline characteristics most associated with in-hospital mortality were respiratory rate (adjusted HR = 3.6, 95%CI: 2.5-5.4 for ≥ 26 breathes/min), older age (adjusted HR = 2.5, 95%CI: 2.0-3.3 for the 80+ age group), and chronic kidney disease (adjusted HR = 2.2, 95%CI: 1.8-2.8). Associations were attenuated when survival models did not account for the competing risk of being discharged. We document lower mortality rates than those in prior studies, likely due to a lower prevalence of comorbidities amongst patients in our sample. Compared with standard Cox models, we find that, when using competing risk models, risk factors have a larger role in explaining COVID-19 mortality. Overall, we provide rigorous evidence describing the characteristics and outcomes of hospitalized patients for LMICs. Thus, our findings are useful to conduct a more accurate in-hospital monitoring of patient subgroups who may be at greater risk. They also provide valuable guidance for public health and policy efforts in Argentina and other developing countries.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth's own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth-caregiver dyads (youth: 14-16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69-0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability (β = .19-.47). Youth-reported financial stress positively predicted within-individual variation in externalizing (β = .18), while youth reports of material deprivation predicted externalizing when looking between families (β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

How do children's hospitals address health inequalities: a grey literature scoping review

OBJECTIVES

Health inequalities are systematic differences in health between people, which are avoidable and unfair. Globally, more political strategies are required to address health inequalities, which have increased since the global SARS-CoV-2/COVID-19 pandemic, with a disproportionate impact on children. This scoping review aimed to identify and collate information on how hospitals around the world that deliver care to children have addressed health inequalities.

DESIGN

Scoping review focused solely on grey literature.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Following Joanna Briggs Institute guidelines, a four-step approach to identifying literature was adopted.

DATA SOURCES

Overton, OpenGrey, OpenMD, Trip Database, DuckDuckGo, Google, targeted websites and children's hospital websites were searched on March 2023 for items published since 2010.

DATA EXTRACTION AND SYNTHESIS

Retrieved items were screened against clear inclusion and exclusion criteria before data were extracted by two independent reviewers using a data extraction tool. Studies were tabulated by a hospital. A meta-analysis was not conducted due to the varied nature of studies and approaches.

RESULTS

Our study identified 26 approaches to reduction of health inequalities, from 17 children's hospitals. Approaches were categorised based on their size and scope. Seven approaches were defined as macro, including hospital-wide inequality strategies. Ten approaches were classed as meso, including the establishment of new departments and research centres. Micro approaches (n=9) included one-off projects or interventions offered to specific groups/services. Almost half of the reported approaches did not discuss the evaluation of impact.

CONCLUSIONS

Children's hospitals provide a suitable location to conduct public health interventions. This scoping review provides examples of approaches on three scales delivered at hospitals across high-income countries. Hospitals with the most comprehensive and extensive range of approaches employ dedicated staff within the hospital and community. This review indicates the value of recruitment of both public health-trained staff and culturally similar staff to deliver community-based interventions.

Nursing Home Residents' COVID-19 Infections in the United States: A Systematic Review of Personal and Contextual Factors

Background: This mixed methods systemic review synthesizes the evidence about nursing home risks for COVID-19 infections. Methods: Four electronic databases (PubMed, Web of Science, Scopus, and Sage Journals Online) were searched between January 2020 and October 2022. Inclusion criteria were studies reported on nursing home COVID-19 infection risks by geography, demography, type of nursing home, staffing and resident's health, and COVID-19 vaccination status. The Mixed Methods Appraisal Tool (MMAT) was used to assess the levels of evidence for quality, and a narrative synthesis for reporting the findings by theme. Results: Of 579 initial articles, 48 were included in the review. Findings suggest that highly populated counties and urban locations had a higher likelihood of COVID-19 infections. Larger nursing homes with a low percentage of fully vaccinated residents also had increased risks for COVID-19 infections than smaller nursing homes. Residents with advanced age, of racial minority, and those with chronic illnesses were at higher risk for COVID-19 infections. Discussion and implications: Findings suggest that along with known risk factors for COVID-19 infections, geographic and resident demographics are also important preventive care considerations. Access to COVID-19 vaccinations for vulnerable residents should be a priority.

Socioeconomic status and pediatric cochlear implant usage during COVID-19

OBJECTIVE

COVID-19 (COVID) delayed access to speech and hearing services. The objective of this study was to identify interactions between socioeconomic status (SES) and cochlear implant (CI) usage during COVID.

METHODS

Consecutive pediatric patients (age 0-17) with CI and audiology visits between 2019 and 2022 at a tertiary care children's hospital were reviewed. Age, sex, race, insurance type, and proxy measures for SES using zip code were recorded. Hours spent with CI on and in different listening environments were compared between pre-COVID (1/1/2019-12/31/2019), COVID (4/1/2020-3/31/2021), and most recent (6/1/2021-5/31/2022) time periods.

RESULTS

Most patients were male (32/59, 54 % ears of 48 patients) and White, non-Hispanic (45/59, 76 %). Median age at implant was 2.0 years (range:0.6-12.2). There were no significant differences in hours spent with CI on during COVID compared with pre-COVID. However, children spent more time listening to louder noises (70-79 dB and ≥80 dB) recently compared with during COVID (p = 0.01 and 0.006, respectively). During COVID, children living in areas with greater educational attainment showed smaller reductions in total hours with CI on (β = 0.1, p = 0.02) and hours listening to speech in noise (β = 0.03, p = 0.005) compared with pre-COVID. In the most recent time period, children of minority race (β = -3.94 p = 0.008) and those who were older at implant (β = -0.630, p = 0.02) were more likely to experience reductions in total hours with CI on compared with during COVID.

CONCLUSION

Interventions which mitigate barriers of implant use and promote rich listening home-environments for at risk populations should be implemented during challenging future social and environmental conditions.

