Fluent Essays

Review your problem or issue and the study materials to formulate a PICOT question for your capstone project change proposal. A PICOT question starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention used to address the problem must be a nursing practice intervention. Include a comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and specify the timeframe needed to implement the change process.  Formulate a PICOT question using the PICOT format (provided in the assigned readings) that addresses the clinical nursing problem. The PICOT question will provide a framework for your capstone project change proposal. In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome. Describe the problem in the PICOT question as it relates to the following: Evidence-based solution Nursing intervention Patient care Health care agency Nursing practice Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is not required.  This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.Capstone Topic Summary   My preceptor Ms. Wilder and I discussed the needs of the community we both serve. Living in South Florida where there is a strong presence of African American population who is underserved by the health care community. The topic I chose will help serve this population. I recently relocated to Georgia which also have a large African American population. The evidence-based topic for the capstone change proposal will focus on the African American population and COVID 19. The category my topic and intervention falls under the community branch. I want to educate the African American population on the benefits of getting the COVID vaccine. History has shown that African American have a sincere distrust in the health care system due to health disparities and previous unconsented experiments performed by the medical community. The pandemic has disproportionately impacted African Americans. But yet this population is reluctant to receive the vaccine. Whether it is from social determents (limited finances, education, insurance or lack of) or health conditions (i.e. hypertension, diabetes), there is need for education to prevent higher mortality rates among the African American population.Lohia et al. Respir Res (2021) 22:37 https://doi.org/10.1186/s12931-021-01647-6 R E S E A R C H Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population Prateek Lohia1* , Kalyan Sreeram1, Paul Nguyen1, Anita Choudhary1, Suman Khicher1, Hossein Yarandi2, Shweta Kapur2 and M. Safwan Badr1 Abstract Background: Comorbidities play a key role in severe disease outcomes in COVID-19 patients. However, the literature on preexisting respiratory diseases and COVID-19, accounting for other possible confounders, is limited. The primary objective of this study was to determine the association between preexisting respiratory diseases and severe disease outcomes among COVID-19 patients. Secondary aim was to investigate any correlation between smoking and clinical outcomes in COVID-19 patients. Methods: This is a multihospital retrospective cohort study on 1871 adult patients between March 10, 2020, and June 30, 2020, with laboratory confirmed COVID-19 diagnosis. The main outcomes of the study were severe disease outcomes i.e. mortality, need for mechanical ventilation, and intensive care unit (ICU) admission. During statistical analysis, possible confounders such as age, sex, race, BMI, and comorbidities including, hypertension, coronary artery disease, congestive heart failure, diabetes, any history of cancer and prior liver disease, chronic kidney disease, end- stage renal disease on dialysis, hyperlipidemia and history of prior stroke, were accounted for. Results: A total of 1871 patients (mean (SD) age, 64.11 (16) years; 965(51.6\%) males; 1494 (79.9\%) African Americans; 809 (43.2\%) with ≥ 3 comorbidities) were included in the study. During their stay at the hospital, 613 patients (32.8\%) died, 489 (26.1\%) needed mechanical ventilation, and 592 (31.6\%) required ICU admission. In fully adjusted models, patients with preexisting respiratory diseases had significantly higher mortality (adjusted Odds ratio (aOR), 1.36; 95\% CI, 1.08–1.72; p = 0.01), higher rate of ICU admission (aOR, 1.34; 95\% CI, 1.07–1.68; p = 0.009) and increased need for mechanical ventilation (aOR, 1.36; 95\% CI, 1.07–1.72; p = 0.01). Additionally, patients with a history of smoking had significantly higher need for ICU admission (aOR, 1.25; 95\% CI, 1.01–1.55; p = 0.03) in fully adjusted models. Conclusion: Preexisting respiratory diseases are an important predictor for mortality and severe disease outcomes, in COVID-19 patients. These results can help facilitate efficient resource allocation for critical care