Neurologic findings among inpatients with COVID-19 at a safety-net US hospital

ObjectiveTo characterize the breadth of neurologic findings associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in a diverse group of inpatients at an urban, safety-net US medical center.MethodsPatients were identified through an electronic medical record review from April 15, 2020, until July 1, 2020, at a large safety-net hospital in Boston, MA, caring primarily for underserved, low-income, and elderly patients. All hospitalized adult patients with positive nasopharyngeal swab or respiratory PCR testing for SARS-CoV-2 during their hospitalization or in the 30 days prior to admission who received an inpatient neurologic or neurocritical care consultation or admission during the study period were enrolled.ResultsSeventy-four patients were identified (42/57% male, median age 64 years). The majority of patients self-identified as Black or African-American (38, 51%). The most common neurologic symptoms at presentation to the hospital included altered mental status (39, 53%), fatigue (18, 24%), and headache (18, 18%). Fifteen patients had ischemic strokes (20%). There were 10 in-hospital mortalities, with moderately severe disability among survivors at discharge (14%, median modified Rankin Scale score of 4).ConclusionsNeurologic findings spanned inflammatory, vascular pathologies, sequelae of critical illness and metabolic derangements, possible direct involvement of the nervous system by SARS-CoV-2, and exacerbation of underlying neurologic conditions, highlighting a broad range of possible etiologies of neurologic complications in patients with coronavirus disease 2019 (COVID-19). Further studies are needed to characterize the infectious and post-infectious neurologic complications of COVID-19 in diverse patient populations.

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Qualitative research study on addressing barriers to healthy diet among low-income individuals at an urban, safety-net hospital

BMJ Nutrition, Prevention & Health ◽

10.1136/bmjnph-2020-000064 ◽

2020 ◽

pp. bmjnph-2020-000064

Author(s):

Erin Cahill ◽

Stacie R Schmidt ◽

Tracey L Henry ◽

Gayathri Kumar ◽

Sara Berney ◽

...

Keyword(s):

Behaviour Change ◽

Healthy Eating ◽

Low Income ◽

Dietary Habits ◽

Qualitative Interviews ◽

Safety Net ◽

Nutritional Knowledge ◽

Adequate Food ◽

Safety Net Hospital ◽

Urban Safety

BackgroundSome American households experience food insecurity, where access to adequate food is limited by lack of money and other resources. As such, we implemented a free 6-month Fruit and Vegetable Prescription Program within a large urban safety-net hospital .Methods32 participants completed a baseline and postintervention qualitative evaluation about food-related behaviour 6 months after study completion. Deductive codes were developed based on the key topics addressed in the interviews; inductive codes were identified from analytically reading the transcripts. Transcripts were coded in MAXQDA V.12 (Release 12.3.2).ResultsThe information collected in the qualitative interviews highlights the many factors that affect dietary habits, including the environmental and individual influences that play a role in food choices people make. Participants expressed very positive sentiments overall about their programme participation.ConclusionsA multifaceted intervention that targets individual behaviour change, enhances nutritional knowledge and skills, and reduces socioeconomic barriers to accessing fresh produce may enhance participant knowledge and self-efficacy around healthy eating. However, socioeconomic factors remain as continual barriers to sustaining healthy eating over the long term. Ongoing efforts that address social determinants of health may be necessary to promote sustainability of behaviour change.

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3532 Vitamin D assay utilization and outcomes in pregnant women in an urban safety net medical center: a retrospective cohort study

Journal of Clinical and Translational Science ◽

10.1017/cts.2019.72 ◽

2019 ◽

Vol 3 (s1) ◽

pp. 30-30

Author(s):

