High Proportion Of People Research Articles

Comparison of physician-delivered models of virtual and home-based in-person care for adults in the last 90 days of life with cancer and terminal noncancer illness during the COVID-19 pandemic.

To measure the association between types of serious illness and the use of different physician-delivered care models near the EOL during the COVID-19 pandemic. Population-based cohort study using health administrative datasets in Ontario, Canada, for adults aged ≥18 years in their last 90 days of life who died of cancer or terminal noncancer illness and received physician-delivered care models near the end-of-life between March 14, 2020 and January 24, 2022. The type of serious illness (cancer or terminal noncancer illness). Physician-delivered care models for adults in the last 90 days of life (exclusively virtual, exclusively home-based in-person, or mixed). The study included 75,930 adults (median age 78 years, 49% female, cancer n = 58,894 [78%], noncancer illness n = 17,036 [22%]). A higher proportion of people with cancer (39.3%) received mixed model of care compared to those with noncancer illnesses (chronic organ failure 24.4%, dementia 37.9%, multimorbidity 28%). Compared to people with cancer, people with chronic organ failure (adjusted odds ratio [aOR], 1.61, 95% CI: 1.54 to 1.68) and those with multimorbidity ([aOR], 1.49, 95% CI: 1.39 to 1.59) had a higher odds of receiving virtual care than a mixed model of care. People with dementia had a higher odds of home-based in-person care than a mixed model of care ([aOR], 1.47, 95% CI 1.27, 1.71) and virtual care ([aOR], 1.40, 95% CI 1.20-1.62) compared to people with cancer. A person's type of serious illness was associated with different care models near the end-of-life. This study demonstrates persistent disease-specific differences in care delivery or possibly the tailoring of models of care in the last 90 days of life based on a person's specific care needs.

HIV-Associated Heart Failure: Phenotypes and Clinical Outcomes in a Safety-Net Setting.

HIV is associated with increased risk of heart failure (HF) but data regarding phenotypes of HF and outcomes after HF diagnosis, especially within the safety net where half of people with HIV in the United States receive care, are less clear. Using an electronic health record cohort of all individuals with HF within a municipal safety-net system from 2001 to 2019 linked to the National Death Index Plus, we compared HF phenotypes, all-cause mortality, HF hospitalization, and cause of death for individuals with and without HIV. Among people with HF (n=14 829), 697 individuals had HIV (4.7%). People with HIV were diagnosed with HF 10 years younger on average. A higher proportion of people with HIV had a reduced ejection fraction at diagnosis (37.9% versus 32.7%). Adjusted for age, sex, and risk factors, coronary artery disease on angiography was similar by HIV status. HIV was associated with 55% higher risk of all-cause mortality (hazard ratio [HR], 1.55 [95% CI, 1.37-1.76]; P<0.001) and lower odds of HF hospitalization (odds ratio [OR], 0.51 [95% CI, 0.39-0.66]; P<0.001). Among people with HIV with HF, cause of death was less often attributed to cardiovascular disease (22.5% versus 54.6% uninfected; P<0.001) and more to substance use (17.9% versus 9.3%; P<0.001), consistent with autopsy findings in a subset (n=81). Among people with HF who receive care within a municipal safety-net system, HIV infection is associated with higher mortality, despite lower odds of HF hospitalization, attributable to noncardiovascular causes including substance-related and HIV-related mortality.

Abstract A060: Identification of tumour-specific variants from pleural effusion cell-free DNA as diagnostic markers of cancers affecting the lungs