services. Keywords: COVID-19, Mechanical ventilation, Intensive care, Smoking, tobacco, Mortality © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the oSocial and Psychological Consequences of the Covid-19 Pandemic in African-American Communities: Lessons From Michigan Rodlescia S. Sneed and Kent Key Michigan State University Sarah Bailey Bridges Into the Future, Inc., Flint, Michigan Vicki Johnson-Lawrence Michigan State University The mental health consequences of the COVID-19 pandemic are particularly relevant in African- American communities because African-Americans have been disproportionately impacted by the disease, yet they are traditionally less engaged in mental health treatment compared with other racial groups. Using the state of Michigan as an example, we describe the social and psychological conse- quences of the pandemic on African-American communities in the United States, highlighting commu- nity members’ concerns about contracting the disease, fears of racial bias in testing and treatment, experiences of sustained grief and loss, and retraumatization of already-traumatized communities. Furthermore, we describe the multilevel, community-wide approaches that have been used thus far to mitigate adverse mental health outcomes within our local African-American communities. Keywords: community mental health, trauma, racial disparities, coronavirus, population health African-American communities in the state of Michigan have been disproportionately impacted by the coronavirus 2019 (COVID-19) pandemic. Despite making up only 13\% of Michi- gan’s population, African Americans account for 32\% of con- firmed cases and 41\% of pandemic related-deaths (Michigan De- partment of Health and Human Services, 2020). In Michigan’s primarily African-American communities, more than 10\% of COVID-19 cases end in death (Michigan Department of Health and Human Services, 2020). A disease that was initially thought to mostly impact older adults and the chronically infirmed has now become a national scourge, devastating African-American com- munities across the United States. From a mental health perspective, the pandemic has heightened fear in a segment of the population that already faces significant barriers to mental health treatment. Despite having rates of mental illness similar to Whites, African Americans experience significant disparities in mental health treatment engagement. Among those with any mental illness, only 31\% of African Americans receive treatment, compared with 48\% of Whites (Agency for Healthcare Research and Quality, 2016). Furthermore, when African Ameri- cans do receive treatment, it is often due to serious mental illness requiring hospitalization rather than mild or moderate illness that can be managed in an outpatient setting. African Americans are less likely than Whites to have ongoing relationships with mental health providers; rather, they are more likely to engage with the mental health care system through emergency departments and primary care visits (U.S Surgeon General, 2001). These disparities are likely due to greater stigma surrounding mental illness, lack of www.diverseeducation.com16 Diverse | February 4, 2021 A few hours a� er receiv-ing the second dose of the COVID-19 vaccine, Dr. Valerie Montgomery Rice, president of Morehouse School of Medicine (MSM), says she was “feeling great.” Rice, who says she has “a history of participating in clinical trials,” received her fi rst dose of the vaccine on Decem- ber 18 with CNN anchor Sanjay Gupta to raise awareness and public trust in the vaccine. Rice and MSM are part of a group of higher ed professionals, doctors and public health experts known as the Black Coalition Against COVID, which is working to address community concerns and dispel misconceptions about the disease and the vaccine and to inspire trust in the medical community around these issues to hopefully save Black lives. � is is no small feat. “Black folks’ mistrust in the medical system really stems from enslavement,” s ay s D r. Ve r o n i c a Newton, an assistant professor of sociology at Georgia State University. She is working with a research team studying C OVID-1 9 res e arch participation in the Black community. From the gynecological experiments conducted on enslaved African A m e r i c a n w o m e n without anesthesia, to the forced sterilization of Black women after emancipation as a form of social control, to the Tuskegee experiments Dr. Veronica Newton A Cultural Conundrum Physicians are fighting against historic distrust and misinformation in their quest to save African American patients, who are dying from COVID-19 at disproportionally high numbers. By Autumn A. Arnett www.diverseeducation.com February 4, 