Association Between Temporary Employment and Gradient Health Outcomes Among Chinese Workers

Temporary workers' health problems in China have raised concerns recently. This study aimed to assess the relationship between temporary employment and three health outcomes with gradient severity and explore mediating mechanisms. Data was obtained from a national cross-sectional survey (China General Social Survey 2018). Compared with regular workers, temporary workers reported more frequent mood disorders (β = 0.197) and disturbance of daily activities (β = 0.132), however, there was no significant difference in serious health risks (inpatient treatment) between temporary and regular workers. Income poverty, subjective social status, and family relative socioeconomic status were significant mediators. The results suggest that temporary workers have higher general health risks, and economic deprivation is the main mechanism. Therefore, Chinese policymakers should provide more inclusive preventive health services beyond the existing health care system focused on critical illness to reduce the general health risks of grassroots workers.

Mechanism design for a fair and equitable approach to global vaccine distribution: The case of COVID-19

Vaccines are one of the most effective tools humanity has in the fight against pandemics. One of the major challenges of vaccine distribution is achieving fair and equitable allocation across the countries of the world, regardless of their economic wealth. The self-interested behaviour of high-income countries and the underutilisation of vaccines allocated to underprepared countries are some of the failures reported during COVID-19 vaccine roll-out. These shortcomings have motivated the need for a central market mechanism that takes into account the countries' vulnerability to COVID-19 and their readiness to distribute and administer their allocated vaccines. In this paper, we leverage game theory to study the problem of equitable global vaccine distribution and propose a fair market mechanism that aligns self-interested behaviour with optimal global objectives. First, we model the interaction between a central vaccine provider (e.g. COVAX) and a country reporting its demand as a two-player game, and discuss the Nash and mixed Nash equilibria of that game. Then, we propose a repeated auction mechanism with an artificial payment system for allocating vaccines among participating countries, where each auction round is based on a Vickrey-Clarke-Groves (VCG) mechanism. The proposed allocation mechanism aims at minimising deaths and incentivises the self-interested countries to report their demand truthfully. Compared with real-world COVAX allocation decisions, our results show that the proposed auction mechanism achieves more efficient outcomes that maximise the number of averted deaths. Pragmatic considerations are investigated and policy recommendations are discussed.

Forensic rhetoric: COVID-19, the forum and the boundaries of healthcare evidence

The COVID-19 pandemic has brought into sharp focus the shifting role of healthcare evidence in public health presentations. This article investigates the rhetoric of those presentations as a phenomenon indicating both the commitment to evidence-based public health messaging and its political loading in three interlinked case studies: computer-generated imagery ; 'podium' presentation and the NSO Fleming leak of COVID-19 contact tracing data. The pandemic has seen healthcare evidence attain ever-greater visibility in public forums, and those forums have themselves undergone rapid transformation. 'Podium' presentations such as press conferences have featured colourful imagery, and the manifold visualisations of SARS-CoV-2 which have accompanied television broadcasts and web pages display an insistent internal rhetoric. I analyse both forms of rhetoric for what they say about the 'forensic' moment created by COVID-19, and evaluate each in relation to Weizman's conception of the forum, which enables both 'frontstage' corporate and governmental image-building and public scrutiny. This paper evaluates the politics of the presentational strategies which have arisen around COVID-19 and the ethical potential of the forum.

The impacts of COVID-19 hospitalizations on non-COVID-19 deaths and hospitalizations: A panel data analysis using Brazilian municipalities

The COVID-19 pandemic in Brazil has brought many challenges, particularly regarding the management of hospital capacity, and a new demand for healthcare that added to the preexisting demands, such as neoplasms, cardiovascular diseases and births. In this paper, we estimate the impact of the pandemic on the number of deaths and hospitalizations for other diseases. We construct a monthly panel data of deaths and hospitalizations for various causes by the municipality of residence and relate them to COVID-19 hospitalizations using regression models that control for municipalities fixed-effects and interactions between State and month fixed-effects. The standard errors are clustered at the municipality level. Our estimates imply that 100 more hospitalizations by COVID-19 is associated with a drop of 49 non-COVID-19 hospitalizations and an additional four deaths for other reasons (all measured per 100,000 pop.). The impact of intensive care units COVID-19 hospitalizations on mortality is larger. The groups most affected are the African Brazilians, less-educated and the elderly. Additional deaths occurred both at households and at hospitals. The main causes of additional deaths were diseases related to the circulatory and endocrine system. The decline in hospitalizations for other causes seems to be related to the overcrowding of hospitals in periods of surge in the COVID-19, alongside with the fall in the demand for care by the citizens who were afraid of COVID-19 infection. These mechanisms affected more strongly the vulnerable groups of the population. Our results highlight the importance of promoting the awareness of heightened risk of non-communicable chronic diseases during a health emergency context. This should be done preferably through already established channels with community outreach, such as the Family Health Program in Brazil.

The Fragility of Scientific Rigour and Integrity in "Sped up Science": Research Misconduct, Bias, and Hype and in the COVID-19 Pandemic

During the early years of the COVID-19 pandemic, preclinical and clinical research were sped up and scaled up in both the public and private sectors and in partnerships between them. This resulted in some extraordinary advances, but it also raised a range of issues regarding the ethics, rigour, and integrity of scientific research, academic publication, and public communication. Many of the failures of scientific rigour and integrity that occurred during the pandemic were exacerbated by the rush to generate, disseminate, and implement research findings, which not only created opportunities for unscrupulous actors but also compromised the methodological, peer review, and advisory processes that would usually identify sub-standard research and prevent compromised clinical or policy-level decisions. While it would be tempting to attribute these failures of science and its translation solely to the "unprecedented" circumstances of the COVID-19 pandemic, the reality is that they preceded the pandemic and will continue to arise once it is over. Existing strategies for promoting scientific rigour and integrity need to be made more rigorous, better integrated into research training and institutional cultures, and made more sophisticated. They might also need to be modified or supplemented with other strategies that are fit for purpose not only in public health emergencies but in any research that is sped-up and scaled up to address urgent unmet medical needs.

Education is protective against depressive symptoms in the context of COVID-19

OBJECTIVE

This study assessed current education stage (ie, undergraduate, graduate) as protective against depressive symptoms among a low socioeconomic status (SES) student population in a public university, in the context of COVID-19-related stressors.

PARTICIPANTS

Participants were students at The City University of New York (CUNY) during the Spring 2020.

METHODS

Demographic data, symptom severity, and current educational stage were collected via an online university-wide survey between April 8, 2020 and May 2, 2020.

