Systematic Review of Clinical Insights into Novel Coronavirus (CoVID-19) Pandemic: Persisting Challenges in U.S. Rural Population

Urban and Rural Disparities in COVID-19 Outcomes in the United States: A Systematic Review

This systematic review investigates disparities in COVID-19 outcomes (infections, hospitalizations, and deaths) between urban and rural populations in the United States. Of the 3,091 articles screened, 55 were selected. Most studies (n = 43) conducted national analyses, using 2020 data, with some extending into 2021. Findings show urban areas had higher COVID-19 cases and hospitalizations in 2020, while rural areas saw increased cases in 2021 and mixed hospitalization results. Urban areas also had higher mortality rates in 2020, with rural rates rising in 2021 and 2022. Most studies did not explore reasons for urban/rural differences. The few that did found that vulnerable groups, including racially and ethnically minoritized populations, older adults, and those with comorbidities and lower socioeconomic status and vaccination rates, experienced exacerbated disparities in rural regions. COVID-19 outcomes varied over time and by area due to population density, healthcare infrastructure, and socioeconomic factors. Tailored interventions are essential for health equity and effective policies.

A Survival Analysis of Rural-Urban Disparities in COVID-19 Vaccination Uptake in the United States

PURPOSE

Though urban-rural disparities in COVID-19 vaccination coverage was documented at a point of time, little is known on the evolution of vaccination uptake over time. This study, using individual level time-to-event data, intend to assess the differences in monthly progression of vaccination uptake among U.S. adults by urban/rural residence.

DESIGN

Survival analysis.

SETTING

Urban and rural areas in 29 U.S. states.

SUBJECTS

135,969 adults aged 18+ years.

MEASURES

Time (in months) to receive the first dose of COVID-19 vaccine since the U.S. Food and Drug Administration (FDA) Emergency Use Authorization of Pfizer-BioNTech- and Moderna- COVID-19 Vaccine in December 2020.

ANALYSIS

Kaplan-Meier survivor functions and stratified Cox proportional hazard models were estimated for the event of being vaccinated by urban/rural residence for 25 months starting from December 2020. Monthly survival probabilities for urban- and rural- adults were further assessed within certain demographic and socioeconomic groups.

RESULTS

We found a gradual divergence of COVID-19 vaccination uptake in favor of urban adults, which was robust across sex, age groups, race and ethnicity, education, and income levels. In April 2021, after vaccine eligibility was expanded, 42.2% adults in urban and 53.3% adults in rural areas were unvaccinated. While only 19.3% urban adults remained unvaccinated in December 2022, this rate was 32.5% among rural adults. Compared to their urban counterparts, rural adults were 0.77 (95% CI: 0.76 - 0.79) times as likely to receive the first dose of COVID-19 vaccine.

CONCLUSIONS

Time-to-event analysis of vaccination against COVID-19 indicated a lower uptake among rural adults, which was persistent across different demographic and socioeconomic groups.

Fostering Trust in Public Health Messaging: Tailoring Communication for Rural Parents

PURPOSE

As pandemic-related mistrust of public health recommendations in rural communities may compound gaps in pediatric immunizations, our team explored parents' perceptions of trustworthiness in messaging.

DESIGN

Qualitative study using 4 virtual focus groups.

SETTING

Rural Wisconsin.

PARTICIPANTS

Participants (n = 25) were parents or guardians of children recruited through our contacts with community-based organizations serving rural communities.

METHODS

Researchers used task-oriented elicitation techniques to initiate discussion on the trustworthiness of messengers and messages providing health recommendations. Participants were asked to (1) review existing public health messaging on a range of topics and from a range of sponsors; and (2) rank a list of potential messengers in terms of trustworthiness (eg, local health department, Centers for Disease Control). Discussions were recorded, and audio files transcribed, to facilitate a team-based, thematic analysis.

RESULTS

Competency in medical knowledge and parenting experience contributed to estimations of trustworthiness. Participants also responded well to messages and messengers that were able to project recognition of their children's uniqueness and their experience as parents. Participants distrusted messengers who were seen as biased or "one-sided" in their perspectives.

CONCLUSIONS

For successful health promotion for rural-living parents, messengers must be recognized as "competent" to provide pediatric health advice and to avoid blanket recommendations that may undermine parents' experience and feelings of being "understood" and affect perceptions of trustworthiness.

Suspected Mpox Symptoms and Testing in Men Who Have Sex With Men in the United States: Cross-Sectional Study

Background

The 2022 mpox outbreak in the United States disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Uptake of mpox testing may be related to symptomology, sociodemographic characteristics, and behavioral characteristics.

Objective

This study aimed to describe suspected mpox symptoms and testing uptake among a sample of GBMSM recruited via the internet in the United States in August 2022.

Methods

We conducted a rapid internet-based mpox survey from August 5 to 15, 2022, among cisgender men 15 years and older who had previously participated in the 2021 American Men's Internet Survey. We estimated the prevalence of suspected mpox symptoms (fever or rash or sores with unknown cause in the last 3 mo) and uptake of mpox testing. We calculated adjusted prevalence ratios (aPRs) and 95% CIs for associations between participant characteristics and suspected mpox symptoms and summarized characteristics of GBMSM reporting mpox testing. Among symptomatic GBMSM who did not receive mpox testing, we described testing self-efficacy, barriers, and facilitators.

Results

Of 824 GBMSM, 126 (15.3%) reported at least 1 mpox symptom in the last 3 months; 58/126 (46%) with rash or sores, 57 (45.2%) with fever, and 11 (8.7%) with both. Increased prevalence of suspected mpox symptoms was associated with condomless anal sex (CAS; aPR 1.53, 95% CI 1.06-2.20). Mpox testing was reported by 9/824 GBMSM (1%), including 5 with symptoms. Most GBMSM reporting mpox testing were non-Hispanic White men (7/9 vs 1 Black and 1 Hispanic or Latino man), and all 9 lived in urban areas. Most reported having an sexually transmitted infections test (8/9), 2 or more partners (8/9), CAS (7/9), and group sex (6/9) in the last 3 months. Of those tested, 3 reported living with HIV and all were on treatment, whereas the remaining 6 men without HIV reported current pre-exposure prophylaxis (PrEP) use. Of symptomatic GBMSM who did not report mpox testing, 47/105 (44.8%) had low mpox testing self-efficacy. Among those with low self-efficacy, the most common barriers to testing were not knowing where to get tested (40/47, 85.1%) and difficulty getting appointments (23/47, 48.9%). Among those with high testing self-efficacy (58/105, 55.2%), the most common facilitators to testing were knowing where to test (52/58, 89.7%), convenient site hours (40/58, 69%), and low-cost testing (38/58, 65.5%).

Conclusions

While all GBMSM who reported testing for mpox were linked to HIV treatment or PrEP, those with symptoms but no mpox testing reported fewer such links. This suggests targeted outreach is needed to reduce structural barriers to mpox services among GBMSM in rural areas, Black and Hispanic or Latino GBMSM, and GBMSM living with HIV. Sustaining and scaling community-tailored messaging to promote testing and vaccination represent critical interventions for mpox control among GBMSM in the United States.

