Pre-existing Health Conditions Research Articles

Inventory of state workers' compensation laws in the United States: first responder mental health.

We conducted a comprehensive review of state workers' compensation laws in the United States to evaluate the extent to which they support first responders with mental injury. Most state workers' compensation systems divide mental injuries into categories based on their presumed etiology: physical-mental, mental-physical, and mental-mental. Major differences exist among states as to which workers are eligible. Proving workplace causation can be difficult where no traumatic physical injuries exist. Latency periods, time limits, preexisting health conditions, restrictions as to types of condition covered, and complex chains of causation may make this burden, which falls on the claimant, even more challenging. Only nine (9) states enacted presumption of causation laws for mental health conditions to ease claimants' burden of proof. This contrasts starkly with presumption laws for chronic and infectious diseases. State decision-makers should create presumptions that mental health conditions in first responders are caused or significantly exacerbated by their stressful workplaces.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

CO205 Impact of GLP-1A Treatment on Eating Disorder Incidence: A Comparative, Real World Data Study in Patients With and Without Pre-Existing Mental Health Conditions

CO205 Impact of GLP-1A Treatment on Eating Disorder Incidence: A Comparative, Real World Data Study in Patients With and Without Pre-Existing Mental Health Conditions

COVID-19 Infection in Autosomal Dominant Polycystic Kidney Disease and Chronic Kidney Disease Patients: Progression of Kidney Disease.

the COVID-19 pandemic has brought to light the intricate interplay between viral infections and preexisting health conditions. In the field of kidney diseases, patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) and Chronic Kidney Disease (CKD) face unique challenges when exposed to the SARS-CoV-2 virus. This study aims to evaluate whether SARS-CoV-2 virus infection impacts renal function differently in patients suffering from ADPKD and CKD when compared to patients suffering only from CKD. clinical data from 103 patients were collected and retrospectively analyzed. We compared the renal function of ADPKD and CKD patients at two distinct time points: before COVID-19 infection (T0) and 1 year after the infection (T1). We studied also a subpopulation of 37 patients with an estimated glomerular filtration rate (eGFR) < 60 mL/min and affected by ADPKD and CKD. clinical data were obtained from 59 (57.3%) ADPKD patients and 44 (42.7%) CKD patients. At T1, ADPKD patients had significantly higher serum creatinine levels compared to CKD patients, and a significantly lower eGFR was observed only in ADPKD patients with eGFR < 60 mL/min compared to CKD patients (p < 0.01, p < 0.05; respectively). Following COVID-19 infection, ADPKD-CKD patients exhibited significantly higher variation in both median serum creatinine (p < 0.001) and median eGFR (p < 0.001) compared to CKD patients. the interplay between COVID-19 and kidney disease is complex. In CKD patients, the relationship between COVID-19 and kidney disease progression is more established, while limited studies exist on the specific impact of COVID-19 on ADPKD patients. Current evidence does not suggest that ADPKD patients are at a higher risk of SARS-CoV-2 infection; however, in our study we showed a significant worsening of the renal function among ADPKD patients, particularly those with an eGFR < 60 mL/min, in comparison to patients with only CKD after a one-year follow-up from COVID-19 infection.

Racial-Ethnic Gaps in Pandemic-Related Economic Hardship: Age Differences Among Older Adults.

Racial-ethnic disparities in experiences of economic hardship during the pandemic are well documented in the population overall and among older adults. Existing research shows that this economic hardship was much less common at older than younger ages. Little is known about the intersection of racial-ethnic and age disparities in pandemic-related hardship in later life. This research report investigated racial-ethnic gaps in economic hardship by age group among older adults. Data were from the 2018 and 2020 U.S. Health and Retirement Study (HRS) including the 2020 coronavirus disease 2019 module. We estimated Heckman-corrected linear probability models to examine differences in experiences of pandemic-related economic hardship in the 2020 HRS by race-ethnicity (non-Hispanic White, non-Hispanic Black, U.S.-born Hispanic, foreign-born Hispanic) across age groups (55-64, 65-74, 75+). In the multivariable analysis, we controlled for sociodemographic characteristics, participation in social programs, pre-existing health conditions and behaviors, and economic resources from the 2018 HRS. Experiences of economic hardship declined with age within each racial-ethnic group. Racial-ethnic gaps in hardship remained at older ages without any controls. However, when all controls were added, racial-ethnic gaps in economic hardship were eliminated for those ages 75+. Individual characteristics prior to the pandemic explained racial-ethnic differences in hardship for the oldest adults (75+) but did not explain gaps for those ages 55-74. Results point to structural factors generating new racial-ethnic gaps in pandemic-related economic hardship among those approaching retirement (ages 55-74) that did not affect the oldest adults (ages 75+).