Abstract Background: Pleural mesothelioma (PM) can be difficult to diagnose due to a combination of the growth pattern of the tumour, the invasive nature of the biopsy procedure and the frailty of the patient. Some patients with PM develop a build-up of fluid around their lungs as their first clinical symptom. This fluid can make breathing difficult and is routinely drained as part of standard care. Currently, a cytological test can be performed to identify if PM cells are present in the fluid, however, while this is a specific test, it lacks sensitivity. We examined if (a) cell-free DNA (cfDNA) originating from tumours affecting the lung could be detected in this fluid and (b) if this cfDNA could be determined as coming from PM compared to non-small cell lung cancer (NSCLC), due to changes in genes that only occur in these types of tumours. Methods: Using the QIAamp MinElute ccfDNA Kit, we were able to isolate sufficient concentrations of cfDNA from pleural effusions (n=80) derived from patient samples procured by our colleagues at Southmead Hospital with either PM or NSCLC to perform gene panel sequencing. Using the QIAseq Targeted DNA Pro Human Lung Cancer Research Panel, with additional booster primers covering BAP1 and SETD2, we performed the library preparation in-house. Data analysis was carried out using the QIAGEN CLC Genomics Workbench, with the specific workflows for the gene panels and results were filtered by QC, proportion of variant reads and variant read count. Data were compared to expected variant frequencies published in TCGA. Results: Tumour-specific cfDNA was isolated from pleural effusions in the majority of samples tested. In a proportion of these, variants indicative of a specific type of tumour (PM or NSCLC) were readily detectable, at slightly lower than the expected frequencies than reported in TCGA. Conclusions and future work: This approach can act as a 'rule-in' clinically diagnostic test for the presence of PM or NSCLC in a higher proportion of people that can currently be identified through cytology testing. These individuals could be spared from receiving an invasive biopsy to diagnose their tumour. We are currently working on (i) increasing the sensitivity of this approach to identify more cases and (ii) if a bioinformatic method can identify tumour-specific copy number alterations from the gene panel sequencing data. Citation Format: Connie MacKinnon, Dr Colette Mustard, Dr Nicole Brace, Dr Beth Sage, Jenny Symonds, Colin Nixon, Dr Anna Bibby, A/Prof Antonia Pritchard. Identification of tumour-specific variants from pleural effusion cell-free DNA as diagnostic markers of cancers affecting the lungs [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr A060.

Questions on travel and sexual behaviours negatively impact ethnic minority donor recruitment: Effect of negative word-of-mouth and avoidance.

Donor selection questions differentially impacting ethnic minorities can discourage donation directly or via negative word-of-mouth. We explore the differential impact of two blood safety questions relating to (i) sexual contacts linked to areas where human immunodeficiency virus (HIV) rates are high and (ii) travelling to areas where malaria is endemic. Epidemiological data are used to assess infection risk and the need for these questions. We report two studies. Study 1 is a behavioural study on negative word-of-mouth and avoiding donation among ethnic minorities (n = 981 people from National Health Service Blood and Transplant (NHSBT) and the general population: 761 were current donors). Study 2 is an epidemiology study (utilizing NHSBT/UK Health Security Agency (UKHSA) surveillance data on HIV-positive donations across the UK blood services between1996 and 2019) to assess whether the sexual risk question contributes to reducing HIV risk and whether travel deferral was more prevalent among ethnic minorities (2015-2019). Studies 1 and 2 provide complementary evidence on the behavioural impact to support policy implications. A high proportion of people from ethnic minorities were discouraged from donating and expressed negative word-of-mouth. This was mediated by perceived racial discrimination within the UK National Health Service. The number of donors with HIV who the sexual contact question could have deferred was low, with between 8% and 9.3% of people from ethnic minorities deferred on travel compared with 1.7% of White people. Blood services need to consider ways to minimize negative word-of-mouth, remove questions that are no longer justified on evidence and provide justification for those that remain.