Molecular characteristics of organic matters in PM2.5 associated with upregulation of respiratory virus infection in vitro

The extent to which organic matters (OM) in PM2.5 affect virus infections and the key organic molecules involved in this process remain unclear. Herein, this study utilized ultra-high resolution mass spectrometry coupled with in vitro experiments to identify the organic molecules associated with respiratory virus infection for the first time. Water-soluble organic matters (WSOM) and water-insoluble organic matters (WIOM) were separated from PM2.5 samples collected at the urban area of Guangzhou, China. Their molecular compositions were analyzed using Fourier transform ion cyclotron resonance mass spectrometry. Subsequently, in vitro experiments were conducted to explore the impact of WSOM and WIOM exposure on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pseudo-virus infection in A549 cells. Results revealed that WSOM and WIOM respectively promoted 1.7 to 2.1-fold and 1.9 to 3.5-fold upregulation of SARS-CoV-2 pseudo-virus infection in a concentration-dependent manner (at 25 to 100 μg mL-1) compared to the virus-only control group. Partial least squares model analysis indicated that the increased virus infection was likely related to phthalate ester and nitro-aromatic molecules in WSOM, as well as LipidC molecules with aliphatic and olefinic structures in WIOM. Interestingly, the molecules responsible for upregulating SARS-CoV-2 receptor angiotensin-converting enzyme 2 (ACE2) expression and virus infection differed. Thus, it was concluded that ACE2 upregulation alone may not fully elucidate the mechanisms underlying increased susceptibility to virus infection. The findings highlight the critical importance of aromatic and lipid molecules found in OM in relation to respiratory virus infection.

Epidemiological model can forecast COVID-19 outbreaks from wastewater-based surveillance in rural communities

Wastewater has emerged as a crucial tool for infectious disease surveillance, offering a valuable means to bridge the equity gap between underserved communities and larger urban municipalities. However, using wastewater surveillance in a predictive manner remains a challenge. In this study, we tested if detecting SARS-CoV-2 in wastewater can forecast outbreaks in rural communities. Under the CDC National Wastewater Surveillance program, we monitored the SARS-CoV-2 in the wastewater of five rural communities and a small city in Idaho (USA). We then used a particle filter method coupled with a stochastic susceptible-exposed-infectious-recovered (SEIR) model to infer active case numbers using quantities of SARS-CoV-2 in wastewater. Our findings revealed that while high daily variations in wastewater viral load made real-time interpretation difficult, the SEIR model successfully factored out this noise, enabling accurate forecasts of the Omicron outbreak in five of the six towns shortly after initial increases in SARS-CoV-2 concentrations were detected in wastewater. The model predicted outbreaks with a lead time of 0 to 11 days (average of 6 days +/- 4) before the surge in reported clinical cases. This study not only underscores the viability of wastewater-based epidemiology (WBE) in rural communities-a demographic often overlooked in WBE research-but also demonstrates the potential of advanced epidemiological modeling to enhance the predictive power of wastewater data. Our work paves the way for more reliable and timely public health guidance, addressing a critical gap in the surveillance of infectious diseases in rural populations.

Caregiver Willingness to Participate in Pediatric Clinical Research During COVID-19

INTRODUCTION

Understanding caregiver willingness to participate in pediatric clinical research is needed. We examined caregiver perceptions of pediatric clinical research during COVID-19 and examined research attitudes and sociodemographic factors as predictors of willingness.

METHODS

A cross-sectional telephone survey was administered to caregivers of children from August 2020 to April 2021. We examined caregiver willingness to participate in the following research modalities during COVID-19: telehealth, in-person, and vaccine-focused.

RESULTS

Participants included 600 caregivers (52.8% non-Hispanic White; Child Age M = 9.3 years; 50.0% from rural areas). Caregivers reported more willingness to participate in nonvaccine research (64.0% telehealth, 59.4% face-to-face) compared to vaccine research (22.1%). Different predictors were found for caregivers living in rural and nonrural areas and specific research attitudes predicted willingness.

DISCUSSION

Caregiver willingness to participate in pediatric clinical research during COVID-19 differed by modality and research attitudes predicting willingness differed by geography. Surveillance regarding pediatric vaccine and clinical research hesitancy broadly should continue.

COVID-19 information-seeking behaviors and preventive behaviors among college students in Oklahoma

Objective: To explore experiences, beliefs, and information-seeking behavior around COVID-19 among college students in Oklahoma. Participants: Fifteen college students participated during the pandemic period from April to July 2020. Methods: An exploratory, qualitative research approach method was used to discover students' experiences, beliefs, and information-seeking behaviors around COVID-19. Exploration of beliefs was guided by the Health Belief Model. Results: Students engaged in COVID-19 information-seeking behaviors predominantly through Internet sites, broadcast news, health professionals, and governmental sources. Students experienced emotional burden as a result of COVID-19 misinformation in these sources. While most students perceived a low chance of acquiring the virus due to their lack of underlying medical conditions, they were still concerned about the consequences of becoming infected. Students noted the difficulty of physical distancing while on campus. Conclusions: Colleges/universities should maximize the dissemination of timely, valid health information for the safety of their students and the broader community.

Racial and Regional Disparities Surrounding In-Hospital Mortality among Patients with 2019 Novel Coronavirus Disease (COVID-19): Evidence from NIS Sample in 2020

OBJECTIVE

This study explores differences in COVID-19 in-hospital mortality rates by patient and geographic factors to identify at-risk populations and analyze how strained health disparities were exacerbated during the pandemic.

METHODS

The latest 2020 United States National Inpatient Sample (NIS) data was used to obtain a population-based estimate for patients with COVID-19. We conducted a cross-sectional retrospective data analysis, and sampling weights were used for all statistical analyses to represent nationwide in-hospital mortality of patients with COVID-19. We used multivariate logistic regression models to identify predictors for how patients with COVID-19 are associated with in-hospital death.

RESULTS

Of 200,531 patients, 88.9% did not have an in-hospital death (n=178,369), and 11.1% had in-hospital death (n=22,162). Patients older than 70 were 10 times more likely to have an in-hospital death than patients younger than 40 (p<0.001). Male patients were 37% more likely to have an in-hospital death than female patients (p<0.001). Hispanic patients were 25% more likely to have in-hospital deaths than White patients (p<0.001). In the sub-analysis, Hispanic patients in the 50-60, 60-70, and 70 age groups were 32%, 34%, and 24%, respectively, more likely to have in-hospital death than White patients (p<0.001). Patients with hypertension and diabetes were 69% and 29%, respectively, more likely to have in-hospital death than patients without hypertension and diabetes.

CONCLUSION

Health disparities in the COVID-19 pandemic occurred across races and regions and must be addressed to prevent future deaths. Age and comorbidities like diabetes have a well-established link to increased disease severity, and we have linked both to higher mortality risk. Low-income patients had a significantly increased risk of in-hospital death starting at over 40 years old.

[Organization of local healthcare systems in remote rural Brazilian municipalities to combat the COVID-19 pandemic]

During the COVID-19 pandemic, populations living further away from urban centers faced immense difficulties accessing health services. This study aims to analyze how Brazilian remote rural municipalities faced the COVID-19 pandemic based on their political, structural, and organizational response to access to healthcare. A qualitative study of multiple cases was conducted with thematic and deductive content analysis of 51 interviews conducted with managers and healthcare professionals in 16 remote rural municipalities in the states of Rondônia, Mato Grosso, Tocantins, Piauí, Minas Gerais, and Amazonas. With their socio-spatial dynamics and long distances to reference centers, the remote rural municipalities responded to the demands of the pandemic but did not have their needs met promptly. They preserved communication with the population, reorganized the local system centered on primary health care (PHC), and changed the functioning of healthcare units, exceeding the limits of their responsibilities to provide the necessary care and awaiting referral to other levels of complexity. They faced a shortage of services, gaps in assistance in the regional network, and inadequate healthcare transport. The pandemic reiterated PHC's difficulties in coordinating care, exposing care gaps in reference regions. The equitable and resolute provision of the local health system in the remote rural municipalities implies inter-federative articulation in formulating and implementing public policies to ensure the right to health.

Giving meaning to internalized violence throughout life by older adults living in rural areas

OBJECTIVES

to understand the meanings of violence internalized throughout life by older adults living in rural areas.

