Background:Shortly after the detection of the COVID virus in January 2020 the US Government introduced and enforced a series of restrictions to protect the elderly from a "deadly virus" and the "pandemic of the century". Persons who disagreed were silenced and punished. Objective:In the 15th month of COVID epidemic (April 2021), we have access to sufficient statistical data and methods to better understand the nature, origin of the COVID pandemic. It is now possible to reliably evaluate the effectiveness of the restrictions and the human factors/driving forces behind this drastic limitation of our natural freedom in this country. Methods:Publicly available epidemiological and population parameters were collected and analyzed using the 'political score' and 'restriction ranking' of 50 states and evaluated by simple and usual statistical methods, mainly correlation analyses. The Political Score of the States (D/R) is the ratio of the number of citizens who self-identified as democrats (D) or republicans (R). The political scores of the 50 states altogether defined a wide, continuous scale, the political scale, that could be used to measure (and statistically evaluate) the effect of politics of a state on the numerical parameters of that state, including population and epidemiologic parameters.The COVID Restriction Score of the States were created to rank the states from 1-50, there 1 is the lowest number of restrictions and 50 is the highest number of restrictions applied by the States. It was based on 13 different key metrics. Results:This study revealed, that 1) restrictions reduced the number of viral infections, but 2) they totally failed to reduce the number of supposedly COVID related deaths, expressed as mortality, 3) they increased (SIC!) the lethality of coronavirus. The grade of restrictions were/are strongly associated to the 4) left/right political ratio of the States, there States with more democrat citizens practiced more restrictions. It was found that race, religion and Medicare/healthcare spending have significant influence on politic as well as on the grade of restriction orders. Factors moving States toward the political left and harder COVID restrictions have 5) larger 'non-white' population, 6) larger number of 'non-protestant' believers, 7) larger Jewish population, and 8) more generous Medicare/healthcare spending. It was not possible to see any influence of the size of the 9) senior (65+) population [i.e. those who are allegedly the most vulnerable and are mostly in need of protective restrictions] neither on the States politic nor on the restrictions. Conclusions:The degree of restrictions enforced by different states ware not primarily determined by biological or epidemiological factors (like number of elderly, say 65+ in the state) but by social, political influences instead. Political (a), religious (b) ethnic (c) and economic (d) forces represented the decisive forces on the state's restrictive orders and not the convincing evidence of the potentially harmful effects of the COVID infection and the well-founded adequacy of the defense against it.
Background: Bacteremia is quite common in Severe Acute Malnourished (SAM) children with pneumonia, who often experience a fatal outcome, especially in developing countries. There is limited information in the medical literature on the risks of bacteremia in SAM children with pneumonia. We have examined the factors associated with bacteremia and their outcome in under-five children who were hospitalized for the management of pneumonia and SAM. Methods: In this unmatched case-control study, SAM children of either sex, aged 0-59 months, admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) with cough or respiratory distress and radiological pneumonia during April 2011 to July 2012 were enrolled (n=405). Those with pneumonia as well as bacteremia constituted the cases (n=18) and randomly selected SAM children with pneumonia without bacteremia constituted controls (n=54). Results: A wide range of bacterial pathogens were isolated among the cases of which 13 (72%) were Gram negatives. Death rate was higher among the cases than the controls (28% vs. 9%) but the difference was not statistically significant (p=0.111). In logistic regression analysis, after adjusting for potential confounders, such as the lack of DPT/oral polio/ HIV/hepatitis vaccination, measles vaccination, vomiting and clinical dehydration (some/severe) the SAM children with pneumonia as well as bacteremia more often had the history of lack of BCG vaccination (95% CI=1.17-29.98) and had diastolic hypotension (<50 mm of Hg) (95% Cl= 1.01-12.86) not only after correction of dehydration but also in its absence. Conclusion: The results of our study suggest that history of lack of BCG vaccination and presence of diastolic hypotension in absence of dehydration on admission are the independent predictors of bacteremia in SAM children with pneumonia. The results indicate the importance of continuation of BCG vaccination to produce benefits beyond the primary benefits.
BACKGROUND:Parental educational attainment is a strong social determinant of health. Parental educational attainment may, however, be differently important for the health and happiness of various demographic groups.AIM:To understand if parental educational attainment is similarly salient for men and women, we tested gender differences in the association between parental educational attainment and health and happiness of American adults.METHODS:This cross-sectional study used data of the General Social Survey (1972-2018), a series of nationally representative surveys in the United States. Our analytical sample included 65,814 adults. The main independent variable was parental education attainment. Outcomes were self-rated health and happiness measured using single items. Age, gender, marital status, employment, and year of the study were the covariates. Gender was the moderator.RESULTS:Overall, individuals with more educated parents reported better self-rated health and happiness. We, however, found significant interactions between gender and parental educational attainment on the outcomes, which suggested that the effect of high parental educational attainment on self-rated health and happiness is larger for women than men.CONCLUSION:In the United States, while parental educational attainment is an important social determinant of health and happiness, this effect may be more pronounced among women than men.
