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Czepiel D, McCormack C, da Silva AT, Seblova D, Moro MF, Restrepo-Henao A, Martínez AM, Afolabi O, Alnasser L, Alvarado R, Asaoka H, Ayinde O, Balalian A, Ballester D, Barathie JA, Basagoitia A, Basic D, Burrone MS, Carta MG, Durand-Arias S, Eskin M, Fernández-Jiménez E, Frey MIF, Gureje O, Isahakyan A, Jaldo R, Karam EG, Khattech D, Lindert J, Martínez-Alés G, Mascayano F, Mediavilla R, Narvaez Gonzalez JA, Nasser-Karam A, Nishi D, Olaopa O, Ouali U, Puac-Polanco V, Ramírez DE, Ramírez J, Rivera-Segarra E, Rutten BP, Santaella-Tenorio J, Sapag JC, Šeblová J, Soto MTS, Tavares-Cavalcanti M, Valeri L, Sijbrandij M, Susser ES, Hoek HW, van der Ven E. Inequality on the frontline: A multi-country study on gender differences in mental health among healthcare workers during the COVID-19 pandemic. Glob Ment Health (Camb) 2024; 11:e34. [PMID: 38572248 PMCID: PMC10988139 DOI: 10.1017/gmh.2024.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/15/2024] [Accepted: 02/05/2024] [Indexed: 04/05/2024] Open
Abstract
Healthcare workers (HCWs) were at increased risk for mental health problems during the COVID-19 pandemic, with prior data suggesting women may be particularly vulnerable. Our global mental health study aimed to examine factors associated with gender differences in psychological distress and depressive symptoms among HCWs during COVID-19. Across 22 countries in South America, Europe, Asia and Africa, 32,410 HCWs participated in the COVID-19 HEalth caRe wOrkErS (HEROES) study between March 2020 and February 2021. They completed the General Health Questionnaire-12, the Patient Health Questionnaire-9 and questions about pandemic-relevant exposures. Consistently across countries, women reported elevated mental health problems compared to men. Women also reported increased COVID-19-relevant stressors, including insufficient personal protective equipment and less support from colleagues, while men reported increased contact with COVID-19 patients. At the country level, HCWs in countries with higher gender inequality reported less mental health problems. Higher COVID-19 mortality rates were associated with increased psychological distress merely among women. Our findings suggest that among HCWs, women may have been disproportionately exposed to COVID-19-relevant stressors at the individual and country level. This highlights the importance of considering gender in emergency response efforts to safeguard women's well-being and ensure healthcare system preparedness during future public health crises.
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Affiliation(s)
- Diana Czepiel
- Parnassia Psychiatric Institute, Parnassia Groep, The Hague, The Netherlands
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Clare McCormack
- Department of Child and Adolescent Psychiatry, New York University Langone Medical Center, New York, NY, USA
| | - Andréa T.C. da Silva
- Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Faculty of Medicine Santa Marcelina, São Paulo, Brazil
| | - Dominika Seblova
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maria F. Moro
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Alexandra Restrepo-Henao
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Epidemiology Group, National School of Public Health, University of Antioquia, Medellín, Colombia
| | - Adriana M. Martínez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Oyeyemi Afolabi
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Lubna Alnasser
- Population Health Research Section, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
| | - Rubén Alvarado
- Department of Public Health, School of Medicine, University of Valparaíso, Valparaiso, Chile
- School of Public Health, University of Chile, Santiago, Chile
| | - Hiroki Asaoka
- Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Olatunde Ayinde
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Arin Balalian
- Question Driven Design and Analysis Group, New York, NY, USA
| | - Dinarte Ballester
- University Hospital, Federal University of Rio Grande, Rio Grande, Brazil
| | - Josleen A.l. Barathie
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Armando Basagoitia
- Unidad de Investigación, Consultora Salud Global Bolivia, Sucre, Bolivia
| | - Djordje Basic
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - María S. Burrone
- Institute of Health Sciences, Universidad de O’Higgins, Rancagua, Chile
| | - Mauro G. Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Sol Durand-Arias
- National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico
| | - Mehmet Eskin
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Eduardo Fernández-Jiménez
- Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Madrid, Spain
- Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Marcela I. F. Frey
- Social and Community Academic Unit, University of Chubut, Chubut, Argentina
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Anna Isahakyan
- National Institute of Health Named After Academician S. Avdalbekyan, Yerevan, Armenia
| | - Rodrigo Jaldo
- Social and Community Academic Unit, University of Chubut, Chubut, Argentina
| | - Elie G. Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, University of Balamand,Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Dorra Khattech
- Department Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
| | - Jutta Lindert
- Faculty of Health and Social Work, University of Applied Sciences Emden/Leer, Emden, Germany
| | - Gonzalo Martínez-Alés
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Franco Mascayano
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Roberto Mediavilla
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Carlos III Health Institute, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Princesa, Madrid, Spain
| | - Javier A. Narvaez Gonzalez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- Maestría en Epidemiología, División de Postgrados, El Bosque University, Bogotá, Colombia
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Sede Bogotá, Bogotá, Colombia
| | - Aimee Nasser-Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, University of Balamand,Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Olusegun Olaopa
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan, Nigeria
| | - Uta Ouali
- Department Psychiatry A, Razi Hospital La Manouba, Manouba, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Victor Puac-Polanco
- Departments of Health Policy & Management and Epidemiology & Biostatistics, Downstate Health Sciences University, Brooklyn, NY, USA
- Faculty of Medical Sciences, University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Dorian E. Ramírez
- Faculty of Medical Sciences, University of San Carlos of Guatemala, Guatemala City, Guatemala
| | - Jorge Ramírez
- School of Public Health, University of Chile, Santiago, Chile
| | - Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Bart P.F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Julian Santaella-Tenorio
- Department of Clinical Epidemiology and Biostatistics, Pontifical Xavierian University, Bogotá, Colombia
| | - Jaime C. Sapag
- Department of Public Health and Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jana Šeblová
- Emergency Department, Motol University Hospital, Prague, Czech Republic
- Czech Society for Emergency and Disaster Medicine, Czech Medical Association of J. E. Purkyně, Prague, Czech Republic
| | - María T. S. Soto
- Dirección de Investigación Ciencia y Tecnología, Universidad San Francisco Xavier de Chuquisaca, Sucre, Bolivia
| | - Maria Tavares-Cavalcanti
- School of Medicine and Psychiatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Linda Valeri
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Marit Sijbrandij
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam, The Netherlands
| | - Ezra S. Susser
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Hans W. Hoek
- Parnassia Psychiatric Institute, Parnassia Groep, The Hague, The Netherlands
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
- University Medical Center Groningen, University Center of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Els van der Ven
- Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Rachel Bezerra Gurgel A, Augusto Coelho Guimarães J, Chakur Brum P, Carlos Pedroso de Lima A, Giavina-Bianchi P, Henrique Mesquita Peres C, Cristina Peres Braido Francisco M, Garcia Neves dos Santos L, de Cassia Cezar Santos R, Eliana Beseggio Santos R, Corá A, José da Silva Duarte A, dos Santos Lazari C, Jose Pereira A, Cerdeira Sabino E, Corchs F, Cotrim Segurado A, Figueiredo Costa S, Levin AS. Impacts of the first wave of the COVID-19 pandemic on leisure and transportation physical activity among healthcare workers. Prev Med Rep 2024; 38:102587. [PMID: 38288262 PMCID: PMC10823129 DOI: 10.1016/j.pmedr.2024.102587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/31/2024] Open
Abstract
Introduction The COVID-19 pandemic may lead to reduced physical activity (PA) in health care workers (HCWs). Objective To evaluate leisure and transport-related PA in HCW of a COVID-19-dedicated hospital during the first wave of the COVID-19 pandemic. Methods This is a cross-sectional study with a sample of 1,527 HCWs. Socioeconomic aspects, occupational characteristics, and engagement in leisure and transport-related PA were investigated through an online survey administered in August of 2020. Results More than 80 % HCWs performed < 150 min/week of leisure-related PA, and 85 % performed ≤ 30 min/day transport-related PA. Being male was associated with more PA (OR: 1.93; 95 % CI:1.40-2.66) and transport-related PA; working in nursing, physical therapy, and cleaning/housekeeping services was associated with low PA (OR: 0.70; 95 % CI:0.51-0.95). Physicians and administrative staff were less active in transport-related PA. Conclusions HCWs working in a COVID-19 hospital had low levels of PA in the domains of leisure and transportation.
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Affiliation(s)
| | | | - Patricia Chakur Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | | | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | | | | | - Rita de Cassia Cezar Santos
- Divisão de Laboratório Central, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | | | - Aline Corá
- Divisão de Laboratório Central, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Divisão de Laboratório Central, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Carolina dos Santos Lazari
- Divisão de Laboratório Central, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Antonio Jose Pereira
- Covid-19 Emergency Committee, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- LIM-46, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Felipe Corchs
- Institute and Department of Psychiatry, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Aluísio Cotrim Segurado
- Divisão de Moléstias Infecciosas, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anna S. Levin
- Divisão de Moléstias Infecciosas, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- LIM-49, Instituto de Medicina Tropical, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Lott N, Gebhard CE, Bengs S, Haider A, Kuster GM, Regitz-Zagrosek V, Gebhard C. Sex hormones in SARS-CoV-2 susceptibility: key players or confounders? Nat Rev Endocrinol 2023; 19:217-231. [PMID: 36494595 PMCID: PMC9734735 DOI: 10.1038/s41574-022-00780-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/14/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a clear sex disparity in clinical outcomes. Hence, the interaction between sex hormones, virus entry receptors and immune responses has attracted major interest as a target for the prevention and treatment of SARS-CoV-2 infections. This Review summarizes the current understanding of the roles of androgens, oestrogens and progesterone in the regulation of virus entry receptors and disease progression of coronavirus disease 2019 (COVID-19) as well as their therapeutic value. Although many experimental and clinical studies have analysed potential mechanisms by which female sex hormones might provide protection against SARS-CoV-2 infectivity, there is currently no clear evidence for a sex-specific expression of virus entry receptors. In addition, reports describing an influence of oestrogen, progesterone and androgens on the course of COVID-19 vary widely. Current data also do not support the administration of oestradiol in COVID-19. The conflicting evidence and lack of consensus results from a paucity of mechanistic studies and clinical trials reporting sex-disaggregated data. Further, the influence of variables beyond biological factors (sex), such as sociocultural factors (gender), on COVID-19 manifestations has not been investigated. Future research will have to fill this knowledge gap as the influence of sex and gender on COVID-19 will be essential to understanding and managing the long-term consequences of this pandemic.
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Affiliation(s)
- Nicola Lott
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | | | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Ahmed Haider
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Gabriela M Kuster
- Department of Cardiology and Department of Biomedicine, University Hospital and University of Basel, Basel, Switzerland
| | - Vera Regitz-Zagrosek
- Charité, Universitätsmedizin Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
- Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland.
- Department of Cardiology, Inselspital Bern University Hospital, Bern, Switzerland.
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Simpson T, Sistad R, Brooks JT, Newberger NG, Livingston NA. Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100116. [PMID: 36844155 PMCID: PMC9948922 DOI: 10.1016/j.dadr.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
Background Findings from a person-level meta-analysis of online alcohol intervention trials suggest that women disproportionately seek out such interventions (Riper et al., 2018). Although women may be a "hidden population" that is particularly drawn to online alcohol interventions, trial design features may explain women's apparent over-representation in these trials. Methods This systematic review examined associations between gender-tailored recruitment/inclusion criteria and proportions of women enrolled in online alcohol intervention trials, evaluated whether community samples have greater proportions of women than clinical samples, and compared country-specific average proportions of women in trials to country-specific proportions of women with Alcohol Use Disorder (AUD). Results Forty-four trials met inclusion/exclusion criteria, 34 community samples and 10 drawn from clinical settings; 4 studies included U.S. veterans and were examined separately. The average proportion of community-recruited women across the studies was 51.20% and the average proportion of clinically-recruited women was 35.81%, a difference that was statistically significant. Across the countries with relevant trials, the expected proportion of those with AUD who are women is 27.1% (World Population Review, 2022). Only 2 studies used targeted recruitment for women so no between-group tests were conducted. There was not a statistically significant difference in the proportion of women across trials that did and did not use gender-tailored alcohol inclusion criteria. Conclusions Results from this systematic review suggest that study design factors do not account for the marked over-representation of women in online alcohol interventions, indicating that women are indeed a "hidden population" whose needs should be understood and accommodated.