METHODS

a qualitative study, anchored in the Symbolic Interactionism theoretical framework and the Grounded Theory methodological framework in the constructivist aspect. Data collection occurred through individual interviews. Data were coded using the Atlas.ti software.

RESULTS

it was possible to identify that the context of rural areas strengthens patriarchy culture as well as contributing to violence silence and naturalization. It was also found that violence is a product of social inequality and gender inequality.

FINAL CONSIDERATIONS

older adults living in rural areas internalized the violence suffered in a unique way, and this scenario's specific aspects can increase intra-family abuse, as there is a patriarchal culture that promotes social and gender inequality.

Epidemiological approaches to multivariable models of health inequity: A study of race, rurality, and occupation during the COVID-19 pandemic

PURPOSE

Methods for assessing the structural mechanisms of health inequity are not well established. This study applies a phased approach to modeling racial, occupational, and rural disparities on the county level.

METHODS

Rural counties with disparately high rates of COVID-19 incidence or mortality were randomly paired with in-state control counties with the same rural-urban continuum code. Analysis was restricted to the first six months of the pandemic to represent the baseline structural reserves for each county and reduce biases related to the disruption of these reserves over time. Conditional logistic regression was applied in two phases-first, to examine the demographic distribution of disparities and then, to examine the relationships between these disparities and county-level social and structural reserves.

RESULTS

In over 200 rural county pairs (205 for incidence, 209 for mortality), disparities were associated with structural variables representing economic factors, healthcare infrastructure, and local industry. Modeling results were sensitive to assumptions about the relationships between race and other social and structural variables measured at the county level, particularly in models intended to reflect effect modification or mediation.

CONCLUSIONS

Multivariable modeling of health disparities should reflect the social and structural mechanisms of inequity and anticipate interventions that can advance equity.

A Low-Cost Wearable Device to Estimate Body Temperature Based on Wrist Temperature

The remote monitoring of vital signs and healthcare provision has become an urgent necessity due to the impact of the COVID-19 pandemic on the world. Blood oxygen level, heart rate, and body temperature data are crucial for managing the disease and ensuring timely medical care. This study proposes a low-cost wearable device employing non-contact sensors to monitor, process, and visualize critical variables, focusing on body temperature measurement as a key health indicator. The wearable device developed offers a non-invasive and continuous method to gather wrist and forehead temperature data. However, since there is a discrepancy between wrist and actual forehead temperature, this study incorporates statistical methods and machine learning to estimate the core forehead temperature from the wrist. This research collects 2130 samples from 30 volunteers, and both the statistical least squares method and machine learning via linear regression are applied to analyze these data. It is observed that all models achieve a significant fit, but the third-degree polynomial model stands out in both approaches. It achieves an R2 value of 0.9769 in the statistical analysis and 0.9791 in machine learning.

Impact of Shifting University Policies During the COVID-19 Pandemic on Self-Reported Employee Social Networks

Objectives

To ascertain if faculty and staff were the link between the two COVID-19 outbreaks in a rural university county, and if the local university's COVID-19 policies affected contact rates of their employees across all its campuses.

Methods

We conducted two anonymous, voluntary online surveys for faculty and staff of a PAC-12 university on their contact patterns both within and outside the university during the COVID-19 pandemic. One was asked when classes were virtual, and another when classes were in-person but masking. Participants were asked about the individuals they encountered, the type and location of the interactions, what COVID-19 precautions were taken - if any, as well as general questions about their location and COVID-19.

Results

We received 271 responses from the first survey and 124 responses from the second. The first survey had a median of 3 contacts/respondent, with the second having 7 contacts/respondent (p<0.001). During the first survey, most contacts were family contacts (Spouse, Children), with the second survey period having Strangers and Students having the most contact (p<0.001). Over 50% of the first survey contacts happened at their home, while the second survey had 40% at work and 35% at home. Both respondents and contacts masked 42% and 46% of the time for the two surveys respectively (p<0.01).

Conclusion

For future pandemics, it would be wise to take employees into account when trying to plan for the safety of university students, employees, and surrounding communities. The main places to be aware of and potentially push infectious disease precautions would be on campus, especially confined spaces like offices or small classrooms, and the home, as these tend to be the largest areas of non-masked close contact.

Epidemiological model can forecast COVID-19 outbreaks from wastewater-based surveillance in rural communities

Wastewater can play a vital role in infectious disease surveillance, especially in underserved communities where it can reduce the equity gap to larger municipalities. However, using wastewater surveillance in a predictive manner remains a challenge. We tested if detecting SARS-CoV-2 in wastewater can predict outbreaks in rural communities. Under the CDC National Wastewater Surveillance program, we monitored several rural communities in Idaho (USA). While high daily variations in wastewater viral load made real-time interpretation difficult, a SEIR model could factor out the data noise and forecast the start of the Omicron outbreak in five of the six cities that were sampled soon after SARS-CoV-2 quantities increased in wastewater. For one city, the model could predict an outbreak 11 days before reported clinical cases began to increase. An epidemiological modeling approach can transform how epidemiologists use wastewater data to provide public health guidance on infectious diseases in rural communities.

Survey of Vaccine Hesitancy in Patients Visiting Three Tertiary-care Emergency Departments in Southeast Louisiana

Objectives

Vaccine hesitancy has been a barrier to achieving herd immunity during the coronavirus 2019 (COVID-19) pandemic. Having low socioeconomic status and education levels, and being a person of color, are associated with higher COVID-19 infection risk and worse outcomes. These same groups are associated with higher vaccine hesitancy. The state of Louisiana has one of the lowest vaccination rates in the country. In this study we aimed to identify demographic, perspective, and health behavior factors associated with vaccine hesitancy in emergency departments (ED) in Southeast Louisiana.

Methods

A cross-sectional survey was distributed at three tertiary-care hospital EDs. Patients >18 years old and not in acute distress were recruited between April-July 2021. The 37-item questionnaire addressed socioeconomic demographics, social determinants of health, COVID-19 safety practices, thoughts and perceptions on COVID-19 and vaccines, sources of COVID-19 and vaccine information, and trust in the healthcare system.

Results

Overall, 247 patients completed our survey. Of those, 29.6% reported they were vaccine hesitant. These respondents were significantly more likely, when compared to vaccine-acceptant respondents, to never have married, to have some college education, make less than <$25,000 in household earnings yearly, be unsure whether vaccines prevent disease, not have discussed the COVID-19 vaccine with their primary care doctor, and to prefer to do their own research for COVID-19 vaccine information. We observed no statistically significant differences based on gender, race/ethnicity, parental status, area of living, or their perceived risk of needing hospitalization for treatment or dying from the virus.

Conclusion

Vaccine hesitancy was associated with multiple socioeconomic factors, perspectives, and beliefs. Vaccine-hesitant individuals were more uncertain about the safety of the COVID-19 vaccine, the feasibility of obtaining the vaccine, and its efficacy. Public health interventions aimed at these findings and improving public trust in healthcare systems are needed to increase vaccine acceptance.

Community Forums to Address Vaccine Hesitancy: A Useful Tool for Meeting the Needs of Diverse Communities

Community forums are a valuable tool in engaging rural communities to address critical public health issues. Recognizing low levels of COVID-19 vaccine uptake in rural Minnesota communities and the critical public health threat that resulted, pharmacy faculty and Extension professionals from the University of Minnesota partnered with a diverse group of rural stakeholders to plan a series of six community forums to provide life-saving, evidence-based education about the COVID-19 vaccine. Each forum allowed trusted local community leaders, public health workers and healthcare providers to share information about the impact of COVID-19 in their communities. Data about the COVID-19 vaccines was provided, and community members were allowed to ask questions and voice their concerns about the virus and the vaccines. Virtual community forums allowed rural stakeholders to reach a diverse and geographically remote population while maintaining COVID-19 distancing requirements. Offering a safe, virtual space and immediate access to reliable and trusted place-based education allowed individuals an opportunity to get their vaccine questions answered immediately. Community forums can be conducted in rural communities as a direct communication tool to address critical public health issues such as vaccine hesitancy, and empower community members to make informed decisions in fighting against the COVID-19 pandemic.

