scholarly journals COVID-19: A Syndemic Requiring an Integrated Approach for Marginalized Populations

2021 ◽  
Vol 9 ◽  
Author(s):  
Rosemary M. Caron ◽  
Amanda Rodrigues Amorim Adegboye
Keyword(s):  
At Risk ◽  
Collective Responsibility ◽  
Health Inequities ◽  
Integrated Approach ◽  
Risk Groups ◽  
Marginalized Populations ◽  
Structural Barriers ◽  
Public Health Services ◽  
Increased Risk ◽  
Novel Coronavirus

The novel coronavirus, SARS-CoV-2, responsible for the COVID-19 pandemic, has challenged healthcare systems globally. The health inequities experienced by immigrants, refugees, and racial/ethnic minorities have been aggravated during the COVID-19 pandemic. The socioeconomic, political, and demographic profile of these vulnerable populations places them at increased risk of contracting COVID-19 and experiencing significant morbidity and mortality. Thus, the burden of the COVID-19 pandemic is disproportionally higher among these at-risk groups. The purpose of this perspective is to: (1) highlight the interactions among the social determinants of health (SDoH) and their bi-directional relationship with the COVID-19 pandemic which results in the current syndemic and; (2) offer recommendations that consider an integrated approach to mitigate COVID-19 risk for marginalized populations in general. For these at-risk populations, we discuss how individual, structural, sociocultural, and socioeconomic factors interact with each other to result in a disparate risk to contracting and transmitting COVID-19. Marginalized populations are the world's collective responsibility. We recommend implementing the Essential Public Health Services (EPHS) framework to promote those systems and policies that enable optimal health for all while removing systemic and structural barriers that have created health inequities. The pledge of “Health for All” is often well-accepted in theory, but the intricacy of its practical execution is not sufficiently recognized during this COVID-19 syndemic and beyond.

scholarly journals Identifying those at risk of reattendance at discharge from emergency departments using explainable machine learning

2020 ◽  
Author(s):  
F. P. Chmiel ◽  
M. Azor ◽  
F. Borca ◽  
M. J. Boniface ◽  
D. K. Burns ◽  
...  
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Emergency Departments ◽  
Risk Groups ◽  
Machine Learning Algorithms ◽  
Care Indicator ◽  
Number Of Patients ◽  
Increased Risk ◽  
Single Centre Study ◽  
Patients At Risk

ABSTRACTShort-term reattendances to emergency departments are a key quality of care indicator. Identifying patients at increased risk of early reattendance can help reduce the number of patients with missed or undertreated illness or injury, and could support appropriate discharges with focused interventions. In this manuscript we present a retrospective, single-centre study where we create and evaluate a machine-learnt classifier trained to identify patients at risk of reattendance within 72 hours of discharge from an emergency department. On a patient hold-out test set, our highest performing classifier obtained an AUROC of 0.748 and an average precision of 0.250; demonstrating that machine-learning algorithms can be used to classify patients, with moderate performance, into low and high-risk groups for reattendance. In parallel to our predictive model we train an explanation model, capable of explaining predictions at an attendance level, which can be used to help inform the design of interventional strategies.

scholarly journals Incidence Rate and Risk Factors for Recurrent Clostridium difficile Infection in Pediatric At-Risk Groups

2020 ◽  
Vol 41 (S1) ◽  
pp. s294-s294
Author(s):  
Verinsa Mouajou ◽  
Lucila Baldassarre
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Clostridium Difficile ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Risk Groups ◽  
Fisher Exact Test ◽  
Targeted Prevention ◽  
Secondary Immunodeficiency ◽  
Increased Risk

Background: Recurrence rates and risk factors of Clostridium difficile infection (CDI) are well established in adults, though little is known about the rate of recurrent CDI (rCDI) within the pediatric population. The purpose of this study was to identify rates and risk factors of rCDI in pediatric at-risk groups to guide the optimization of targeted prevention efforts against disease recurrence. Methods: We report on the ongoing retrospective cohort study of pediatric patients at the CHU Sainte-Justine with a laboratory confirmed diagnosis of CDI between April 1, 2012, and March 31, 2017. Incidence rates of rCDI were obtained per 100 cases. Frequencies of rCDI were compared using the Fisher exact test. Univariate and multivariate logistic regression were used to identify risk factors for rCDI. Two-tailed P < .05 was considered significant. All statistical calculations were performed using R version 3.5.2 software. Results: Of 80 patients analyzed with CDI, 16 had rCDI, for a rCDI rate in this population of 20%. Most recurrences were observed in secondarily immunosuppressed patients including, but not limited to, oncology patients undergoing chemotherapy and/or radiotherapy (30.4%) and patients with inflammatory bowel disease (IBD, 29.2%). Patients that were administered vancomycin orally (PO) had recurrent infection less often than patients that administered metronidazole PO or IV (8.3% vs 23.4%, respectively). This trend was observed in all at-risk patient groups. Patients with secondary immunodeficiency had 7.4 times increased odds of recurrence compared to nonimmunodeficient patients (adjusted OR, 7.43,; 95% CI, 1.84–50.4; P = .0126). Conclusions: Initial vancomycin PO therapy seems to be associated with a lower risk of recurrence. Pediatric patients with IBD and with secondary immunodeficiency are at increased risk of rCDI. Given that these populations have an increased underlying risk of diarrhea, it would be worthwhile to determine whether toxin is actually produced (EIA testing) and to prioritize prevention efforts.Funding: NoneDisclosures: None