COVID-19 Pandemic and Posttraumatic Growth in Residents of a Continuing Care Retirement Community: A Mixed Methods Study.

The coronavirus disease 2019 (COVID-19) pandemic impacted life for older adults living in residential settings, affecting their psychosocial well-being. Risk for COVID-19 is associated with increasing age and pre-existing health conditions. The current study aimed to describe the challenges of COVID-19 and post-traumatic growth (PTG) for residents of a continuing care retirement community (CCRC) in South Florida. A parallel mixed methods approach was used to explore the experience of older adults with PTG. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis to identify emergent themes. Ninety-eight older adults living in a single CCRC completed a survey. Age ranged from 67 to 99 years (mean age = 86 years), with >90% identifying as non-Hispanic White and female (78%). Using the PTG theoretical framework, experiences were categorized into five dimensions: new possibilities, relating to others, personal strength, spiritual growth, and appreciation for life. The current study focused on the challenges and growth experienced by older adults, as framed by PTG theory. Findings shed light on the capacity of this demographic, with an average age of 86 years, to overcome obstacles and achieve PTG. [Journal of Gerontological Nursing, 50(6), 25-33.].

Host obesity impacts genetic variation in influenza A viral populations.

Obesity is well established as a risk factor for many noncommunicable diseases; however, its consequences for infectious disease are poorly understood. Here, we investigated the impact of host obesity on influenza A virus (IAV) genetic variation using a diet-induced obesity ferret model and the A/Hong Kong/1073/1999 (H9N2) strain. Using a co-caging study design, we investigated the maintenance, generation, and transmission of intrahost IAV genetic variation by sequencing viral genomic RNA obtained from nasal wash samples over multiple days of infection. We found evidence for an enhanced role of positive selection acting on de novo mutations in obese hosts that led to nonsynonymous changes that rose to high frequency. In addition, we identified numerous cases of mutations throughout the genome that were specific to obese hosts and that were preserved during transmission between hosts. Despite detection of obese-specific variants, the overall viral genetic diversity did not differ significantly between obese and lean hosts. This is likely due to the high supply rate of de novo variation and common evolutionary adaptations to the ferret host regardless of obesity status, which we show are mediated by variation in the hemagglutinin and polymerase genes (PB2 and PB1). We also identified defective viral genomes (DVGs) that were found uniquely in either obese or lean hosts, but the overall DVG diversity and dynamics did not differ between the two groups. Our study suggests that obesity may result in a unique selective environment impacting intrahost IAV evolution, highlighting the need for additional genetic and functional studies to confirm these effects.IMPORTANCEObesity is a chronic health condition characterized by excess adiposity leading to a systemic increase in inflammation and dysregulation of metabolic hormones and immune cell populations. Influenza A virus (IAV) is a highly infectious pathogen responsible for seasonal and pandemic influenza. Host risk factors, including compromised immunity and pre-existing health conditions, can contribute to increased infection susceptibility and disease severity. During viral replication in a host, the negative-sense single-stranded RNA genome of IAV accumulates genetic diversity that may have important consequences for viral evolution and transmission. Our study provides the first insight into the consequences of host obesity on viral genetic diversity and adaptation, suggesting that host factors associated with obesity alter the selective environment experienced by a viral population, thereby impacting the spectrum of genetic variation.

Assessing heart rate fragmentation to predict atrial fibrillation in the general population aged 65