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Affiliation(s)
- Tracy Simpson
- Center of Excellence in Substance Addiction Treatment & Education, VA Puget Sound Healthcare System, Seattle, WA, USA,University of Washington School of Medicine, Seattle, WA, USA,Corresponding author at: 1660 S. Columbian Way (S-116-CESATE), Seattle, WA 98108, USA.
| | - Rebecca Sistad
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jack T. Brooks
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Noam G. Newberger
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
| | - Nicholas A. Livingston
- VA Boston Healthcare System, Boston, MA, USA,Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA,National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
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Putra HA, Park K, Yamashita F. Sex Differences in the Correlation between Fatigue Perception and Regional Gray Matter Volume in Healthy Adults: A Large-Scale Study. J Clin Med 2022; 11:jcm11206037. [PMID: 36294358 PMCID: PMC9604802 DOI: 10.3390/jcm11206037] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
The relationship between fatigue perception and regional gray matter volume (rGMV) has seldom been studied in healthy adults. Therefore, this study aimed to analyze sex differences in the correlation between rGMV and fatigue perception using Chalder’s fatigue questionnaire (CFQ). The CFQ was used to analyze the sexual features of rGMV related to the degree of perceived fatigue in 2955 healthy adults (male = 1560, female = 1395) of various ages (20–89 years, median 56). A higher CFQ score denotes a higher perceived fatigue level by the participant. According to the CFQ scores in males, the volumes of the right orbital part of the inferior frontal gyrus and left precuneus were negatively correlated (i.e., smaller rGMV had a higher CFQ score), whereas the left angular gyrus was positively correlated. In females, the right inferior temporal gyrus was negative, whereas the left middle temporal gyrus and right putamen were positive (i.e., larger rGMV had a higher CFQ score). The lack of identified regions in this large-scale study between males and females might be related to sex differences in clinical or pathological fatigue morbidities. Additionally, the sex differences in the negative or positive correlations between rGMV and fatigue perception may contribute to a better understanding of the neuronal mechanism in the early stages of fatigue development.
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Affiliation(s)
- Handityo Aulia Putra
- Research Organization for Regional Alliances, Kochi University of Technology, Kochi 782-8502, Japan
- Correspondence: ; Tel.: +81-887-57-2025
| | - Kaechang Park
- Research Organization for Regional Alliances, Kochi University of Technology, Kochi 782-8502, Japan
| | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Iwate 028-3694, Japan
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Dong Z, Yan Q, Cao W, Liu Z, Wang X. Identification of key molecules in COVID-19 patients significantly correlated with clinical outcomes by analyzing transcriptomic data. Front Immunol 2022; 13:930866. [PMID: 36072597 PMCID: PMC9441550 DOI: 10.3389/fimmu.2022.930866] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022] Open
Abstract
Background Although several key molecules have been identified to modulate SARS-CoV-2 invasion of human host cells, the molecules correlated with outcomes in COVID-19 caused by SARS-CoV-2 infection remain insufficiently explored. Methods This study analyzed three RNA-Seq gene expression profiling datasets for COVID-19 and identified differentially expressed genes (DEGs) between COVID-19 patients and normal people, commonly in the three datasets. Furthermore, this study explored the correlation between the expression of these genes and clinical features in COVID-19 patients. Results This analysis identified 13 genes significantly upregulated in COVID-19 patients’ leukocyte and SARS-CoV-2-infected nasopharyngeal tissue compared to normal tissue. These genes included OAS1, OAS2, OAS3, OASL, HERC6, SERPING1, IFI6, IFI44, IFI44L, CMPK2, RSAD2, EPSTI1, and CXCL10, all of which are involved in antiviral immune regulation. We found that these genes’ downregulation was associated with worse clinical outcomes in COVID-19 patients, such as intensive care unit (ICU) admission, mechanical ventilatory support (MVS) requirement, elevated D-dimer levels, and increased viral loads. Furthermore, this analysis identified two COVID-19 clusters based on the expression profiles of the 13 genes, termed COV-C1 and COV-C2. Compared with COV-C1, COV-C2 more highly expressed the 13 genes, had stronger antiviral immune responses, were younger, and displayed more favorable clinical outcomes. Conclusions A strong antiviral immune response is essential in reducing severity of COVID-19.
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Affiliation(s)
- Zehua Dong
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Qiyu Yan
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Wenxiu Cao
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
| | - Zhixian Liu
- Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Zhixian Liu, ; Xiaosheng Wang,
| | - Xiaosheng Wang
- Biomedical Informatics Research Lab, School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Big Data Research Institute, China Pharmaceutical University, Nanjing, China
- *Correspondence: Zhixian Liu, ; Xiaosheng Wang,
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7
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Sylvester SV, Rusu R, Chan B, Bellows M, O'Keefe C, Nicholson S. Sex differences in sequelae from COVID-19 infection and in long COVID syndrome: a review. Curr Med Res Opin 2022; 38:1391-1399. [PMID: 35726132 DOI: 10.1080/03007995.2022.2081454] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We conducted literature reviews to uncover differential effects of sex on sequelae from coronavirus disease 2019 (COVID-19) and on long COVID syndrome. METHODS Two authors independently searched OvidSP in Embase, Medline, Biosis, and Derwent Drug File. Publications reporting original, sex-disaggregated data for sequelae of COVID-19 (published before August 2020) and long COVID syndrome (published before June 2021) were included in the reviews. The association between COVID-19 sequelae (i.e. lasting <4 weeks after symptom onset) and sex, and between long COVID syndrome (i.e. lasting >4 weeks after symptom onset) and sex, was determined by odds ratio (OR) and 95% confidence interval (CI) (statistical significance defined by 95% CI not including 1). RESULTS Of 4346 publications identified, 23 and 12 met eligibility criteria for COVID-19 sequelae and long COVID syndrome, respectively. COVID-19 sequelae in the categories of psychiatric/mood (OR = 1.80; 95% CI: 1.35-2.41), ENT (OR = 1.42; 95% CI: 1.39-1.46), musculoskeletal (OR = 1.15; 95% CI: 1.14-1.16), and respiratory (OR = 1.09; 95% CI: 1.08-1.11) were significantly more likely among females (vs. males), whereas renal sequelae (OR = 0.83; 95% CI: 0.75-0.93) were significantly more likely among males. The likelihood of having long COVID syndrome was significantly greater among females (OR = 1.22; 95% CI: 1.13-1.32), with the odds of ENT (OR = 2.28; 95% CI: 1.94-2.67), GI (OR = 1.60; 95% CI: 1.04-2.44), psychiatric/mood (OR = 1.58; 95% CI: 1.37-1.82), neurological (OR = 1.30; 95% CI: 1.03-1.63), dermatological (OR = 1.29; 95% CI: 1.05-1.58), and other (OR = 1.36; 95% CI: 1.25-1.49) disorders significantly higher among females and the odds of endocrine (OR = 0.75; 95% CI: 0.69-0.81) and renal disorders (OR = 0.74; 95% CI: 0.64-0.86) significantly higher among males. CONCLUSIONS Sex-disaggregated differences for COVID-19 sequelae and long COVID syndrome were observed. Few COVID-19 studies report sex-disaggregated data, underscoring the need for further sex-based research/reporting of COVID-19 disease.
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Affiliation(s)
- Shirley V Sylvester
- Johnson & Johnson, Women's Health, Office of the Chief Medical Officer, New Brunswick, NJ, USA
| | - Rada Rusu
- Clinical Operations, Johnson & Johnson, Office of the Chief Medical Officer, Toronto, Canada
| | - Biankha Chan
- Clinical Operations, Johnson & Johnson, Office of the Chief Medical Officer, Toronto, Canada
| | - Martha Bellows
- Johnson & Johnson, Healthcare Technology Center, Providence, RI, USA
| | - Carly O'Keefe
- Johnson & Johnson, Healthcare Technology Center, Providence, RI, USA
| | - Susan Nicholson
- Johnson & Johnson, Women's Health, Office of the Chief Medical Officer, New Brunswick, NJ, USA
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Characterization of Clinical Features of Hospitalized Patients Due to the SARS-CoV-2 Infection in the Absence of Comorbidities Regarding the Sex: An Epidemiological Study of the First Year of the Pandemic in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158895. [PMID: 35897265 PMCID: PMC9331852 DOI: 10.3390/ijerph19158895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/18/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023]
Abstract
The male sex, due to the presence of genetic, immunological, hormonal, social, and environmental factors, is associated with higher severity and death in Coronavirus Disease (COVID)-19. We conducted an epidemiological study to characterize the COVID-19 clinical profile, severity, and outcome according to sex in patients with the severe acute respiratory syndrome (SARS) due to the fact of this disease. We carried out an epidemiological analysis using epidemiological data made available by the OpenDataSUS, which stores information about SARS in Brazil. We recorded the features of the patients admitted to the hospital for SARS treatment due to the presence of COVID-19 (in the absence of comorbidities) and associated these characteristics with sex and risk of death. The study comprised 336,463 patients, 213,151 of whom were men. Male patients presented a higher number of clinical signs, for example, fever (OR = 1.424; 95%CI = 1.399−1.448), peripheral arterial oxygen saturation (SpO2) < 95% (OR = 1.253; 95%CI = 1.232−1.274), and dyspnea (OR = 1.146; 95%CI = 1.125−1.166) as well as greater need for admission in intensive care unit (ICU, OR = 1.189; 95%CI = 1.168−1.210), and the use of invasive ventilatory support (OR = 1.306; 95%CI = 1.273−1.339) and noninvasive ventilatory support (OR = 1.238; 95%CI = 1.216−1.260) when compared with female patients. Curiously, the male sex was associated only with a small increase in the risk of death when compared with the female sex (OR = 1.041; 95%CI = 1.023−1.060). We did a secondary analysis to identify the main predictors of death. In that sense, the multivariate analysis enabled the prediction of the risk of death, and the male sex was one of the predictors (OR = 1.101; 95%CI = 1.011−1.199); however, with a small effect size. In addition, other factors also contributed to this prediction and presented a great effect size, they are listed below: older age (61−72 years old (OR = 15.778; 95%CI = 1.865−133.492), 73−85 years old (OR = 31.978; 95%CI = 3.779−270.600), and +85 years old (OR = 68.385; 95%CI = 8.164−589.705)); race (Black (OR = 1.247; 95%CI = 1.016−1.531), Pardos (multiracial background; OR = 1.585; 95%CI = 1.450−1.732), and Indigenous (OR = 3.186; 95%CI = 1.927−5.266)); clinical signs (for instance, dyspnea (OR = 1.231; 95%CI = 1.110−1.365) and SpO2 < 95% (OR = 1.367; 95%CI = 1.238−1.508)); need for admission in the ICU (OR = 3.069; 95%CI = 2.789−3.377); and for ventilatory support (invasive (OR = 10.174; 95%CI = 8.803−11.759) and noninvasive (OR = 1.609; 95%CI = 1.438−1.800)). In conclusion, in Brazil, male patients tend to present the phenotype of higher severity in COVID-19, however, with a small effect on the risk of death.
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Patrono A, Renzetti S, Manco A, Brunelli P, Moncada SM, Macgowan MJ, Placidi D, Calza S, Cagna G, Rota M, Memo M, Tira M, Lucchini RG. COVID-19 Aftermath: Exploring the Mental Health Emergency among Students at a Northern Italian University. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148587. [PMID: 35886439 PMCID: PMC9318913 DOI: 10.3390/ijerph19148587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 12/04/2022]
Abstract
In this study, we investigated the symptoms of physical and mental health associated with lifestyle changes due to a lockdown among the students of a university in Northern Italy, one of the most affected areas in Europe during the first wave of COVID-19. We examined the psychopathological variations in relation to mental health problems in a young population. The goal was to develop interventions to resolve these new psychosocial problems. From June to July 2020, students participated in an anonymous survey asking about habits and symptoms that emerged during the lockdown and the COVID-19 pandemic. Five health outcomes were assessed: digestive disorders; headaches; fear of COVID-19; panic and anxiety crises; and depression/sadness. The conditions and duration of the social isolation, lifestyle, SARS-CoV-2 infection in the household, financial situation, and productivity were considered in the analysis. A total of 3533 students completed the survey. The participants experienced headaches, depression and sadness, digestive disorders, a fear of COVID-19, and anxiety/panic crises. The duration of isolation was associated with an increased risk of digestive disorders, headaches, and COVID-19 fear. The female gender, medium–intense telephone usage, sleep quality, memory difficulties, and performance reduction were associated with an increased risk of the health outcomes. Future interventions should focus on promoting and implementing different habits with the support of health and university organizations.
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Affiliation(s)
- Alessandra Patrono
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (S.C.); (M.R.); (M.M.)
- Correspondence:
| | - Stefano Renzetti
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
| | - Angela Manco
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
| | - Paola Brunelli
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
| | - Stefanny M. Moncada
- Departamento de Gobierno, Universidad del Desarrollo, Santiago 7590000, Chile;
| | - Mark J. Macgowan
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA;
| | - Donatella Placidi
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
| | - Stefano Calza
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (S.C.); (M.R.); (M.M.)
| | - Giuseppa Cagna
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
| | - Matteo Rota
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (S.C.); (M.R.); (M.M.)
| | - Maurizio Memo
- Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy; (S.C.); (M.R.); (M.M.)
| | - Maurizio Tira
- Department of Civil, Environmental, Architectural Engineering and Mathematics (DICATAM), University of Brescia, 25121 Brescia, Italy;
| | - Roberto G. Lucchini
- Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25121 Brescia, Italy; (S.R.); (A.M.); (P.B.); (D.P.); (G.C.); (R.G.L.)