UNSEEN TUBERCULOSIS: STUDY AMONG INPATIENTS OF A TERTIARY CARE HOSPITAL OF NORTH KARNATAKA

Objective: Tuberculosis (TB) remains a significant global health challenge, particularly in high-burden countries like India. However, high proportion of people never diagnosed or treated. Delayed diagnosis poses a significant threat to hospital inpatients, health-care workers, and medical trainees. Hence, systematic screening of high-risk groups, including hospital inpatients, has been recommended as a strategy to identify TB. Using signs and symptoms as an independent screening tool remains a global challenge for its relatively low accuracy. However, it could still be of value when it was used in a specific target population like inpatients of hospital. Hence, this study is aimed to determine the proportion of presumptive and active TB cases among inpatients. Methods: A hospital-based cross-sectional study was conducted among inpatients above 18 years of age admitted in non-emergency wards admitted during March to April 2023 at ESIC Hospital in Kalaburagi. A pre-existing TB diagnosis and patients admitted to critical care units were excluded. The convenient sampling method was used to recruit participants. Data were collected through using a pre-designed, semi-structured questionnaire. The patients who presented with one of the four symptoms for screening had undergone investigations such as cartridge-based nucleic acid amplification test, chest X-ray, and sputum microscopy to confirm the diagnosis, and the findings were recorded as proportion. Results: Out of 1363 inpatients, 35 (2.5%) patients had classified as presumptive TB case. Out of 35, 3 (8.57%) were found to be actual TB cases. All patients who had positive results for TB were young patients and belonged to low socioeconomic class. Two of three were rifampicin-sensitive TB cases. Conclusion: Timely screening of the patient’s is of utmost importance to avoid further spread of TB infection among inpatients. The higher prevalence of actual TB cases in younger adults needs further exploration.

Summary of Research: Effects of Adalimumab-adbm Versus Adalimumab Reference Product on Patient-Reported Outcomes in Rheumatoid Arthritis: Results from VOLTAIRE-RA.

This Summary of Research overviews the results of a study that looked at patient-reported outcomes in the VOLTAIRE-RA trial (NCT02137226), originally published in Rheumatology and Therapy. A biosimilar is a biologic medicine made to be very similar to the original biologic medicine (also known as the reference product). The VOLTAIRE-RA trial compared the efficacy and safety of an adalimumab biosimilar (Cyltezo®, adalimumab-admb) with the adalimumab reference product, Humira®, in people with rheumatoid arthritis. As part of the VOLTAIRE-RA study, participants took either adalimumab-adbm or adalimumab reference product for 24weeks. Patient-reported outcomes were captured after 12weeks and after 24weeks of treatment to assess the effects of treatment on each participant's health-related quality of life. People with rheumatoid arthritis who were given adalimumab-adbm or adalimumab reference product experienced similar clinically meaningful improvements in their health-related quality of life after 12weeks of treatment. A high proportion of people in this trial who were given adalimumab-adbm or adalimumab reference product reported greater improvement versus a reference US population matched by age and sex. This is notable, as it represents a treatment goal that was difficult to achieve in earlier rheumatoid arthritis trials of non-biologic treatments.

Mobile vaccination units to increase COVID-19 vaccination uptake in areas with lower coverage: a within-neighbourhood analysis using national registration data, the Netherlands, September-December 2021.

BackgroundVaccine uptake differs between social groups. Mobile vaccination units (MV-units) were deployed in the Netherlands by municipal health services in neighbourhoods with low uptake of COVID-19 vaccines.AimWe aimed to evaluate the impact of MV-units on vaccine uptake in neighbourhoods with low vaccine uptake.MethodsWe used the Dutch national-level registry of COVID-19 vaccinations (CIMS) and MV-unit deployment registrations containing observations in 253 neighbourhoods where MV-units were deployed and 890 contiguous neighbourhoods (total observations: 88,543 neighbourhood-days). A negative binomial regression with neighbourhood-specific temporal effects using splines was used to study the effect.ResultsDuring deployment, the increase in daily vaccination rate in targeted neighbourhoods ranged from a factor 2.0 (95% confidence interval (CI): 1.8-2.2) in urbanised neighbourhoods to 14.5 (95% CI: 11.6-18.0) in rural neighbourhoods. The effects were larger in neighbourhoods with more voters for the Dutch conservative Reformed Christian party but smaller in neighbourhoods with a higher proportion of people with non-western migration backgrounds. The absolute increase in uptake over the complete intervention period ranged from 0.22 percentage points (95% CI: 0.18-0.26) in the most urbanised neighbourhoods to 0.33 percentage point (95% CI: 0.28-0.37) in rural neighbourhoods.ConclusionDeployment of MV-units increased daily vaccination rate, particularly in rural neighbourhoods, with longer travel distance to permanent vaccination locations. This public health intervention shows promise to reduce geographic and social health inequalities, but more proactive and long-term deployment is required to identify its potential to substantially contribute to overall vaccination rates at country level.

Analyzing Google COVID-19 Vaccine Intent Search Trends and Vaccine Readiness in the United States: Panel Data Study.