Abstract Rationale Screening the general population aged 65 for atrial fibrillation (AF) has been proposed as a preventive measure against potential complications. The dysfunction of the autonomic nervous system (ANS) plays an important role in atrial fibrillation (AF). Short-term HRV is conceptually attributed to physiologic vagal tone modulation. But recent data suggest that a component of short-term HRV, called heart rate fragmentation (HRF), is related to ANS breakdown and may be a predictor of AF occurrence. Metrics derived from heart rate variability (HRV) that depict heart rate fragmentation (HRF) have been suggested to reflect autonomic nervous system (ANS) dysfunction. Objectives To assess the predictive capacity of HRF markers for AF occurrence over an 18-year follow-up in individuals aged 65 at the study’s inspection and to develop a predictive score for AF onset. Methods A cohort study was designed to prospectively assess the predictive value of ANS activity level among general population regarding cardiovascular events and mortality. 1011 subjects aged 65 were enrolled in the study from September 2000 to December 2002. The study population had no history of AF and a low cardiovascular risk. A median follow-up of 17.8 years was managed. HRV data were acquired by 24-h Holter electrcardiogram (ECG) monitoring at baseline and assessed by frequency domain and time domain methods. Heart rate fragmentation using the percentage of inflection points (PIP) and alpha 1-index (using fractal evaluation of NN intervals) were then calculated. The study outcome was the development of AF during follow-up, defined as a standard 12-lead ECG recording or Holter recording with ≥ 30 s of AF. Results AF was diagnosed in 123 patients during the 18-year follow-up, representing a cumulative incidence of 13.4%. Using multivariate analysis, the occurrence of AF was independently predicted by the male gender (HR=1.74, 95%CI:1.16-2.63, p&amp;lt;0.01), a heart rate below 70bpm (HR=1.85, 95%CI:1.18-2.90, p&amp;lt;0.01), an increased percentage of NN intervals that differ by more than 50 ms from the previous interval (pnn50) (HR=1.69, 95%CI:1.06-2.70, p=0.03), an increased percentage of inflection points (HR=2.80, 95%CI:1.66-4.72,p&amp;lt;0.01), and a reduced alpha 1 index (HR=1.61, 95%CI:1.03-2.53, p=0.04). Given these results, a predictive score was built up based on the 4 independent predictors, ranging from 0 to 6 (Graphical Abstract). The high-risk group, defined as having a PROOF-AF score of 4 or higher, exhibited a 3.3-fold higher risk of developing AF (Figure). The PROOF-AF score demonstrated superior predictive performance compared to other available risk scores for incident AF such as CHARGE-AF score, C2HEST score, FHS score, and JMC score. Conclusion HRF parameters, included in the PROOF-AF score, may be used to identify individuals aged 65 without pre-existing health conditions who are at high-risk of developing AF and assist population screening.Graphical abstractFigure

#1466 Age- and kidney function-dependent life expectancy of patients after COVID-19

Abstract Background and Aims The life expectancy among survivors of SARS-CoV-2 infection may be influenced by age, pre-existing health conditions, and the severity of the initial infection. This study aimed to investigate the life expectancy in patients that survived the acute phase of COVID-19 and the association with kidney function. Method Survival data of 649 unvaccinated patients from our previous study “Prospective Validation of a Proteomic Urine Test for Early and Accurate Prognosis of Critical Course Complications in Patients with SARS-CoV-2 Infection” (CRIT-COV-U) [1] was collected until December 2023 in six different countries. These patients had been recruited within the first and second wave in 2020-2021 (mostly infected with wild-type virus) and had survived the acute phase of COVID-19 (CritCov-U study period 21 days after infection). The age dependent death rate in this cohort was compared to age- and sex-matched data of non-SARS-CoV-2 infected patients (n = 5192) extracted from human urinary database. The association of chronic kidney disease biomarker CKD273 with mortality was investigated in both cohorts using Kaplan-Meier analysis. Cox-regression analysis was used to assess variables associated with mortality in the COVID-19 population. Results Mortality was age dependent in both cohorts and markedly higher in patients who had survived the acute phase of COVID-19 in comparison to non-infected individuals (Fig. A-E). Within the first year after infection, mortality was up to 16.5 times higher in patients younger than 50 years in comparison to non-infected controls. Kidney status estimated by the CKD273 score was associated with a poor outcome in both COVID-19 patients and age- and sex-matched controls, respectively (Fig. F-G). The hazard ratio (HR) for mortality during the first year of follow-up for patients with the highest CKD273 score was 12.7, a huge increase in comparison to HR = 6.6 in the matched control group. In the Cox-regression model, CKD273 significantly contributed to death prediction, next to age and COVID-19 severity score at baseline. Conclusion SARS-CoV-2 infection during the first and second wave increased the risk of mortality in the follow-up period beyond the acute phase of the first 21 days. Kidney function appears to be a key element in the underlying molecular pathology of this process, indicating the importance of kidney-protective measures. Of note, among those who survived the acute phase of COVID-19, increase in mortality within the first year after infection compared to a non-infected control group was highest in the younger individuals.

