Analyzing Spatial-Temporal Impacts of Neighborhood Socioeconomic Status Variables on COVID-19 Outbreaks as Potential Social Determinants of Health

The COVID-19 pandemic is not only a medical disease outbreak but also a social inequality and health disparity problem. This study analyzed dynamic temporal and spatial associations between confirmed COVID-19 cases and socioeconomic status (SES) variables at the neighborhood level with three case studies to (1) analyze five temporal stages in the County of San Diego, California;(2) compare six U.S. metropolitan areas;and (3) compare SES associations across two spatial scales (counties and zip code units). We identified eleven SES variables as potential contributors to the social determinants of health that influence COVID-19 outbreaks and showed how their correlation coefficients vary over five phases. We found that changes in COVID-19 hot spots and clusters are minimal across the five stages. The consistent spatial patterns through the five outbreak periods imply that the place effects associated with fundamental health disparity factors are persistent and not easily changed. The impact of COVID-19 on SES varies in different local contexts. We also found that Hispanic populations, uninsured groups, Spanish-speaking families, those with less than a ninth-grade education level, and high household densities strongly correlated with COVID-19 cases in all six metropolitan areas. We did not find high scale dependency in SES association patterns between county and zip code spatial units, but analysis at a finer level can provide more association patterns. © 2023 by American Association of Geographers.

The effect of the CIVID-19 pandemic on mental health associated trauma, admissions and fractures at a london major trauma centre

Aim: Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre. Method: We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history. Results: here were 824 Orthopaedic referrals and 358 admissions (6/ day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively. Conclusions: Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the 'second wave' of COVID-19.

Heterologous infection and vaccination shapes immunity against SARS-CoV-2 variants

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Delivery of liver services within primary care can improve treatment outcomes in persons experiencing homelessness

Background: Persons experiencing homelessness (PEH) often have complex health needs compounded by difficulty accessing healthcare. Liver disease is the third commonest cause for death in PEH after accidents and suicides. Some studies have identified chronic hepatitis C (CHC) in up to 50% of this population. Alcohol disorders are also extremely common. Methods: From June 2018, a weekly Hepatology clinic was co-located with a primary care clinic serving a population of 2,500 PEH. Blood borne virus testing, near patient HCV RNA testing, transient elastography and antiviral drug dispensing for Hepatitis B and C was introduced. All patients with HCV were treated in line with national guidelines. Results: Between the period of June 2018 and November 2020, 326 patients were reviewed within the Hepatology clinic. A total of 1,236 appointments were offered with 632 attendances (51.1%). 241 patients were referred due to a positive HCV Ab test. 193 were HCV RNA positive (80%), 30 RNA negative (12.4%) and 19 had unknown HCV RNA status. Transient elastography was performed on 138 with 31 having advanced fibrosis (22.4%). Those patients with advanced fibrosis were referred into secondary Hepatology care to begin HCC surveillance monitoring. Treatment was initiated on 101/193 HCV RNA positive patients. 93 patients were receiving opiate substitution therapy. 65% had a co-existing mental health diagnosis whilst 24% had an alcohol intake that was a contributing factor to their liver disease, 2% were coinfected with Hepatitis B and C and 3% were co-infected with both Hepatitis C and HIV. The genotypes were 44 G1a;3 G1b;6 G2;34 G3;1 G4 and 13 unknown. There is a high rate of sustained virological response (SVR) being achieved with 61 patients having achieved SVR (82%). 13 patients needed to re-start treatment. 37 have SVR 12 pending. 3 patients have relapsed. Of the remaining 92 known RNA positive patients within the clinic, 40 identified within our service have been treated elsewhere during the peak of the COVID-19 pandemic. 24 SVR blood tests were performed for the patients treated in other locations. 21 patients are approved to start treatment and active attempts are being made to re-engage these patients, this also includes outreach work to the locations were people sleep rough. 9 are awaiting genotyping and transient elastography. 5 are no longer patients of the primary care clinic and attempts have been made to arrange onward referrals to Hepatology services in their new locations and 5 patients have died. Conclusion: Persons experiencing homelessness often have difficulty accessing healthcare. By facilitating access to Hepatology services tailored to their needs at a site where they access primary care and receive opiate substitution therapy, favourable SVR rates can be achieved with significant risk reduction.

Point of Contact: Investigating Change in Perception through a Serious Game for COVID-19 Preventive Measures

COVID-19 exposed the need to identify newer tools to understand perception of information, behavioral conformance to instructions and model the effects of individual motivation and decisions on the success of measures being put in place. We approach this challenge through the lens of serious games. Serious games are designed to instruct and inform within the confines of their magic circle. We built a multiplayer serious game, Point of Contact (PoC), to investigate effects of a serious game on perception and behavior. We conducted a study with 23 participants to gauge perceptions of COVID-19 preventive measures and quantify the change after playing PoC. The results show a significant positive change to participants' perceptions towards COVID-19 preventive measures, shifting perceptions towards following guidelines more strictly due to a greater awareness of how the virus spreads. We discuss these implications and the value of a serious game like PoC towards pandemic risk modelling at a microcosm level. © 2021 ACM.

"Mi Hijo es lo Principal" - Guatemalan Mothers Navigate the COVID-19 Pandemic

In the context of the COVID-19 pandemic, motherwork has increased. Mothers, including in Guatemala, have taken on expanded responsibilities of virtual schooling and keeping the family safe and healthy, in addition to prepandemic familial and professional contributions. Twelve Guatemalan mothers of children under age 7 were interviewed about how they negotiated the pandemic;data were coded using thematic analysis and consensual qualitative research frameworks. Analysis revealed six themes: daily stressors, fostering children's development, implementing coping strategies, utilizing technology, establishing closer relationships, and achieving personal and occupational growth. Guatemalan mothers tapped into existing ideologies of motherhood, relied on traditional values of Guatemalan culture - faith, family, and gratitude - prioritized their children's well-being, and found unexpected benefits. Social policies that specifically address women's conditions, agency, and strengths could forward achievement of Sustainable Development Goal 5, Gender Equality, in Guatemala. © 2021 Hogrefe Publishing.

The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre.

INTRODUCTION: Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS: We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS: There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION: There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION: While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.

Custom solution for personal protective equipment (PPE) in the orthopaedic setting: retrofitting Stryker Flyte T5 PPE system.

The coronavirus disease 2019 pandemic has meant that there is growing pressure on hospital resources, not least the availability of appropriate personal protective equipment (PPE), particularly face masks and respirator masks. Within the field of orthopaedic surgery, it is a common sight to see surgeons wearing 'space suits' (SSs) which comprise a helmet, hood and surgical gown. In this study, the authors made modifications to two different SS systems to incorporate a high-efficiency particulate air (HEPA) filter into the fan inlet to assess their potential as re-usable PPE systems for surgeons with regard to protection from a virus spread via respiratory droplets. The testing was carried out using particle counters upstream and downstream on a mannequin wearing two different SS systems with and without modifications to the fan inlet. The results show that using a layer of HEPA filter, cut to size and sealed to the fan inlet in the helmet, will reduce downstream particulates at the user's mouth by >99.5%; this is equivalent to a respirator mask. HEPA filter material is relatively cheap and can be used repeatedly, making this a viable alternative to disposable, and even resterilized, respirator masks in the setting of a respiratory-droplet-spread viral pandemic.