Factors such as anxiety, worry, and perceptions of insufficient knowledge about a topic motivate individuals to seek web-based health information to guide their health-related decision-making. These factors converged during the COVID-19 pandemic and were linked to COVID-19 vaccination decision-making. While research shows that web-based search relevant to COVID-19 was associated with subsequent vaccine uptake, less is known about COVID-19 vaccine intent search (which assesses vaccine availability, accessibility, and eligibility) as a signal of vaccine readiness. To increase knowledge about vaccine intent search as a signal of vaccine readiness, we investigated the relationship between COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume on Google. We compiled panel data from several data sources in all US counties between January 2021 and April 2023, a time during which those with primary COVID-19 vaccinations increased from <57,000 to >230 million adults. We estimated a random effects generalized least squares regression model with time-fixed effects to assess the relationship between county-level COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume. We controlled for health care capacity, per capita COVID-19 cases and vaccination doses administered, and sociodemographic indicators. The county-level proportions of unvaccinated adults who reported that they would wait and see before getting a COVID-19 vaccine were positively associated with COVID-19 vaccine intent relative search volume (β=9.123; Z=3.59; P<.001). The county-level proportions of vaccine-enthusiast adults, adults who indicated they were either already vaccinated with a primary COVID-19 vaccine series or planned to complete the vaccine series soon, were negatively associated with COVID-19 vaccine intent relative search volume (β=-10.232; Z=-7.94; P<.001). However, vaccine intent search was higher in counties with high proportions of people who decided to wait and see and lower in counties with high proportions of vaccine enthusiasts. During this period of steep increase in COVID-19 vaccination, web-based search may have signaled differences in county-level COVID-19 vaccine readiness. More vaccine intent searches occurred in high wait-and-see counties, whereas fewer vaccine intent searches occurred in high vaccine-enthusiast counties. Considering previous research that identified a relationship between vaccine intent search and subsequent vaccine uptake, these findings suggest that vaccine intent search aligned with people's transition from the wait-and-see stage to the vaccine-enthusiast stage. The findings also suggest that web-based search trends may signal localized changes in information seeking and decision-making antecedent to vaccine uptake. Changes in web-based search trends illuminate opportunities for governments and other organizations to strategically allocate resources to increase vaccine uptake. Resource use is part of the larger public policy decisions that influence vaccine uptake, such as efforts to educate the public during evolving public health crises, including future pandemics.

Health Behaviour of Police Officers in Relation to Hypertension. Observations from a Hungarian County

"The aim of this study is to assess the health behavior of those who are treated for high blood pressure among law enforcement officers, compared to those who are not under treatment for high blood pressure. Methodology: In Hungary, a cross-sectional survey was carried out among those serving in the County of Szabolcs-Szatmár-Bereg. This is the publication of partial results of a study carried out in the framework of a comprehensive health behavior survey. Findings: The number of items in the sample is 1,719. 11.40% were treated for hypertension. There is a significant difference in gender (χ2= 3.979; p=0.047). The highest proportion of people with hypertension is among those with a secondary school leaving certificate (18.8%). The lowest prevalence is among university graduates (9.1%). Education level is significantly associated with hypertension (χ2=17.013; p=0.004). There is a very strong significant association between length of time in service and hypertension (χ2=83.204; p= 0.000). The proportion of people with hypertension increases steadily with the length of service. No significant differences were found for work schedule, smoking, alcohol consumption or physical activity. When examining the relationship between social support and hypertension, there is a significant difference between grandparent support and parent support (p=0.002; p=0.012). Those treated for hypertension can count on less parental or grandparental support. Non-hypertensives have higher personal health awareness (p=0001), as well as higher self-assessment of health (p=0.000). They are more motivated to avoid unhealthiness (p=0.002) and to maintain their health (p=0.009). They feel in better health (p=0.000) and are confident that this will be maintained in the future (p=0.000). Health concern is higher among hypertension patients (p=0.045). Both internal and external health control scores are higher (p=0.000; P=0.001) as is health anxiety (p=0.000). Value: The prevalence of hypertension increases with age, so it is of paramount importance that appropriate health promotion programmes help law-enforcement workers to maintain their health. Keyword: high blood pressure, law enforcement, health behavior, health promotion"