Attitudes, Beliefs, and Intention to Receive a COVID-19 Vaccine for Pediatric Patients With Sickle Cell Disease.

Sickle cell disease (SCD), which occurs primarily in individuals of African descent, has been identified as a preexisting health condition for COVID-19 with higher rates of hospitalization, intensive care unit admissions, and death. National data indicate Black individuals have higher rates of vaccine hesitancy and lower COVID-19 vaccination rates. Understanding the key predictors of intention to receive a COVID-19 vaccine is essential as intention is strongly associated with vaccination behavior. This multisite study examined attitudes, beliefs, intentions to receive COVID-19 vaccines, and educational preferences among adolescents, young adults, and caregivers of children living with SCD. Participants completed an online survey between July 2021 and March 2022. Multivariate logistic regression was used to examine the association between participant age and COVID-19 vaccine attitudes, beliefs, and vaccine intentions. Of the 200 participants, 65.1% of adolescents, 62.5% of young adults, and 48.4% of caregivers intended to receive a COVID-19 vaccine for themselves or their child. Perception that the vaccine was safe was statistically significant and associated with patient and caregiver intention to receive the COVID-19 vaccine for themselves or their child. Participant age was also statistically significant and associated with the intent to get a booster for patients. Study findings highlight key concerns and influencers identified by patients with SCD and their caregivers that are essential for framing COVID-19 vaccine education during clinical encounters. Study results can also inform the design of messaging campaigns for the broader pediatric SCD population and targeted interventions for SCD subpopulations (eg, adolescents, caregivers).

Air Pollution and Covid-19

Air quality stands out as an important determinant of health, as its degradation was associated with around 4.2 million premature deaths in 2019, primarily due to heart and respiratory problems. It is shown that the elderly, the children, and individuals with pre-existing health conditions are simultaneously more sensitive to the impacts of air pollution and Covid-19, due to their fragile immune systems. Scientific evidence has shown the consequences of exposure to air pollutants to respiratory system diseases, emphasizing that it could be an important factor in explaining the spatial pattern of Covid-19 incidence and mortality. The aim of this study is to analyze the spatial association between air pollutant PM₂.₅ and the incidence and mortality of Covid-19 during March and December of 2020 in mainland Portugal. Weighted geographical models (GWR), were applied to identify and understand patterns, as well as explanatory factors in this relationship. The results obtained through the GWR models reveal that the pollutant PM₂.₅ has an association that varies in space. The incidence rate is higher in the southern, central, and northern regions of the country. The results of this study contribute to the analysis and assessment of the impact of air pollutants on human health, specifically in relation to health outcomes associated with Covid-19. It became evident that the concentration of PM₂.₅ is an important factor in explaining Covid-19 incidence rate in Portugal.

Health insurance among survivors of childhood cancer following affordable care act implementation.

The Affordable Care Act (ACA) increased private non-employer health insurance options, expanded Medicaid eligibility, and provided pre-existing health conditions protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre/post-ACA implementation. Using the multicenter Childhood Cancer Survivor Study, we included participants from two cross-sectional surveys: pre-ACA (2007-2009; survivors: N = 7,505; siblings: N = 2,175) and post-ACA (2017-2019; survivors: N = 4,030; siblings: N = 987). A subset completed both surveys (1,840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private/public/uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys. The proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance coverage was greater among those age 18-25 (survivors: 15.8% vs < 2.3% ages 26+; siblings +17.8% vs < 4.2% ages 26+). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratios [OR]=1.7, 95%CI 1.1-2.6). Survivors with severe chronic conditions (OR = 4.7, 95%CI 3.0-7.3) and those living in Medicaid expansion states (OR = 2.4, 95%CI 1.7-3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low/mid income survivors (<$60,000) experienced both insurance losses and gains in reference to highest household income survivors (≥$100,000), relative to odds of keeping the same insurance status. Post-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage.