2021 | Diverse 17 that withheld treatment for Syphilis from infected Black men, to even more recently not believing Black women and putting their lives at risk during childbirth, there has been systemic institutional violence against Black bodies by the medical community, Newton says. “I think it’s really important that we remember that it’s institutional racism and sexism that has led Blacks to mistrust medical professionals, not just, ‘Oh, Black people don’t have a trust of medical professionals,’” she says. “It’s more than Blacks all having a bad experience with a specifi c type of doctor. It’s across all facets and specifi cities within the medical fi eld.” � ese disparities don’t only aff ect poor Black people. Dr. Geden Franck, an assistant professor in the school of medicine at Texas A&M University, pointed out how a lack of cultural responsiveness has impacted patient care. “Yes, there are errors within the system, there are misdiagnoses within the system, but we tend to see there is a higher percentage of these when dealing with cultures or races that physicians are unfamiliar with — like what happened with Serena Williams during her pregnancy,” Franck says. “That showed us that even when the African American patient is very affl uent, they still face these dispari1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2 Office of Public Health Practice and Training, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 3 Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 4 Center for Teaching and Learning, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Corresponding Author: Beth A. Resnick, DrPH, Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, 624 N Broadway #457, Baltimore, MD 21205, USA. Email: [email protected] jhu. edu Commentary Public Health Reports 2021, Vol. 136(1) 23-26 © 2020, Association of Schools and Programs of Public Health All rights reserved. Article reuse guidelines: sagepub. com/ journals- permissions DOI: 10. 1177/ 0033 3549 20966024 journals. sagepub. com/ home/ phr The COVID-19 Pandemic: An Opportunity to Transform Higher Education in Public Health Beth A. Resnick, DrPH1 ; Paulani C. Mui, MPH2; Janice Bowie, PhD, MPH3; Sukon Kanchanaraksa, PhD, MHS4; Elizabeth Golub, PhD, MEd5; and Joshua M. Sharfstein, MD1 The coronavirus disease 2019 (COVID-19) pandemic has revealed deficiencies in our public health infrastructure and led to calls for long- overdue investment, an improved focus on equity, and new approaches to crisis readiness and response. Higher education in public health faces a similar moment of reckoning. The immediacy of the pandemic forced schools and programs of public health to shift to remote learning and to support response efforts. The pandemic provides an opportunity to consider funda- mental changes to improve our approaches to, effectiveness in, and impact on public health education. Immediate Educational Changes Undertaken Schools and programs of public health were forced to move quickly in response to COVID-19 to keep teaching students, sup- porting the training needs of public health agencies, engaging the public, assisting communities, working across sectors, and con- ducting research. The immediate shift from onsite to remote learning forced rapid adaptations to teach and engage with students at a distance, including the use of online formats for classroom teaching, webi- nars, discussion groups, mentoring, and applied learning. Sheltering in place also elevated the need for student engagement in research and practice activities to assist communities in their COVID-19 response in myriad ways. For example, public health students across the country assisted with performing contact trac- ing, monitoring statistics on cases, staffing COVID-19 testing sites and help lines, creating COVID-19 educational materials in multiple languages, collecting 1 Department of Health and Human Performance, College of Charleston, Charleston, SC, USA 2 Department of Health Sciences, James Madison University, Harrisonburg, VA, USA 3 Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA 4 Department of Anthropology, Rollins College, Winter Park, FL, USA 5 Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA Corresponding Author: Sarah B. Maness, PhD, College of Charleston, Department of Health and Human Performance, 24 George St, Charleston, SC 29401, USA. Email: [email protected] cofc. edu Commentary Public Health Reports 2021, Vol. 136(1) 18-22 © 2020, Association of Schools and Programs of Public Health All rights reserved. Article reuse guidelines: sagepub. com/ journals- permissions DOI: 10. 