Eye care service utilization and associated factors among diabetic patients in Africa: A Systematic Review and Meta-Analysis

Introduction'Vision 2020, the Right to Sight', jointly coordinated by the World Health Organization's program for the prevention of blindness and deafness and the international agency for the prevention of blindness, was launched in 1999, however, the initiative faces many challenges to hitting its target. One of the challenges for this is, the absence of comprehensive data regarding eye care service utilization among diabetes mellitus patients in Africa. Therefore, this study was aimed at assessing the prevalence of eye care service utilization and associated factors among adult diabetes mellitus patients in Africa. MethodsThis systematic review and meta-analysis was conducted as per the international preferred reporting items for systematic review and meta-analysis protocols (PRISMA) guidelines. Published articles were searched using reputable databases (PubMed, Cochrane Library) and Web searches (Science Direct, African Journals Online, and Google Scholar). Quality appraisal was assessed based on the Joanna Briggs Institute's (JBI) critical appraisal checklist. The extracted data was exported to STATA version 11 (STATA Corp., LLC) for further analysis. Heterogeneity between the results of primary studies was assessed using Cochran's Q chi-square test and quantified with the I2 statistics. Publication bias was assessed by visual inspection of the funnel plot and Egger's regression tests. ResultsThe database search found 26,966 articles. The pooled prevalence of eye care service utilization among diabetic patients in Africa is found to be 40.92 % (95 % CI: 27.14–54.70, P < 0.001). Good knowledge (POR = 3.57, 95 % CI: 2.67–4.76), good attitude (POR = 5.68, 95 % CI: 4.20–7.68), age greater than 65 years old (POR = 7.11, 95 % CI: 3.86–13.10), urban residence (POR = 5.03, 95 % CI: 2.12–11.96), and disease duration greater than 6 years (POR = 3.81, 95 % CI: 2.25–6.45) were factors associated with eye care service utilization. ConclusionThis meta-analysis revealed that a high proportion of people with diabetes failed to use eye care services. Older age, good knowledge, urban residence and longer duration of illness were found to be the contributing factors for the utilization of eye care services in diabetes mellitus patients. Therefore, by considering the negative impact of low eye care service utilization, it is important to improve the habit of regular screening of the eye into routine assessment of diabetes mellitus follow up targeting patients with older age and longer duration of illness to reduce the magnitude of the problem.

Combined impact of sleep and obesity on female infertility in the NHANES 2017–2020

BackgroundSleep health and obesity may affect the risk of female infertility. However, few studies focused on the interaction of obesity and sleep health on the female infertility risk. This study aimed to evaluate the combined impact of trouble sleeping / sleep duration and overweight/obesity/ abdominal obesity on the risk of female infertility.MethodsThe data for this cross-sectional study was obtained from National Health and Nutritional Examination Survey, which provided information on trouble sleeping, sleep duration, overweight/obesity, abdominal obesity, and confounding factors. Adopted weighted univariate and multivariate logistic regression models to explore the relationship between trouble sleeping, sleep duration, overweight/obesity, abdominal obesity, and the risk of infertility, respectively, and the combined effect of trouble sleeping and overweight/obesity, trouble sleeping and abdominal obesity, sleep duration and overweight/obesity, sleep duration and abdominal obesity, on the female infertility risk.ResultsThis study included a total of 1,577 women, and 191 were diagnosed with infertility. Women with infertility had a higher proportion of people with overweight/obesity, abdominal obesity, sleep duration ≤ 7 h and trouble sleeping than those with non-infertility. The result indicated that trouble sleeping [odds ratio (OR) = 2.25, 95% confidence intervals (CI): 1.49–3.39], sleep duration ≤ 7 h (OR = 1.59, 95% CI: 1.03–2.48), and the combined impact of abdominal obesity and trouble sleeping (OR = 2.18, 95% CI: 1.28–3.72), abdominal obesity and sleep duration ≤ 7 h (OR = 2.00, 95% CI: 1.17–3.40), overweight/obesity and trouble sleeping (OR = 2.29, 95% CI: 1.24–4.26), and overweight/obesity and sleep duration ≤ 7 h (OR = 1.88, 95% CI: 1.01–3.49) were associated with increased odds of infertility, respectively.ConclusionThere was combined effects of trouble sleeping/sleep duration ≤ 7 h and overweight/obesity/ abdominal obesity on increased odds of female infertility.