RESULTS

The prevalence of probable depression was lower amongst persons who reported being currently in a more advanced educational stage compared to people currently in a lower educational stage. COVID-19-related stressor exposure was the largest predictor of depressive symptoms, followed by demographics and current education stage.

CONCLUSIONS

Current education stage is related to depressive symptoms during COVID-19. Pandemic-related educational disruptions and shifts to remote learning may limit educational achievement for low-SES student populations creating further threats to these students' health.

Araníbar J, Munayco Escate CV. High altitudes, population density, and poverty: Unraveling the complexities of COVID-19 in Peru during the years 2020-2022

Background

Several factors related to hospitalizations, morbidity, and mortality from COVID-19 have been identified. However, limited exploration has been done on geographic and socioeconomic factors that could significantly impact these outcomes.

Objectives

This study aimed to determine whether altitude, population density, and percentage of population in total poverty are associated with COVID-19 incidence per 1000 inhabitants and COVID-19 case-fatality rate in Peru, from 2020 to 2022.

Methods

This study utilized a multiple group ecological design and relied on secondary databases containing daily records of COVID-19 positive cases and deaths due to COVID-19. An epidemiological analysis was performed, subsequently processed using a random effects model.

Results

As of August 2022, Peru had recorded a total of 3,838,028 COVID-19 positive cases and 215,023 deaths due to COVID-19. Our analysis revealed a statistically significant negative association between altitude and COVID-19 incidence (aBETA: -0.004; Standard Error: 0.001; p < 0.05). Moreover, we observed a positive association between population density and incidence (aBETA: 0.006; Standard Error: 0.001; p < 0.05). However, we found no significant association between the percentage of population in total poverty and COVID-19 incidence.

Conclusion

Our study found that an increase in altitude was associated with a decrease in COVID-19 incidence, while an increase in population density was associated with an increase in COVID-19 incidence. High altitude, population density and percentage of population in total poverty does not change case-fatality rate due to COVID-19.

Anti-pandemic resilience assessment for countries along the Belt and Road route

Background

The COVID-19 pandemic is sweeping the world, and countries along the Belt and Road (B&R) route have also been hit hard. However, the impact varied greatly from country to country, some severely and others mildly. What factors have led to such a wide variation?

Method

In this paper, we considered institutional, infrastructural, economic, social, and technological resilience as components of overall anti-pandemic resilience, and constructed a set of indicators to evaluate this resilience for B&R countries in 2020. We evaluated the anti-pandemic resilience using the combined empowerment-VIKOR method, and classified the countries into different resilience levels by means of hierarchical clustering. The validity of the evaluation indicator system was verified by analyzing the consistency between the actual performance and the assessed resilience.

Results

The ranking results showed that Israel and Bahrain were representative of countries that had the highest resilience, Hungary and Estonia represented countries with moderate resilience, and Laos and Cambodia represented countries with the lowest resilience. We also found that countries with high resilience had much better institutional and economic resilience than countries with moderate resilience, whereas countries with low resilience lagged behind in both infrastructural and social resilience. Based on these findings, policy recommendations were offered to help B&R countries respond to future pandemics.

Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City

OBJECTIVES

To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.

METHODS

We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index.

RESULTS

Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index.

CONCLUSIONS

The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.

Impact of COVID-19 on Pregnancy Outcomes across Trimesters in the United States

BACKGROUND

Current knowledge regarding the association between trimester-specific changes during pregnancy and COVID-19 infection is limited. We utilized the National Inpatient Sample (NIS) database to investigate trimester-specific outcomes among hospitalized pregnant women diagnosed with COVID-19.

RESULTS

Out of 3,447,771 pregnant women identified, those with COVID-19 exhibited higher in-hospital mortality rates in their third trimester compared with those without the virus. Notably, rates of mechanical ventilation, acute kidney injury, renal replacement therapy, and perinatal complications (preeclampsia, HELLP syndrome, and preterm birth) were significantly elevated across all trimesters for COVID-19 patients. COVID-19 was found to be more prevalent among low-income, Hispanic pregnant women.

CONCLUSIONS

Our findings suggest that COVID-19 during pregnancy is associated with increased risk of maternal mortality and complications, particularly in the third trimester. Furthermore, we observed significant racial and socioeconomic disparities in both COVID-19 prevalence and pregnancy outcomes. These findings emphasize the need for equitable healthcare strategies to improve care for diverse and socioeconomically marginalized groups, ultimately aiming to reduce adverse COVID-19-associated maternal and fetal outcomes.

Applying an interpretable machine learning framework to study mobility inequity in the recovery phase of COVID-19 pandemic

The COVID-19 pandemic is a public health crisis that also fuels the pervasive social inequity in the United States. Existing studies have extensively analyzed the inequity issues on mobility across different demographic groups during the lockdown phase. However, it is unclear whether the mobility inequity is perennial and will continue into the mobility recovery phase. This study utilizes ride-hailing data from Jan 1st, 2019, to Mar 31st, 2022, in Chicago to analyze the impact of various factors, such as demographic, land use, and transit connectivity, on mobility inequity in the different recovery phases. Instead of commonly used statistical methods, this study leverages advanced time-series clustering and an interpretable machine learning algorithm. The result demonstrates that inequity still exists in the mobility recovery phase of the COVID-19 pandemic, and the degree of mobility inequity in different recovery phases is varied. Furthermore, mobility inequity is more likely to exist in the census tract with more families without children, lower health insurance coverage, inflexible workstyle, more African Americans, higher poverty rate, fewer commercial land use, and higher Gini index. This study aims to further the understanding of the social inequity issue during the mobility recovery phase of the COVID-19 pandemic and help governments propose proper policies to tackle the unequal impact of the pandemic.

Association of COVID-19 with respiratory syncytial virus (RSV) infections in children aged 0-5 years in the USA in 2022: a multicentre retrospective cohort study

OBJECTIVE

To investigate whether COVID-19 infection was associated with increased risk for incident respiratory syncytial virus (RSV) infections and associated diseases among young children that might have contributed to the 2022 surge of severe paediatric RSV cases in the USA.