Rural-Urban Disparities in Hospital Admissions and Mortality Among Patients with COVID-19: Evidence from South Carolina from 2021 to 2022

Although rural communities have been hard-hit by the COVID-19 pandemic, there is limited evidence on COVID-19 outcomes in rural America using up-to-date data. This study aimed to estimate the associations between hospital admissions and mortality and rurality among COVID-19 positive patients who sought hospital care in South Carolina. We used all-payer hospital claims, COVID-19 testing, and vaccination history data from January 2021 to January 2022 in South Carolina. We included 75,545 hospital encounters within 14 days after positive and confirmatory COVID-19 testing. Associations between hospital admissions and mortality and rurality were estimated using multivariable logistic regressions. About 42% of all encounters resulted in an inpatient hospital admission, while hospital-level mortality was 6.3%. Rural residents accounted for 31.0% of all encounters for COVID-19. After controlling for patient-level, hospital, and regional characteristics, rural residents had higher odds of overall hospital mortality (Adjusted Odds Ratio - AOR = 1.19, 95% Confidence Intervals - CI = 1.04-1.37), both as inpatients (AOR = 1.18, 95% CI = 1.05-1.34) and as outpatients (AOR = 1.63, 95% CI = 1.03-2.59). Sensitivity analyses using encounters with COVID-like illness as the primary diagnosis only and encounters from September 2021 and beyond - a period when the Delta variant was dominant and booster vaccination was available - yielded similar estimates. No significant differences were observed in inpatient hospitalizations (AOR = 1.00, 95% CI = 0.75-1.33) between rural and urban residents. Policymakers should consider community-based public health approaches to mitigate geographic disparities in health outcomes among disadvantaged population subgroups.

Widening rural-urban gap in life expectancy in China since COVID-19

INTRODUCTION

Disparities in life expectancy between rural and urban populations are well established but how it varies with epidemics and pandemics remains poorly understood. We aimed to quantify the rural-urban differences in the mortality burden of COVID-19 and to contribute to understanding the disparity trends in life expectancy between 1987 and 2021 in China.

METHODS

We used monthly death counts from death registration systems. Rural-urban gap estimation and decomposition were carried out using period life tables to calculate life expectancy, the Arriaga decomposition technique to break down into age-specific and cause-specific mortality, and the Lee-Carter forecasts to estimate the expected gap.

RESULTS

The rural-urban gap increased to 22.7 months (95% credible interval (CI) 19.6 to 25.8) in 2020 and further to 23.7 months (95% CI 19.6 to 26.7) in 2021, and was larger than expected under the continuation of the prepandemic trends. Compared with that in the recent 2003 SARS-CoV-2 epidemic and the 2009 influenza epidemic, excess rural-urban gaps in the COVID-19 pandemic changed from urban disadvantage to rural disadvantage, and the contributions shifted toward old age groups and circulatory diseases. Variations in the rural-urban gap since 1987 were positively correlated with the rural-urban disparity in public health expenditures, especially among ages <60 (p values <0.005).

CONCLUSIONS

Our findings identified a widening rural-urban gap in life expectancy since COVID-19, and a shifting trend towards old ages and circulatory diseases, disrupting the diminishing trend of the gap over 35 years. The findings highlight the unequal impact of the pandemic on different communities in terms of mortality burdens.

Using wastewater to overcome health disparities among rural residents

The SARS-CoV-2 pandemic highlighted the need for novel tools to promote health equity. There has been a historical legacy around the location and allocation of public facilities (such as health care) focused on efficiency, which is not attainable in rural, low-density, United States areas. Differences in the spread of the disease and outcomes of infections have been observed between urban and rural populations throughout the COVID-19 pandemic. The purpose of this article was to review rural health disparities related to the SARS-CoV-2 pandemic while using evidence to support wastewater surveillance as a potentially innovative tool to address these disparities more widely. The successful implementation of wastewater surveillance in resource-limited settings in South Africa demonstrates the ability to monitor disease in underserved areas. A better surveillance model of disease detection among rural residents will overcome issues around the interactions of a disease and social determinants of health. Wastewater surveillance can be used to promote health equity, particularly in rural and resource-limited areas, and has the potential to identify future global outbreaks of endemic and pandemic viruses.

Cardiovascular disease treatment using traditional Chinese medicine：Mitochondria as the Achilles' heel

Cardiovascular disease (CVD), involving the pathological alteration of the heart or blood vessels, is one of the main causes of disability and death worldwide, with an estimated 18.6 million deaths per year. CVDs are caused by a variety of risk factors, including inflammation, hyperglycemia, hyperlipidemia, and increased oxidative stress. Mitochondria, the hub of ATP production and the main generator of reactive oxygen species (ROS), are linked to multiple cellular signaling pathways that regulate the progression of CVD and therefore are recognized as an essential target for CVD management. Initial treatment of CVD generally focuses on diet and lifestyle interventions; proper drugs or surgery can prolong or save the patient's life. Traditional Chinese medicine (TCM), a holistic medical care system with an over 2500-year history, has been proven to be efficient in curing CVD and other illnesses, with a strengthening effect on the body. However, the mechanisms underlying TCM alleviation of CVD remain elusive. Recent studies have recognized that TCM can alleviate cardiovascular disease by manipulating the quality and function of mitochondria. This review systematically summarizes the association of mitochondria with cardiovascular risk factors, and the relationships between mitochondrial dysfunction and CVD progression. We will investigate the research progress of managing cardiovascular disease by TCM and cover widely used TCMs that target mitochondria for the treatment of cardiovascular disease.

Associations of Combustible Cigarette, Electronic Cigarette, and Dual Use With COVID Infection and Severity in the U.S.: A Cross-sectional Analysis of the 2021 National Health Information Survey

Given the potential respiratory health risks, the association of COVID infection and the use of combustible cigarettes, electronic nicotine delivery systems (ENDS), and concurrent dual use is a priority for public health. Many published reports have not accounted for known covarying factors. This study sought to calculate adjusted odds ratios for self-reported COVID infection and disease severity as a function of smoking and ENDS use, while accounting for factors known to influence COVID infection and disease severity (i.e., age, sex, race and ethnicity, socioeconomic status and educational attainment, rural or urban environment, self-reported diabetes, COPD, coronary heart disease, and obesity status). Data from the 2021 U.S. National Health Interview Survey, a cross-sectional questionnaire design, were used to calculate both unadjusted and adjusted odds ratios for self-reported COVID infection and severity of symptoms. Results indicate that combustible cigarette use is associated with a lower likelihood of self-reported COVID infection relative to non-use of tobacco products (AOR = .64; 95% CI [.55, .74]), whereas ENDS use is associated with a higher likelihood of self-reported COVID infection (AOR = 1.30; 95% CI [1.04, 1.63]). There was no significant difference in COVID infection among dual users (ENDS and combustible use) when compared with non-users. Adjusting for covarying factors did not substantially change the results. There were no significant differences in COVID disease severity between those of varying smoking status. Future research should examine the relationship between smoking status and COVID infection and disease severity utilizing longitudinal study designs and non-self-report measures of smoking status (e.g., the biomarker cotinine), COVID infection (e.g., positive tests), and disease severity (e.g., hospitalizations, ventilator assistance, mortality, and ongoing symptoms of long COVID).