- Department of Environmental Health Sciences, School of Public Health, Florida International University, Miami, FL 33199, USA
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10
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Buitrago Ramírez F, Ciurana Misol R, Fernández Alonso MDC, Tizón JL. [COVID-19 pandemic: Effects on the mental health of healthcare professionals]. Aten Primaria 2022; 54:102359. [PMID: 35567920 PMCID: PMC9013602 DOI: 10.1016/j.aprim.2022.102359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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11
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The Changes in the Daily Lives and Life Satisfaction of Female Academicians during the Pandemic Process. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1107568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: The new type of coronavirus (COVID-19) disease has more serious consequences and risks by gender and plays a role in biological, socio-cultural and behavioral differences. This process is particularly severe in terms of the problems faced by women and some disadvantaged groups. The aim of this study is to determine the effect of changes in the daily lives of female academicians on life satisfaction during the COVID-19 pandemic process.
Methods: The sample of this descriptive study consists of 178 female academicians who have been actively working at a public university in the northeast of Turkey between Oct 1, 2020 and Feb 1, 2021. The data of the research were collected by "Personal Information Form" and "Contentment with Life Scale". Descriptive statistics (percentage, frequency, average), Pearson product-moment correlation analysis, t-test, and ANOVA test were used to evaluate the data.
Results: It was found that 83.1% of the female academicians preferred to stay at their own homes and 52.8% of them did not receive support while fulfilling their daily responsibilities during the pandemic process in which female academicians had to work and learn at home. The total score of the Contentment with Life Scale of female academicians was found to be 20.15 ± 6.95. Female academicians who participated in the study had moderate level of contentment with life. It was determined in the study that the increase in the time spent on academic development, academic studies, and themselves increased female academicians’ life contentment and was statistically significant (p˂0.05). It was found that increased time spent for housework decreased life satisfaction.
Conclusions: It was determined that professional and individual development is quite significant in increasing life satisfaction in female academicians. That strategies that can increase female academicians life contentment should be developed and women who are sensitive and need to be protected should be supported more in this situation.
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Maher A, Dehnavi H, Salehian E, Omidi M, Hannani K. Relationship Between Income Level and Hospitalization Rate in COVID-19 Cases; an Example of Social Factors Affecting Health. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e23. [PMID: 35573715 PMCID: PMC9078072 DOI: 10.22037/aaem.v10i1.1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Considering the population's socioeconomic status and clinical features is essential in planning and performing interventions related to disease control. The main purpose of this study was to investigate the relationship between income level and hospitalization rate of COVID-19 patients. METHODS A cross-sectional study was performed on 198,944 hospitalized COVID-19 patients in Tehran province between March 2020 and March 2021. Data of hospitalized COVID-19 patients was obtained from the Hospital Intelligent Management System (HIM). The income data of patients were obtained from the Iranian Database on Targeted Subsidies belonging to the Ministry of Cooperatives, Labor, and Social Welfare. Data analyses were performed using SPSS software. RESULTS About 2.5% of the inpatients were from the first decile, while 20.6% were from the tenth. The share of the lower three deciles of total hospitalization was about 11%, while the share of the upper three deciles was 50%. There was a big difference between the upper- and lower-income deciles regarding death rates. In the first decile, 30% of inpatients died, while the proportion was 10% in the tenth decile. There was a significant and positive relationship between income decline and hospitalization (r = 0.75; p = 0.02). Also, there was a significant and negative relationship between income decline and death rate (r = -0.90; p = 0.01). CONCLUSION Low-income groups use fewer inpatient services, are more prone to severe illness and death from COVID-19, and treatment in this group has a lower chance of success. Using a systemic approach to address socioeconomic factors in healthcare planning is crucial.
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Affiliation(s)
- Ali Maher
- Department of Health Management and Economics, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Dehnavi
- Department of Health Management and Economics, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Hamed Dehnavi; Department of Health Management and Economics, Virtual School of Medical Education and Management, Valiasr Avenue, Tehran, Iran. Tel: (+98 21) 26214956 , , ORCID: 0000-0002-8183-4458
| | - Elham Salehian
- Resources Development Deputy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mona Omidi
- Resources Development Deputy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Khatereh Hannani
- Resources Development Deputy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vena W, Pizzocaro A, Maida G, Amer M, Voza A, Di Pasquale A, Reggiani F, Ciccarelli M, Fedeli C, Santi D, Lavezzi E, Lania AG, Mazziotti G. Low testosterone predicts hypoxemic respiratory insufficiency and mortality in patients with COVID-19 disease: another piece in the COVID puzzle. J Endocrinol Invest 2022; 45:753-762. [PMID: 34792796 PMCID: PMC8600346 DOI: 10.1007/s40618-021-01700-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Hypogonadism was described in high number of male subjects with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this study, we investigated whether low testosterone (T) values may influence the clinical presentation and outcome of SARS-CoV-2-related pneumonia in a large population of adult males with coronavirus disease 19 (COVID-19). METHODS Two hundred twenty one adult males hospitalized for COVID-19 at the IRCCS Humanitas Research Hospital, Rozzano-Milan (Italy) were consecutively evaluated for arterial partial pressure oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio, serum T and inflammatory parameters at study entry, need of ventilation during hospital stay and in-hospital mortality. RESULTS Subjects low T values (< 8 nmol/L; 176 cases) were significantly older (P = 0.001) and had higher serum interleukin-6 (P = 0.001), C-reactive protein (P < 0.001), lactate dehydrogenase (P < 0.001), ferritin (P = 0.012), lower P/F ratio (P = 0.001), increased prevalence of low T3 syndrome (P = 0.041), acute respiratory insufficiency (P < 0.001), more frequently need of ventilation (P < 0.001) and higher mortality rate (P = 0.009) compared to subjects with higher T values. In the multivariable regression analyses, T values maintained significant associations with acute respiratory insufficiency (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.79-0.94; P < 0.001 and in-hospital mortality (OR 0.80, 95% CI 0.69-0.95; P = 0.009), independently of age, comorbidities, thyroid function and inflammation. CONCLUSION Low T levels values are associated with unfavorable outcome of COVID-19. Prospective studies are needed to evaluate the long-term outcomes of hypogonadism related to COVID-19 and the clinical impact of T replacement during and after acute illness.
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Affiliation(s)
- W Vena
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Pizzocaro
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - G Maida
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M Amer
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Voza
- Emergency Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - A Di Pasquale
- Pneumology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - F Reggiani
- Nephrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - M Ciccarelli
- Pneumology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - C Fedeli
- Emergency Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
| | - D Santi
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - E Lavezzi
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - A G Lania
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
| | - G Mazziotti
- Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, via Manzoni 56, Rozzano, 20089, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
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Mongin D, Cullati S, Kelly-Irving M, Rosselet M, Regard S, Courvoisier DS. Neighbourhood socio-economic vulnerability and access to COVID-19 healthcare during the first two waves of the pandemic in Geneva, Switzerland: A gender perspective. EClinicalMedicine 2022; 46:101352. [PMID: 35360147 PMCID: PMC8959442 DOI: 10.1016/j.eclinm.2022.101352] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Neighbourhood socio-economic inequities have been shown to affect COVID-19 incidence and mortality, as well as access to tests. This article aimed to study how associations of inequities and COVID-19 outcomes varied between the first two pandemic waves from a gender perspective. METHODS We performed an ecological study based on the COVID-19 database of Geneva between Feb 26, 2020, and June 1, 2021. Outcomes were the number of tests per person, the incidence of COVID-19 cases, the incidence of COVID-19 deaths, the positivity rate, and the delay between symptoms and test. Outcomes were described by neighbourhood socio-economic levels and stratified by gender and epidemic waves (first wave, second wave), adjusting for the proportion of inhabitants older than 65 years. FINDINGS Low neighbourhood socio-economic levels were associated with a lower number of tests per person (incidence rate ratio [IRR] of 0.88, 0.85 and 0.83 for low, moderate, and highly vulnerable neighbourhood respectively), a higher incidence of COVID-19 cases and of COVID-19 deaths (IRR 2.3 for slightly vulnerable, 1.9 for highly vulnerable). The association between socio-economic inequities and incidence of COVID-19 deaths was mainly present during the first wave of the pandemic, and was stronger amongst women. The increase in COVID-19 cases amongst vulnerable populations appeared mainly during the second wave, and originated from a lower access to tests for men, and a higher number of COVID-19 cases for women. INTERPRETATION The COVID-19 pandemic affected people differently depending on their socio-economic level. Because of their employment and higher prevalence of COVID-19 risk factors, people living in neighbourhoods of lower socio-economic levels, especially women, were more exposed to COVID-19 consequences. FUNDING This research was supported by the research project SELFISH, financed by the Swiss National Science Foundation, grant number 51NF40-160590 (LIVES centre international research project call).
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Affiliation(s)
- Denis Mongin
- Faculty of medicine, University of Geneva, 26 avenue de Beau Séjour, Geneva 1206, Switzerland
- Corresponding author.
| | - Stéphane Cullati
- Division Quality of care, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Population Health Laboratory (#PopHealthLab), Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Michelle Kelly-Irving
- Interdisciplinary Federal Research Institute on Health and Society (IFERISS-Fed 4241), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP-UMR1295, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Maevane Rosselet
- Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
| | - Simon Regard
- Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
- Department of Security, Population and Health, General Health Directorate, Geneva 1211, Switzerland
| | - Delphine S. Courvoisier
- Division Quality of care, Department of Readaptation and Geriatrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Surgeon, Geneva Directorate of Health, Geneva, Switzerland
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Brown C, Wilkins K, Craig-Neil A, Upshaw T, Pinto AD. Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations. Public Health Rev 2022; 42:1604031. [PMID: 35140994 PMCID: PMC8802804 DOI: 10.3389/phrs.2021.1604031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/04/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: Efforts to contain the COVID-19 pandemic should take into account worsening health inequities. While many public health experts have commented on inequities, no analysis has yet synthesized recommendations into a guideline for practitioners. The objective of this rapid review was to identify the areas of greatest concern and synthesize recommendations. Methods: We conducted a rapid systematic review (PROSPERO: CRD42020178131). We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials databases from December 1, 2019 to April 27, 2020. We included English language peer-reviewed commentaries, editorials, and opinion pieces that addressed the social determinants of health in the context of COVID-19. Results: 338 articles met our criteria. Authors represented 81 countries. Income, housing, mental health, age and occupation were the most discussed social determinants of health. We categorized recommendations into primordial, primary, secondary and tertiary prevention that spoke to the social determinants of COVID-19 and equity. Conclusion: These recommendations can assist efforts to contain COVID-19 and reduce health inequities during the pandemic. Using these recommendations, public health practitioners could support a more equitable pandemic response. Systematic Review Registration: PROSPERO, CRD42020178131.
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Affiliation(s)
- Chloe Brown
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katie Wilkins
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Tara Upshaw
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew David Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Meijs DAM, van Bussel BCT, Stessel B, Mehagnoul-Schipper J, Hana A, Scheeren CIE, Peters SAE, van Mook WNKA, van der Horst ICC, Marx G, Mesotten D, Ghossein-Doha C. Better COVID-19 Intensive Care Unit survival in females, independent of age, disease severity, comorbidities, and treatment. Sci Rep 2022; 12:734. [PMID: 35031644 PMCID: PMC8760268 DOI: 10.1038/s41598-021-04531-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Although male Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) patients have higher Intensive Care Unit (ICU) admission rates and a worse disease course, a comprehensive analysis of female and male ICU survival and underlying factors such as comorbidities, risk factors, and/or anti-infection/inflammatory therapy administration is currently lacking. Therefore, we investigated the association between sex and ICU survival, adjusting for these and other variables. In this multicenter observational cohort study, all patients with SARS-CoV-2 pneumonia admitted to seven ICUs in one region across Belgium, The Netherlands, and Germany, and requiring vital organ support during the first pandemic wave were included. With a random intercept for a center, mixed-effects logistic regression was used to investigate the association between sex and ICU survival. Models were adjusted for age, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, comorbidities, and anti-infection/inflammatory therapy. Interaction terms were added to investigate effect modifications by sex with country and sex with obesity. A total of 551 patients (29% were females) were included. Mean age was 65.4 ± 11.2 years. Females were more often obese and smoked less frequently than males (p-value 0.001 and 0.042, respectively). APACHE II scores of females and males were comparable. Overall, ICU mortality was 12% lower in females than males (27% vs 39% respectively, p-value < 0.01) with an odds ratio (OR) of 0.62 (95%CI 0.39-0.96, p-value 0.032) after adjustment for age and APACHE II score, 0.63 (95%CI 0.40-0.99, p-value 0.044) after additional adjustment for comorbidities, and 0.63 (95%CI 0.39-0.99, p-value 0.047) after adjustment for anti-infection/inflammatory therapy. No effect modifications by sex with country and sex with obesity were found (p-values for interaction > 0.23 and 0.84, respectively). ICU survival in female SARS-CoV-2 patients was higher than in male patients, independent of age, disease severity, smoking, obesity, comorbidities, anti-infection/inflammatory therapy, and country. Sex-specific biological mechanisms may play a role, emphasizing the need to address diversity, such as more sex-specific prediction, prognostic, and therapeutic approach strategies.
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Affiliation(s)
- Daniek A M Meijs
- Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands.