scholarly journals Menopausal osteoporosis in the practice of a gynecologist

2021 ◽  
pp. 320-331
Author(s):  
I. V. Kuznetsova ◽  
R. A. Chilova
Keyword(s):  
At Risk ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Risk Groups ◽  
Health Examination ◽  
Bolus Administration ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
Antiresorptive Agents ◽  
Increased Risk

Osteoporosis represents a great healthcare challenge due to an increased risk of fragility fractures that significantly decreases quality of life, shortens life expectancy, and looms as an onerous burden on both the social environment of patients and society as a whole. Osteoporotic fractures can’t be prevented without early diagnosis of low bone mineral density in people at risk. Unfortunately, the population at risk of osteoporosis is not covered by the periodic health examination program in real practice, and involving doctors of different specialties in the prevention and treatment of this disease is one of the options for addressing the challenge. As the risk of osteoporosis is associated with age and estrogen deficiency in women, the gynecologist can and should assume responsibility for the formation of risk groups, monitoring and timely recommendations on preventive and therapeutic actions. The gynecologist’s possibilities should not be reduced solely to recommendations for correcting lifestyle and prescribing menopausal hormone therapy. Antiresorptive agents of the first-line osteoporosis therapy may also be included in the gynecologist’s drug arsenal. Among them are the most commonly used bisphosphonates that are characterized by a good efficacy and safety profile during the long-term use. However, oral administration of bisphosphonates is associated with low compliance due to adverse reactions and the need for strict observance of the rules for their administration. In contrast, intravenous administration of bisphosphonates improves compliance and allows to ensure the optimal treatment outcome. Ibandronate intended for intravenous bolus administration once every three weeks for 5 years is one of the possibilities of using parenteral bisphosphonate therapy in the practice of gynecology. 

A Silenced Population

Crisis ◽  
2017 ◽  
Vol 38 (6) ◽  
pp. 433-442 ◽  
Author(s):  
Kim Gryglewicz ◽  
Melanie Bozzay ◽  
Brittany Arthur-Jordon ◽  
Gabriela D. Romero ◽  
Melissa Witmeier ◽  
...  
Keyword(s):  
At Risk ◽  
Depressive Symptomatology ◽  
The United States ◽  
Future Research ◽  
At Risk Youth ◽  
Peer Relationship ◽  
Student Records ◽  
Cross Sectional ◽  
Increased Risk ◽  
Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

Who’s at risk of entering Social Security Disability Insurance? A comparison of application and allowance rates for groups of at-risk individuals

2020 ◽  
Vol 53 (3) ◽  
pp. 341-352 ◽  
Author(s):  
Kara Contreary ◽  
Todd Honeycutt
Keyword(s):  
At Risk ◽  
Social Security ◽  
Disability Insurance ◽  
Risk Groups ◽  
Evidence Base ◽  
Social Security Disability Insurance ◽  
Program Participation ◽  
Before And After ◽  
Social Security Disability ◽  
Employment Characteristics

BACKGROUND: The U.S. government has implemented several programs to reduce federal expenditures on Social Security Disability Insurance (DI) and help beneficiaries return to work, but the limited success of these efforts has raised interest in approaches that help workers with disabilities remain in the workforce. OBJECTIVE: This paper provides information on individuals at risk of applying for DI benefits to help build the evidence base for policies that provide workers with disabilities support to eliminate the need to apply for and receive DI benefits. METHODS: Using three panels of the Survey of Income and Program Participation matched to SSA administrative data, we describe the employment characteristics of seven groups at risk of applying for DI benefits before and after application, as well as the outcomes of their DI applications. RESULTS: New private disability insurance recipients were more likely to apply for and receive DI than members of other at-risk groups. However, individuals with high healthcare expenditures made up the largest proportion of successful applicants across the at-risk groups considered here. CONCLUSION: While it seems plausible that individuals within an at-risk group who are likely to apply for DI benefits can be identified and provided supports to help them maintain employment, focusing on a specific group to promote employment over DI benefits may have a limited effect on the DI program because applicants come from multiple groups.