DESIGN

This is a retrospective population-based cohort study. Five outcomes were examined, including overall RSV infection, positive lab test-confirmed RSV infection, clinically diagnosed RSV diseases, RSV-associated bronchiolitis and unspecified bronchiolitis. Risk ratio (RR) and 95% CI of the outcomes that occurred during the 2022 and 2021 RSV seasons were calculated by comparing propensity-score matched cohorts.

SETTING

Nationwide multicentre database of electronic health records (EHRs) of 61.4 million patients in the USA including 1.7 million children 0-5 years of age, which was accessed through TriNetX Analytics that provides web-based and secure access to patient EHR data from hospitals, primary care and specialty treatment providers.

PARTICIPANTS

The study population consisted of 228 940 children of 0-5 years with no prior RSV infection who had medical encounters in October 2022. Findings were replicated in a separate study population of 370 919 children of 0-5 years with no prior RSV infection who had medical encounters in July 2021-August 2021 during a non-overlapping time period.

RESULTS

For the 2022 study population (average age 2.4 years, 46.8% girls, 61% white, 16% black), the risk for incident RSV infection during October 2022-December 2022 was 6.40% for children with prior COVID-19 infection, higher than 4.30% for the matched children without COVID-19 (RR 1.40, 95% CI 1.27 to 1.55); and among children aged 0-1 year, the overall risk was 7.90% for those with prior COVID-19 infection, higher than 5.64% for matched children without (RR 1.40, 95% CI 1.21 to 1.62). For the 2021 study population (average age 2.2 years, 46% girls, 57% white, 20% black), the risk for incident RSV infection during July 2021-December 2021 was 4.85% for children with prior COVID-19 infection, higher than 3.68% for the matched children without COVID-19 (RR 1.32, 95% CI 1.12 to 1.56); and 7.30% for children aged 0-1 year with prior COVID-19 infection, higher than 4.98% for matched children without (RR 1.47, 95% CI 1.18 to 1.82).

CONCLUSION

COVID-19 was associated with a significantly increased risk for RSV infections among children aged 0-5 years in 2022. Similar findings were replicated for a study population of children aged 0-5 years in 2021. Our findings suggest that COVID-19 contributed to the 2022 surge of RSV cases in young children through the large buildup of COVID-19-infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.

Trends in COVID-19 Vaccine Hesitancy and Uptake Among Persons Living With HIV in Washington, DC

OBJECTIVE

The COVID-19 pandemic has disproportionately affected older people, people with underlying health conditions, racial and ethnic minorities, socioeconomically disadvantaged, and people living with HIV (PWH). We sought to describe vaccine hesitancy and associated factors, reasons for vaccine hesitancy, and vaccine uptake over time in PWH in Washington, DC.

METHODS

We conducted a cross-sectional survey between October 2020 and December 2021 among PWH enrolled in a prospective longitudinal cohort in DC. Survey data were linked to electronic health record data and descriptively analyzed. Multivariable logistic regression was performed to identify factors associated with vaccine hesitancy. The most common reasons for vaccine hesitancy and uptake were assessed.

RESULTS

Among 1029 participants (66% men, 74% Black, median age 54 years), 13% were vaccine hesitant and 9% refused. Women were 2.6-3.5 times, non-Hispanic Blacks were 2.2 times, Hispanics and those of other race/ethnicities were 3.5-8.8 times, and younger PWH were significantly more likely to express hesitancy or refusal than men, non-Hispanic Whites, and older PWH, respectively. The most reported reasons for vaccine hesitancy were side effect concerns (76%), plans to use other precautions/masks (73%), and speed of vaccine development (70%). Vaccine hesitancy and refusal declined over time (33% in October 2020 vs. 4% in December 2021, P < 0.0001).

CONCLUSIONS

This study is one of the largest analyses of vaccine hesitancy among PWH in a US urban area highly affected by HIV and COVID-19. Multilevel culturally appropriate approaches are needed to effectively address COVID-19 vaccine concerns raised among PWH.

COVID-19 and children's behavioral health: An overview

The paper reviews the impact of the COVID-19 pandemic on children's and adolescents' well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.

'I probably wouldn't want to talk about anything too personal': A qualitative exploration of how issues of privacy, confidentiality and surveillance in the home impact on access and engagement with online services and spaces for care-experienced young people

This paper draws on a qualitative interview-based study that explored online mental health and wellbeing interventions and services for care-experienced young people. The study involved young people (n = 4), foster carers (n = 8), kinship carers (n = 2) and social care professionals (n = 9) in Wales, UK. The paper reflects on the complexities of online communication in the space of 'the home'. It documents the ways in which care-experienced young people's living arrangements can restrict access to services and complicate confidentiality within portals to the virtual world, creating an environment where young people and their carers 'wouldn't want to talk about anything too personal'. Drawing on data generated in a study focused on services and interventions to support the mental health and wellbeing of care-experienced children and young people, the paper considers privacy, confidentiality and surveillance in the home and reflects on how associated relational practices impact on care-experienced young people. While the data discussed in this paper was generated during the Covid-19 pandemic, its findings have implications for how care-experienced young people and their carers can be supported to engage with the digital world in the future.

Association of Psychosocial Risk Factors and Outcomes in Heart Failure: Does COVID-19 Affect Outcomes?

Psychosocial risk factors (PSRFs) have emerged as crucial nontraditional risk factors affecting outcomes in patients with heart failure (HF). There is a paucity of data studying these risk factors in HF nationally. Additionally, whether the COVID-19 pandemic impacted outcomes remains unexplored, given the increased psychosocial risk during these times. Our objective is to assess the impact of PSRFs on the outcomes of HF and their comparison across non-COVID-19 and COVID-19 eras. Patients with a diagnosis of HF were selected using the 2019-2020 Nationwide Readmissions Database. Two cohorts were created based on the presence or absence of PSRFs and compared across non-COVID-19 and COVID-19 eras. We examined the association using hierarchical multivariable logistic regression models. A total of 305,955 patients were included, of which 175,348 (57%) had PSRFs. Patients with PSRFs were younger, less likely to be female, and had a higher prevalence of cardiovascular risk factors. All-cause readmissions were higher in patients with PSRFs in both the eras. All-cause mortality [odds ratio, OR 1.15 (1.04-1.27), P = 0.005] and composite of MACE [OR 1.11 (1.06-1.16), P < 0.001] were higher in patients in the non-COVID-19 era. Compared to 2019, patients with PSRFs and HF in 2020 had significantly higher all-cause mortality [OR 1.13 (1.03-1.24), P = 0.009]; however, the composite of MACE was comparable [OR 1.04 (1.00-1.09), P = 0.03]. In conclusion, the presence of PSRFs in patients with HF is associated with a significant increase in all-cause readmissions in COVID-19 and non-COVID-19 eras. The worse outcomes evident in the COVID-19 era highlights the importance of multidisciplinary care in this vulnerable population.