Grace Hyojung Yoon ◽

Michael Holick ◽

Arash Hossein

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Low Income ◽

Medical Center ◽

Safety Net ◽

Vitamin D Supplementation ◽

Vitamin D Levels ◽

Urban Safety ◽

Study Population ◽

Boston Medical

OBJECTIVES/SPECIFIC AIMS: The goals of this retrospective cohort study is threefold: 1) to assess how many pregnant women at Boston Medical Center from 2012 to 2017 have had their vitamin D status checked prior to and during pregnancy, 2) determine associations between vitamin D levels, birth outcomes and demographics and 3) assess how many of those found to have lower than satisfactory vitamin D levels (<30ng/mL) received interventions, including receiving vitamin D supplementation and/or being referred to an appropriate specialist such as an endocrinologist or a nutritionist. METHODS/STUDY POPULATION: Our study population is mothers over age 18 who received care at Boston Medical Center during their pregnancy from 2012 to 2017. Our primary outcomes are vitamin D utilization rates and associations between vitamin D levels with clinical outcomes during pregnancy and at birth. Secondary outcomes are demographic predictors of mothers who receive vitamin D testing and those who have complications associated with low vitamin D. We will conduct multiple linear regressions to check for associations between vitamin D levels, birth outcomes and demographic variables. We will adjust vitamin D levels with maternal BMI. De-identified clinical data was gathered from Boston University Medical Center’s (BUMC) Clinical Data Warehouse. This retrospective study was approved with a HIPAA waiver by the BUMC Institutional Data Warehouse. All statistical analysis was completed using SAS version 9.4 and was primarily done by the student PI and reviewed by Dr. Hossein, the co-investigator who is trained as a statistician and geneticist. The team also utilized Boston University’s Biostatistics, Epidemiology & Research Design (BERD) team to check the feasibility of the statistical methods. RESULTS/ANTICIPATED RESULTS: We anticipate that our descriptive demographic data will reflect the medical center’s predominantly black/Hispanic and low-income profile. Based on previous literature, we expect low vitamin D levels to have positive associations with gestational diabetes, pre-eclampsia, and preterm birth. Analyses are currently actively in progress and we expect to have results before the ACTS conference date in March, 2019. DISCUSSION/SIGNIFICANCE OF IMPACT: Vitamin D is an essential part of the human body system. It is well documented in current literature that vitamin D is correlated with bone health, mental health and maternal health. Moreover, there is evidence that maternal vitamin D supplementation prevents vitamin D deficiency in newborns. Previous literature suggests that low vitamin D may be associated with gestational diabetes, pre-eclampsia, and pre-term births. Boston Medical Center is Massachusetts’ largest urban medical center and acts as its only safety-net hospital, serving predominantly low-income and socially marginalized patient populations. There is limited existing research on assessment of maternal vitamin D in urban hospital settings. Pregnant women rarely receive vitamin D screenings as part of their prenatal checkups as current national and regional guidelines do not require pregnant women to be screened for vitamin D deficiency or insufficiency. The results will demonstrate the potential effects vitamin D supplementation, or lack thereof, in expectant mothers living in urban, safety net communities. We hope to inform prenatal care practices and attitudes of vitamin D supplementation in maternal health with the results of our study.

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The Impact of Payer Status on Hospital Admissions: Evidence from an Academic Medical Center

10.21203/rs.3.rs-384429/v1 ◽

2021 ◽

Author(s):

Yanying Zhao ◽

Ioannis Ch. Paschalidis ◽

Jianqiang Hu

Keyword(s):

Access To Care ◽

Low Income ◽

Hospital Admissions ◽

Medical Center ◽

Conditional Logistic Regression ◽

Private Insurance ◽

Academic Medical Center ◽

Safety Net ◽

Safety Net Hospital ◽

The Impact

Abstract Background: Inequity exists in accessing to care for patients with different payer statuses. However, there are few studies on the difference of hospital admissions. This study aims to examine how the payer status affects patients hospitalization from the perspective of a safety-net hospital. Methods: We extracted all patients with visiting record in this medical center between 5/1/2009-4/30/2014, and then linked the outpatient and inpatient records three year before target admission time to patients. We conduct a retrospective observational study using a conditional logistic regression methodology. To control the illness of patients with different diseases in training the model, we construct a three-dimension variable with data stratification technology. The model is validated on a dataset distinct from the one used for training. Results: Payer status is strongly associated with a patient’s admission. Patients covered by private insurance or uninsured are less likely to be admitted than those totally or partially insured by government. For uninsured patients, inequity in access to hospitalization is observed. Among all non-clinical influential factors considered in our study, payer status is a significant important factor. Conclusion: Attention is needed on improving the access to care for vulnerable (low-income) patients, for example, by actively advertising free care programs, reaching out to community organizations with better access to these individuals, or offering assurances that access to care is not linked to immigration procedures. Also, in order to reduce preventable admissions, basic preventive care services should be enhanced.