Dental Implant Placement in Patients with a History of Medications Related to Osteonecrosis of the Jaws: A Systematic Review

2020 ◽  
Author(s):  
Judd Sher ◽  
Kate Kirkham-Ali ◽  
Denny Luo ◽  
Catherine Miller ◽  
Dileep Sharma
Keyword(s):  
Systematic Review ◽  
At Risk ◽  
Drug Therapy ◽  
Dental Implant ◽  
Case Series ◽  
Cochrane Central Register ◽  
Bisphosphonate Treatment ◽  
Implant Placement ◽  
Increased Risk ◽  
History Of

The present systematic review evaluates the safety of placing dental implants in patients with a history of antiresorptive or antiangiogenic drug therapy. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. PubMed, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and OpenGrey databases were used to search for clinical studies (English only) to July 16, 2019. Study quality was assessed regarding randomization, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases using a modified Newcastle-Ottawa scale and the Joanna Briggs Institute critical appraisal checklist for case series. A broad search strategy resulted in the identification of 7542 studies. There were 28 studies reporting on bisphosphonates (5 cohort, 6 case control, and 17 case series) and one study reporting on denosumab (case series) that met the inclusion criteria and were included in the qualitative synthesis. The quality assessment revealed an overall moderate quality of evidence among the studies. Results demonstrated that patients with a history of bisphosphonate treatment for osteoporosis are not at increased risk of implant failure in terms of osseointegration. However, all patients with a history of bisphosphonate treatment, whether taken orally for osteoporosis or intravenously for malignancy, appear to be at risk of ‘implant surgery-triggered’ MRONJ. In contrast, the risk of MRONJ in patients treated with denosumab for osteoporosis was found to be negligible. In conclusion, general and specialist dentists should exercise caution when planning dental implant therapy in patients with a history of bisphosphonate and denosumab drug therapy. Importantly, all patients with a history of bisphosphonates are at risk of MRONJ, necessitating this to be included in the informed consent obtained prior to implant placement. The James Cook University College of Medicine and Dentistry Honours program and the Australian Dental Research Foundation Colin Cormie Grant were the primary sources of funding for this systematic review.

scholarly journals Deficits in explicit emotion regulation in bipolar disorder: a systematic review

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Marcel Kurtz ◽  
Pia Mohring ◽  
Katharina Förster ◽  
Michael Bauer ◽  
Philipp Kanske
Keyword(s):  
At Risk ◽  
Bipolar Disorder ◽  
Emotion Regulation ◽  
Mood State ◽  
Bipolar Disorders ◽  
Protective Measure ◽  
Behavioral Measures ◽  
Increased Risk ◽  
Regulation Strategies ◽  
Depressive Episodes

Abstract Background This study aimed to compile and synthesize studies investigating explicit emotion regulation in patients with bipolar disorder and individuals at risk of developing bipolar disorder. The importance of explicit emotion regulation arises from its potential role as a marker for bipolar disorders in individuals at risk and its potent role in therapy for bipolar disorder patients. Methods To obtain an exhaustive compilation of studies dealing specifically with explicit emotion regulation in bipolar disorder, we conducted a systematic literature search in four databases. In the 15 studies we included in our review, the emotion-regulation strategies maintenance, distraction, and reappraisal (self-focused and situation-focused) were investigated partly on a purely behavioral level and partly in conjunction with neural measures. The samples used in the identified studies included individuals at increased risk of bipolar disorder, patients with current affective episodes, and patients with euthymic mood state. Results In summary, the reviewed studies' results indicate impairments in explicit emotion regulation in individuals at risk for bipolar disorder, patients with manic and depressive episodes, and euthymic patients. These deficits manifest in subjective behavioral measures as well as in neural aberrations. Further, our review reveals a discrepancy between behavioral and neural findings regarding explicit emotion regulation in individuals at risk for bipolar disorders and euthymic patients. While these groups often do not differ significantly in behavioral measures from healthy and low-risk individuals, neural differences are mainly found in frontostriatal networks. Conclusion We conclude that these neural aberrations are a potentially sensitive measure of the probability of occurrence and recurrence of symptoms of bipolar disorders and that strengthening this frontostriatal route is a potentially protective measure for individuals at risk and patients who have bipolar disorders.