Association between quality of life and burden of cancer caregivers: An example in a low and middle income country

ObjectiveLimited knowledge on burden and quality of life (QoL) among cancer caregivers is available in low and middle income countries. This study aims to investigate the QoL, levels of burden, and their associations among Vietnamese cancer caregivers. MethodsThis study was conducted across three hospitals in Vietnam. 348 caregivers were recruited from January to June 2021. Data were collected by using socio-demographic questionnaires, the Zarit Burden Interview scale, and Caregiver Qol Cancer. The association between QoL and burden was analyzed by using multivariate linear regression. ResultsOlder age (p = 0.03), employed (p = 0.01), and care more than 40 h (p = 0.007) were associated with a higher burden, respectively. QoL of financial concern had the lowest score (mean = 48.03, SD = 28.87), compared to the other subscale. Caregivers who had pre-existing health conditions, unstable work, spent more than 40 h per week, and took care dependent cancer patients were associated with a lower overall QoL score. Comparing to caregivers of no burden, those of mild burden had a lower QoL score by 10.70; while those of mild severe burden had the worse QoL (lower by 23.80 scores). ConclusionsPerceptional burden among caregivers is associated with QoL. Further policies are recommended to protect cancer caregivers, to alleviate the caregiving burden, and thus to improve the overall QoL.

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.

Evaluation of reports received on a digital platform for monitoring and self-care of individuals facing the COVID-19 pandemic in Brazil: Contributions to public health

ObjectivesTo evaluate the contribution of the digital platform “Meu Diário de Quarentena (MDQ)" or My Quarantine Diary concerning the monitoring and self-care of individuals with COVID-19 in Brazil. And to analyze the epidemiological and clinical characteristics related to the disease and the users who adhered to the support provided by MDQ. MethodsMDQ was developed by a multidisciplinary team and offered to the general population to provide self-care and health education during the COVID-19 pandemic, relying on users' self-reporting of information (such as signs and symptoms, pre-existing health conditions, and medications used during quarantine). The outcomes were measured, and the web app's support experience for public health was reported. ResultsMDQ had 2439 active users on the platform, with 485 (19.9 %) self-reporting a COVID-19 diagnosis, mostly from individuals in the southeastern region of Brazil (56.5 %). The most common pre-existing health condition reported was related to circulatory system diseases. The most frequent reported signs and symptoms included headache, cough, myalgia, nasal congestion and muscle weakness. Corticosteroids, multivitamins, and anti-inflammatories were the most used medications during the pandemic period. There were several reports related to how users were feeling during the pandemic, and among these reports, negative feelings toward isolation stood out, such as “feeling lonely”, “anxious”, and “feeling useless”. A significant association was found between sex (p < 0.001) and age (p < 0.001) in relation to self-reported cases of COVID-19. ConclusionsThe use of MDQ during extended quarantine was an easy and interesting way of interaction and support for people during COVID-19 pandemic.

Identification of individual-level clinical factors associated with increased risk of death during heatwaves: a time-stratified case-crossover study using national primary care records in England

BackgroundDespite an increase in heat-related deaths occurring in England in recent years, one of the key recommended actions of identifying individuals at risk and deploying targeted interventions is not routinely...

Empowering Education: Addressing Vaccination Hesitancy in The Covid-19 Era

The COVID-19 pandemic started in 2019 with the emergence of a new coronavirus and has greatly affected societies worldwide. It has led to an increase in mortality rates, disturbed pre-existing health conditions, disrupted educational systems, and reduced global workforce productivity and production. The scientific community has expedited vaccine development to combat the pandemic. However, the emergence of various vaccines has paradoxically resulted in a decline in public confidence, contributing to anti-vaccine sentiments. This study explores the pivotal role of education in fortifying vaccination rates and seeks to identify effective strategies to address hesitancy and strengthen public health measures. This research uses the two-stage least squares (2SLS) methodology to analyze the “Learning Loss Covid-19” cross-sectional dataset, which the World Bank published on January 4, 2023. The investigation focuses on the relationship between “Vaccination rate (per person)” and “Year of Education” across 41 countries. The empirical findings show that education has a significant impact on vaccination rates. An increase of one year in educational attainment leads to an approximate 14% increase in doses administered per person and a substantial 23% surge in the average dosage across nations. Therefore, education plays a crucial role in fortifying and elevating vaccination rates, demonstrating its significance as a potent tool in global public health endeavours.

