scholarly journals Long Covid after Breakthrough COVID-19: the post-acute sequelae of breakthrough COVID-19

2021 ◽  
Author(s):  
Ziyad Al-Aly ◽  
Benjamin Bowe ◽  
Yan Xie
Keyword(s):  
Acute Phase ◽  
Seasonal Influenza ◽  
Care Setting ◽  
Comparative Approach ◽  
Department Of Veterans Affairs ◽  
Risk Of Death ◽  
Pulmonary System ◽  
Neurologic Disorders ◽  
The Us ◽  
Broad Array

Abstract The post-acute sequelae of COVID-19 have been described1, but whether breakthrough COVID-19 (that is the disease that ensues following vaccine breakthrough SARS-CoV-2 infection) results in post-acute sequelae is not yet clear. Here we use the national healthcare databases of the US Department of Veterans Affairs to characterize 6-month risks of incident post-acute sequelae in people with breakthrough COVID-19 who survived for at least 30 days after diagnosis. We show that compared to people with no evidence of COVID-19, beyond the first 30 days of illness, people with breakthrough COVID-19 exhibit a higher risk of death and broad array of incident post-acute sequelae in the pulmonary system, as well as extrapulmonary sequelae that include cardiovascular disorders, coagulation disorders, gastrointestinal disorders, general disorders (e.g., fatigue), kidney disorders, mental health disorders, metabolic disorders, musculoskeletal disorders, and neurologic disorders. Our analyses by care setting of the acute phase of the disease show that people who were not hospitalized during the first 30 days after diagnosis with breakthrough COVID-19 exhibit a small but not insignificant increase in risk of death and post-acute sequelae; the risks are further increased in people who were hospitalized during the acute phase of the disease. Our comparative approach shows that people with breakthrough COVID-19 exhibit lower risks of death and post-acute sequelae than people with COVID-19 who were not previously vaccinated for it; and in analyses among individuals who were hospitalized during the acute phase of the disease, people with breakthrough COVID-19 exhibit higher risks of death and post-acute sequelae than people with seasonal influenza. Altogether, our findings show increased risks of death and post-acute sequalae in people with breakthrough COVID-19; the risks are evident among those who were not hospitalized during the acute phase of the disease. Our comparative approach provides context for understanding the risks in relation to COVID-19 without prior vaccination and seasonal influenza. The findings will inform the ongoing effort to optimize strategies for prevention of breakthrough SARS-CoV-2 infections and will guide development and optimization of post-acute care pathways for people with breakthrough COVID-19.

Anxieties of Experience

2017 ◽  
Author(s):  
Jeffrey Lawrence
Keyword(s):  
American Literature ◽  
Latin American ◽  
World Literature ◽  
Latin American Literature ◽  
First Century ◽  
Comparative Approach ◽  
Leaves Of Grass ◽  
Literary Authority ◽  
The Us ◽  
New Interpretation

Anxieties of Experience: The Literatures of the Americas from Whitman to Bolaño offers a new interpretation of US and Latin American literature from the nineteenth century to the present. Revisiting longstanding debates in the hemisphere about whether the source of authority for New World literature derives from an author’s first-hand contact with American places and peoples or from a creative (mis)reading of existing traditions, the book charts a widening gap in how modern US and Latin American writers defined their literary authority. In the process, it traces the development of two distinct literary strains in the Americas: the “US literature of experience” and the “Latin American literature of the reader.” Reinterpreting a range of canonical works from Walt Whitman’s Leaves of Grass to Roberto Bolaño’s 2666, Anxieties of Experience shows how this hemispheric literary divide fueled a series of anxieties, misunderstandings, and “misencounters” between US and Latin American authors. In the wake of recent calls to rethink the “common grounds” approach to literature across the Americas, the book advocates a comparative approach that highlights the distinct logics of production and legitimation in the US and Latin American literary fields. Anxieties of Experience closes by exploring the convergence of the literature of experience and the literature of the reader in the first decades of the twenty-first century, arguing that the post-Bolaño moment has produced the strongest signs of a truly reciprocal literature of the Americas in more than a hundred years.