Preservation of native languages of national minorities in a multinational region

The purpose of the article is to reveal the factors influencing the preservation of the native language of national minorities in a multiethnic region. The object of the study is the non-Russian population of Bashkortostan, which, according to the 2020 census, is represented in the ethnic structure of the republic by Mari (84988 people) and Chuvash (79,950 people), Udmurts (17,149 people). Despite the dispersed settlement, the studied peoples live compactly in a number of areas and have their own linguistic area. Based on the analysis of regional ethnosociological experience, the article raises the problem of preserving the native languages of non-Russian ethnic groups of the republic. The results of a study on this issue among respondents of different age groups (18-65 years and older) from among national minorities, as well as the use of native languages (Mari, Chuvash, Udmurt) in family practice are considered. The empirical basis of the article is based on data from the All-Russian Population Census in 2020 and an ethnosociological survey conducted in the republic in 2020 by the author of the publication among the Mari, Chuvash and Udmurt populations of the republic. It is concluded that the languages of non-Russian peoples are losing their main role in everyday life. In communication in all spheres, preference is given to Russian, which has conquered the ethnolanguage space of Bashkortostan. As a result, the respondents demonstrated, on the one hand, the primacy of the Russian language. On the other hand, they nevertheless expressed hope for the preservation of the national language of the Mari, Chuvash and Udmurt peoples of the republic in conditions of consistent generational connection and experience, through family language communication. A special contribution to the research of the topic is the identification of factors and trends in the formation of the linguistic competence of the studied peoples in the republic. According to the ethnosociological survey, it was found that Udmurts (93.8%), Mari (97.8%), Chuvash (92.6%) still have high recognition of their nationality as their native language, which, in turn, shows their level of ethnolanguage identity in Bashkortostan. The Chuvash, compared with representatives of other non-Russian ethnic groups, have a high proportion of people who speak Russian (99%). Consequently, the results of the sociological research show a high level of both linguistic competence and speech activity of the above-mentioned non-Russian peoples in the republic.

Age-friendly Transport: Traffic Safety for All

The elderly make up an increasing percentage of the European population and, with it, of the Hungarian population. Modern society is built around mobility. These two factors together lead to an increasing proportion of elderly drivers on the roads. Given the high proportion of people with chronic neurological conditions (stroke, Parkinson's disease, dementia), particular care should be taken to regularly check their fitness to drive. At present, there is no standardized, well-established protocol for the objective assessment of fitness to drive in the case of these diseases. Our paper discusses this matter.

Prevalence, severity and impacts of breathlessness in Indian adults: An exploratory, nationally representative, cross-sectional online survey.

There are no known estimates of the prevalence, severity and impacts from breathlessness in low- and middle-income countries. This study aimed to explore the prevalence, severity, self-attributed underlying conditions and impacts of breathlessness limiting exertion in community-dwelling adults in India. This exploratory, population-based online survey recruited a pre-planned sample of 3,000 adult respondents stratified by age, sex and rurality (quotas as per the 2011 Indian National Census). Measures included: demographics; breathlessness limiting exertion (modified Medical Research [mMRC] scale); health-related quality of life (EQ-5D-5L); and disability (World Health Organisation's Disability Assessment Schedule 2.0 12-item questionnaire [WHODAS-12]). Respondents (n = 3,046) had a mean age of 38 years (SD 15); 57% were male, 59% lived in rural areas and 33% had completed 12th grade. Breathlessness limiting exertion (mMRC ≥1) was reported by 44%, mostly attributed to poor nutrition (28%), lung conditions excluding tuberculosis (17%) or anaemia (13%). Compared to those without breathlessness, a higher proportion of people with breathlessness (mMRC ≥1) reported problems across all EQ-5D-5L dimensions. Most people reporting breathlessness (81%) indicated the symptom had adversely affected their normal activities. Disability scores (WHODAS-12 total and individual domains) increased as breathlessness worsened. To conclude, in India, conservative estimates indicate 626 million people live with breathlessness of whom 52 million people live with severe breathlessness. The symptom is associated with poorer health-related quality of life and marked disability, including reduced ability to perform daily activities.