Did the design and planning of testing and contact tracing interventions for COVID-19 consider social inequalities in health? A multiple case study from Brazil, Canada, France & Mali

The COVID-19 pandemic has led to an unprecedented global crisis. It has exposed and exacerbated weaknesses in public health systems worldwide, particularly with regards to reaching the most vulnerable populations, disproportionately impacted by the pandemic. The objective of our study was to examine whether and how social inequalities in health (SIH) were considered in the design and planning of public health responses to COVID-19 in jurisdictions of Brazil, Canada, France, and Mali. This article reports on a qualitative multiple case study of testing and contact tracing interventions in regions with high COVID-19 incidence in each country, namely: Manaus (Brazil), Montréal (Canada), Île-de-France (France), and Bamako (Mali). We conducted interviews with 108 key informants involved in these interventions in the four jurisdictions, focusing on the first and second waves of the pandemic. We analyzed our data thematically using a theoretical bricolage framework. Our analysis suggests that the lack of a common understanding of SIH among all actors involved and the sense of urgency brought by the pandemic eclipsed the prioritization of SIH in the initial responses. The pandemic increased intersectoral collaboration, but decision-making power was often unequal between Ministries of Health and other actors in each jurisdiction. Various adaptations to COVID-19 interventions were implemented to reach certain population groups, therefore improving the accessibility, availability, and acceptability of testing and contact tracing. Our study contributes to identifying lessons learned from the current pandemic, namely that the ways in which SIH are understood shape how interventions are planned; that having clear guidelines on how to integrate SIH into public health interventions could lead to more inclusive pandemic responses; that for intersectoral collaboration to be fruitful, there needs to be sufficient resources and equitable decision-making power between partners; and that interventions must be flexible to respond to emerging needs while considering long-standing structural inequalities.

Differential practice and associated factors of COVID-19 personal preventive measures among the slum and estate communities of Uganda: A community-based cross-sectional survey

Background

Compliance with personal preventive measures (PPMs) remains essential in the prevention and control of the coronavirus disease 2019 (COVID-19) pandemic and future infectious disease outbreaks. This study aimed at examining and comparing the practice of COVID-19 PPMs and associated factors in selected slum and estate communities of Uganda.

Methods

This was a cross-sectional survey conducted among 1025 slum and estate residents in Uganda. The outcome variable was compliance with COVID-19 PPMs, including face mask use, hand washing/hygiene, and social distancing. Logistic regression models were fitted to assess the associated factors, using SPSS (version 26).

Results

Of the 1025 participants, 511 and 514 were slum and estate residents, respectively. Compliance with PPMs was as follows; face mask use (slum 45.0% vs. estate 49.6%; P = 0.27), hand washing/hygiene (slum 38.4% vs. estate 44.9%; P = 0.04), and social distancing (slum 19.4% vs. estate 36.0%; P < 0.001). Compared to estate residents, slum residents had more knowledge related to COVID-19, perceived COVID-19 would have a longer timeline and larger impact on their life, had more depression and anxiety symptoms, and faced more difficulties to access information. Illness perceptions, infection risk, and severity perceptions were associated with higher odds of PPMs compliance in both groups, except for perceiving a high chance of contracting COVID-19, which was associated with lower odds of social distancing in the slum community. Depression and anxiety symptoms were associated with higher odds of PPMs compliance in both groups. Frequent exposure to COVID-19 information through health care workers and family members and friends was associated with higher odds of all the PPMs in both communities. Moreover, getting COVID-19 information from local channels was significantly associated with higher odds of mask use and hand hygiene, but only in the estate community.

Conclusions

Our findings provided implications to improve PPMs compliance in future infectious disease outbreaks. To improve PPMs compliance rates, redesigning community education to focus on fostering positive perceptions and addressing the water and sanitation needs of slum communities are essential. Moreover, designing programs that provide free or subsidised face masks and soap to the most vulnerable and engaging religious leaders are also vital strategies.

Subjective socioeconomic status and income inequality are associated with self-reported morality across 67 countries

Individuals can experience a lack of economic resources compared to others, which we refer to as subjective experiences of economic scarcity. While such experiences have been shown to shift cognitive focus, attention, and decision-making, their association with human morality remains debated. We conduct a comprehensive investigation of the relationship between subjective experiences of economic scarcity, as indexed by low subjective socioeconomic status at the individual level, and income inequality at the national level, and various self-reported measures linked to morality. In a pre-registered study, we analyze data from a large, cross-national survey (N = 50,396 across 67 countries) allowing us to address limitations related to cross-cultural generalizability and measurement validity in prior research. Our findings demonstrate that low subjective socioeconomic status at the individual level, and income inequality at the national level, are associated with higher levels of moral identity, higher morality-as-cooperation, a larger moral circle, and increased prosocial intentions. These results appear robust to several advanced control analyses. Finally, exploratory analyses indicate that observed income inequality at the national level is not a statistically significant moderator of the associations between subjective socioeconomic status and the included measures of morality. These findings have theoretical and practical implications for understanding human morality under experiences of resource scarcity.

Understanding the challenges and gaps in community engagement interventions for COVID-19 prevention strategies in Rohingya refugees: a qualitative study with frontline workers and community representatives

Background

Rohingya refugees in Bangladesh are vulnerable to infectious diseases such as COVID-19 due to the crowded living conditions with fragile shelters, and limited water, sanitation and hygiene facilities and practices. While risk communication and community engagement (RCCE) is the cornerstone of outbreak control, there is limited evidence available on the effectiveness of the RCCE strategies in this setting.

Objectives

The goal of this study is to evaluate the effectiveness of RCCE strategies and to explore the challenges and community recommendations in relation to COVID-19 preventive measures in the context of Rohingya refugee camps in Bangladesh.