Anti-System Politics

2020 ◽  
Author(s):  
Jonathan Hopkin
Keyword(s):  
Comparative Approach ◽  
The European Union ◽  
Political Systems ◽  
The United Kingdom ◽  
The Us ◽  
Long Term Result ◽  
The Rich ◽  
Dramatic Shift ◽  
To Come ◽  
The Right

Recent elections in the advanced Western democracies have undermined the basic foundations of political systems that had previously beaten back all challenges—from both the Left and the Right. The election of Donald Trump to the US presidency, only months after the United Kingdom voted to leave the European Union, signaled a dramatic shift in the politics of the rich democracies. This book traces the evolution of this shift and argues that it is a long-term result of abandoning the postwar model of egalitarian capitalism in the 1970s. That shift entailed weakening the democratic process in favor of an opaque, technocratic form of governance that allows voters little opportunity to influence policy. With the financial crisis of the late 2000s, these arrangements became unsustainable, as incumbent politicians were unable to provide solutions to economic hardship. Electorates demanded change, and it had to come from outside the system. Using a comparative approach, the text explains why different kinds of anti-system politics emerge in different countries and how political and economic factors impact the degree of electoral instability that emerges. Finally, it discusses the implications of these changes, arguing that the only way for mainstream political forces to survive is for them to embrace a more activist role for government in protecting societies from economic turbulence.

Transformation of the US Veterans Health Administration

2006 ◽  
Vol 1 (2) ◽  
pp. 99-105 ◽  
Author(s):  
Jonathan B. Perlin
Keyword(s):  
United States ◽  
Health Care ◽  
Veterans Health Administration ◽  
The United States ◽  
Veterans Affairs ◽  
United States Department ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
The Us

Ten years ago, it would have been hard to imagine the publication of an issue of a scholarly journal dedicated to applying lessons from the transformation of the United States Department of Veterans Affairs Health System to the renewal of other countries' national health systems. Yet, with the recent publication of a dedicated edition of the Canadian journal Healthcare Papers (2005), this actually happened. Veterans Affairs health care also has been similarly lauded this past year in the lay press, being described as ‘the best care anywhere’ in the Washington Monthly, and described as ‘top-notch healthcare’ in US News and World Report's annual health care issue enumerating the ‘Top 100 Hospitals’ in the United States (Longman, 2005; Gearon, 2005).

scholarly journals Racial/ethnic differences in inpatient mortality and use of institutional postacute care following subarachnoid hemorrhage

2013 ◽  
Vol 119 (6) ◽  
pp. 1627-1632 ◽  
Author(s):  
Blessing N. R. Jaja ◽  
Gustavo Saposnik ◽  
Rosane Nisenbaum ◽  
Benjamin W. Y. Lo ◽  
Tom A. Schweizer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Institutional Care ◽  
Inpatient Mortality ◽  
Risk Of Death ◽  
The Us ◽  
Hispanic Patients ◽  
Racial Ethnic ◽  
White Patients

Object The goal of this study was to determine racial/ethnic differences in inpatient mortality rates and the use of institutional postacute care following subarachnoid hemorrhage (SAH) in the US. Methods A cross-sectional study of hospital discharges for SAH was conducted using the Nationwide Inpatient Sample for the years 2005–2010. Discharges with a principal diagnosis of SAH were identified and abstracted using the appropriate ICD-9-CM diagnostic code. Racial/ethnic groups were defined as white, black, Hispanic, Asian/Pacific Islander (API), and American Indian. Multinomial logistic regression analyses were performed comparing racial/ethnic groups with respect to the primary outcome of risk of in-hospital mortality and the secondary outcome of likelihood of discharge to institutional care. Results During the study period, 31,631 discharges were related to SAH. Race/ethnicity was a significant predictor of death (p = 0.003) and discharge to institutional care (p ≤ 0.001). In the adjusted analysis, compared with white patients, API patients were at higher risk of death (OR 1.34, 95% CI 1.13–1.59) and Hispanic patients were at lower risk of death (OR 0.84, 95% CI 0.72–0.97). The likelihood of discharge to institutional care was statistically similar between white, Hispanic, API, and Native American patients. Black patients were more likely to be discharged to institutional care compared with white patients (OR 1.27, 95% CI 1.14–1.40), but were similar to white patients in the risk of death. Conclusions Significant racial/ethnic differences are present in the risk of inpatient mortality and discharge to institutional care among patients with SAH in the US. Outcome is likely to be poor among API patients and best among Hispanic patients compared with other groups.