Prevalence and risk factors for long COVID among adults in Scotland using electronic health records: a national, retrospective, observational cohort study

Long COVID is a debilitating multisystem condition. The objective of this study was to estimate the prevalence of long COVID in the adult population of Scotland, and to identify risk factors associated with its development. In this national, retrospective, observational cohort study, we analysed electronic health records (EHRs) for all adults (≥18 years) registered with a general medical practice and resident in Scotland between March 1, 2020, and October 26, 2022 (98-99% of the population). We linked data from primary care, secondary care, laboratory testing and prescribing. Four outcome measures were used to identify long COVID: clinical codes, free text in primary care records, free text on sick notes, and a novel operational definition. The operational definition was developed using Poisson regression to identify clinical encounters indicative of long COVID from a sample of negative and positive COVID-19 cases matched on time-varying propensity to test positive for SARS-CoV-2. Possible risk factors for long COVID were identified by stratifying descriptive statistics by long COVID status. Of 4,676,390 participants, 81,219 (1.7%) were identified as having long COVID. Clinical codes identified the fewest cases (n=1,092, 0.02%), followed by free text (n=8,368, 0.2%), sick notes (n=14,469, 0.3%), and the operational definition (n=64,193, 1.4%). There was limited overlap in cases identified by the measures; however, temporal trends and patient characteristics were consistent across measures. Compared with the general population, a higher proportion of people with long COVID were female (65.1% versus 50.4%), aged 38-67 (63.7% versus 48.9%), overweight or obese (45.7% versus 29.4%), had one or more comorbidities (52.7% versus 36.0%), were immunosuppressed (6.9% versus 3.2%), shielding (7.9% versus 3.4%), or hospitalised within 28 days of testing positive (8.8% versus 3.3%%), and had tested positive before Omicron became the dominant variant (44.9% versus 35.9%). The operational definition identified long COVID cases with combinations of clinical encounters (from four symptoms, six investigation types, and seven management strategies) recorded in EHRs within 4-26 weeks of a positive SARS-CoV-2 test. These combinations were significantly (p<0.0001) more prevalent in positive COVID-19 patients than in matched negative controls. In a case-crossover analysis, 16.4% of those identified by the operational definition had similar healthcare patterns recorded before testing positive. The prevalence of long COVID presenting in general practice was estimated to be 0.02-1.7%, depending on the measure used. Due to challenges in diagnosing long COVID and inconsistent recording of information in EHRs, the true prevalence of long COVID is likely to be higher. The operational definition provided a novel approach but relied on a restricted set of symptoms and may misclassify individuals with pre-existing health conditions. Further research is needed to refine and validate this approach. Chief Scientist Office (Scotland), Medical Research Council, and BREATHE.

Rapidly Developing a Community- and Evidence-Based Heat Action Plan

Abstract Extreme heat contributes to 8000–12 000 excess U.S. deaths per year. Partly due to increasing summer temperatures and a renewed focus on environmental justice, local governments started new initiatives to manage and adapt to extreme heat. For example, Miami-Dade County, Florida, United States, appointed Jane Gilbert as the world’s first Chief Heat Officer. This manuscript summarizes Miami-Dade County’s preliminary efforts to build local evidence, engage the community, and rapidly respond to extreme heat. The manuscript’s goal is to expedite the translation of existing tools into mainstream extreme heat, health, and equity planning. The study generated local evidence to identify the places and periods of time with elevated heat-related illness using a statistical vulnerability and time series analysis, respectively. The places with the highest severe heat-related illness rates had hotter land surface temperatures and/or higher proportions of people who were outdoor workers, Indigenous, living in poverty or mobile homes, and households with children. “Everyday” summer conditions instead of rare heatwaves increase the risk of a heat-related death. The Chief Heat Officer convened workshops that engaged 298 unique community members on six cross-sectoral heat topics. Key recommendations included increasing multisectoral heat monitoring and risk communication, building more affordable housing, preserving and expanding greenspace, and creating heat resilience hubs. The activities culminated in a Heat Action Plan, which was completed in less than two years from the receipt of project funding.