Multifetal Pregnancy After Implementation of a Publicly Funded Fertility Program

A publicly funded fertility program was introduced in Ontario, Canada, in 2015 to increase access to fertility treatment. For in vitro fertilization (IVF), the program mandated an elective single-embryo transfer (eSET) policy. However, ovulation induction and intrauterine insemination (OI/IUI)-2 other common forms of fertility treatment-were more difficult to regulate in this manner. Furthermore, prior epidemiologic studies only assessed fetuses at birth and did not account for potential fetal reductions that may have been performed earlier in pregnancy. To examine the association between fertility treatment and the risk of multifetal pregnancy in a publicly funded fertility program, accounting for both fetal reductions and all live births and stillbirths. This population-based, retrospective cohort study used linked administrative health databases at ICES to examine all births and fetal reductions in Ontario, Canada, from April 1, 2006, to March 31, 2021. Mode of conception: (1) unassisted conception, (2) OI/IUI, or (3) IVF. The main outcome was multifetal pregnancy (ie, a twin or higher-order pregnancy). Modified Poisson regression generated adjusted relative risks (ARRs) and derived population attributable fractions (PAFs) for multifetal pregnancies attributable to fertility treatment. Absolute rate differences (ARDs) were used to compare the era before eSET was promoted (2006-2011) with the era after the introduction of the eSET mandate (2016-2021). Of all 1 724 899 pregnancies, 1 670 825 (96.9%) were by unassisted conception (mean [SD] maternal age, 30.6 [5.2] years), 24 395 (1.4%) by OI/IUI (mean [SD] maternal age, 33.1 [4.4] years), and 29 679 (1.7%) by IVF (mean [SD] maternal age, 35.8 [4.7] years). In contrast to unassisted conception, individuals who received OI/IUI or IVF tended to be older, reside in a high-income quintile neighborhood, or have preexisting health conditions. Multifetal pregnancy rates were 1.4% (95% CI, 1.4%-1.4%) for unassisted conception, 10.5% (95% CI, 10.2%-10.9%) after OI/IUI, and 15.5% (95% CI, 15.1%-15.9%) after IVF. Compared with unassisted conception, the ARR of any multifetal pregnancy was 7.0 (95% CI, 6.7-7.3) after OI/IUI and 9.9 (95% CI, 9.6-10.3) after IVF, with corresponding PAFs of 7.1% (95% CI, 7.1%-7.2%) and 13.4% (95% CI, 13.3%-13.4%). Between the eras of 2006 to 2011 and 2016 to 2021, multifetal pregnancy rates decreased from 12.9% to 9.1% with OI/IUI (ARD, -3.8%; 95% CI, -4.2% to -3.4%) and from 29.4% to 7.1% with IVF (ARD, -22.3%; 95% CI, -23.2% to -21.6%). In this cohort study of more than 1.7 million pregnancies in Ontario, Canada, a publicly funded IVF program mandating an eSET policy was associated with a reduction in multifetal pregnancy rates. Nevertheless, ongoing strategies are needed to decrease multifetal pregnancy, especially in those undergoing OI/IUI.

A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana

IntroductionDespite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana. MethodsWe conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data. ResultsAt the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges. ConclusionPregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.

The Australian Traumatic Brain Injury Initiative: Systematic Review and Consensus Process to Determine the Predictive Value of Pre-existing Health Conditions for People with Moderate-Severe Traumatic Brain Injury.

The first aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) encompasses development of a set of measures that comprehensively predict outcomes for people with moderate-severe TBI across Australia. This process engaged diverse stakeholders and information sources across six areas: social, health, and clinical factors; biological markers; treatments; and longer-term outcomes. Here, we report the systematic review of pre-existing health conditions as predictors of outcome for people with moderate-severe TBI. Standardized searches were implemented across databases until March 31, 2022. English-language reports of studies evaluating association between pre-existing health conditions and clinical outcome in at least 10 patients with moderate-severe TBI were included. A predefined algorithm was used to assign a judgement of predictive value to each observed association. The list of identified pre-existing health conditions was then discussed with key stakeholders during a consensus meeting to determine the feasibility of incorporating them into standard care. The searches retrieved 22,217 records, of which 47 articles were included. The process led to identification of 88 unique health predictors (homologized to 21 predictor categories) of 55 outcomes (homologized to 19 outcome categories). Only pre-existing health conditions with high and moderate predictive values were discussed during the consensus meeting. Following the consensus meeting, 5 out of 11 were included (migraine, mental health conditions, ≥4 pre-existing health conditions, osteoporosis, and body mass index [BMI]) as common data elements in the AUS-TBI data dictionary. Upon further discussion, 3 additional pre-existing health conditions were included. These are pre-existing heart disease, frailty score, and previous incidence of TBI.