Improving the Lung Cancer Resection Rate in the US Department of Veterans Affairs Health System

2006 ◽  
Vol 7 (4) ◽  
pp. 268-272 ◽  
Author(s):  
Mark Thomas Dransfield ◽  
Brion Jacob Lock ◽  
Robert I. Garver
Keyword(s):  
Lung Cancer ◽  
Health System ◽  
Veterans Affairs ◽  
Department Of Veterans Affairs ◽  
Resection Rate ◽  
Cancer Resection ◽  
The Us

Survival Outcome and Insurance Status Among Hodgkin's Lymphoma (HL) Patients: Data from SEER 2007-2014

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 915-915
Author(s):  
Qian Wang ◽  
Changchuan Jiang ◽  
Yaning Zhang ◽  
Stuthi Perimbeti ◽  
Prateeth Pati ◽  
...  
Keyword(s):  
Cox Regression ◽  
Conflicts Of Interest ◽  
Age Groups ◽  
Survival Outcome ◽  
Disease Stage ◽  
Insurance Status ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Us ◽  
Insured Patients

Abstract Introduction: Previous studies have shown that uninsured and Medicaid patients had higher morbidity and mortality due to limited access to healthcare. Disparities in cancer-related treatment and survival outcome by different insurance have been well established (Celie et al. J Surg Oncol.,2017). There are approximately 8,260 newly diagnosed HL cases in the US yearly (Master et al. Anticancer Res.2017). Therefore, we aim to investigate the variation of survival outcome and insurance status among HL patients. Methods: We extracted data from the US National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 18 program. HL patients who were diagnosed from 2007-2014 were included. Demographic information including age, sex, race, annual household income, education and insurance were also collected. Insurance includes uninsured, insured and any Medicaid. Race/ethnicity includes white, black and other (including American Indian/AK native, Asian/Pacific Islander). HL is categorized by using International Classification of Disease for Oncology (ICD-O-3) into classical HL NOS (CHL NOS), nodular lymphocyte predominant HL (NLP), lymphocyte rich (LR), mixed cellularity (MC), lymphocyte depleted (LD), and nodular sclerosis (NS). Treatment modality included RT alone, CT alone, RT and CT combined, and no RT or CT. Survival time was estimated by using the date of diagnosis and one of the following dates: date of death, date last known to be alive or date of the study cutoff (December 31, 2014). Chi-square test and multivariate Cox regression were performed by using SAS 9.4 (SAS Institute Inc., Cary, NC, USA). Exclusion criteria include: 1) patients with unknown or unspecified race; 2) patients who survived less than 6 months because time of radiotherapy/chemotherapy was not known to the time of diagnosis; 3) patients with any other type of cancer prior to the diagnosis of HL; 4) patients with second or later primaries, and who were not actively followed. Results: A total of 14.286 HL patients were included in the analysis. Table 1 indicates the insurance status and demographic and tumor characteristics among HL patients diagnosed between 2007 and 2014. Patients with black race, male sex, and B symptoms were more likely to be uninsured and on any Medicaid compared to other races, female sex and without B symptoms (p<0.01). As stage of disease increased, the percentage of insured patients decreased from 82.0% to 71.7%, (p<0.01). As with year of diagnosis advanced, the percentage of uninsured did not appear to be changed however the proportion of both those with insurance and any Medicaid decreased slightly by 2.4% (p<0.01). Those who received RT only were most likely to have insurance (89.6%) followed by combination modality (80.1%). As expected, uninsured status was associated with lower income and education level (p<0.01). Table 2 shows the insurance and hazard ratio among HL patients by year of diagnosis adjusting for race, sex, histology type, income, education, and year of diagnosis. Any Medicaid patients had the highest HR of death from 2007-2010 compared to insured patients. Without insurance was also associated with increased risk of death but only significant in 2008, HR=2.26, 95% CI (1.35, 3.80). The survival outcomes comparing different insurance status by age groups (<=29 and 30-64) were demonstrated in Kaplan-Meier Curve. In the age 29 or less group, insured patient showed has the best survival outcome followed by any Medicaid and then the uninsured. In the age 30-64 group, Medicaid patients had the worst survival outcome compared to those with or without insurance. Conclusion: Insurance status is one of the most important contributors of health disparity, especially in malignancy given the significant financial toxicity of therapies. We found that the proportion of the uninsured was trending up before the Affordable Care Act (ACA). Regarding the HL outcome, insured patients had the best survival across all age groups even though not significantly while Medicaid patients had the worst outcomes in almost all age groups, even worse than the uninsured after adjusting for the disease stage at diagnosis and sociodemographic factors. It would be of interest to explore the reason behind Medicaid patients' relatively poor outcomes. Future studies may also investigate how ACA, Medicaid expansion, and the possible upcoming republican healthcare reform influence HL outcome. Disclosures No relevant conflicts of interest to declare.