scholarly journals Evaluating of the association between ABO blood groups and coronavirus disease 2019 (COVID-19) in Iraqi patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ali H. Ad’hiah ◽  
Risala H. Allami ◽  
Raghdan H. Mohsin ◽  
Maha H. Abdullah ◽  
Ali J. R. AL-Sa’ady ◽  
...  
Keyword(s):  
Blood Groups ◽  
Abo Blood Groups ◽  
Risk Of Death ◽  
Increased Risk ◽  
Fluorescence Probing ◽  
Group A ◽  
Risk Of Disease ◽  
Novel Coronavirus ◽  
Polymorphic System ◽  
Made In

Abstract Background Susceptibility to the pandemic coronavirus disease 2019 (COVID-19) has recently been associated with ABO blood groups in patients of different ethnicities. This study sought to understand the genetic association of this polymorphic system with risk of disease in Iraqi patients. Two outcomes of COVID-19, recovery and death, were also explored. ABO blood groups were determined in 300 hospitalized COVID-19 Iraqi patients (159 under therapy, 104 recovered, and 37 deceased) and 595 healthy blood donors. The detection kit for 2019 novel coronavirus (2019-nCoV) RNA (PCR-Fluorescence Probing) was used in the diagnosis of disease. Results Mean age was significantly increased in patients compared to controls (49.8 ± 11.7 vs. 28.9 ± 6.6 years; p < 0.001). A similar observation was made in recovered (42.1 ± 10.4 vs. 28.9 ± 6.6 years; p < 0.001) and deceased (53.6 ± 9.7 vs. 28.9 ± 6.6 years; p < 0.001) cases. The mean age was also significantly increased in deceased cases compared to recovered cases (53.6 ± 9.7 vs. 42.1 ± 10.4 years; p < 0.001). There were gender-dependent differences in COVID-19 prevalence. The percentage of COVID-19 was higher in males than in females (all cases: 59.7 vs. 40.3%; recovered cases: 55.8 vs. 44.2%). Such male-gender preponderance was more pronounced in deceased cases (67.6 vs. 32.4%). Logistic regression analysis revealed that groups AB and B + AB were significantly associated with increased risk to develop COVID-19 (OR = 3.10; 95% CI 1.59–6.05; pc = 0.007 and OR = 2.16; 95% CI 1.28–3.63; pc = 0.028, respectively). No ABO-associated risk was observed in recovered cases. On the contrary, groups A (OR = 14.60; 95% CI 2.85–74.88; pc = 0.007), AB (OR = 12.92; 95% CI 2.11–79.29; pc = 0.042), A + AB (OR = 14.67; 95% CI 2.98–72.33; pc = 0.007), and A + B + AB (OR = 9.67; 95% CI 2.02–46.24; pc = 0.035) were associated with increased risk of death in deceased cases. Conclusions The findings of this study suggest that group AB may be a susceptibility biomarker for COVID-19, while group A may be associated with increased risk of death.

scholarly journals Seroprevalence of Antibodies against Diphtheria, Tetanus and Pertussis in Adult At-Risk Patients

Vaccines ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 18
Author(s):  
Lise Boey ◽  
Eline Bosmans ◽  
Liane Braz Ferreira ◽  
Nathalie Heyvaert ◽  
Melissa Nelen ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Diseases ◽  
Age Groups ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Recent Infection ◽  
Vaccination Programs ◽  
Vaccine Preventable Diseases ◽  
Increased Risk ◽  
Risk Patients

Patients with chronic diseases are at increased risk of complications following infection. It remains, however, unknown to what extend they are protected against vaccine-preventable diseases. We assessed seroprevalence of antibodies against diphtheria, tetanus and pertussis to evaluate whether current vaccination programs in Belgium are adequate. Antibody titers were assessed with a bead-based multiplex assay in serum of 1052 adults with chronic diseases. We included patients with diabetes mellitus type 1 (DM1) (n = 172), DM2 (n = 77), chronic kidney disease (n = 130), chronic obstructive pulmonary disease (COPD) (n = 170), heart failure (n = 77), HIV (n = 196) and solid organ transplant (SOT) recipients (n = 230). Factors associated with seroprevalence were analysed with multiple logistic regression. We found seroprotective titers in 29% for diphtheria (≥0.1 IU/mL), in 83% for tetanus (≥0.1 IU/mL) and 22% had antibodies against pertussis (≥5 IU/mL). Seroprotection rates were higher (p < 0.001) when vaccinated within the last ten years. Furthermore, diphtheria seroprotection decreased with age (p < 0.001). Tetanus seroprotection was less reached in women (p < 0.001) and older age groups (p < 0.001). For pertussis, women had more often a titer suggestive of a recent infection or vaccination (≥100 IU/mL, p < 0.01). We conclude that except for tetanus, the vast majority of at-risk patients remains susceptible to vaccine-preventable diseases such as diphtheria and pertussis.

Sign in / Sign up

Export Citation Format

Share Document