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Hospital-acquired Clostridioides difficile infection among patients at an urban safety-net hospital in Philadelphia: Demographics, neighborhood deprivation, and the transferability of national statistics

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1324 ◽

2020 ◽

pp. 1-7

Author(s):

Daniel T. Vader ◽

Chelsea Weldie ◽

Seth L. Welles ◽

Michele A. Kutzler ◽

Neal D. Goldstein

Keyword(s):

Low Income ◽

Private Insurance ◽

Antibiotic Use ◽

Safety Net ◽

University Hospital ◽

National Surveillance ◽

National Data ◽

Clostridioides Difficile ◽

Safety Net Hospital ◽

Urban Safety

Abstract Objective: To investigate associations between healthcare-associated Clostridioides difficile infection and patient demographics at an urban safety-net hospital and compare findings with national surveillance statistics. Methods: Study participants were selected using a case-control design using medical records collected between August 2014 and May 2018 at Hahnemann University Hospital in Philadelphia. Controls were frequency matched to cases by age and length of stay. Final sample included 170 cases and 324 controls. Neighborhood-level factors were measured using American Community Survey data. Multilevel models were used to examine infection by census tract, deprivation index, race/ethnicity, insurance type, referral location, antibiotic use, and proton-pump inhibitor use. Results: Patients on Medicare compared to private insurance had 2.04 times (95% CI, 1.31–3.20) the odds of infection after adjusting for all covariables. Prior antibiotic use (2.70; 95% CI, 1.64–4.46) was also associated with infection, but race or ethnicity and referral location were not. A smaller proportion of hospital cases occurred among white patients (25% vs 44%) and patients over the age of 65 (39% vs 56%) than expected based on national surveillance statistics. Conclusions: Medicare and antibiotics were associated with Clostridioides difficile infection, but evidence did not indicate association with race or ethnicity. This finding diverges from national data in that infection is higher among white people compared to nonwhite people. Furthermore, a greater proportion of hospital cases were aged <65 years than expected based on national data. National surveillance statistics on CDI may not be transportable to safety-net hospitals, which often disproportionately serve low-income, nonwhite patients.

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Comparing Once- versus Twice-Weekly Yoga Classes for Chronic Low Back Pain in Predominantly Low Income Minorities: A Randomized Dosing Trial

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2013/658030 ◽

2013 ◽

Vol 2013 ◽

pp. 1-13 ◽

Cited By ~ 39

Author(s):

Robert B. Saper ◽

Ama R. Boah ◽

Julia Keosaian ◽

Christian Cerrada ◽

Janice Weinberg ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Low Income ◽

Chronic Low Back Pain ◽

Community Health Centers ◽

Safety Net ◽

Low Back ◽

Related Function ◽

Safety Net Hospital ◽

Urban Safety

Background. Previous studies have demonstrated that once-weekly yoga classes are effective for chronic low back pain (cLBP) in white adults with high socioeconomic status. The comparative effectiveness of twice-weekly classes and generalizability to racially diverse low income populations are unknown.Methods. We conducted a 12-week randomized, parallel-group, dosing trial for 95 adults recruited from an urban safety-net hospital and five community health centers comparing once-weekly (n=49) versus twice-weekly (n=46) standardized yoga classes supplemented by home practice. Primary outcomes were change from baseline to 12 weeks in pain (11-point scale) and back-related function (23-point modified Roland-Morris Disability Questionnaire).Results. 82% of participants were nonwhite; 77% had annual household incomes <$40,000. The sample’s baseline mean pain intensity [6.9 (SD 1.6)] and function [13.7 (SD 5.0)] reflected moderate to severe back pain and impairment. Pain and back-related function improved within both groups (P<0.001). However, there were no differences between once-weekly and twice-weekly groups for pain reduction [-2.1(95% CI-2.9,-1.3) versus −2.4 (95% CI-3.1,-1.8),P=0.62] or back-related function [-5.1(95% CI-7.0,-3.2) versus −4.9 (95% CI-6.5,-3.3),P=0.83].Conclusions. Twelve weeks of once-weekly or twice-weekly yoga classes were similarly effective for predominantly low income minority adults with moderate to severe chronic low back pain. This trial is registered with ClinicalTrials.govNCT01761617.

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