Spatial Autocorrelation of COVID-19 in Slovakia

The pandemic situation of COVID-19, which affected almost the entire civilized world with its consequences, offered a unique opportunity for analysis of geographical space. In a relatively short period of time, the COVID-19 pandemic became a truly global event with consequences affecting all areas of life. Circumstances with COVID-19, which affected the territory of Slovakia and its regions, represent a sufficient premise for analysis three years after the registration of the first case in Slovakia. The study presents the results of a detailed spatiotemporal analysis of the course of registered cases of COVID-19 in six periods in Slovakia. The aim of the paper was to analyze the development of the number of people infected with the disease COVID-19 in Slovakia. At the level of the districts of Slovakia, using spatial autocorrelation, we identified spatial differences in the disease of COVID-19. Moran's global autocorrelation index and Moran's local index were used in the synthesis of knowledge. Spatial analysis of data on the number of infected in the form of spatial autocorrelation analysis was used as a practical sustainable approach to localizing statistically significant areas with high and low positivity. This manifested itself in the monitored area mainly in the form of positive spatial autocorrelation. The selection of data and methods used in this study together with the achieved and presented results can serve as a suitable tool to support decisions in further measures for the future.

The clinical manifestation and outcome of COVID-19 in patients with a history of ischemic heart disease; a retrospective case-control study

INTRODUCTION

Coronary artery disease (CAD) is considered an independent risk factor for COVID-19. However, no study has specifically examined the clinical manifestations and outcomes of COVID-19 in patients with ischemic heart disease (IHD).

METHODS

In a retrospective case-control study between 20 March 2020 to 20 May 2020, the medical record of 1611 patients with laboratory-confirmed SARS-CoV-2 infection was reviewed. IHD was defined as a history of an abnormal coronary angiography, coronary angioplasty, coronary artery bypass graft (CABG), or chronic stable angina. Demographic data, past medical history, drug history, symptoms, vital signs, laboratory findings, outcome, and death were investigated from medical records.

RESULTS

1518 Patients (882 men (58.1%)) with a mean age of 59.3 ± 15.5 years were included in the study. Patients with IHD (n = 300) were significantly less likely to have fever (OR: 0.170, 95% CI: 0.34-0.81, P < 0.001), and chills (OR: 0.74, 95% CI: 0.45-0.91, P < 0.001). Patients with IHD were 1.57 times more likely to have hypoxia (83.3% vs. 76%, OR: 1.57, 95% CI: 1.13-2.19, P = 0.007). There was no significant difference in terms of WBC, platelets, lymphocytes, LDH, AST, ALT, and CRP between the two groups (P > 0.05). After adjusting for demographic characteristics, comorbidities and vital signs, the risk factors for mortality of these patients were older age (OR: 1.04 and 1.07) and cancer (OR: 1.03, and 1.11) in both groups. In addition, in the patients without IHD, diabetes mellitus (OR: 1.50), CKD (OR: 1.21) and chronic respiratory diseases (OR: 1.48) have increased the odds of mortality. In addition, the use of anticoagulants (OR: 2.77) and calcium channel blockers (OR: 2.00) has increased the odds of mortality in two groups.

CONCLUSION

In comparison with non-IHD, the symptoms of SARS-CoV-2 infection such as fever, chills and diarrhea were less common among patients with a history of IHD. Also, older age, and comorbidities (including cancer, diabetes mellitus, CKD and chronic obstructive respiratory diseases) have been associated with a higher risk of mortality in patients with IHD. In addition, the use of anticoagulants and calcium channel blockers has increased the chance of death in two groups without and with IHD.

COVID-19 Hospitalization Trends in Rural Versus Urban Areas in the United States

Since the summer of 2020, the rate of coronavirus cases in the United States has been higher in rural areas than in urban areas, raising concerns that patients with coronavirus disease 2019 (COVID-19) will overwhelm under-resourced rural hospitals. Using data from the University of Minnesota COVID-19 Hospitalization Tracking Project and the U.S. Department of Health and Human Services, we document disparities in COVID-19 hospitalization rates between rural and urban areas. We show that rural-urban differences in COVID-19 admission rates were minimal in the summer of 2020 but began to diverge in fall 2020. Rural areas had statistically higher hospitalization rates from September 2020 through early 2021, after which rural-urban admission rates re-converged. The insights in this article are relevant to policymakers as they consider the adequacy of hospital resources across rural and urban areas during the COVID-19 pandemic.

Rural-urban differences in monkeypox behaviors and attitudes among men who have sex with men in the United States

PURPOSE

An outbreak of the monkeypox virus has been documented in the United States with most cases occurring among gay, bisexual, and other men who have sex with men (MSM). As monkeypox cases increase among relatively rural states, current public health messaging may not resonate with rural at-risk populations. Given this, there is a need to assess potential rural-urban differences in monkeypox behaviors and attitudes among MSM.

METHODS

A total of 582 eligible MSM completed an online cross-sectional survey between August 6 and 15, 2022. Participants answered questions about their demographics, sexual behaviors, monkeypox testing and vaccination behaviors, monkeypox media consumption and attitudes, and their intention and attitudes found in the Health Belief Model of getting the monkeypox vaccine. Rural-urban differences in behaviors and attitudes were assessed with a chi-square test of independence. Differences in intention to get vaccinated and Health Belief Model factors were assessed with a Mann-Whitney U test.

FINDINGS

Rural MSM, in comparison to their urban counterparts, were found to be less likely to report modifying their behaviors to decrease monkeypox exposure, being susceptible to monkeypox, or perceiving severe consequences acquiring monkeypox. Similarly, rural MSM had a lower intention to get vaccinated for monkeypox.

CONCLUSIONS

As vaccination uptake among rural populations for vaccine-preventable diseases remains suboptimal, results from this novel study can inform the development of monkeypox prevention, testing, and vaccination messaging campaigns geared toward rural MSM and other at-risk populations. It will be important to ensure that monkeypox prevention, testing, and vaccination interventions are available and accessible in rural areas.

Understanding COVID: Collaborative Government Campaign for Citizen Digital Health Literacy in the COVID-19 Pandemic

The strategy "Understanding COVID" was a Public Health campaign designed in 2020 and launched in 2021 in Asturias-Spain to provide reliable and comprehensive information oriented to vulnerable populations. The campaign involved groups considered socially vulnerable and/or highly exposed to COVID-19 infection: shopkeepers and hoteliers, worship and religious event participants, school children and their families, and scattered rural populations exposed to the digital divide. The purpose of this article was to describe the design of the "Understanding COVID" strategy and the evaluation of the implementation process. The strategy included the design and use of several educational resources and communication strategies, including some hundred online training sessions based on the published studies and adapted to the language and dissemination approaches, that reached 1056 people of different ages and target groups, an accessible website, an informative video channel, posters and other pedagogical actions in education centers. It required a great coordination effort involving different public and third-sector entities to provide the intended pandemic protection and prevention information at that difficult time. A communication strategy was implemented to achieve different goals: reaching a diverse population and adapting the published studies to different ages and groups, focusing on making it comprehensible and accessible for them. In conclusion, given there is a common and sufficiently important goal, it is possible to achieve effective collaboration between different governmental bodies to develop a coordinated strategy to reach the most vulnerable populations while taking into consideration their different interests and needs.

Optimization of physician resources in primary care during a pandemic: A ‘hot’ and ‘cold’ team approach

Background

Healthcare in rural localities has faced unique pressures in the midst of the COVID-19 (coronavirus disease 2019) pandemic.

Methodology

The Marathon Family Health Team physicians created a novel pandemic model that divides active physicians into ‘hot’ and ‘cold’ teams with a “sideline” reserve based on physician infectious status and ongoing exposure risk, in order to address the potential instability of small medical groups in isolated situations.

Results

Implemented in stages, the model maximizes group agility and healthcare provisions, while minimizing the risk of physicians as vectors for transmission or a possible healthcare system collapse from simultaneous physician incapacitation.

