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Journal ArticleDOI

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

11 May 2021-Frontiers in Public Health (Frontiers Media SA)-Vol. 9, pp 675280-675280
TL;DR: In this paper, the authors highlight the interactions among the social determinants of health (SDoH) and their bi-directional relationship with the current syndemic and offer recommendations that consider an integrated approach to mitigate COVID-19 risk for marginalized populations in general.
Abstract: 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.

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Journal ArticleDOI
TL;DR: It was found that COVID-19 lockdown led to a significant increase in the levels of glycated haemoglobin, fasting glucose and body mass index in patients with type 2 diabetes, and the effect of the lockdown on lipid parameters, including total cholesterol, triglycerides, LDL and HDL cholesterol was not consistent.
Abstract: The impact of the COVID-19 lockdown on glycaemic control and other metabolic parameters in patients with type 2 diabetes is still evolving. Aim: This systematic review and meta-analysis aims to examine the effects of COVID-19 lockdown on glycaemic control and lipid profile in patients with type 2 diabetes. Methods: The PRISMA framework was the method used to conduct the systematic review and meta-analysis, and the search strategy was based on the population, intervention, control and outcome (PICO) model. The Health Sciences Research databases was accessed via EBSCO-host, and EMBASE were searched for relevant articles. Searches were conducted from inception of the databases until 17 September 2021. Results: The results identified three distinct areas: glycaemic control, lipid parameters and body mass index. It was found that COVID-19 lockdown led to a significant (p < 0.01) increase in the levels of glycated haemoglobin (%) compared with pre-COVID group (gp) with a mean difference of 0.34 (95% CI: 0.30, 0.38). Eleven studies contributed to the data for glycated haemoglobin analysis with a total of 16,895 participants (post-COVID-19 lockdown gp, n = 8417; pre-COVID gp, n = 8478). The meta-analysis of fasting plasma glucose (mg/dL) also showed a significant (p < 0.05) increase in levels of post-COVID-19 lockdown gp compared with pre-COVID gp, with a mean difference of 7.19 (95% CI: 5.28, 9.10). Six studies contributed to fasting plasma glucose analysis involving a total of 2327 participants (post-COVID-19 lockdown, n = 1159; pre-COVID gp, n = 1168). The body mass index (BMI) (kg/m2) analysis also demonstrated that post-COVID-19 lockdown gp had a significantly (p < 0.05) higher BMI than the pre-COVID gp with a mean difference of 1.13 (95% CI: 0.99; 1.28), involving six studies and a total of 2363 participants (post-COVID-19 lockdown gp, n = 1186; pre-COVID gp, n = 1177). There were significantly (p < 0.05) lower levels of total cholesterol (mmol/L), triglyceride (mmol/L) and LDL cholesterol (mmol/L), and higher levels of HDL cholesterol (mg/dL) in the post-COVID-19 lockdown gp compared with pre-COVID gp, although these results were not consistent following sensitivity analysis. Conclusion: The findings of the systematic review and meta-analysis have demonstrated that COVID-19 lockdown resulted in a significant increase (p < 0.05) in the levels of glycated haemoglobin, fasting glucose and body mass index in patients with type 2 diabetes. In contrast, the effect of the lockdown on lipid parameters, including total cholesterol, triglycerides, LDL and HDL cholesterol was not consistent.

30 citations

Journal ArticleDOI
TL;DR: In this paper, a systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of the COVID-19 pandemic to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID19.
Abstract: Objectives: The COVID-19 pandemic represents a major crisis for governments and populations. The public's risk perceptions, knowledge, and behaviors are key factors that play a vital role in the transmission of infectious diseases. Our scoping review aims to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID-19. Methods: A systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of COVID-19. Thirty-one studies meeting the inclusion criteria were appraised and analyzed. Results: The levels of risk perceptions, knowledge, and behaviors towards COVID-19 were moderate to high in both general and high-risk adult populations. Adults were knowledgeable about preventive behaviors. Our review identified hand-washing and avoiding crowded places as dominant preventive behaviors. Being a female, older, more educated, and living in urban areas was associated with better knowledge of COVID-19 and appropriate preventive behaviors. Conclusion: This review offers a first understanding of risk perceptions, knowledge and behaviors of adult populations during the early stages of the COVID-19 pandemic. [ FROM AUTHOR] Copyright of Public Health Reviews (2107-6952) is the property of Frontiers Media S.A. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