- Department of Intensive Care Medicine, Laurentius Ziekenhuis, Roermond, the Netherlands.
| | - Bas C T van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Björn Stessel
- Department of Intensive Care Medicine, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | | | - Anisa Hana
- Department of Intensive Care Medicine, Laurentius Ziekenhuis, Roermond, the Netherlands
| | - Clarissa I E Scheeren
- Department of Intensive Care Medicine, Zuyderland Medisch Centrum, Heerlen/Sittard, the Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Maastricht UMC+ Academy for Postgraduate Medical Education, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Gernot Marx
- Department of Intensive Care Medicine, University Hospital Rheinisch Westfälische Hochschule (RWTH) Aachen, Aachen, Germany
| | - Dieter Mesotten
- Department of Intensive Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Chahinda Ghossein-Doha
- Department of Intensive Care Medicine, Maastricht University Medical Center + (Maastricht UMC+), P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
- Department of Cardiology, Maastricht UMC+, Maastricht, the Netherlands
- School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, the Netherlands
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17
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Barbieri T, Basso G, Scicchitano S. Italian Workers at Risk During the COVID-19 Epidemic. ITALIAN ECONOMIC JOURNAL 2022; 8. [PMCID: PMC8298199 DOI: 10.1007/s40797-021-00164-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We analyze the task-content of occupations operating in about 600 sectors of the economy with a focus on the dimensions that expose workers to contagion risks during the COVID-19 epidemic. We do so in the Italian context, leveraging extremely detailed and granular information from ICP, the Italian equivalent of O*Net (the survey that describes the task content of US occupations). We find that several sectors need physical proximity to operate, mainly in services and retail trade. Workers at risk of complications from COVID-19 (mainly males above the age of 50) are concentrated in sectors characterized by little physical proximity or where working from home is feasible. We then study the sectoral lockdowns put in place by the Italian Government in March 2020. We find that governmental restrictions hit the sectors where the risk of contagion in the workplace was more widespread: the effect is stronger for proximity to the public than that with co-workers. The share of workers who have the possibility to work from home is higher in sectors that were not forced to close. The evidence we provide is useful to identify which activities pose larger risks for contagion among workers in the workplace and where to reinforce safety measures.
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Affiliation(s)
| | | | - Sergio Scicchitano
- National Institute for Public Policies Analysis (INAPP), GLO, Corso d’Italia 33, 00198 Rome, Italy
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18
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Pustahija T, Ristić M, Medić S, Vuković V, Štrbac M, Rajčević S, Patić A, Petrović V. Epidemiological characteristics of COVID-19 travel-associated cases in Vojvodina, Serbia, during 2020. PLoS One 2021; 16:e0261840. [PMID: 34941947 PMCID: PMC8699980 DOI: 10.1371/journal.pone.0261840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/12/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is currently the biggest public health problem worldwide. Intensive international travel and tourism have greatly contributed to its rapid global spreading. This study is the first comprehensive analysis of the epidemiological characteristics and clinical outcomes of the travel-associated COVID-19 cases in Vojvodina, Serbia, from March 6 to December 31, 2020 and it concerns permanent residents of Serbia. A cross-sectional study was conducted using data from the dedicated surveillance database of the Institute of Public Health of Vojvodina. Overall, 650 travel-associated COVID-19 cases were recorded in Vojvodina during the observed period, mainly imported from Bosnia and Herzegovina, followed by Austria and Germany (N = 195, 30%; N = 79, 12.15% and N = 75, 11.54%, respectively). The majority of cases were in the working-age groups, 18–44 and 45–64 years (56.46% and 34.15%, respectively). Overall, 54 (8.31%) patients developed pneumonia. In comparison to patients without pneumonia, those with pneumonia were older (mean age = 55.39 years vs. 41.34 years, p<0.01) and had a higher percentage of comorbidities (57.41% vs. 16.61%). Men were more likely to develop pneumonia than women (OR = 2.22; 95% CI: 1.14–4.30, p = 0.02), as well as those in retired-age group (OR = 4.11; 95% CI: 2.0–8.46, p<0.01). Obesity (OR = 14.40; 95% CI: 3.8–54.6, p<0.01), diabetes (OR = 9.82; 95% CI: 3.15–30.61, p<0.01) and hypertension (OR = 7.99; 95% CI: 3.98–16.02, p<0.01) were the most prominent main comorbidities as predictors of pneumonia. Our results represent general epidemiological and clinical dynamics of COVID-19 disease in Vojvodina. Also, they provide evidence that the predictors of pneumonia were: increasing age, male sex, having underlying comorbidities, an increasing number of days from the return to laboratory confirmation of COVID-19 (OR = 1.08, 95% CI: 1.03–1.12, p<0.01), as well as an increasing number of days from symptoms onset to diagnosis (OR = 1.14, 95% CI: 1.07–1.21, p<0.01), while anosmia and ageusia were protective factors for developing it (OR = 0.31, 95% CI: 0.12–0.79, p = 0.01).
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Affiliation(s)
| | - Mioljub Ristić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Snežana Medić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Vuković
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Mirjana Štrbac
- Institute of Public Health of Vojvodina, Novi Sad, Serbia
| | - Smiljana Rajčević
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandra Patić
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Microbiology with Parasitology and Immunology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Vladimir Petrović
- Institute of Public Health of Vojvodina, Novi Sad, Serbia.,Department of Epidemiology, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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19
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Toth-Manikowski SM, Caldwell J, Joo M, Chen J, Meza N, Bruinius J, Gupta S, Hannan M, Kagalwalla M, Madrid S, Melamed ML, Pacheco E, Srivastava A, Viamontes C, Lash JP, Leaf DE, Ricardo AC. Sex-related differences in mortality, acute kidney injury, and respiratory failure among critically ill patients with COVID-19. Medicine (Baltimore) 2021; 100:e28302. [PMID: 34918709 PMCID: PMC8677989 DOI: 10.1097/md.0000000000028302] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/22/2021] [Indexed: 01/05/2023] Open
Abstract
Although the number of deaths due to coronavirus disease 2019 (COVID-19) is higher in men than women, prior studies have provided limited sex-stratified clinical data.We evaluated sex-related differences in clinical outcomes among critically ill adults with COVID-19.Multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units at 67 U.S. hospitals from March 4 to May 9, 2020. Multilevel logistic regression was used to evaluate 28-day in-hospital mortality, severe acute kidney injury (AKI requiring kidney replacement therapy), and respiratory failure occurring within 14 days of intensive care unit admission.A total of 4407 patients were included (median age, 62 years; 2793 [63.4%] men; 1159 [26.3%] non-Hispanic White; 1220 [27.7%] non-Hispanic Black; 994 [22.6%] Hispanic). Compared with women, men were younger (median age, 61 vs 64 years, less likely to be non-Hispanic Black (684 [24.5%] vs 536 [33.2%]), and more likely to smoke (877 [31.4%] vs 422 [26.2%]). During median follow-up of 14 days, 1072 men (38.4%) and 553 women (34.3%) died. Severe AKI occurred in 590 men (21.8%), and 239 women (15.5%), while respiratory failure occurred in 2255 men (80.7%) and 1234 women (76.5%). After adjusting for age, race/ethnicity and clinical variables, compared with women, men had a higher risk of death (OR, 1.50, 95% CI, 1.26-1.77), severe AKI (OR, 1.92; 95% CI 1.57-2.36), and respiratory failure (OR, 1.42; 95% CI, 1.11-1.80).In this multicenter cohort of critically ill adults with COVID-19, men were more likely to have adverse outcomes compared with women.
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Affiliation(s)
| | - Jillian Caldwell
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Min Joo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jinsong Chen
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Natalie Meza
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Jacob Bruinius
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Shruti Gupta
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Mary Hannan
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | | | - Samantha Madrid
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Michal L. Melamed
- Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY
| | - Esther Pacheco
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Anand Srivastava
- Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - David E. Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
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20
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Hachim IY, Hachim MY, Talaat IM, López-Ozuna VM, Saheb Sharif-Askari N, Al Heialy S, Halwani R, Hamid Q. The Molecular Basis of Gender Variations in Mortality Rates Associated With the Novel Coronavirus (COVID-19) Outbreak. Front Mol Biosci 2021; 8:728409. [PMID: 34604307 PMCID: PMC8484873 DOI: 10.3389/fmolb.2021.728409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023] Open
Abstract
Since the outbreak of the novel coronavirus disease (COVID-19) at the end of 2019, the clinical presentation of the disease showed a great heterogeneity with a diverse impact among different subpopulations. Emerging evidence from different parts of the world showed that male patients usually had a longer disease course as well as worse outcome compared to female patients. A better understanding of the molecular mechanisms behind this difference might be a fundamental step for more effective and personalized response to this disease outbreak. For that reason, here we investigate the molecular basis of gender variations in mortality rates related to COVID-19 infection. To achieve this, we used publicly available lung transcriptomic data from 141 females and compare it to 286 male lung tissues. After excluding Y specific genes, our results showed a shortlist of 73 genes that are differentially expressed between the two groups. Further analysis using pathway enrichment analysis revealed downregulation of a group of genes that are involved in the regulation of hydrolase activity including (CHM, DDX3X, FGFR3, SFRP2, and NLRP2) in males lungs compared to females. This pathway is believed to be essential for immune response and antimicrobial activity in the lung tissues. In contrast, our results showed an increased upregulation of angiotensin II receptor type 1 (AGTR1), a member of the renin-angiotensin system (RAS) that plays a role in angiotensin-converting enzyme 2 (ACE2) activity modulation in male lungs compared to females. Finally, our results showed a differential expression of genes involved in the immune response including the NLRP2 and PTGDR2 in lung tissues of both genders, further supporting the notion of the sex-based immunological differences. Taken together, our results provide an initial evidence of the molecular mechanisms that might be involved in the differential outcomes observed in both genders during the COVID-19 outbreak. This maybe essential for the discovery of new targets and more precise therapeutic options to treat COVID-19 patients from different clinical and epidemiological characteristics with the aim of improving their outcome.
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Affiliation(s)
- Ibrahim Y Hachim
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Dubai, United Arab Emirates
| | - Mahmood Y Hachim
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Iman Mamdouh Talaat
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Dubai, United Arab Emirates.,Department of Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Vanessa M López-Ozuna
- Woman's Breast Health Centre, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Saba Al Heialy
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Rabih Halwani
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Dubai, United Arab Emirates.,Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Qutayba Hamid
- Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates.,Sharjah Institute for Medical Research, University of Sharjah, Dubai, United Arab Emirates.,Meakins-Christie Laboratories, McGill University, Montreal, QC, Canada
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21
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Global evaluation of coronavirus disease 2019 cases and clustering of similar countries. North Clin Istanb 2021; 8:321-331. [PMID: 34585065 PMCID: PMC8430355 DOI: 10.14744/nci.2021.42492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/30/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: It was aimed to be obtained descriptive values with respect to the outbreak time course, demographic structure, and symptom distribution by the help of case-based data, and to be compared countries by being grouped according to their similarities of outbreak indicators. METHODS: The data were obtained from open-access database. Univariate tests and cluster analysis were used to analyze the data. RESULTS: After the symptoms onset, the prolonged admission to the hospital significantly increases the risk of death. The average age and percentage of the male gender of the deceased cases were found to be significantly higher. In addition, the symptoms including fever, throat complaints, and dyspnea were determined in 70%. Countries were divided into four clusters according to their similarities in terms of three outbreak indicators. The differences among the clusters with regard to mean age, urban rate, and average of the outbreak indicators were found significant. CONCLUSION: Delaying treatment from the moment the symptoms appear will increase the risk of death and the average time to recovery or death was 2.5 weeks. It can be stated that the most important measure is to focus on methods that can detect the cases before symptoms. The indicators that have a very important role in defining the pandemic are also related to each other. Therefore, multivariate methods, which take these relationships into account, are able to produce more accurate information in determining the similarities of countries.
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22
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 04/05/2024] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, were significantly different in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univatiate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters were increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly with increasing disease severity. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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23
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 04/05/2024] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, were significantly different in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univatiate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters were increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly with increasing disease severity. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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24
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Bintoro SUY, Dwijayanti NMI, Pramudya D, Amrita PN, Romadhon PZ, Asmarawati TP, Bachtiar A, Hadi U. Hematologic and coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non- ICU ward: a single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000Res 2021; 10:791. [PMID: 34904053 PMCID: PMC8596187 DOI: 10.12688/f1000research.53803.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 01/08/2023] Open
Abstract
Background : This research aimed to examine and analyze risk factors for death, hematologic parameters and coagulation in COVID-19 patients at RSUD Dr. Soetomo Surabaya, one of the referral centers for probable COVID-19 patient cases in East Java. Method : This was a retrospective analytical study by taking secondary data on patients with probable COVID-19 cases who were treated in hospital isolation rooms from May to September, 2020. Result : Of 538 probable COVID-19 patients, 217 were tested positive, with an average age of 52.11±13.12 years, and there were 38 death cases. Hematologic parameters, such as white blood cell, neutrophil and lymphocyte counts, showed significantly different result in the deceased group. On the other hand, coagulation parameters, consisting of D-dimer, CRP, PT, and aPTT showed significantly similar value in the deceased group. Univariate analysis concluded that chronic kidney disease, diabetes mellitus, coronary heart disease, WBC, NLR, and PPT counts could predict the mortality, while multivariate analysis revealed that coronary heart disease was the only significant independent predictor of mortality. Conclusion : This research shows that hematologic and coagulation parameters increased in the majority of COVID-19 patients and the deceased group. While the number of neutrophils and WBC increases, the number of lymphocytes decreases significantly as the disease gets more severe.. Coronary heart disease is an independent predictor of mortality.