Conclusion

The hot/cold pandemic model can be applied to various healthcare facilities, including but not limited to hospitals and assessment centres, and the model's scale can be further adjusted for larger settings. By making use of incapacitated physicians who have been “sidelined” due to illness or burnout but still able to work from home, this model is integrative, efficient and innovative.

Parenting Pre-teens During COVID-19 in a Rural Midwestern Community: An Interpretive Phenomenological Study

To uncover the experiences of parenting Generation Z pre-teen children in rural communities impacted by the Stay Home Missouri order from April through May 2020. Researchers have focused on urban parents, leading to gaps in understanding the impact of the COVID-19 quarantine on rural parents and children. A qualitative study employing interpretive phenomenology. 14 white cis-male-sexed fathers and cis-female-sexed mothers living in midwestern rural communities participated in this study. Semi-structured interviews with 14 participants parenting pre-teen children were conducted. The interviews were analyzed using interpretive phenomenology. The COREQ checklist was followed. One theme that emerged from the narratives was the study participants' understandings of parenting, discovered when their routines were disrupted by the Stay Home Missouri order. This theme involved three sub-themes: 1) responding to the challenges of protecting pre-teen children; 2) coping with disrupted social relationships; and 3) renegotiating responsibilities. Professionals who work with families need to find ways to assist parents during and after a health emergency that requires quarantine. COVID-19 is not the first pandemic to endanger humanity, and the next pandemic-or a future variant of SARS-could require an additional period of local, regional, or national quarantine. Implications for professionals supporting parents during periods of severe disruption-such as future public health crises as well as large scale quarantines-are offered to assist with preparation for and coping with severe disruptions to parenting.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00507-9.

What Cuts in Federal COVID-19 Funding Could Mean for Rural Communities

The COVID-19 pandemic has widened the health disparities between urban and rural communities as rural populations face more limited health care capacities and worse COVID-19 outcomes than their urban counterparts. When this article was written, congress was debating continuing federal funds for free COVID-19 testing, vaccines, and treatment. In this article, we discuss the potential consequences rural communities may experience should such funding fail to be approved. Peer-reviewed literature and our research indicate these budget cuts could harm rural communities' financial distress, risk of severe disease outcomes, and trust in health care systems, making continued funding for public health resources critical for vulnerable rural communities.

Rural-urban outcome differences associated with COVID-19 hospitalizations in North Carolina

People living in rural regions in the United States face more health challenges than their non-rural counterparts which could put them at additional risks during the COVID-19 pandemic. Few studies have examined if rurality is associated with additional mortality risk among those hospitalized for COVID-19. We studied a retrospective cohort of 3,991 people hospitalized with SARS-CoV-2 infections discharged between March 1 and September 30, 2020 in one of 17 hospitals in North Carolina that collaborate as a clinical data research network. Patient demographics, comorbidities, symptoms and laboratory data were examined. Logistic regression was used to evaluate associations of rurality with a composite outcome of death/hospice discharge. Comorbidities were more common in the rural patient population as were the number of comorbidities per patient. Overall, 505 patients died prior to discharge and 63 patients were discharged to hospice. Among rural patients, 16.5% died or were discharged to hospice vs. 13.3% in the urban cohort resulting in greater odds of death/hospice discharge (OR 1.3, 95% CI 1.1, 1.6). This estimate decreased minimally when adjusted for age, sex, race/ethnicity, payer, disease comorbidities, presenting oxygen levels and cytokine levels (adjusted model OR 1.2, 95% CI 1.0, 1.5). This analysis demonstrated a higher COVID-19 mortality risk among rural residents of NC. Implementing policy changes may mitigate such disparities going forward.

Repercussions of COVID-19 on the daily lives of women living in a rural settlement

OBJECTIVE

To understand the repercussions of COVID-19 on women's daily lives in a rural settlement.

METHODS

A qualitative study was conducted in a rural settlement of the Landless Workers' Movement (MST) in a municipality in Northeastern Brazil between January and March 2021. Forty-eight women participated through semi-structured interviews. The data collected were analyzed by the Collective Subject Discourse method in light of the referential of pandemic processes.

RESULTS

The grouping of the speeches unveiled similar and/or complementary meanings about the coping strategies and the feelings generated due to the pandemic. Four Central Ideas were organized: denial to progressive awareness; Perception of the problem, acceptance, and explanation of reality; Negotiation; and Retrospection/reflection.

CONCLUSION

The pandemic repercussions are intrinsically related to an inhospitable reality from the perspective of the experience of women daily forgotten, marginalized, and suppressed.

A machine learning and clustering-based approach for county-level COVID-19 analysis

COVID-19 is a global pandemic threatening the lives and livelihood of millions of people across the world. Due to its novelty and quick spread, scientists have had difficulty in creating accurate forecasts for this disease. In part, this is due to variation in human behavior and environmental factors that impact disease propagation. This is especially true for regionally specific predictive models due to either limited case histories or other unique factors characterizing the region. This paper employs both supervised and unsupervised methods to identify the critical county-level demographic, mobility, weather, medical capacity, and health related county-level factors for studying COVID-19 propagation prior to the widespread availability of a vaccine. We use this feature subspace to aggregate counties into meaningful clusters to support more refined disease analysis efforts.

Impact of the COVID-19 Pandemic on HIM Professionals in a Rural State

The COVID-19 pandemic has greatly disrupted the healthcare industry, impacting health information professionals through facility changes, remote work, shifting priorities, and personal stressors. This study explores the impacts of these disruptions on health information professionals in a rural state. Participants indicated involvement in expanding and new responsibilities related to tracing and data collection, the expansion of telehealth services, and disaster planning. Their work was impacted by facility closures and suspended services, an increase in remote work, increased communications during the pandemic, and the shift to virtual continuing education. As with much of society, many participants also experienced worsening mental well-being, social wellness, and stress related to a variety of factors. Despite the stress and uncertainty, participants also found inspiration in the pandemic, taking time to reprioritize, connect with others, and find strength in human resilience.

An exploration of factors characterising unusual spatial clusters of COVID-19 cases in the East Midlands region, UK: A geospatial analysis of ambulance 999 data

Complex interactions between physical landscapes and social factors increase vulnerability to emerging infections and their sequelae. Relative vulnerability to severe illness and/or death (VSID) depends on risk and extent of exposure to a virus and underlying health susceptibility. Identifying vulnerable communities and the regions they inhabit in real time is essential for effective rapid response to a new pandemic, such as COVID-19. In the period between first confirmed cases and the introduction of widespread community testing, ambulance records of suspected severe illness from COVID-19 could be used to identify vulnerable communities and regions and rapidly appraise factors that may explain VSID. We analyse the spatial distribution of more than 10,000 suspected severe COVID-19 cases using records of provisional diagnoses made by trained paramedics attending medical emergencies. We identify 13 clusters of severe illness likely related to COVID-19 occurring in the East Midlands of the UK and present an in-depth analysis of those clusters, including urban and rural dynamics, the physical characteristics of landscapes, and socio-economic conditions. Our findings suggest that the dynamics of VSID vary depending on wider geographic location. Vulnerable communities and regions occur in more deprived urban centres as well as more affluent peri-urban and rural areas. This methodology could contribute to the development of a rapid national response to support vulnerable communities during emerging pandemics in real time to save lives.

A case of multiple sclerosis with protracted course of COVID-19

BACKGROUND

We reported a case of multiple sclerosis (MS) with persistent symptomatic COVID-19 which was complicated by new-appearing severe pneumonia 40 days after disease onset.