Materials and methods

It was a qualitative study. Methods used were (a) observation of RCCE intervention by 3 clinical supervisors accompanying 25 Community Health Workers (CHWs) and (b) 5 focus group discussions engaging 60 community representatives. Data were analyzed using a thematic analysis approach, separately for observation and focus group discussions.

Results

The study identified a number of good practices of RCCE, including selecting CHWs from the local community, engaging female CHWs, using local dialect, and collaborating with community/religious leaders. Certain good practices need scaling up, such as utilization of multiple communication methods and interpersonal communication skills. Some areas need improvement, such as CHWs being overburdened with multiple tasks, less effort to active listening, repeated delivery of same messages, inadequate linkage to culture, context, and resources, and less effort to empower the community. Engaging the community, five critical themes were identified in relation to poor COVID-19 preventive practices: culture, religion, and language; local context and resources; community trust and interaction with aid workers; communication methods; and gender and social inclusion. Religious misinterpretation, cultural barriers, physical barriers, lack of resources, breach of trust between the community and aid workers, inconsistent/complex messages, lack of gender and social inclusion, and stigmatization are among some key factors. Some key actions were recommended to improve COVID-19 RCCE strategy.

Conclusion

We urge the RCCE partners to make use of the findings and recommendations to develop a robust RCCE strategy relevant to local culture and context, responsive to people's concerns and needs, and inclusive of gender, age and social vulnerabilities.

Pre-pandemic psychological and behavioral predictors of responses to the COVID-19 pandemic in nine countries

Prior to the COVID-19 pandemic, adolescents (N = 1,330; Mages = 15 and 16; 50% female), mothers, and fathers from nine countries (China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, United States) reported on adolescents' internalizing and externalizing problems, adolescents completed a lab-based task to assess tendency for risk-taking, and adolescents reported on their well-being. During the pandemic, participants (Mage = 20) reported on changes in their internalizing, externalizing, and substance use compared to before the pandemic. Across countries, adolescents' internalizing problems pre-pandemic predicted increased internalizing during the pandemic, and poorer well-being pre-pandemic predicted increased externalizing and substance use during the pandemic. Other relations varied across countries, and some were moderated by confidence in the government's handling of the pandemic, gender, and parents' education.

Social disparities in alcohol's harm to others: evidence from 32 European countries

BACKGROUND

Alcohol use can cause harm not only to the person who consumes it but also to others. Prior research has found that these alcohol-attributable harms to others differ across socioeconomic groups, though several findings have been contradictory. The aim of this contribution was to study the role of individual-level and population-level income inequalities in alcohol's harm to others among women and men.

METHODS

Logistic regression analysis of cross-sectional survey data from 2021, covering 39,629 respondents from 32 European countries. Harms from others' drinking were defined as experiences of physical harm, involvement in a serious argument, or involvement in a traffic accident, due to another person's drinking, within the past year. We examined the association of individual-level income and country-specific income inequality (Gini index) with harms from a known person's or a stranger's drinking, adjusting for the respondent's age, daily drinking levels, and at least monthly risky single-occasion drinking.

RESULTS

At the individual level, people with lower incomes had 21% to 47% increased odds of reporting harms from a known person's drinking (women and men) or stranger's drinking (men only) than their same-gender counterparts in the highest income quintile. At the national level, countries with higher income inequality showed increased risks of harms from a known person's drinking among women (OR = 1.09, 95% confidence interval [CI]: 1.05 - 1.14), while among men the risk of harm from strangers' drinking decreased with higher income inequality (OR = 0.86, 95% CI: 0.81 - 0.92). These associations with income inequality were observed among respondents from all but the lowest income groups.

CONCLUSION

Alcohol can cause harm to others, with women and people with low incomes being disproportionally exposed to these harms. Alcohol control policies targeting high consumption levels, especially among men, as well as upstream policies to reduce inequalities, are needed to lower the health burden of alcohol beyond those who consume it.

Increased risk of SARS-CoV-2 infection and COVID-19 death among older patients at long-term care hospitals in Korea

Introduction

Long-term care hospitals are known to be vulnerable to SARS-CoV-2 infection and death given their numerous older chronic disease patients. However, the actual effect of long-term care hospital admission is not well known in Korea; hence, this study sought to analyze the effect of long-term care hospitalization on SARS-CoV-2 infection and COVID-19 death by correcting for patients' characteristics.

Methods

This cross-sectional study used the data from K-COV-N cohort, which is linked to the National Health Insurance Service and the Korea Disease Control and Prevention Agency; it analyzed 70,373 individuals aged ≥60 years, who had been tested for COVID-19 between January 1 and May 30, 2020 (KDCA-NHIS-2020-1-601). Patients admitted to a long-term care hospital were defined as those with a confirmed history of hospitalization within 30 days of the COVID-19 testing date. The final data analysis was performed in December 2022. Logistic regression analysis of the national data was employed to determine the association between long-term care hospital admission, the risk of SARS-CoV-2 infection, and death from COVID-19. The odds ratios for SARS-CoV-2 infection and death from COVID-19 were calculated by adjusting for sex, age, residential area, health insurance premium, disability, and the Charlson Comorbidity Index.

Results

Older patients at long-term care hospitals had a high risk of SARS-CoV-2 infection (OR:2.91, 95% CI:2.33-3.64) and death from COVID-19 (OR:3.58, 95% CI:2.13-6.02). A difference in SARS-CoV-2 infection risk was observed based on residential area, health insurance premium (economic level), and disability; no difference was observed for COVID-19 mortality risk.

Discussion

Admission to a long-term care hospital itself could be a risk factor for SARS-CoV-2 infection and the consequent high mortality risk after adjusting for sex, age, disability, and comorbidities. Patients are at high risk of infection through contact with workers, leading to death; therefore, quarantine policies for workers must be strengthened.

Exploring stakeholders perspectives on TB contact investigation in Cali, Colombia: a qualitative study

Introduction

Contact investigation is a proven intervention for tuberculosis (TB) case finding and prevention. Although widely endorsed by national public health authorities and the World Health Organization, many countries struggle to implement it effectively. The objective of the study is to describe and characterize the barriers and facilitators of TB contact investigation in Cali, Colombia from the perspective and experience of the key stakeholders involved.