8 citations

Journal ArticleDOI
TL;DR: In this paper , the authors explored geographic patterns of local-level COVID-19 vulnerability and associations with social and health determinants across Colorado and found that COVID19 rates were associated with mental health and chronic conditions along with social determinants that represent inequities in education, income, healthcare access, and race/ethnicity.
Abstract: Abstract The COVID-19 pandemic has drawn greater attention to social determinants of health and associated health inequities, which disproportionately affect vulnerable populations and places in the U.S. In this study, we explored geographic patterns of local-level COVID-19 vulnerability and associations with social and health determinants across Colorado. To conceptualize social and health determinants and how together they generate risk and exposure, we integrated the concepts of social vulnerability and syndemic to situate COVID-19 vulnerability within a broader hazards of place framework. Using geospatial statistics and GIS, we estimated census tract-level rates of COVID-19, which are not yet available in Colorado, and mapped areas of high and low incidence risk. We also developed composite indices that characterized social and health vulnerabilities to measure multivariate associations with COVID-19 rates. The findings revealed hotspots of persistent risk in mountain communities since the pandemic emerged in Colorado, as well as clusters of risk in the Urban Front Range’s central and southern counties, and across many parts of eastern Colorado. Vulnerability analyses indicate that COVID-19 rates were associated with mental health and chronic conditions along with social determinants that represent inequities in education, income, healthcare access, and race/ethnicity (minority percent of population), which may have disproportionately exposed some communities more than others to infection and severe health outcomes. Overall, the findings provide geographic health information about COVID-19 and vulnerability context, which may better inform local decision-making for interventions and policies that support equity of social determinants of health. Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2021382 .

8 citations

Journal ArticleDOI
TL;DR: In this article , a cross-sectional online survey-based study was conducted to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain.
Abstract: Available evidence suggests that there might be an association between the stressors experienced during the COVID-19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain.A cross-sectional online survey-based study was conducted (March-July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the "Equity and Menstrual Health in Spain" research project.Among participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants self-reporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times <12 months: aOR: 1.68, 95% CI, 1.48-1.90), poorer self-perceived health (eg, poor: aOR: 2.00, 95% CI, 1.31-3.07), and those diagnosed with polycystic ovary syndrome (aOR: 1.13, 95% CI, 1.02-1.26). Among participants with a self-reported COVID-19 diagnosis, factors that significantly increased the odds for menstrual alterations were experiencing financial strains (eg, financial issues always/many times <12 months: aOR: 1.53, 95% CI, 1.09-2.14), poorer self-perceived health (eg, poor: aOR: 3.09, 95% CI, 1.01-9.52). Overall, factors that decreased the odds of reporting menstrual alterations included age >25, being a carer, not having a gynecological condition and using hormonal contraception.Findings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice.

8 citations

Journal ArticleDOI
TL;DR: A high prevalence of mental health effects was observed in patients without COVID-19 and increased in the population with Long COVID syndrome and previous mental health disorders.
Abstract: The COVID-19 pandemic is currently a worldwide threat and concern, not only because of COVID-19 itself but its sequelae. The aim of this study was to evaluate whether a relation between COVID-19, Long COVID, and the prevalence of mental health disorders exist. A total of 203 people from Tabasco were included in this study, answering a survey integrated by three dominions: General and epidemiological data, the DASS-21 test (to determine the presence of signs or symptoms suggestive of depression, anxiety, and/or stress) and an exploratory questionnaire about Long COVID syndrome. A descriptive and inferential statistical analysis was made via Microsoft Excel and Graphpad Prism software, evaluating differences through the Mann–Whitney U test and considering p < 0.05 as statistically significant. Of the 203 people surveyed, 96 (47.29%) had had COVID-19 and 107 (52.71%) had not; from the ones that had COVID-19, 29 (30.21%) presented mental health disorders and 88 (91.66%) presented at least one symptom or sign of Long COVID syndrome; meanwhile, 31 (32.29%) presented 10 or more symptoms or signs. From the comparison between the population with previous mental health disorders and COVID-19 and those without background disorders or COVID-19, the results were the following: 27.58% vs. 16.82% presented severe depression, 48.27% vs. 17.75% presented severe anxiety, and 27.58% vs. 20.56% presented severe stress. A high prevalence of mental health effects was observed in patients without COVID-19 and increased in the population with Long COVID syndrome and previous mental health disorders.

5 citations

References
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Journal ArticleDOI
TL;DR: This work aims to demonstrate the efforts towards in-situ applicability of EMMARM, which aims to provide real-time information about concrete mechanical properties such as E-modulus and compressive strength.

1,480 citations

Journal ArticleDOI
TL;DR: The potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic are explored, focusing on the likely unequal impacts of the economic crisis.
Abstract: This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics-drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemic pandemic It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.

1,015 citations

Journal ArticleDOI
TL;DR: It is argued for a shift from individual culture-based frameworks, to perspectives that address how multiple dimensions of inequality intersect to impact health outcomes, and suggestions for integrating intersectionality theory in future research on immigrant health.

928 citations

Journal ArticleDOI
TL;DR: The contributions of the syndemics approach for understanding both interacting chronic diseases in social context, and the implications of a Syndemics orientation to the issue of health rights, are examined.

805 citations

Journal ArticleDOI
TL;DR: To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, 13 country case studies from various regions around the world are compiled.
Abstract: The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.

430 citations