CASE PRESENTATION

A 38-year-old man with history of multiple sclerosis referred to our hospital with fever, shaking chills, cough and dyspnea. In his history, the patient had developed mild COVID-19 from 40 days ago. After 7 days of disease onset, the COVID symptoms had been subsided partially but fatigue, myalgia, intermittent fever and loss of taste and smell had been continued. In physical examinations, his oral temperature was 39.4 °C. He had respiratory distress and his blood oxygen saturation on the room air was 90%. The spiral chest CT scan was performed which revealed bilateral ground glass and alveolar opacities in favor of COVID-19 pneumonia. The result of RT-PCR test for SARS-COV-2 was reported positive, subsequently. His current MS medication was rituximab and he had received the last dose of rituximab, two months before developing COVID-19. The patient was admitted to COVID ward and put on Remdesivir, subcutaneous interferon-beta1b and dexamethasone. He improved gradually and was discharged from the hospital with favorable condition after 10 days. This patient had a rare protracted disease course. We presumed that prolong high degree fever (above 38 °C) in our patient is beyond the diagnosis of post-COVID-19 syndrome and is more compatible with persistent infection.

CONCLUSION

Although, most immunocompromised patients effectively clear SARS-CoV-2 infection, but this case report highlights the risk of persistent infection associated with recurrence of disease.

Assessment of the Quality of Life and Living Conditions of the Rural Population of the Kazakhstan during the COVID-19 Pandemic

BACKGROUND: Low availability of medical care and low level of comfort living in rural areas, underdeveloped infrastructure, and difficult working conditions lead to the deterioration of health of rural residents. Rural areas are characterized by less comfortable living conditions than in the city, which can affect health-related quality of life. AIM: The purpose of this study was to assess the satisfaction of the population with the quality of life in rural areas as well as to study the quality of life of the rural population of the Republic of Kazakhstan related to health. METHODS: This study was a one-stage cross-sectional study. Online questionnaire was asked by 411 local residents, of which only 302 were suitable for processing. RESULTS: The results showed that almost a third of the respondents are unemployed (27.2%). In the course of the survey, respondents could subjectively assess their own health, for example, almost a third of respondents (35.76%) assess their health as “poor” and “below average.” At the same time, 18.21% of respondents are not satisfied with the quality of medical services provided in rural areas. The coefficients of correlation between the desire to move to the city and age, income level, family composition, marital status, and type of housing were established. The universal social functioning-36 index was 0.6 (±0.02) for women and 0.55 (±0.033) for men CONCLUSIONS: We can say that the quality of life of the rural population remains quite low. This is evidenced by low income, high unemployment, and the problem of drinking water. Quarantine measures related to COVID-19 also had an impact on the increase in unemployment, however, during the quarantine, there is a deterioration in mental health indicators among men compared to women. The results of the study confirmed that the issue of accessibility of medical services remains very urgent for rural residents.

Violência contra a pessoa idosa no contexto rural em tempos de COVID-19: velhas e novas emergências

RESUMO Objetivo ampliar o debate sobre os fatores presentes no cotidiano da população idosa rural do Brasil, que contribuem para o aumento da violência contra a pessoa idosa (VCPI) na pandemia. Método estudo teórico-reflexivo, que apresenta como referenciais a Política Nacional de Saúde Integral das Populações do Campo e da Floresta e a Teoria da Vulnerabilidade, proposta por Ayres, que buscam compreender a exposição dos indivíduos a desfechos agravantes à saúde. O desenvolvimento se pautou na literatura nacional e internacional, e foi organizado pelo eixo condutor “as vulnerabilidades, redes formais e informais de proteção contra VCPI: reflexões em tempos de pandemia de COVID-19 em contexto de ruralidades”. Resultados o distanciamento social necessário para a mitigação da pandemia de COVID-19 pode estar impactando negativamente os idosos da zona rural a enfrentarem a VCPI. Acredita-se que o conjunto de estratégias das redes formais e informais não tem atingido adequadamente as necessidades dos idosos da área rural. Considerações finais e implicações para a prática é de fundamental importância que, em meio à pandemia do coronavírus, haja implantação de estratégias para a manutenção e ampliação dos equipamentos sociais da rede formal e informal de proteção contra VCPI, levando em consideração as necessidades da área rural.

Elder abuse in the rural context in times of COVID-19: old and new emergencies

ABSTRACT Objective to expand the debate on factors present in the daily life of rural older adults in Brazil, which contribute to the increase in elder abuse (EA) in the pandemic. Method a theoretical-reflective study, which presents the Brazilian National Comprehensive Health Policy for Rural and Forest Populations and the Vulnerability Theory as frameworks, proposed by Ayres, that seek to understand the exposure of individuals to aggravating health outcomes. The development was based on national and international literature, and was organized by the guiding axis “vulnerabilities, formal and informal networks of protection against EA: reflections in times of the COVID-19 pandemic in a context of rurality”. Results the social distancing necessary for mitigating the COVID-19 pandemic may be negatively impacting rural older adults facing EA. It is believed that the set of strategies of formal and informal networks has not adequately met older adults’ needs in rural areas. Final considerations and implications for practice it is of fundamental importance that, amidst the coronavirus pandemic, strategies are implemented for maintenance and expansion of the formal and informal network social equipment of protection against EA, taking into account rural people’s needs.

Repercussões da COVID-19 no cotidiano de mulheres residentes em um assentamento rural

RESUMO Objetivo: Compreender as repercussões da COVID-19 no cotidiano de mulheres em um assentamento rural. Métodos: Estudo de abordagem qualitativa, realizado num assentamento rural do Movimento dos Trabalhadores Rurais Sem Terra, em um município no Nordeste do Brasil, entre janeiro e março de 2021. Participaram 48 mulheres por meio de entrevista semiestruturada. Os dados coletados foram analisados pelo método do Discurso do Sujeito Coletivo, à luz do referencial dos processos pandêmicos. Resultados: O agrupamento dos discursos desvelou sentidos semelhantes e/ou complementares acerca das estratégias de enfrentamento e dos sentimentos gerados como consequência da pandemia. Foram organizadas quatro Ideias Centrais: Negação ao progressivo reconhecimento; Percepção do problema, aceitação e explicação da realidade; Negociação; e Retrospecção/reflexão. Conclusão: As repercussões da pandemia estão intrinsicamente relacionadas a uma inóspita realidade da perspectiva da vivência de mulheres que são cotidianamente esquecidas, marginalizadas e silenciadas.

Resolvin D1, therapeutic target in acute respiratory distress syndrome

Acute lung injury (ALI), or its more severe form, acute respiratory distress syndrome (ARDS), is a disease with high mortality and is a serious challenge facing the World Health Organization because there is no specific treatment. The excessive and prolonged immune response is the hallmark of this disorder, so modulating and regulating inflammation plays an important role in its prevention and treatment. Resolvin D1 (RvD1) as a specialized pro-resolving mediator has the potential to suppress the expression of inflammatory cytokines and to facilitate the production of antioxidant proteins by stimulating lipoxin A4 receptor/formyl peptide receptor 2 (ALX/FPR2). These changes limit the invasion of immune cells into the lung tissue, inhibit coagulation, and enhance cell protection against oxidative stress (OS). In particular, this biomolecule reduces the generation of reactive oxygen species (ROS) by blocking the activation of inflammatory transcription factors, especially nuclear factor-κB (NF-κB), and accelerating the synthesis of antioxidant compounds such as heme oxygenase 1 (HO-1) and superoxide dismutase (SOD). Therefore, the destruction and dysfunction of important cell components such as cytoplasmic membrane, mitochondria, Na+/k + adenosine triphosphatase (ATPase) and proteins involved in the phagocytic activity of scavenger macrophages are attenuated. Numerous studies on the effect of RvD1 over inflammation using animal models revealed that Rvs have both anti-inflammatory and pro-resolving capabilities and therefore, might have potential therapeutic value in treating ALI. Here, we review the current knowledge on the classification, biosynthesis, receptors, mechanisms of action, and role of Rvs in ALI/ARDS.