Association of socioeconomic disadvantage and ethnicity with perinatal neonatal, and infant mortality in Slovakia

BackgroundInfant mortality rates are reliable indices of the child and general population health status and health care delivery. The most critical factors affecting infant mortality are socioeconomic status and ethnicity. The aim of this study was to assess the association between socioeconomic disadvantage, ethnicity, and perinatal, neonatal, and infant mortality in Slovakia before and during the COVID-19 pandemic.MethodsThe associations between socioeconomic disadvantage (educational level, long-term unemployment rate), ethnicity (the proportion of the Roma population) and mortality (perinatal, neonatal, and infant) in the period 2017–2022 were explored, using linear regression models.ResultsThe higher proportion of people with only elementary education and long-term unemployed, as well as the higher proportion of the Roma population, increases mortality rates. The proportion of the Roma population had the most significant impact on mortality in the selected period between 2017 and 2022, especially during the COVID-19 pandemic (2020–2022).ConclusionsLife in segregated Roma settlements is connected with the accumulation of socioeconomic disadvantage. Persistent inequities between Roma and the majority population in Slovakia exposed by mortality rates in children point to the vulnerabilities and exposures which should be adequately addressed by health and social policies.

Mushroom Picking as a Special Form of Recreation and Tourism in Woodland Areas—A Case Study of Poland

The paper looks at the potential benefits of mushrooms in terms of health, recreation, and tourism. Mycotourism is an innovative, specialised tourism product that has been successfully introduced in some regions of the world, helping to combat seasonality and promote economic development in rural areas. The aim of the study was to analyse the development of mycotourism in Poland in comparison with other countries. As a method, a questionnaire on the cultural significance of mushrooms was developed and disseminated via social media. It was found that there are strong mycophilic tendencies in Poland, leading to a strong interest in mushrooms, both in terms of cultural and culinary traditions. They are also a factor that attracts tourists to the forest areas. In contrast, the UK and Germany are more mycophobic, resulting in a lower interest in mushrooms, limited culinary use, and a lower awareness of their role in the ecosystem and their potential health benefits. The low average score for knowledge of mushrooms in countries such as the UK indicates a need for increased mycological education that can contribute to a better understanding of the conservation of these important components of the forest floor. The high proportion of people who see mushroom picking in Poland as a form of recreation emphasises its role as an important cultural and potential nature tourism asset. In Poland, where long traditions are associated with mushrooms and mushroom picking, they have a strong influence on the choice of mycological tourism, especially in regions with a rich tradition of mushroom picking. The high percentage of mushrooms used for culinary purposes, especially in Poland, emphasises their value and influences the health component of the diet, which is rich in proteins, vitamins, and minerals. Research has shown that mushroom consumption and its effects on health are perceived positively. This is evidenced by higher ratings in Poland than in the UK and Germany, indicating a general awareness of the health benefits of mushrooms, even though their use in medicine remains limited. The low level of awareness of the role of mushrooms and their potential health benefits suggests that educational and promotional activities should be increased to sensitise the public to mushrooms.

Locations and characteristics of pharmacy deserts in the United States: a geospatial study.

Pharmacies are important health care access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US states and the District of Columbia. We also compared sociodemographic characteristics of pharmacy desert vs non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the United States live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible health care setting in the United States, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to health care. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.

Walkable and Safe Route to Transit for Pedestrians in Greater Montréal: An Environmental Justice Approach

The experience of walking to transit stops plays a critical role in the use of public transportation. Having a safe and walkable environment for this part of the trip is even more important for vulnerable population groups, who depend more heavily on public transportation. The aim of this paper was to evaluate first mile/last mile walkability and road risks in the Montréal metropolitan area using an environmental justice approach. Using a spatially sound method, we determined that areas where more people identify as visible minorities are disadvantaged as far as walking-to-transit routes are concerned and that areas with higher proportions of people on low incomes and people aged 65 and over have more walkable environments but also have to deal with more road risk.