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Affiliation(s)
- Siprianus Ugroseno Yudho Bintoro
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Ni Made Intan Dwijayanti
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Dana Pramudya
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Putu Niken Amrita
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Pradana Zaky Romadhon
- Hematology – Medical Oncology Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
| | - Tri Pudy Asmarawati
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Arief Bachtiar
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Department of Pulmonology and Respiratory Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
| | - Usman Hadi
- Dr. Soetomo General Teaching Hospital, Surabaya, East Java, 60286, Indonesia
- Tropical and Infectious Diseases Division, Department of Internal Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia
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Zhu J, Wei Z, Suryavanshi M, Chen X, Xia Q, Jiang J, Ayodele O, Bradbury BD, Brooks C, Brown CA, Cheng A, Critchlow CW, Devercelli G, Gandhi V, Gondek K, Londhe AA, Ma J, Jonsson-Funk M, Keenan HA, Manne S, Ren K, Sanders L, Yu P, Zhang J, Zhou L, Bao Y. Characteristics and outcomes of hospitalised adults with COVID-19 in a Global Health Research Network: a cohort study. BMJ Open 2021; 11:e051588. [PMID: 34362806 PMCID: PMC8350974 DOI: 10.1136/bmjopen-2021-051588] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To examine age, gender, and temporal differences in baseline characteristics and clinical outcomes of adult patients hospitalised with COVID-19. DESIGN A cohort study using deidentified electronic medical records from a Global Research Network. SETTING/PARTICIPANTS 67 456 adult patients hospitalised with COVID-19 from the USA; 7306 from Europe, Latin America and Asia-Pacific between February 2020 and January 2021. RESULTS In the US cohort, compared with patients 18-34 years old, patients ≥65 had a greater risk of intensive care unit (ICU) admission (adjusted HR (aHR) 1.73, 95% CI 1.58 to 1.90), acute respiratory distress syndrome(ARDS)/respiratory failure (aHR 1.86, 95% CI 1.76 to 1.96), invasive mechanical ventilation (IMV, aHR 1.93, 95% CI, 1.73 to 2.15), and all-cause mortality (aHR 5.6, 95% CI 4.36 to 7.18). Men appeared to be at a greater risk for ICU admission (aHR 1.34, 95% CI 1.29 to 1.39), ARDS/respiratory failure (aHR 1.24, 95% CI1.21 to 1.27), IMV (aHR 1.38, 95% CI 1.32 to 1.45), and all-cause mortality (aHR 1.16, 95% CI 1.08 to 1.24) compared with women. Moreover, we observed a greater risk of adverse outcomes during the early pandemic (ie, February-April 2020) compared with later periods. In the ex-US cohort, the age and gender trends were similar; for the temporal trend, the highest proportion of patients with all-cause mortality were also in February-April 2020; however, the highest percentages of patients with IMV and ARDS/respiratory failure were in August-October 2020 followed by February-April 2020. CONCLUSIONS This study provided valuable information on the temporal trends of characteristics and outcomes of hospitalised adult COVID-19 patients in both USA and ex-USA. It also described the population at a potentially greater risk for worse clinical outcomes by identifying the age and gender differences. Together, the information could inform the prevention and treatment strategies of COVID-19. Furthermore, it can be used to raise public awareness of COVID-19's impact on vulnerable populations.
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Affiliation(s)
- Julia Zhu
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Zhongyuan Wei
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Manasi Suryavanshi
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Xiu Chen
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Qian Xia
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Jenny Jiang
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - Olulade Ayodele
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Brian D Bradbury
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Corinne Brooks
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Carolyn A Brown
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Alvan Cheng
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Cathy W Critchlow
- Research & Development Strategy & Operations, Amgen, Inc, Thousand Oaks, California, USA
| | - Giovanna Devercelli
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Vivek Gandhi
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kathleen Gondek
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Ajit A Londhe
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Junjie Ma
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Michele Jonsson-Funk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hillary A Keenan
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Sudhakar Manne
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Kaili Ren
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Lynn Sanders
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Peter Yu
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Jie Zhang
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California, USA
| | - Linyun Zhou
- Data Sciences Institute, Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts, USA
| | - Ying Bao
- Center for Observational Research and Data Science, Bristol-Myers Squibb, Princeton, New Jersey, USA
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Al-Rawi A, Grepin K, Li X, Morgan R, Wenham C, Smith J. Investigating Public Discourses Around Gender and COVID-19: a Social Media Analysis of Twitter Data. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2021; 5:249-269. [PMID: 34258510 PMCID: PMC8266166 DOI: 10.1007/s41666-021-00102-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022]
Abstract
We collected over 50 million tweets referencing COVID-19 to understand the public’s gendered discourses and concerns during the pandemic. We filtered the tweets based on English language and among three gender categories: men, women, and sexual and gender minorities. We used a mixed-method approach that included topic modelling, sentiment analysis, and text mining extraction procedures including words’ mapping, proximity plots, top hashtags and mentions, and most retweeted posts. Our findings show stark differences among the different genders. In relation to women, we found a salient discussion on the risks of domestic violence due to the lockdown especially towards women and girls, while emphasizing financial challenges. The public discourses around SGM mostly revolved around blood donation concerns, which is a reminder of the discrimination against some of these communities during the early days of the HIV/AIDS epidemic. Finally, the discourses around men were focused on the high death rates and the sentiment analysis results showed more negative tweets than among the other genders. The study concludes that Twitter influencers can drive major online discussions which can be useful in addressing communication needs during pandemics.
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Affiliation(s)
- Ahmed Al-Rawi
- School of Communication, Simon Fraser University, Schrum Science Centre-K 9653, Burnaby, BC V5A 1S6 Canada
| | - Karen Grepin
- School of Public Health, Hong Kong University, Pok Fu Lam, Hong Kong
| | - Xiaosu Li
- School of Communication, Simon Fraser University, Schrum Science Centre-K 9653, Burnaby, BC V5A 1S6 Canada
| | - Rosemary Morgan
- Bloomberg School of Public Health, John Hopkins University, Baltimore, MD USA
| | - Clare Wenham
- Department of Health Policy, London School of Economics, London, UK
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Schrum Science Centre-K 9653, Burnaby, BC V5A 1S6 Canada
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Cash-Gibson L, Pericàs JM, Martinez-Herrera E, Benach J. Health Inequalities in the Time of COVID-19: The Globally Reinforcing Need to Strengthen Health Inequalities Research Capacities. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2021; 51:300-304. [PMID: 33684016 PMCID: PMC8191151 DOI: 10.1177/0020731421993939] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and concern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society's unmet needs.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
- Institute for Research, Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín, Colombia
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
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Nordhues HC, Bhagra A, Stroud NN, Vencill JA, Kuhle CL. COVID-19 Gender Disparities and Mitigation Recommendations: A Narrative Review. Mayo Clin Proc 2021; 96:1907-1920. [PMID: 34218863 PMCID: PMC8057762 DOI: 10.1016/j.mayocp.2021.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 12/23/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has rapidly created widespread impacts on global health and the economy. Data suggest that women are less susceptible to severe illness. However, sex-disaggregated data are incomplete, leaving room for misinterpretation, and focusing only on biologic sex underestimates the gendered impact of the pandemic on women. This narrative review summarizes what is known about gender disparities during the COVID-19 pandemic and the economic, domestic, and health burdens along with overlapping vulnerabilities related to the pandemic. In addition, this review outlines recommended strategies that advocacy groups, community leaders, and policymakers should implement to mitigate the widening gender disparities related to COVID-19.
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Key Words
- covid-19, coronavirus disease 2019
- gbv, gender-based violence
- lgbtq+, lesbian, gay, bisexual, transgender, queer, and other marginalized sexual orientations
- mhpss, mental health and psychosocial support
- or, odds ratio
- srh, sexual and reproductive health
- thb, trafficking in human beings
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Affiliation(s)
- Hannah C Nordhues
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN. https://twitter.com/@HannahNordhues
| | - Anjali Bhagra
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Natya N Stroud
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jennifer A Vencill
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Carol L Kuhle
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
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Meng Y, Wong MS, Xing H, Kwan MP, Zhu R. Assessing the Country-Level Excess All-Cause Mortality and the Impacts of Air Pollution and Human Activity during the COVID-19 Epidemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6883. [PMID: 34206915 PMCID: PMC8295924 DOI: 10.3390/ijerph18136883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022]
Abstract
The impact of Coronavirus Disease 2019 (COVID-19) on cause-specific mortality has been investigated on a global scale. However, less is known about the excess all-cause mortality and air pollution-human activity responses. This study estimated the weekly excess all-cause mortality during COVID-19 and evaluated the impacts of air pollution and human activities on mortality variations during the 10th to 52nd weeks of 2020 among sixteen countries. A SARIMA model was adopted to estimate the mortality benchmark based on short-term mortality during 2015-2019 and calculate excess mortality. A quasi-likelihood Poisson-based GAM model was further applied for air pollution/human activity response evaluation, namely ground-level NO2 and PM2.5 and the visit frequencies of parks and workplaces. The findings showed that, compared with COVID-19 mortality (i.e., cause-specific mortality), excess all-cause mortality changed from -26.52% to 373.60% during the 10th to 52nd weeks across the sixteen countries examined, revealing higher excess all-cause mortality than COVID-19 mortality in most countries. For the impact of air pollution and human activities, the average country-level relative risk showed that one unit increase in weekly NO2, PM2.5, park visits and workplace visits was associated with approximately 1.54% increase and 0.19%, 0.23%, and 0.23% decrease in excess all-cause mortality, respectively. Moreover, compared with the impact on COVID-19 mortality, the relative risks of weekly NO2 and PM2.5 were lower, and the relative risks of weekly park and workplace visits were higher for excess all-cause mortality. These results suggest that the estimation based on excess all-cause mortality reduced the potential impact of air pollution and enhanced the influence of human activities compared with the estimation based on COVID-19 mortality.
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Affiliation(s)
- Yuan Meng
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
| | - Man Sing Wong
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
- Research Institute for Sustainable Urban Development, The Hong Kong Polytechnic University, Hong Kong
| | - Hanfa Xing
- School of Geography, South China Normal University, Guangzhou 510000, China;
- College of Geography and Environment, Shandong Normal University, Jinan 250000, China
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong;
- Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong
- Department of Human Geography and Spatial Planning, Utrecht University, 3584 CB Utrecht, The Netherlands
| | - Rui Zhu
- Department of Land Surveying and Geo-Informatics, The Hong Kong Polytechnic University, Hong Kong; (Y.M.); (R.Z.)
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Excess mortality by specific causes of deaths in the city of São Paulo, Brazil, during the COVID-19 pandemic. PLoS One 2021; 16:e0252238. [PMID: 34097694 PMCID: PMC8184000 DOI: 10.1371/journal.pone.0252238] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To investigate the excess of deaths by specific causes, in the first half of 2020 in the city of São Paulo-Brazil, during the COVID-19 pandemic. METHODS Ecological study conducted from 01/01 to 06/30 of 2019 and 2020. Population and mortality data were obtained from DATASUS. The standardized mortality ratio (SMR) by age was calculated by comparing the standardized mortality rate in 2020 to that of 2019, for overall and specific mortality. The ratio between the standardized mortality rate due to COVID-19 in men as compared to women was calculated for 2020. Crude mortality rates were standardized using the direct method. RESULTS COVID-19 was responsible for 94.4% of the excess deaths in São Paulo. In 2020 there was an increase in overall mortality observed among both men (SMR 1.3, 95% CI 1.17-1.42) and women (SMR 1.2, 95% CI 1.06-1.36) as well as a towards reduced mortality for all cancers. Mortality due to COVID-19 was twice as high for men as for women (SMR 2.1, 95% CI 1.67-2.59). There was an excess of deaths observed in men above 45 years of age, and in women from the age group of 60 to 79 years. CONCLUSION There was an increase in overall mortality during the first six months of 2020 in São Paulo, which seems to be related to the COVID-19 pandemic. Chronic health conditions, such as cancer and other non-communicable diseases, should not be disregarded.
