The Compounding Effect of Rurality on Health Disparities Among Black Patients with COVID-19

Background: West Virginia had garnered national attention for its vaccination rollout against coronavirus 2019 (COVID-19). Outcomes of this mostly rural population, however, have been underreported. As the pandemic continues, identifying high risk populations remains important to further epidemiologic information and target vaccines. Purpose: The objective of this study is to examine the effects of COVID-19 and the influence of race and rurality on hospitalization and outcomes in Appalachians. Methods: In this retrospective study, data from patients who tested positive and were admitted for COVID-19 and seen within the state’s largest health system (West Virginia University Health System) between March 18 and September 16, 2020 were analyzed. Cases were stratified into rural or urban based on rural urban continuum codes (RUCCs) and by race into ‘white’, ‘black’, or ‘other’. Associations between rurality, rurality and race, and outcomes were assessed. Results: A total of 2011 adult West Virginians tested positive, of which 8.2% were hospitalized. Of the hospitalized patients, 33.5% were rural and 11.6% were black. Rural black patients were three times more likely (OR: 3.33; 95%CI:1.46-7.60) to be admitted. Rural blacks were also more likely to have a history of obstructive pulmonary disease (OR: 2.73; 1.24-6.01), hypertension (OR: 2.78; 1.38-5.57), and multiple chronic conditions (3.04; 1.48-6.22). Implications: Rural blacks were more likely to have risk factors for severe COVID-19 influencing their increased risk of hospitalization. These findings support that race as a risk factor for severe COVID-19 is compounded by rurality and identifies an important target group for vaccination

The effects of alcohol hangover on mood and performance assessed at home

The current study evaluated the next day consequences of a social night of drinking compared to a no alcohol night, with standardised mood and portable screen-based performance measures assessed in the morning at participants’ homes, and a breathalyser screen for zero alcohol. A mixed sex group (n = 20) took part in the study. Participants reported consuming on average 16.9 units (135 g) alcohol, resulting in a hangover rating of 60 (out of 100) compared to 0.3 following the no alcohol night. Statistical significance comparisons contrasting the hangover with the no alcohol condition revealed an increase in negative mood and irritability during hangover and an (unexpected) increase in risk and thrill seeking. Performance scores showed an overall slowing of responses across measures, but with less impact on errors. The results support the description of hangover as a general state of cognitive impairment, reflected in slower responses and reduced accuracy across a variety of measures of cognitive function. This suggests a general level of impairment due to hangover, as well as increased negative mood. The use of a naturalistic design enabled the impact of more typical levels of alcohol associated with real life social consumption to be assessed, revealing wide ranging neurocognitive impairment with these higher doses. This study has successfully demonstrated the sensitivity of home-based assessment of the impact of alcohol hangover on a range of subjective and objective measures. The observed impairments, which may significantly impair daily activities such as driving a car or job performance, should be further investigated and taken into account by policy makers

Delayed entry to care by men with HIV infection in Kumasi, Ghana

Introduction: In resource-limited settings, men may face considerable barriers to accessing HIV care as early interventions tend to focus on antenatal care settings.Methods: We performed a retrospective chart review of all adult patients referred to Komfo Anokye Teaching Hospital HIV clinic in Kumasi, Ghana in 2011 to identify the differences in clinical and  demographic variables by gender at presentation to care using two-sample t tests with adjusted variance and Wilcox rank sum tests for continuous variables and Pearson chi-squared tests for categorical  variables. We also compared differences in clinical and  demographic variables among men stratified by CD4 count at initiation of care in order to identify  variables associated with later entry to care. Results: Demographically, men were more likely to be older  (men age 42 vs. 37, p<0.01), have a  greater number of dependent children (1.8 v. 1.5, p=0.04), to be living with or married to their partner (65.4% vs. 49.0%, p<0.01), and to have a higher level of education (tertiary education, 45.8% vs. 25.4%, p<0.01) than women. Clinically, men were more likely to have a lower CD4 count at entry to care (260 v. 311 cells/μL, p<0.01), to report clinical symptoms to the nurse during intake (p<0.01), and to have any history of alcohol use (p<0.01). Conclusion: Men in Ghana are accessing treatment at a later stage of their disease than women. Efforts to test and link men to care early should be intensified.Key words: Gender disparities, men, HIV, Ghana, access to care, entry to care

Exposure to green and historic urban environments and mental well-being: Results from EEG and psychometric outcome measures

Previous studies have identified the benefits of exposure to green or historic environments using qualitative methods and psychometric measures, but studies using a combination of measures are lacking. This study builds on current literature by focusing specifically on green and historic urban environments and using both psychological and physiological measures to investigate the impact of virtual exposure on well-being. Results from the psychological measures showed that the presence of historic elements was associated with a significantly stronger recuperation of hedonic tone (p = 0.01) and reduction in stress (p = 0.04). However, the presence of greenness had no significant effect on hedonic tone or stress. In contrast, physiological measures (EEG) showed significantly lower levels of alpha activity (p < 0.001) in occipital regions of the brain when participants viewed green environments, reflecting increased engagement and visual attention. In conclusion, this study has added to the literature by showing the impact that historic environments can have on well-being, as well as highlighting a lack of concordance between psychological and physiological measures. This supports the use of a combination of subjective and direct objective measures in future research in this field