Methods

We collected data from group discussions during two workshop sessions with clinic and public health staff involved in TB contact investigation (June 2019 and March 2020 respectively) and semi-structured interviews with TB cases and their household contacts (July 2019 to April 2020). We undertook an inductive thematic analysis with the RADaR technique to characterize the barriers and facilitators of the TB contact investigation process.

Results

The two workshops included 21 clinics and 12 public health staff. We also conducted 26 semi-structured interviews with TB cases and their household contacts. Using thematic analysis, we identified four common themes: Healthcare Operations, Essential Knowledge, Time Limitations and Competing Responsibilities, and Interpersonal Interactions. The main barriers to conducting household visits were low data quality, stigma and mistrust, safety concerns for health workers, and limited resources. The main barriers to TB uptake by contacts were competing responsibilities, low TB risk perceptions among contacts, and difficulty accessing diagnostic tests for contacts. In contrast, good communication and social skills among health workers and accurate TB knowledge facilitated successful household visits and TB test uptake, according to key stakeholders.

Conclusion

This study provides a deeper understanding of TB contact investigation barriers and facilitators in a high-prevalence urban setting in a middle-income country from the perspective and experience of key stakeholders. The study shed light on the barriers that hinder household contacts engagement and TB test uptake such as issues of systemic capacity and TB knowledge. Also, highlighted facilitators such as the importance of interpersonal communication skills among health workers in the public and private sector. The insights from this study can serve as a valuable resource for public health organizations seeking to enhance their contact investigation efforts and improve TB control in similar settings.

Predicting COVID-19 exposure risk perception using machine learning

BACKGROUND

Self-perceived exposure risk determines the likelihood of COVID-19 preventive measure compliance to a large extent and is among the most important predictors of mental health problems. Therefore, there is a need to systematically identify important predictors of such risks. This study aims to provide insight into forecasting and understanding risk perceptions and help to adjust interventions that target various social groups in different pandemic phases.

METHODS

This study was based on survey data collected from 5001 Norwegians in 2020 and 2021. Interpretable machine learning algorithms were used to predict perceived exposure risks. To detect the most important predictors, the models with best performance were chosen based on predictive errors and explained variances. Shapley additive values were used to examine individual heterogeneities, interpret feature impact and check interactions between the key predictors.

RESULTS

Gradient boosting machine exhibited the best model performance in this study (2020: RMSE=.93, MAE=.74, RSQ=.22; 2021: RMSE=.99, MAE=.77, RSQ=.12). The most influential predictors of perceived exposure risk were compliance with interventions, work-life conflict, age and gender. In 2020, work and occupation played a dominant role in predicting perceived risks whereas, in 2021, living and behavioural factors were among the most important predictors. Findings show large individual heterogeneities in feature importance based on people's sociodemographic backgrounds, work and living situations.

CONCLUSION

The findings provide insight into forecasting risk groups and contribute to the early detection of vulnerable people during the pandemic. This is useful for policymakers and stakeholders in developing timely interventions targeting different social groups. Future policies and interventions should be adapted to the needs of people with various life situations.

Communication inequalities in the COVID-19 pandemic: socioeconomic differences and preventive behaviors in the United States and South Korea

BACKGROUND

Communication inequalities are important mechanisms linking socioeconomic backgrounds to health outcomes. Guided by the structural influence model of communication, this study examined the intermediate role of health communication in the relationship between education, income, and preventive behavioral intentions during the COVID-19 pandemic in the United States and South Korea.

METHODS

The data were collected through two online surveys conducted by two professional research firms in the US (April 1-3, 2020) and South Korea (April 9-16, 2020). To test the mediating role of health communication, as well as the hypothesized relationships in the proposed model, we performed a path analysis using Mplus 6.1.

RESULTS

In analyzing survey data from 1050 American and 1175 Korean adults, we found that one's socioeconomic positions were associated with their intentions to engage in COVID-19 preventive behaviors through affecting their health communication experiences and then efficacious beliefs. Differences in education and income were associated with willingness to engage in preventive behaviors by constraining health communication among people with low levels of education and income. The findings showed notable differences and some similarities between the US and South Korea. For example, while income was positively associated with health communication in both US and South Korea, education was only significantly related to health communication in US but not in South Korea.

CONCLUSIONS

This study suggests health communication strategies such as choice of communication channels and messages to promote intention for COVID-19 prevention behaviors in particular consideration of individual differences in socioeconomic positions in countries with different cultural features. Pubic policies and health campaigns can utilize the suggestions to promote efficacy and preventive behavioral intention during early pandemics.

Embedding Aboriginal cultural governance, capacity, perspectives and leadership into a local Public Health Unit Incident Command System during COVID-19 in New South Wales, Australia

This case study describes the development and implementation of a governance structure that prioritised First Nations peoples in a local public health Incident Command System activated for the COVID-19 pandemic response in New South Wales, Australia. Using lessons learnt from past pandemics and planning exercises, public health leaders embedded an approach whereby First Nations peoples determined and led community and culturally informed pandemic control strategies and actions.In March 2020, First Nations governance was embedded into the local public health emergency response to COVID-19 in the Hunter New England region of New South Wales, Australia, enabling First Nations staff and community members to actively participate in strategic and operational decision-making with the objective of minimising COVID-19-related risks to First Nations peoples and communities. The model provided cultural insight and oversight to the local COVID-19 response; strengthened and advanced First Nations leadership; increased the First Nations public health workforce; led the development of First Nations disease surveillance strategies; and supported working groups to appropriately respond to local needs and priorities. This model demonstrates the feasibility of reframing a standard Incident Command System to embed and value First Nations principles of self-determination and empowerment to appropriately plan and respond to public health emergencies.