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Alshammary F, Siddiqui AA, Amin J, Ilyas M, Rathore HA, Hassan I, Alam MK, Kamal MA. Prevention Knowledge and Its Practice Towards COVID-19 Among General Population of Saudi Arabia: A Gender-based Perspective. Curr Pharm Des 2021; 27:1642-1648. [PMID: 32811408 DOI: 10.2174/1381612826666200818213558] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/16/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study is an original contribution to the gender-based perspective of measuring knowledge and practice towards COVID-19 among the Saudi population. OBJECTIVE This study investigates the existing knowledge of COVID-19 among both genders and its likely use in practice to combat COVID-19. DESIGN AND SETTING Cross-sectional study with an online survey and data collected from all the five regions of Saudi Arabia. PARTICIPANTS AND METHODS A structured, self-reported validated questionnaire was developed based on the World Health Organization (WHO) general public advice towards COVID-19 prevention. This study has employed snow-ball sampling technique. SAMPLE SIZE 627 participants (Male n=343, 54.7%) and (Females n=284, 45.3%). RESULTS This study has found that women not only carry better knowledge, but their practicing behavior is far better than the male respondents. Females practiced their knowledge of hands hygiene more in comparison to males (86% vs. 80 %, p >0.05). Female respondents were also practicing more about sneezing/coughing into their elbows as compared to males (79% vs. 71%, p < 0.05). Likewise, the practice of knowledge of staying at home to prevent infection (females 98.2% vs males 95.5%, p > 0.05), and (females 83.2% vs. males 81.5%, p > 0.05), respectively. CONCLUSION This study shows that women were more compliant with the WHO public health COVID-19 prevention advice than men, which can decrease the chances of COVID-19 infection.
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Affiliation(s)
- Freah Alshammary
- College of Dentistry, Preventive Dental Sciences, University of Hail, Ha'il, Saudi Arabia
| | - Ammar Ahmed Siddiqui
- College of Dentistry, Preventive Dental Sciences, University of Hail, Ha'il, Saudi Arabia
| | - Junaid Amin
- College of Applied Medical Sciences, University of Hail, Ha'il, Saudi Arabia
| | - Muhammad Ilyas
- College of Business Management, University of Hail, Ha'il, Saudi Arabia
| | | | - Ibne Hassan
- College of Business Management, University of Hail, Ha'il, Saudi Arabia
| | | | - Mohammad Amjad Kamal
- King Fahad Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
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Assunção AÁ, Maia EG, Jardim R, de Araújo TM. Incidence of Reported Flu-Like Syndrome Cases in Brazilian Health Care Workers in 2020 (March to June). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115952. [PMID: 34206062 PMCID: PMC8198595 DOI: 10.3390/ijerph18115952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 01/10/2023]
Abstract
Health care workers (HCWs) are at an increased risk of being exposed to COVID-19. This study aimed to characterize flu-like syndrome cases (FS) in HCWs notified in Brazil and compare them with FS cases in the general community (GC). In the Brazilian protocol, FS corresponds to a suspected case of COVID-19. The manuscript analyzed cases of FS in five Brazilian states, estimating the incidence rates of cases of FS and clinical and epidemiological characteristics. Registered cases (March to June 2020) totaled about 1,100,000 cases of FS. HCWs represented 17% of the registers, whose incidence was 20.41/100 vs. 2.15/100 in the GC. FS cases in HCWs concentrated the highest percentages in the age group of 30 to 49 years (65.15%) and among the nursing staff (46.86%). This study was the first interstate evaluation in Brazil to estimate suspected cases of FS by COVID-19 in HCWs. In order to control the spread of viral respiratory infections in HCWs, including COVID-19, it is necessary to review the management of health information to identify who they are, how many they are, and to what situations these workers are most frequently exposed, as well as in what professions they have. This information can guide specific, practical, and far-reaching actions.
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Affiliation(s)
- Ada Ávila Assunção
- Departamento de Medicina Preventiva e Social, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, Brazil
- Correspondence:
| | - Emanuella Gomes Maia
- Departamento de Ciências da Saúde, Universidade Estadual de Santa Cruz, Ilhéus 45662-900, Brazil;
| | - Renata Jardim
- Departamento de Educação e Saúde, Universidade Federal de Sergipe, Lagarto 49100-000, Brazil;
| | - Tânia Maria de Araújo
- Departamento de Saúde, Universidade Estadual de Feira de Santana, Feira de Santana 44036-900, Brazil;
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Goujon A, Natale F, Ghio D, Conte A. Demographic and territorial characteristics of COVID-19 cases and excess mortality in the European Union during the first wave. JOURNAL OF POPULATION RESEARCH 2021; 39:533-556. [PMID: 34093083 PMCID: PMC8164406 DOI: 10.1007/s12546-021-09263-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2021] [Indexed: 01/01/2023]
Abstract
This article explores for a large number of countries in the European Union (plus the United Kingdom) the main demographic differentials in positive tested COVID-19 cases and excess mortality during the first wave in 2020, accounting for differences at territorial level, where population density and size play a main role in the diffusion and effects of the disease in terms of morbidity and mortality. This knowledge complements and refines the epidemiological information about the spread and impact of the virus. For this analysis, we rely on the descriptive exploration of (1) data from The European Surveillance System (TESSy) database developed at the European Centre for Disease Prevention and Control (ECDC) on the number of cases and fatality rates and (2) of weekly mortality data collected by Eurostat. The analysis at territorial level studies the changes in R0-the basic reproduction number-and median excess mortality, across territories with different levels of urbanization. The unique findings of this study encompassing most European Union Member States confirm and define the demographic and territorial differential impacts in terms of infections and fatalities during the first wave of the pandemic in 2020. The information is important for stakeholders at European Union, national and sub-national levels in charge of designing containment measures for COVID-19 and adaptation policies for the future by anticipating the rebound for certain segments of the population with differential medical and economic needs.
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Affiliation(s)
- Anne Goujon
- European Commission Joint Research Centre, Ispra, Italy
| | | | - Daniela Ghio
- European Commission Joint Research Centre, Ispra, Italy
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Nair VS, Banerjee D. "Crisis Within the Walls": Rise of Intimate Partner Violence During the Pandemic, Indian Perspectives. Front Glob Womens Health 2021; 2:614310. [PMID: 34816184 PMCID: PMC8594051 DOI: 10.3389/fgwh.2021.614310] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/20/2021] [Indexed: 01/27/2023] Open
Abstract
The ongoing coronavirus disease 2019 pandemic has been a social "un-equalizer," besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge-attitude-practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind "closed doors" are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a "hidden pandemic" during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.
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Affiliation(s)
- Vasundharaa S. Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India,*Correspondence: Debanjan Banerjee
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Tejpal A, Gianos E, Cerise J, Hirsch JS, Rosen S, Kohn N, Lesser M, Weinberg C, Majure D, Satapathy SK, Bernstein D, Barish MA, Spyropoulos AC, Brown RM. Sex-Based Differences in COVID-19 Outcomes. J Womens Health (Larchmt) 2021; 30:492-501. [PMID: 33885345 DOI: 10.1089/jwh.2020.8974] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Smaller studies suggest lower morbidity and mortality associated with coronavirus disease 2019 (COVID-19) in women. Our aim is to assess the impact of female sex on outcomes in a large cohort of patients hospitalized with COVID-19. Materials and Methods: This is a retrospective observational cohort study of 10,630 adult patients hospitalized with a confirmed COVID-19 polymerase chain reaction between March 1, 2020 and April 27, 2020, with follow-up conducted through June 4, 2020. Logistic regression was used to examine the relationship between sex and the primary outcomes, including length of stay, admission to intensive care unit (ICU), need for mechanical ventilation, pressor requirement, and all-cause mortality as well as major adverse events and in-hospital COVID-19 treatments. Results: In the multivariable analysis, women had 27% lower odds of in-hospital mortality (odds ratio [OR] = 0.73, 95% confidence interval [CI] 0.66-0.81; p < 0.001), 24% lower odds of ICU admission (OR = 0.76, 95% CI 0.69-0.84; p < 0.001), 26% lower odds of mechanical ventilation (OR = 0.74, 95% CI 0.66-0.82; p < 0.001), and 25% lower odds of vasopressor requirement (OR = 0.75, 95% CI 0.67-0.84; p < 0.001). Women had 34% less odds of having acute cardiac injury (OR = 0.66, 95% CI 0.59-0.74; p < 0.001; n = 7,289), 16% less odds of acute kidney injury (OR = 0.84, 95% CI 0.76-0.92; p < 0.001; n = 9,840), and 27% less odds of venous thromboembolism (OR = 0.73, 95% CI 0.56-0.96; p < 0.02; c-statistic 0.85, n = 9,407). Conclusions: Female sex is associated with lower odds of in-hospital outcomes, major adverse events, and all-cause mortality. There may be protective mechanisms inherent to female sex, which explain differences in COVID-19 outcomes.
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Affiliation(s)
- Astha Tejpal
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Eugenia Gianos
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - Jane Cerise
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Jamie S Hirsch
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Department of Nephrology and Hypertension, North Shore University Hospital, Manhasset, New York, USA.,Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Stacey Rosen
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Cardiology, North Shore University Medical Center, Manhasset, New York, USA
| | - Nina Kohn
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Martin Lesser
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
| | - Catherine Weinberg
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
| | - David Majure
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Cardiology, North Shore University Medical Center, Manhasset, New York, USA
| | - Sanjaya K Satapathy
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Hepatology, North Shore University Medical Center, Manhasset, New York, USA
| | - David Bernstein
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Division of Hepatology, North Shore University Medical Center, Manhasset, New York, USA
| | - Matthew A Barish
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Department of Radiology, North Shore University Hospital, Northwell Health, Manhasset, New York, USA
| | - Alex C Spyropoulos
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA.,Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA.,Department of Internal Medicine, North Shore University Medical Center, Manhasset, New York, USA
| | - Rachel-Maria Brown
- Division of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, New York, USA
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36
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The Collateral Damage of the COVID-19 Outbreak on Mental Health and Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094440. [PMID: 33922054 PMCID: PMC8122618 DOI: 10.3390/ijerph18094440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/20/2021] [Accepted: 04/09/2021] [Indexed: 12/12/2022]
Abstract
The potential consequences of the COVID-19 outbreak are multifarious and remain largely unknown. Deaths as a direct result of the condition are already in the millions, and the number of indirect deaths is likely to be even higher. Pre-existing historical inequalities are compounded by the virus, driving increased rates of infection and deaths amongst people who use drugs and alcohol, those belonging to racial-ethnic minority groups, poorer communities, LBGTQ+ populations, healthcare workers, and other members of the care economy; all of whom are already at increased risk of adverse mental health effects. In this paper we suggest that a central role of mental health practitioners is advocacy: both for people who use psychiatric services and for those who, due to the effects of the pandemic, are at an increased risk of needing to do so.
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Shi MJ, Lv JG, Lin L, Guo JY. Trends in Coronavirus Disease 2019 Hospitalization and Prognosis: Gender Effect. Curr Med Sci 2021; 41:312-317. [PMID: 33877547 PMCID: PMC8056196 DOI: 10.1007/s11596-021-2348-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/27/2021] [Indexed: 01/08/2023]
Abstract
We here aimed to investigate the impact of gender on the clinical characteristics and laboratory results of patients with coronavirus disease 2019 (COVID-19) and provide clues to the pathological mechanisms underlying COVID-19. A retrospective study was performed. Clinical characteristics, severity of lung infection, laboratory results, and prognoses of patients of different gender were analyzed. A total of 242 patients were finally included. The median age was 58 years (IQR: 40–68), including 54 (22.3%) hospital staffs. Ninety-four (38.8%) were male and 148 (61.1%) were female. The proportion of patients with diabetes was significantly higher in the male group than in the female group (P=0.034). Male patients had a significantly larger proportion of severe lung infection, higher leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, C-reactive protein, and procalcitonin than female. Furthermore, male patients had worse liver, cardiac, and coagulation function than their female counterparts. Male patients with COVID-19 showed more severe inflammation reaction and coagulation dysfunction than female patients. In conclusion, gender is associated with host response to SARS-CoV-2 infection.
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Affiliation(s)
- Mei-Jing Shi
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Department of Emergence, General Hospital of the Yangtze River Shipping, Wuhan, 430030, China
| | - Jia-Gao Lv
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Lin
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jun-Yi Guo
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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38
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Tsai S, Nguyen H, Ebrahimi R, Barbosa MR, Ramanan B, Heitjan DF, Hastings JL, Modrall JG, Jeon-Slaughter H. COVID-19 associated mortality and cardiovascular disease outcomes among US women veterans. Sci Rep 2021; 11:8497. [PMID: 33875764 PMCID: PMC8055870 DOI: 10.1038/s41598-021-88111-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/01/2021] [Indexed: 12/13/2022] Open
Abstract
The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research. We conducted an observational study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We assembled a retrospective cohort from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. A case was defined as a woman veteran who tested positive for SARS-COV-2, and a control as a woman veteran who tested negative. We used Kaplan-Meier curves and the Cox proportional hazards model to examine the distribution of time to death and the effects of baseline predictors on mortality risk. We used generalized linear models to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date. Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Confidence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no significant race difference in mortality, cardiovascular events, or onset of heart disease. SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted.
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Affiliation(s)
- Shirling Tsai
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hang Nguyen
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Southern Methodist University, Dallas, TX, USA
| | - Ramin Ebrahimi
- Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Monica R Barbosa
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bala Ramanan
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Daniel F Heitjan
- Southern Methodist University, Dallas, TX, USA
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeffrey L Hastings
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - J Gregory Modrall
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Haekyung Jeon-Slaughter
- Veterans Affairs North Texas Health Care System, Dallas, TX, USA.