The impact of alcohol hangover on simulated driving performance during a ‘commute to work’—zero and residual alcohol effects compared

Driving is increasing across the world and road traffic accidents are a major cause of serious injuries and fatalities. The link between alcohol consumption and impaired driving has long been established and has led to legislation in many countries, with enforcement of legal limits based on blood alcohol concentration levels. Alcohol hangover research is an emerging field with a range of laboratory and naturalistic studies now clearly demonstrating the significant impairments that can result from hangover, even when alcohol levels are measured at or close to zero the day following a social drinking occasion. Driving is a commonplace activity but requires competency with a range of complex and potentially demanding tasks. Driving impaired can have serious consequences, including death and serious injury. There have been only limited alcohol hangover driving studies. The studies presented examined the consequences of alcohol hangover with a driving simulator contrasting a group with zero residual alcohol (N = 26) next day and another with residual alcohol (N = 26) assessed with breathalyzer in the morning before undertaking a 20 min commute to work. All participants completed a morning drive after a night without alcohol consumption and another after a night of social drinking. The driving scenarios were relatively demanding including traffic and pedestrians, traffic lights and other potential hazards in a mixed rural and urban journey. Subjective hangover and workload were assessed in addition to a range of driving performance variables, including divided attention, steering control and driving violations. Analyses contrasted driving in the no alcohol condition with the residual alcohol condition. The combined groups data (N = 52) was contrasted with the zero and residual alcohol groups. Significant contrasts were found for a range of driving measures, including divided attention, vehicle control, and driving violations as well as perceived workload. The pattern of impairment was broadly similar across both groups, indicating that whether or not residual alcohol was present, consistent driving impairment was seen. The relatively high number of significant variables may reflect the increased cognitive demand of the 20 min commute drive including busy and complex urban environments. This was also reflected in the significant increase in perceived workload recorded across the 6 dimensions of the National Aeronautics and Space Administration Task Load Index (NASA-TLX). Associations between subjective measures and driving performance with hangover suggested a potential lack of awareness of impairment, though were limited in number. The overall findings indicate that the levels of impairment seen reflect those seen with alcohol impaired driving, even when breath alcohol is zero

Exposure to green space and prevention of anxiety and depression among young people in urban settings: A global scoping review

Purpose: There is a mental health crisis, particularly among young people. Despite many young people living in urban settings, reviews about the association between exposure to green or natural environments and mental health tend to focus on either children or adults. The aim of this review is to examine the scope of the global literature for this age group, to inform a systematic review on the role of exposure to green space in preventing anxiety and depression amongst young people aged 14–24 years. Design/methodology/approach: Seven databases were searched for quantitative and qualitative sources published from January 2000 to June 2020. This identified 201 sources and their characteristics are described here. Gaps in the literature are also highlighted. Findings: The number of relevant studies published per year has increased over time. Most studies are set in North America (28%) or Europe (39%). The most common study designs were observational (34%) or experimental (28%). A wide range of exposures and interventions are described. Research limitations/implications: This review included literature from predominantly high-income countries and has shown the under-representation of low-middle income countries and lack of ethnic diversity in study populations. It has also highlighted the lack of clinical measures of anxiety and depression as outcomes. Originality/value: This inter-disciplinary review has contributed to the field by describing the geographic distribution of the literature and the broad range of exposures to green spaces being reported. Unlike previous scoping reviews, this review focused specifically on young people and on measures of anxiety and depression and their pre-cursers

Measures of greenspace exposure and their association to health-related outcomes for the periods before and during 2020’s Lockdown: A cross-sectional study in the West of England

Greenspaces are argued to be one of the important features in the urban environment that impact the health of the population. Previous research suggested either positive, negative or no associations between greenspaces and health-related outcomes. This paper takes a step backward to, first, explore different quantitative spatial measures of evaluating greenspace exposure, before attempting to investigate the relationship between those measures and health-related outcomes. The study uses self-reported health data from an online cross-sectional survey conducted for residents in the West of England. This yielded data of greenspace use; physical activity; wellbeing (ICECAP-A score); and connectedness to nature for 617 participants, divided into two sets: health outcomes for the period before versus during the 2020 lockdown. The study uses the participants’ postcodes (provided in the survey) to calculate eleven spatial measures of greenspace exposure using GIS software. 88 multivariate regression models were run while controlling for eleven con-founders of the participants’ characteristics. Results inferred 57 significant associations such that six spatial measures of greenspace exposure (NDVI R200m; NDVI R300m; NDVI R500m; Network Distance to nearest greenspace access; Euclidean Distance to nearest greenspace access; and Euclidean Distance to nearest 0.5ha doorstep greenspace access) have significant association to at least one of the four health-related outcomes, suggesting a positive impact on population health when living in greener areas or being closer to greenspaces. Moreover, there are further significant associations between the frequency of use of greenspaces and increasing physical activity or feeling more connected to nature. Still, the residents’ patterns of using greenspaces significantly changed during versus before lockdown, and has impacted the relationships between health outcomes and the greenspace exposure measures