The coronavirus pandemic is shedding light on existing health disparities and has the potential to accentuate both racial and rural/urban health divides [1]. The pandemic that first struck in major metropolitan areas is increasingly findings its front line in rural counties [2]. The Kaiser Family Foundation recently reported that coronavirus cases and deaths are surging at a faster rate in rural areas compared to urban areas. Also of concern, rural areas without confirmed cases may lack testing necessary for an accurate assessment of virus prevalence. Expanding access to reliable testing in isolated rural areas is an immediate challenge.
Background: Malaria remains a global pressing issue despite several interventions to reduce its prevalence. This study aimed at determining the knowledge and prevalence of malaria among rural households in the Western-North region of Ghana. Method: This was a cross-sectional study conducted in three rural communities in the Bibiani Anhwiaso-Bekwai Municipality of the Western-North region of Ghana. A total of 481 participants from 155 randomly selected households were screened for malaria using rapid diagnostic test (RDT). Socio-demographic data, information related to ITN and knowledge of malaria were collected using a semi-structured questionnaires. Multivariate logistic regression analysis was performed to determine independent association of variables with malaria. Results: Malaria prevalence among participants was 39.1%. Prevalence was significantly higher among females (23.0%) and children under 5 years (12.6%) (p<0.05). Household ownership (83.9%) and the use of ITN (96.2%) were high in the Municipality. Although most participants had poor knowledge of malaria in terms of its transmission, the overall knowledge was good (54.2%). Having poor knowledge increased the risk of malaria infection (AOR=3.1, CI=0.89-10.7, p=0.07). Conclusion: The prevalence of malaria was high among the study participants particularly among females and children under 5 years. Most of the participants had good knowledge of malaria in-terms of causative agent, signs and symptoms and preventive measures. However, knowledge on transmission pathways of malaria was poor. There is the need for increased community sensitization on malaria transmission and individual behaviours such as limiting time spent outside to minimize human-mosquito contact.
Objective : This article explores how racism manifests in a rural place of healthcare from the perspectives of patients-both a patient’s experience of racial vilification and patients’ racially-prejudicial views towards healthcare providers. In the analysis, we illuminate the important implications of racism for experiences of health and healthcare in rural Australian places. We argue that critical interrogation of these enduring racial tensions is required to improve the quality of rural healthcare. Methods : This article analyses two interview data sets, originally collected in a study investigating rurally-living patients’ experiences of chronic obstructive pulmonary disease that exemplify how racism manifests in a rural hospital environment. Each transcript was selectively coded for instances of racism and/or instances pertaining to the phenomena of racism. These codes were then reviewed, developed and refined into themes that were contextualized within broader social discourses and race politics that sustain racism. Results : Contrasting themes of feeling ‘ unwelcome and unsafe ’ in the hospital and expressions of being ‘privileged and strong’ were identified. These themes were situated within participants’ particular contexts and circumstances, most especially their racialised subject positions. These themes illustrate the profound effects of racism on access and the maintenance of culturally unsafe environments for hospital patients, specifically those identifying as First Nation Australian, and emphasise the critical importance of cultural diversity within the rural health workforce. Conclusion : The analysis demonstrates how racism impacts upon and affects two central functions accessibility and acceptance in the provision of healthcare in rural places. It is suggested that a range of health actors, including policy makers, health service managers and translational researchers, need to converge on and engage with how racism manifests in contemporary rural healthcare settings to address issues of ‘race’ and racism in contemporary places of rural healthcare from multiple, intersecting subject positions.
For patients with serious hematologic malignancies, hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment option. Majority of HSCT recipients receive tacrolimus as part of their immunosuppressive regimen. The purpose of this study is to evaluate the clinical impact of a pharmacist driven immunosuppression drug monitoring protocol for HSCT recipients on tacrolimus. This was a single-center, pre-post interventional study conducted at the University of Chicago Medical Center. Data collected via chart review includes the immunosuppressive agent used, interacting medications, adverse events, dose adjustments, drug concentrations, time to engraftment, and diagnosis of GVHD. Following the incorporation of a therapeutic drug monitoring protocol, the percentage of therapeutic tacrolimus levels was similar to when there was no protocol in place; 68% versus 64%, respectively (p = 0.34). There were 18 total adverse events observed in the pre-protocol group versus 10 in the post-protocol group (p = 0.03). Nephrotoxicity was the most common adverse event occurring in 23% of patients in the pre-protocol group and 15% of patients in the post-protocol group (p = 0.18). In the post-protocol group, there were 20 patients with two or more interacting drugs versus two patients in the pre-protocol group (p < 0.05). Additionally, the post-protocol group had 12 instances of an empiric dose adjustment made whereas the pre-protocol group had three instances (p = 0.006). Although there was no significant difference in percentage of therapeutic tacrolimus levels, pharmacist involvement resulted in improved safety outcomes such as management of drug interactions and incidence of adverse events.