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Stratton P, Gorodetsky E, Clayton J. Pregnant in the United States in the COVID-19 pandemic: A collision of crises we cannot ignore. J Natl Med Assoc 2021; 113:499-503. [PMID: 33883068 PMCID: PMC8542420 DOI: 10.1016/j.jnma.2021.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/02/2021] [Accepted: 03/21/2021] [Indexed: 01/20/2023]
Abstract
NO abstract intended, Introduction is listed here The COVID-19 pandemic and call for social justice is occurring when the United States, unlike its peer countries, has already experienced a steady 20-year rise in maternal morbidity and mortality with pregnant women today facing a 50 percent higher risk of mortality than their mothers. 1 Most vulnerable are women of color, black and American Indian/Alaska Native women, who have experienced longstanding disparities in access to and quality of healthcare and may begin pregnancy with hypertension, diabetes, and obesity, complications known to be more common in women enduring segregation. 2–4 Initially, the race-related health disparities and resultant disproportionately higher rates of COVID-19 cases and mortality in indigenous communities and black, latinx, or other communities of color were mistakenly considered innate racial differences. More recently, these higher rates have been attributed to underlying social, structural, and environmental determinants of health including resource inequities, inadequate housing, and occupational and environmental hazards that result in greater exposure to and less protection from COVID-19. 5,6 Augmented by the added physiologic stress of pregnancy, these comorbidities and disparities compound the risk of pregnancy-associated cardiomyopathy, thromboembolism, and hemorrhage, often resulting in lasting physical and mental health consequences.
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Affiliation(s)
- Pamela Stratton
- Scientific Consulting Group, Inc., Gaithersburg, MD, United States; Office of the Clinical Director, Intramural Research Program, National Institute of Neurological Disorders and Stroke, Bethesda, MD, United States.
| | - Elena Gorodetsky
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Janine Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
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40
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Desai S, Deshmukh N, Pramanik S. Precarity in a Time of Uncertainty: Gendered Employment Patterns during the Covid-19 Lockdown in India. FEMINIST ECONOMICS 2021; 27:152-172. [PMID: 36032646 PMCID: PMC9417195 DOI: 10.1080/13545701.2021.1876903] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
India implemented one of the world's most stringent lockdowns in response to the COVID-19 crisis. This paper examines whether the impacts of the lockdown on employment differed by gender in areas surrounding Delhi. An ongoing monthly employment survey between March 2019 and May 2020 allows for comparison in employment before and after the lockdown. Estimates based on random-effects logistic regression models show that for men, the predicted probability of employment declined from 0.88 to 0.57, while that for women fell from 0.34 to 0.22. Women's concentration in self-employment may be one of the reasons why women's employment was somewhat protected. However, when we look only at wage workers, we find that women experienced greater job losses than men with predicted employment probability for wage employment for men declining by 40 percent compared to 72 percent for women.
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Affiliation(s)
- Sonalde Desai
- University of Maryland, Department of Sociology and NCAER
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41
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Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry 2021; 20:124-130. [PMID: 33026219 PMCID: PMC7675495 DOI: 10.1002/wps.20806] [Citation(s) in RCA: 405] [Impact Index Per Article: 135.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Concerns have been expressed that persons with a pre-existing mental disorder may represent a population at increased risk for COVID-19 infec-tion and with a higher likelihood of adverse outcomes of the infection, but there is no systematic research evidence in this respect. This study assessed the impact of a recent (within past year) diagnosis of a mental disorder - including attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, depression and schizophrenia - on the risk for COVID-19 infection and related mortality and hospitalization rates. We analyzed a nation-wide database of electronic health records of 61 million adult patients from 360 hospitals and 317,000 providers, across 50 states in the US, up to July 29, 2020. Patients with a recent diagnosis of a mental disorder had a significantly increased risk for COVID-19 infection, an effect strongest for depression (adjusted odds ratio, AOR=7.64, 95% CI: 7.45-7.83, p<0.001) and schizophrenia (AOR=7.34, 95% CI: 6.65-8.10, p<0.001). Among patients with a recent diagnosis of a mental disorder, African Americans had higher odds of COVID-19 infection than Caucasians, with the strongest ethnic disparity for depression (AOR=3.78, 95% CI: 3.58-3.98, p<0.001). Women with mental disorders had higher odds of COVID-19 infection than males, with the strongest gender disparity for ADHD (AOR=2.03, 95% CI: 1.73-2.39, p<0.001). Patients with both a recent diagnosis of a mental disorder and COVID-19 infection had a death rate of 8.5% (vs. 4.7% among COVID-19 patients with no mental disorder, p<0.001) and a hospitalization rate of 27.4% (vs. 18.6% among COVID-19 patients with no mental disorder, p<0.001). These findings identify individuals with a recent diagnosis of a mental disorder as being at increased risk for COVID-19 infection, which is further exacerbated among African Americans and women, and as having a higher frequency of some adverse outcomes of the infection. This evidence highlights the need to identify and address modifiable vulnerability factors for COVID-19 infection and to prevent delays in health care provision in this population.
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Affiliation(s)
- QuanQiu Wang
- Center for Artificial Intelligence in Drug DiscoverySchool of Medicine, Case Western Reserve UniversityClevelandOHUSA
| | - Rong Xu
- Center for Artificial Intelligence in Drug DiscoverySchool of Medicine, Case Western Reserve UniversityClevelandOHUSA
| | - Nora D. Volkow
- National Institute on Drug AbuseNational Institutes of HealthBethesdaMDUSA
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Ewer KJ, Barrett JR, Belij-Rammerstorfer S, Sharpe H, Makinson R, Morter R, Flaxman A, Wright D, Bellamy D, Bittaye M, Dold C, Provine NM, Aboagye J, Fowler J, Silk SE, Alderson J, Aley PK, Angus B, Berrie E, Bibi S, Cicconi P, Clutterbuck EA, Chelysheva I, Folegatti PM, Fuskova M, Green CM, Jenkin D, Kerridge S, Lawrie A, Minassian AM, Moore M, Mujadidi Y, Plested E, Poulton I, Ramasamy MN, Robinson H, Song R, Snape MD, Tarrant R, Voysey M, Watson MEE, Douglas AD, Hill AVS, Gilbert SC, Pollard AJ, Lambe T. T cell and antibody responses induced by a single dose of ChAdOx1 nCoV-19 (AZD1222) vaccine in a phase 1/2 clinical trial. Nat Med 2021; 27:270-278. [PMID: 33335323 DOI: 10.1038/s41591-020-01194-5] [Citation(s) in RCA: 386] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Coronavirus Disease 2019 (COVID-19), has caused a global pandemic, and safe, effective vaccines are urgently needed1. Strong, Th1-skewed T cell responses can drive protective humoral and cell-mediated immune responses2 and might reduce the potential for disease enhancement3. Cytotoxic T cells clear virus-infected host cells and contribute to control of infection4. Studies of patients infected with SARS-CoV-2 have suggested a protective role for both humoral and cell-mediated immune responses in recovery from COVID-19 (refs. 5,6). ChAdOx1 nCoV-19 (AZD1222) is a candidate SARS-CoV-2 vaccine comprising a replication-deficient simian adenovirus expressing full-length SARS-CoV-2 spike protein. We recently reported preliminary safety and immunogenicity data from a phase 1/2 trial of the ChAdOx1 nCoV-19 vaccine (NCT04400838)7 given as either a one- or two-dose regimen. The vaccine was tolerated, with induction of neutralizing antibodies and antigen-specific T cells against the SARS-CoV-2 spike protein. Here we describe, in detail, exploratory analyses of the immune responses in adults, aged 18-55 years, up to 8 weeks after vaccination with a single dose of ChAdOx1 nCoV-19 in this trial, demonstrating an induction of a Th1-biased response characterized by interferon-γ and tumor necrosis factor-α cytokine secretion by CD4+ T cells and antibody production predominantly of IgG1 and IgG3 subclasses. CD8+ T cells, of monofunctional, polyfunctional and cytotoxic phenotypes, were also induced. Taken together, these results suggest a favorable immune profile induced by ChAdOx1 nCoV-19 vaccine, supporting the progression of this vaccine candidate to ongoing phase 2/3 trials to assess vaccine efficacy.
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Affiliation(s)
- Katie J Ewer
- The Jenner Institute, University of Oxford, Oxford, UK.
| | | | | | - Hannah Sharpe
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | | | - Amy Flaxman
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Daniel Wright
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | | | - Christina Dold
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Jamie Fowler
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Sarah E Silk
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Jennifer Alderson
- The Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Brian Angus
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Eleanor Berrie
- Clinical Biomanufacturing Facility, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Paola Cicconi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Irina Chelysheva
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Catherine M Green
- Clinical Biomanufacturing Facility, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Daniel Jenkin
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Simon Kerridge
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Alison Lawrie
- The Jenner Institute, University of Oxford, Oxford, UK
| | | | - Maria Moore
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Yama Mujadidi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Emma Plested
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Ian Poulton
- The Jenner Institute, University of Oxford, Oxford, UK
| | - Maheshi N Ramasamy
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Hannah Robinson
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Rinn Song
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Matthew D Snape
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Richard Tarrant
- Clinical Biomanufacturing Facility, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | | | | | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Teresa Lambe
- The Jenner Institute, University of Oxford, Oxford, UK.
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43
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Socioeconomic Inequalities in COVID-19 in a European Urban Area: Two Waves, Two Patterns. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031256. [PMID: 33573323 PMCID: PMC7908269 DOI: 10.3390/ijerph18031256] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/17/2021] [Accepted: 01/24/2021] [Indexed: 01/07/2023]
Abstract
Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41–1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44–1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe.
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Maertl T, De Bock F, Huebl L, Oberhauser C, Coenen M, Jung-Sievers C. Physical Activity during COVID-19 in German Adults: Analyses in the COVID-19 Snapshot Monitoring Study (COSMO). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E507. [PMID: 33435497 PMCID: PMC7827974 DOI: 10.3390/ijerph18020507] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/24/2020] [Accepted: 01/06/2021] [Indexed: 12/15/2022]
Abstract
The novel coronavirus (COVID-19) and the resulting outbreak response measures in Germany and worldwide led to severe limitations in everyday life. This affected all sorts of daily activities and the possibility for physical activity (PA), which represents a major coping strategy against stress. The objective of this study was to analyse PA in German adults during a total lockdown phase including school closures in April 2020 in certain subgroups and in relation to other coping strategies. Data from the COVID-19 Snapshot Monitoring (COSMO) survey, an online cross-sectional study with 1034 participants between 18 and 74 years, were utilised (14/15 April 2020). In addition to descriptive analyses, the odds of performing PA according to the World Health Organization (WHO) recommendations for adults (at least 2.5 h/week of at least moderate intensity) were analysed by univariate and multivariate logistic regression analyses. In total, 440 (42.6%) participants fulfilled this criterion. Participants with children <6 years were less likely to meet the WHO recommendation (OR = 0.51; 95% CI: 0.33-0.78), while those with a higher level of education, good coping behaviour, regular alcohol consumption, and being satisfied with life were more likely to meet the WHO recommendation. In conclusion, PA intervention strategies tailored to specific vulnerable subgroups such as individuals with low educational background and parents with young children are needed in future pandemic response.
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Affiliation(s)
- Theresa Maertl
- Institute for Medical Information Processing, Biometry and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (T.M.); (C.O.); (M.C.)
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Freia De Bock
- Federal Centre for Health Education, Maarweg 149-161, 50825 Cologne, Germany;
| | - Lena Huebl
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany;
- I. Department of Medicine, University Medical Centre Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Cornelia Oberhauser
- Institute for Medical Information Processing, Biometry and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (T.M.); (C.O.); (M.C.)
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Michaela Coenen
- Institute for Medical Information Processing, Biometry and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (T.M.); (C.O.); (M.C.)
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
| | - Caroline Jung-Sievers
- Institute for Medical Information Processing, Biometry and Epidemiology–IBE, Chair of Public Health and Health Services Research, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany; (T.M.); (C.O.); (M.C.)
- Pettenkofer School of Public Health, Elisabeth-Winterhalter-Weg 6, 81377 Munich, Germany
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Moran JK, Bretz J, Winkler J, Gutwinski S, Brandl EJ, Schouler-Ocak M. The Differential Impact of Lockdown Measures Upon Migrant and Female Psychiatric Patients - A Cross-Sectional Survey in a Psychiatric Hospital in Berlin, Germany. Front Psychiatry 2021; 12:642784. [PMID: 34122174 PMCID: PMC8192805 DOI: 10.3389/fpsyt.2021.642784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/28/2021] [Indexed: 01/07/2023] Open
Abstract
The COVID-19 pandemic could have major effects on already vulnerable individuals with psychiatric disorders. It is important to assess how different patient groups respond to stress related to the pandemic, and what additional factors influence it, including family-related stress, migration background, and sex. We conducted a survey in a sample of 294 psychiatric patients in a large outpatient clinic in Berlin, measuring level of distress in relation to COVID-19 lockdown as well as family-related distress. We also measured potential influencing factors such as media consumption and medical support. In the migration background group, we found that women had more lockdown related psychological distress than men. This was not apparent in those patients with a German background. We found that females were more strongly affected by family-related distress, particularly those with a migration background. People with PTSD were most strongly affected by family-related distress, whereas people with psychotic disorders and addiction reported the least distress. There were no effects of media consumption. There were no differences in ability to abide by the lockdown related restrictions across diagnoses. Our results support earlier findings on differential vulnerability of diagnostic groups to these stressors. Thus, clinicians can optimize treatment by taking family-related stressors into account particularly for females and people with a migrant background.