Falls Resulting in Traumatic Injury Among Older Adults

2011 ◽  
Vol 22 (2) ◽  
pp. 161-168 ◽  
Author(s):  
Dawn Grimm ◽  
Lorraine C. Mion
Keyword(s):  
Older Adults ◽  
Critical Care ◽  
Care Setting ◽  
Traumatic Injury ◽  
Critical Care Nurses ◽  
Community Dwelling ◽  
Cervical Fractures ◽  
Cord Injury ◽  
The Us ◽  
Community Dwelling Older Adults

Falls among community-dwelling older adults are common and dangerous, often leading to traumatic brain injury, cervical fractures, and spinal cord injury. Physical and physiologic changes with aging, preexisting diseases, and treatments result in increased morbidity and mortality for this population. Trauma critical care nurses can expect to see increasing numbers of older adults in intensive care units as the US population of those older than 65 years increases to 53 million by 2020. Older adults pose additional dilemmas in care. This article reviews falls, mechanism of injury, and nursing care issues of particular significance to this vulnerable population in the critical care setting.

scholarly journals Veterans’ response to an automated text messaging protocol during the COVID-19 pandemic

2020 ◽  
Vol 27 (8) ◽  
pp. 1300-1305 ◽  
Author(s):  
Jason J Saleem ◽  
Jacob M Read ◽  
Boyd M Loehr ◽  
Kathleen L Frisbee ◽  
Nancy R Wilck ◽  
...  
Keyword(s):  
Text Messaging ◽  
Short Message ◽  
Department Of Veterans Affairs ◽  
Community Healthcare ◽  
The Us ◽  
Message Service ◽  
Substantial Resource ◽  
Survey Results ◽  
Service Application ◽  
Nurse Triage

Abstract The US Department of Veterans Affairs (VA) is using an automated short message service application named “Annie” as part of its coronavirus disease 2019 (COVID-19) response with a protocol for coronavirus precautions, which can help the veteran monitor symptoms and can advise the veteran when to contact his or her VA care team or a nurse triage line. We surveyed 1134 veterans on their use of the Annie application and coronavirus precautions protocol. Survey results support what is likely a substantial resource savings for the VA, as well as non-VA community healthcare. Moreover, the majority of veterans reported at least 1 positive sentiment (felt more connected to VA, confident, or educated and/or felt less anxious) by receiving the protocol messages. The findings from this study have implications for other healthcare systems to help manage a patient population during the coronavirus pandemic.

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