Hits and Misses: Digital Contact Tracing in a Pandemic

Traditional contact tracing is one of the most powerful weapons people have in the battle against a pandemic, especially when vaccines do not yet exist or do not afford complete protection from infection. But the effectiveness of contact tracing hinges on its ability to find infected people quickly and obtain accurate information from them. Therefore, contact tracing inherits the challenges associated with the fallibilities of memory. Against this backdrop, digital contact tracing is the "dream scenario"-an unobtrusive, vigilant, and accurate recorder of danger that should outperform manual contact tracing on every dimension. There is reason to celebrate the success of digital contact tracing. Indeed, epidemiologists report that digital contact tracing probably reduced the incidence of COVID-19 cases by at least 25% in many countries, a feat that would have been hard to match with its manual counterpart. Yet there is also reason to speculate that digital contact tracing delivered on only a fraction of its potential because it almost completely ignored the relevant psychological science. We discuss the strengths and weaknesses of digital contact tracing, its hits and misses in the COVID-19 pandemic, and its need to be integrated with the science of human behavior.

The determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

INTRODUCTION

Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated.

METHODS

Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings) among this high-risk subgroup in a vulnerable population. Among respondents who report adhering to these measures, the paper also investigates the determinants of sustained adherence over a period of 6 months.

RESULTS

The findings suggest that no individual-level characteristics were robustly associated with mask wearing. For avoiding social gatherings, education was inversely associated with adherence to this preventive measure. Avoiding social gatherings was also significantly lower for residents of informal tented settlements (ITSs). Among initial adherents, and for both preventive practices, ITS dwellers were also significantly less likely to maintain adherence.

CONCLUSION

Identifying variables associated with adherence to non-pharmaceutical preventive practices, particularly for vulnerable groups, can help inform and refine interventions in the face of changing conditions. The material, physical, administrative and socio-economic constraints of life in an ITS suggest that avoiding social gatherings is hardly feasible. Yet despite the challenging conditions of ITSs, the indication to wear a mask is initially complied with, suggesting that tailoring policies to the limits and constrains of context can lead to successful outcomes even in very adverse settings.

Risk factors for COVID-19 mortality among telehealth patients in Bangladesh: A prospective cohort study

BACKGROUND AND OBJECTIVE

Estimating the contribution of risk factors of mortality due to COVID-19 is particularly important in settings with low vaccination coverage and limited public health and clinical resources. Very few studies of risk factors of COVID-19 mortality used high-quality data at an individual level from low- and middle-income countries (LMICs). We examined the contribution of demographic, socioeconomic and clinical risk factors of COVID-19 mortality in Bangladesh, a lower middle-income country in South Asia.

METHODS

We used data from 290,488 lab-confirmed COVID-19 patients who participated in a telehealth service in Bangladesh between May 2020 and June 2021, linked with COVID-19 death data from a national database to study the risk factors associated with mortality. Multivariable logistic regression models were used to estimate the association between risk factors and mortality. We used classification and regression trees to identify the risk factors that are the most important for clinical decision-making.

FINDINGS

This study is one of the largest prospective cohort studies of COVID-19 mortality in a LMIC, covering 36% of all lab-confirmed COVID-19 cases in the country during the study period. We found that being male, being very young or elderly, having low socioeconomic status, chronic kidney and liver disease, and being infected during the latter pandemic period were significantly associated with a higher risk of mortality from COVID-19. Males had 1.15 times higher odds (95% Confidence Interval, CI: 1.09, 1.22) of death compared to females. Compared to the reference age group (20-24 years olds), the odds ratio of mortality increased monotonically with age, ranging from an odds ratio of 1.35 (95% CI: 1.05, 1.73) for ages 30-34 to an odds ratio of 21.6 (95% CI: 17.08, 27.38) for ages 75-79 year group. For children 0-4 years old the odds of mortality were 3.93 (95% CI: 2.74, 5.64) times higher than 20-24 years olds. Other significant predictors were severe symptoms of COVID-19 such as breathing difficulty, fever, and diarrhea. Patients who were assessed by a physician as having a severe episode of COVID-19 based on the telehealth interview had 12.43 (95% CI: 11.04, 13.99) times higher odds of mortality compared to those assessed to have a mild episode. The finding that the telehealth doctors' assessment of disease severity was highly predictive of subsequent COVID-19 mortality, underscores the feasibility and value of the telehealth services.

CONCLUSIONS

Our findings confirm the universality of certain COVID-19 risk factors-such as gender and age-while highlighting other risk factors that appear to be more (or less) relevant in the context of Bangladesh. These findings on the demographic, socioeconomic, and clinical risk factors for COVID-19 mortality can help guide public health and clinical decision-making. Harnessing the benefits of the telehealth system and optimizing care for those most at risk of mortality, particularly in the context of a LMIC, are the key takeaways from this study.

Impact of the government's restrictions and guidance in relation to "social distancing" on the lives of ethnic minority populations: A mixed methods study

Background and Aims

The impacts of the COVID-19 pandemic have not been equal, with a disproportionate impact among ethnic minority communities. Structural inequalities in social determinants of health such as housing and employment have contributed to COVID-19's impact on deprived communities, including many ethnic minority communities. To compare (1) how the UK government's "social distancing" restrictions and guidance were perceived and implemented by ethnic minority populations compared to white populations, (2) the impact of restrictions and guidance upon these groups.

Methods

An explanatory sequential mixed methods study incorporated a quantitative survey and qualitative semi-structured interviews to explore individual perceptions and experiences of COVID-19 and the national restrictions. Survey participants (n = 1587) were recruited from North West England; 60 (4%) participants were from ethnic minority communities. Forty-nine interviews were conducted; 19 (39%) participants were from ethnic minority communities. Interviews were transcribed verbatim and analysed using a thematic approach. Data collection was between April and August 2020.

Results

Significant differences in demographics and household overcrowding were observed between white vs ethnic minority survey respondents, who were also significantly less confident in their knowledge of COVID-19, less likely to be high-risk drinkers, and marginally more likely to have experienced job loss and/or reduced household income. There were no group differences in wellbeing, perceptions, or nonfinancial impacts. Two inter-related themes included: (1) government guidance, incorporating people's knowledge and understanding of the guidance and their confusion/frustration over messaging; (2) the impacts of restrictions on keyworkers, home-schooling, working from home and changes in lifestyle/wellbeing.

Conclusions

Further research is needed on the long-term impacts of COVID-19 on ethnic minority communities. If policy responses to COVID-19 are to benefit ethnic minority communities, there is a need for future studies to consider fundamental societal issues, such as the role of housing and economic disadvantage.