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Affiliation(s)
- James K Moran
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Bretz
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Winkler
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Eva J Brandl
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Meryam Schouler-Ocak
- Department of Psychiatry and Psychotherapy, St. Hedwig Hospital, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Li G, Liu Y, Jing X, Wang Y, Miao M, Tao L, Zhou Z, Xie Y, Huang Y, Lei J, Gong G, Jin P, Hao Y, Faria NR, Clercq ED, Zhang M. Mortality risk of COVID-19 in elderly males with comorbidities: a multi-country study. Aging (Albany NY) 2020; 13:27-60. [PMID: 33472167 PMCID: PMC7835001 DOI: 10.18632/aging.202456] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/09/2020] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic causes severe morbidity and mortality. This multi-country study aimed to explore risk factors that drive mortality in COVID-19 patients who received neither dexamethasone nor remdesivir. We analyzed a cohort of 568 survivors and 507 non-survivors from China, European regions, and North America. Elderly males ≥70 years accounted for only 25% of survivors, but this rate was significantly higher in non-survivors from China (55%), European regions (63%), and North America (47%). Compared with survivors, non-survivors had more incidences of comorbidities such as cerebrovascular disease and chronic obstructive pulmonary disease (COPD, p-values<0.05). Survival analyses revealed age, male gender, shortness of breath, cerebrovascular disease, and COPD as mortality-associated factors. Survival time from symptom onset was significantly shorter in elderly versus young patients (median: 29 versus 62 days), males versus females (median: 46 versus 59 days), and patients with versus without comorbidities (mean: 41 versus 61 days). Mortality risk was higher in elderly males with comorbidities than in young females without comorbidities (p-value<0.01). Elderly male survivors with comorbidities also had longer hospital stays than other survivors (25 versus 18.5 days, p-value<0.01). Overall, the high mortality risk in elderly males with COVID-19-associated comorbidities supports early prevention and critical care for elderly populations.
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Affiliation(s)
- Guangdi Li
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yacong Liu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xixi Jing
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yali Wang
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Miao Miao
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, China
| | - Li Tao
- School of Mathematics and Statistics, Central South University, Changsha, China
| | - Zhiguo Zhou
- The First Hospital of Changsha, Changsha, China
| | - Yuanlin Xie
- The Fourth Hospital of Changsha, Changsha, China
| | | | - Jianhua Lei
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guozhong Gong
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Jin
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nuno Rodrigues Faria
- Department of Zoology, University of Oxford, Oxford, UK.,Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Min Zhang
- Institute of Hepatology and Department of Infectious Diseases, The Second Xiangya Hospital, Central South University, Changsha, China
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Waya JLL, Lako R, Bunga S, Chun H, Mize V, Ambani B, Wamala JF, Guyo AG, Gray JH, Gai M, Maleghemi S, Kol M, Rumunu J, Tukuru M, Olu OO. The first sixty days of COVID-19 in a humanitarian response setting: a descriptive epidemiological analysis of the outbreak in South Sudan. Pan Afr Med J 2020; 37:384. [PMID: 33796197 PMCID: PMC7992418 DOI: 10.11604/pamj.2020.37.384.27486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 12/21/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction the coronavirus disease 2019 (COVID-19) was declared a pandemic on March 11, 2020. South Sudan, a low-income and humanitarian response setting, reported its first case of COVID-19 on April 5, 2020. We describe the socio-demographic and epidemiologic characteristics of COVID-19 cases in this setting. Methods we conducted a cross-sectional descriptive analysis of data for 1,330 confirmed COVID-19 cases from the first 60 days of the outbreak. Results among the 1,330 confirmed cases, the mean age was 37.1 years, 77% were male, 17% were symptomatic with 95% categorized as mild, and the case fatality rate was 1.1%. Only 24.7% of cases were detected through alerts and sentinel site surveillance, with 95% of the cases reported from the capital, Juba. Epidemic doubling time averaged 9.8 days (95% confidence interval [CI] 7.7 - 13.4), with an attack rate of 11.5 per 100,000 population. Test positivity rate was 18.2%, with test rate per 100,000 population of 53 and mean test turn-around time of 9 days. The case to contact ratio was 1: 2.2. Conclusion this 2-month initial period of COVID-19 in South Sudan demonstrated mostly young adults and men affected, with most cases reported as asymptomatic. Systems´ limitations highlighted included a small proportion of cases detected through surveillance, low testing rates, low contact elicitation, and long collection to test turn-around times limiting the country´s ability to effectively respond to the outbreak. A multi-pronged response including greater access to testing, scale-up of surveillance, contact tracing and community engagement, among other interventions are needed to improve the COVID-19 response in this setting.
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Affiliation(s)
- Joy Luba Lomole Waya
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Richard Lako
- National COVID-19 Incident Management System, Ministry of Health, Juba, Republic of South Sudan
| | - Sudhir Bunga
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Helen Chun
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Valerie Mize
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Boniface Ambani
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | | | - Argata Guracha Guyo
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - John Henry Gray
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Malick Gai
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Sylvester Maleghemi
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Matthew Kol
- National Public Health Emergency Operations Centre, Juba, Republic of South Sudan
| | - John Rumunu
- Ministry of Health, Directorate of Preventive Health Services, Juba, Republic of South Sudan
| | - Michael Tukuru
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
| | - Olushayo Oluseun Olu
- COVID-19 Response Team, World Health Organization, Juba, Republic of South Sudan
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48
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Belice T, Demir I. The gender differences as a risk factor in diabetic patients with COVID-19. IRANIAN JOURNAL OF MICROBIOLOGY 2020; 12:625-628. [PMID: 33613918 PMCID: PMC7884270 DOI: 10.18502/ijm.v12i6.5038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objectives: In a Turkish cohort study, we revealed first time in literature the gender differences in admission to hospital and rates of mortality for diabetic patients with COVID-19. Materials and Methods: The demographics, length of stay, mortality rates and concomitant chronic metabolic diseases of 152 patients diagnosed with COVID-19 were found in our hospital electronic document system (Probel) and recorded in excel files for further statistical analysis. Results: In the mortality group (n:22), the numbers of men and women were 9 (40.9%) and 4 (18.2%), respectively. Comparing gender rates in diabetic group, the mortality risk of diabetic men was higher and statistically significant (p<0.05, Pearson Chi-square value:7.246). Conclusion: We hope that the findings of this research will give scientists an idea of gender differences in viral pandemics for further studies.
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Affiliation(s)
- Tahir Belice
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Ismail Demir
- Department of Internal Medicine, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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49
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Al-Ajlouni YA, Park SH, Alawa J, Shamaileh G, Bawab A, El-Sadr WM, Duncan DT. Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: a cross-sectional analysis of adults in Jordan. BMJ Open 2020; 10:e041995. [PMID: 33371040 PMCID: PMC7757395 DOI: 10.1136/bmjopen-2020-041995] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Jordan, a Middle Eastern country, declared a state of national emergency due to COVID-19 and a strict nationwide lockdown on 17 March 2020, banning all travel and movement around the country, potentially impacting mental health. This study sought to investigate the association between mental health (eg, anxiety and depressive symptoms) and sleep health among a sample of Jordanians living through a state of COVID-19-induced nationwide lockdown. METHODS Using Facebook, participants (n=1240) in Jordan in March 2020 were recruited and direct to a web-based survey measuring anxiety (items from General Anxiety Disorder 7-item (GAD-7) scale instrument), depressive symptoms (items from Center for Epidemiologic Studies Depression Scale), sleep health (items from the Pittsburgh Sleep Quality Index) and sociodemographic. A modified Poisson regression model with robust error variance. Adjusted prevalence ratios (aPRs) and 95% CIs were estimated to examine how anxiety and depressive symptoms may affect different dimensions of sleep health: (1) poor sleep quality, (2) short sleep duration, (3) encountering sleep problems. RESULTS The majority of participants reported having experienced mild (33.8%), moderate (12.9%) or severe (6.3%) levels of anxiety during lockdown, and nearly half of respondents reported depressive symptoms during lockdown. Similarly, over 60% of participants reported having experienced at least one sleep problem in the last week, and nearly half reported having had short sleep duration. Importantly, anxiety was associated with poor sleep health outcomes. For example, corresponding to the dose-response relationship between anxiety and sleep health outcomes, those reporting severe anxiety were the most likely to experience poor sleep quality (aPR =8.95; 95% CI=6.12 to 13.08), short sleep duration (aPR =2.23; 95% CI=1.91 to 2.61) and at least one problem sleep problem (aPR=1.73; 95% CI=1.54 to 1.95). Moreover, depressive symptoms were also associated with poor sleep health outcomes. As compared with scoring in the first quartile, scoring fourth quartile was associated with poor sleep quality (aPR=11.82; 95% CI=6.64 to 21.04), short sleep duration (aPR=1.87; 95% CI=1.58 to 2.22), and experiencing at least one sleep problem (aPR=1.90; 95% CI=1.66 to 2.18). CONCLUSIONS Increased levels of anxiety and depressive symptoms can negatively influence sleep health among a sample of Jordanian adults living in a state of COVID-19-induced nationwide lockdown.
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Affiliation(s)
- Yazan A Al-Ajlouni
- Department of Primary Care and Public Health, Cambridge University, Cambridge, UK
| | - Su Hyun Park
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Jude Alawa
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Ghaith Shamaileh
- Department of Cell and Molecular Biology, Tulane University School of Science and Engineering, New Orleans, Louisiana, USA
| | - Aziz Bawab
- Presbyterian Hospital, New York City, New York, USA
| | - Wafaa M El-Sadr
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
- ICAP at Columbia University, New York City, New York, USA
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
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50
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Polan C, Burggraf M, Kauther MD, Meyer HL, Rademacher F, Braitsch H, Jöckel KH, Hardes J, Streitbürger A, Dudda M. Development of Case Numbers during the COVID-19 Pandemic in a Center of Maximum-Care for Traumatology and Orthopedic Oncology. Healthcare (Basel) 2020; 9:healthcare9010003. [PMID: 33375208 PMCID: PMC7822100 DOI: 10.3390/healthcare9010003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 01/17/2023] Open
Abstract
(1) Background: The COVID-19 pandemic has led to a significant change in the utilization of trauma surgery and tumor orthopedic hospital facilities. (2) Methods: In a monocentric retrospective analysis, the weekly numbers of cases requiring intra-clinical treatment in the first four months of 2020 were compared with those of 2019. Patients' visits to the emergency department and shock room, consultation hours, work-related accidents, case numbers in the normal and intensive care units, ventilation hours, the "Simplified Acute Physiology Score/ Therapeutic Intervention Scoring System" (SAPS/TISS), the average length of stay in hospital, the number of operations and their degree of urgency, as well as deaths, were analyzed in a study based on the data from 7606 outpatient consultations in 2019 and 6755 in 2020, as well as 993 inpatient cases in 2019 and 950 in 2020. (3) Results: There was a significant reduction in the number of treatments per week in the emergency department (261 ± 29 vs. 165 ± 25; p < 0.001) with the same number of shock room treatments and fewer consultation hour contacts (226 ± 29 vs. 119 ± 65; p = 0.012). There were fewer inpatient cases (66 ± 7 vs. 42 ± 11; p = 0.001), resulting in a fall in the days of hospitalization (492 ± 63 vs. 308 ± 78; p < 0.001) and number of operations (73 ± 7 vs. 55 ± 10; p = 0.012), especially elective procedures (20 ± 3 vs. 7 ± 7; p = 0.008). The SAPS/TISS score was lower (1351 ± 1213 vs. 399 ± 281; p = 0.023). Fewer fracture treatments and septic surgeries were performed, while the number of procedures to treat orthopedic malignancies remained constant. (4) Conclusions: During the first phase of the COVID-19 pandemic, we observed a significant reduction in the number of cases treated in orthopedics. While the number of multiple-injured patients was unchanged, fewer patients presented for primary and regular care. Treatment of acute injuries and malignant tumor diseases was not at risk. There was no effect on in-house mortality. We see a potential for the recruitment of medical staff from the outpatient department, operating room, and the ward. In the event of a future second wave, our results may allow for early planning, particularly of the all-important human resources. Reorganization by hospitals and decreased patient numbers in trauma surgery can enable the reallocation of medical staff, equipment, and beds to increase capacity for COVID-19 patients.
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Affiliation(s)
- Christina Polan
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
- Correspondence:
| | - Manuel Burggraf
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
| | - Max Daniel Kauther
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
| | - Heinz-Lothar Meyer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
| | - Friederike Rademacher
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
| | - Henrik Braitsch
- Central Department of Medical Controlling, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany;
| | - Jendrik Hardes
- Department of Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (J.H.); (A.S.)
| | - Arne Streitbürger
- Department of Tumor Orthopedics, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (J.H.); (A.S.)
| | - Marcel Dudda
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; (M.B.); (M.D.K.); (H.-L.M.); (F.R.); (M.D.)
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