RESUMEN
Background: Internationally, researchers have called for evidence to support tackling health inequalities during the severe acute respiratory syndrome coronavirus 2 (COVID19) pandemic. Despite the 2020 Marmot review highlighting growing health gaps between wealthy and deprived areas, studies have not explored social determinants of health (ethnicity, frailty, comorbidities, household overcrowding, housing quality, air pollution) as modulators of presentation, intensive care unit (ITU) admissions and outcomes among COVID19 patients. There is an urgent need for studies examining social determinants of health including socioenvironmental risk factors in urban areas to inform the national and international landscape. Methods: An in-depth retrospective cohort study of 408 hospitalized COVID19 patients admitted to the Queen Elizabeth Hospital, Birmingham was conducted. Quantitative data analyses including a two-step cluster analysis were applied to explore the role of social determinants of health as modulators of presentation, ITU admission and outcomes. Results: Patients admitted from highest Living Environment deprivation indices were at increased risk of presenting with multi-lobar pneumonia and, in turn, ITU admission whilst patients admitted from highest Barriers to Housing and Services (BHS) deprivation Indies were at increased risk of ITU admission. Black, Asian and Minority Ethnic (BAME) patients were more likely, than Caucasians, to be admitted from regions of highest Living Environment and BHS deprivation, present with multi-lobar pneumonia and require ITU admission. Conclusion: Household overcrowding deprivation and presentation with multi-lobar pneumonia are potential modulators of ITU admission. Air pollution and housing quality deprivation are potential modulators of presentation with multi-lobar pneumonia. BAME patients are demographically at increased risk of exposure to household overcrowding, air pollution and housing quality deprivation, are more likely to present with multi-lobar pneumonia and require ITU admission. Irrespective of deprivation, consideration of the Charlson Comorbidity Score and the Clinical Frailty Score supports clinicians in stratifying high risk patients.
RESUMEN
One hundred and twenty early lactating Holstein dairy cows were assigned to investigate the effect of dietary chromium (Cr) supplementation (0 or 6 mg Cr/head/day from organic preparation) on the productive and reproductive performance as well as on some blood serum parameters under heat stress (35-40 degrees C). Cows received treatment from 3 weeks pre-partum through 12 weeks post-partum. Chromium supplemented diet had lower body weight loss and improved dry matter intake with consequent reduction in the energy balance deficits during the first period after calving when compared with the control group. Chromium supplementation increased (p < 0.05) milk yield by 6.7%, 12.3% and 16.5% at 4, 8 and 12 weeks post-partum, respectively, whereas milk composition and milk to feed ratio were unaffected (p > 0.05) when compared with the control. Moreover, dietary Cr supplementation had no effect (p > 0.05) on blood serum glucose, calcium and phosphorus concentrations. A reduction (p < 0.05) of non-esterified fatty acids at 1 week pre-partum, 2 and 4 weeks post-partum was also observed. Serum insulin concentration increased whereas cortisol concentration decreased, when compared with the control group, throughout the whole experimental period. Also Cr supplementation showed a trend towards improving reproductive performance as indicated by increased percentage of pregnant cows in the first 28 days of breeding. It could be concluded that dietary Cr supplementation at level of 6 mg/head/day may offer a potential protective management practice to lessen the effect of heat stress in dairy cattle.