Experiences made by family physicians managing patients with SARS-CoV-2 infection during spring 2020 - a cross-sectional analysis

BACKGROUND

In Germany, family physicians care for about 85% of the patients infected with SARS-CoV-2. The geographic distribution of the first wave in 2020 was heterogeneous, and each federal state experienced different percentages of patients that died from COVID-19. Each of the 16 federal states implemented its own regulation about medical care for SARS-CoV-2 infected patients. Against this background, the objective of this analysis was to gather experiences made by primary care physicians managing SARS-CoV-2 infected patients during the first wave in March 2020 and to clinically characterize these patients.

METHODS

In total, 5,632 physicians were invited to participate in an online questionnaire surveying routine data regarding the general care situation at the physician practice level and the care for patients infected with SARS-CoV-2. Bivariate and multivariate analyses were applied to characterize treatment experiences and to identify patient characteristics predicting the course of disease.

RESULTS

132 family physicians from all German federal states (except from Berlin) participated in this analysis (response rate 2.3%) and provided routine care data for 1,085 patients. Information from 373 of these patients were provided in greater detail. On average, each physician treated 8.5 patients infected with SARS-CoV-2. About 15% of the physicians used video consultations to communicate with their infected patients. More than 82% made positive experiences with the exceptional regulation to provide a certificate of incapacity to work by telephone. Half of the physicians faced equipment insufficiencies due to a lack of protective gear, and in 10% of the practices, the staff themselves acquired SARS-CoV-2 infection. Greater numbers of SARS-CoV-2 cases treated in a practice translated into higher odds for members of the practice to get infected (odds ratio (OR) 1.03, 95% CI [1.01;1.06]). Older persons, males and patients in rural areas had higher odds of a severe course of disease.

CONCLUSIONS

Our results show that a large percentage of primary care physicians additionally managed their COVID-19 patients remotely by telephone or video during the outbreak, while also being at a higher risk for SARS-CoV-2 infection. Further, the increased severity in rural areas underlines the importance of strong primary health care in order to enable hospitals to concentrate on critically ill patients.

Longitudinal Examination of COVID-19 Public Health Measures on Mental Health for Rural Patients With Serious Mental Illness

Introduction

There is emerging evidence to support that the COVID-19 pandemic and related public health measures may be associated with negative mental health sequelae. Rural populations in particular may fair worse because they share many unique characteristics that may put them at higher risk for adverse outcomes with the pandemic. Yet, rural populations may also be more resilient due to increased sense of community. Little is known about the impact of the pandemic on the mental health and well-being of a rural population pre- and post-pandemic, especially those with serious mental illness.

Material and Methods

We conducted a longitudinal, mixed-methods study with assessments preceding the pandemic (between October 2019 and March 2020) and during the stay-at-home orders (between April 23, 2020, and May 4, 2020). Changes in hopelessness, suicidal ideation, connectedness, and treatment engagement were assessed using a repeated-measures ANOVA or Friedman test.

Results

Among 17 eligible participants, 11 people were interviewed. Overall, there were no notable changes in any symptom scale in the first 3-5 months before the pandemic or during the stay-at-home orders. The few patients who reported worse symptoms were significantly older (mean age: 71.7 years, SD: 4.0). Most patients denied disruptions to treatment, and some perceived telepsychiatry as beneficial.

Conclusions

Rural patients with serious mental illness may be fairly resilient in the face of the COVID-19 pandemic when they have access to treatment and supports. Longer-term outcomes are needed in rural patients with serious mental illness to better understand the impact of the pandemic on this population.

Analysis of Hazard Rate of Municipalities in Slovakia in Terms of COVID-19

The coronavirus became a phenomenon in 2020, which is making an unwanted but wide space for the study of various scientific disciplines. The COVID-19 pandemic situation which has reached almost the whole civilized world by its consequences thus offers a unique possibility to analyze the graphic space and the human activities inside it. The aim of this study is to predict and identify the potential rate of threat on the example of COVID-19 in Slovakia through an established model. This model consisted of an assessment of the partial phenomena of exposure, vulnerability, and overall risk. The statistical data used to evaluate these phenomena concerned individual cities in Slovakia. These represent the smallest administrative unit. Indirect methods based on the point method were applied in the paper. The spreading and transfer of the disease was influenced much more by the exposure presented by traffic availability, especially, but also the concentration of inhabitants in the selected locations (shops, cemeteries, and others). In the results, our modeling confirmed the regions with the highest intensity, especially in the districts (Bratislava, Košice, Prešov, and Nitra). The selection of the data and method used in this study together with the results reached and presented may serve as an appropriate tool for the support of decision-making of other measures for the future.

Association Between Age and Ethnicity with Pediatric Clinical Outcomes in COVID-2019

The novel coronavirus SARS-CoV-2 (COVID-19) has infected people across the world, including an increasing number of children in the United States (U.S.). The epidemiology of pediatric infection in the U.S. and how it influences clinical outcomes is still being characterized. In this study, we describe a cohort of 989 children with laboratory-confirmed SARS-CoV-2 infection. Children under age 20 in a statewide health system with SARS-CoV-2 infection, defined by positive PCR testing, between February 1 and August 30, 2020 were included in this observational cohort study. Data extracted from the medical record included age, demographic information, clinical illness severity, hospital stay, and comorbidities. Analysis included descriptive statistics and Chi-square as appropriate. Nine hundred and eighty-children met inclusion criteria for this study, ranging from 1 month to 20 years in age. Most children (62.4%) were asymptomatic at the time of diagnosis and children over the age of 2 were significantly more likely to be asymptomatic at diagnosis than younger children (P < .05). Hispanic children were significantly more likely to be symptomatic at the time of diagnosis (56.3% asymptomatic; P < .05). The high proportion of children with asymptomatic infection emphasizes the importance of understanding the unique role of children in the pandemic. Older children are more likely to be asymptomatic, but also more likely to experience severe or critical illness when symptoms do develop. Hispanic children were more likely to be symptomatic at diagnosis, highlighting the importance of culturally specific outreach to vulnerable communities.

SARS-CoV-2 PCR-positive and PCR-negative cases of pneumonia admitted to the hospital during the peak of COVID-19 pandemic: analysis of in-hospital and post-hospital mortality

BACKGROUND

During the spike of COVID-19 pandemic in Kazakhstan (June-2020), multiple SARS-CoV-2 PCR-test negative pneumonia cases with higher mortality were reported by media. We aimed to study the epidemiologic characteristics of hospitalized PCR-test positive and negative patients with analysis of in-hospital and post-hospital mortality. We also compare the respiratory disease characteristics between 2019 and 2020.

METHODS

The study population consist of 17,691 (March-July-2020) and 4600 (March-July-2019) hospitalized patients with respiratory diseases (including COVID-19). The incidence rate, case-fatality rate and survival analysis for overall mortality (in-hospital and post-hospital) were assessed.

RESULTS

The incidence and mortality rates for respiratory diseases were 4-fold and 11-fold higher in 2020 compared to 2019 (877.5 vs 228.2 and 11.2 vs 1.2 per 100,000 respectively). The PCR-positive cases (compared to PCR-negative) had 2-fold higher risk of overall mortality. We observed 24% higher risk of death in males compared to females and in older patients compared to younger ones. Patients residing in rural areas had 66% higher risk of death compared to city residents and being treated in a provisional hospital was associated with 1.9-fold increased mortality compared to those who were treated in infectious disease hospitals.

CONCLUSION

This is the first study from the Central Asia and Eurasia regions, evaluating the mortality of SARS-CoV-2 PCR-positive and PCR-negative respiratory system diseases during the peak of COVID-19 pandemic. We describe a higher mortality rate for PCR-test positive cases compared to PCR-test negative cases, for males compared to females, for elder patients compared to younger ones and for patients living in rural areas compared to city residents.