1177/ 0033 3549 20969169 journals. sagepub. com/ home/ phr Social Determinants of Health and Health Disparities: COVID-19 Exposures and Mortality Among African American People in the United States Sarah B. Maness, PhD1 ; Laura Merrell, PhD2; Erika L. Thompson, PhD3 ; Stacey B. Griner, PhD3 ; Nolan Kline, PhD4; and Christopher Wheldon, PhD5 The coronavirus disease 2019 (COVID-19) pandemic in the United States provides yet another example of the enduring and pernicious effect of social determinants of health (SDH) on African American communities. SDH, as defined by the Healthy People 2020 SDH framework, include domains of economic stability, education, social and community con- text, health and health care, and neighborhood and built environment.1 Within each domain, key areas represent ele- ments of focus for the decade (Box). Compared with non- Hispanic White people, African American people have higher rates of COVID-19 cases (2.6 times higher), hospital- ization (4.7 times higher), and death (2.1 times higher).2-4 Although the pandemic is ongoing, it is not premature to call attention to the root causes of health inequity in the United States that have persisted for decades and are being high- lighted in the current crisis. The disparities in COVID-19 case fatality rates between African American and White people have been referred to as a “perfect storm.”5 Such a comparison obfuscates the larger social and political circumstances that structure poor health. Unlike a storm, which is a natural phenomenon that cannot be prevented, the higher rate of COVID-19 deaths among African American people was predictable and pre- ventable because of racial injustice. These deaths were pre- dictable because of the long history of health inequities in the United States and preventable through systemic changes to eliminate systemic racism and improve SDH. The social and political will needed to correct these injustices histori- cally has been, and continues to be, lacking. SDH underlie health disparities that increase the potential for exposure to, PREVENTING CHRONIC DISEASE P U B L I C H E A L T H R E S E A R C H , P R A C T I C E , A N D P O L I C Y V o l u m e 1 7 , E 8 3 A U G U S T 2 0 2 0 COMMENTARY Community Engagement of African Americans in the Era of COVID-19: Considerations, Challenges, Implications, and Recommendations for Public Health Tabia Henry Akintobi, PhD, MPH1; Theresa Jacobs, MD2,3; Darrell Sabbs3,4; Kisha Holden, PhD, MSCR5; Ronald Braithwaite, PhD1; L. Neicey Johnson, JD, RN, BSN3,6; Daniel Dawes, JD5; LaShawn Hoffman7,8 Accessible Version: www.cdc.gov/pcd/issues/2020/20_0255.htm Suggested citation for this article: Henry Akintobi T, Jacobs T, S a b b s D , H o l d e n K , B r a i t h w a i t e R , J o h n s o n L N , e t a l . Community Engagement of African Americans in the Era of COVID-19: Considerations, Challenges, Implications, and Recommendations for Public Health. Prev Chronic Dis 2020; 17:200255. DOI: https://doi.org/10.5888/pcd17.200255. PEER REVIEWED Summary What is already known on this topic? African Americans are more likely to contract coronavirus disease 2019 (COVID-19), be hospitalized for it, and die of the disease when compared with other racial/ethnic groups. Psychosocial, sociocultural, and environ- mental vulnerabilities, compounded by preexisting health conditions, ex- acerbate this health disparity. What is added by this report? This report adds to an understanding of the interconnected historical, policy, clinical, and community factors associated with pandemic risk, which underpin community-based participatory research approaches to ad- vance the art and science of community engagement among African Amer- icans in the COVID-19 era. What are the implications for public health practice? When considered together, the factors detailed in this commentary create opportunities for new approaches to intentionally engage socially vulner- able African Americans. The proposed response strategies will proactively prepare public health leaders for the next pandemic and advance com- munity leadership toward health equity. Abstract African Americans, compared with all other racial/ethnic groups, are more likely to contract coronavirus disease 2019 (COVID-19), be hospitalized for it, and die of the disease. Psychosocial, so- ciocultural, and environmental vulnerabilities, compounded by preexisting health conditions, exacerbate this health disparity. In- terconnected historical, policy, clinical, and community factors ex- plain and underpin community-based participatory research ap- proaches to advance the art and science of community engage- ment among African Americans in the COVID-19 era. In this commentary, we detail the pandemic response strategies of the Morehouse School of Medicine Prevention Research Center. We discuss the implications of these complex factors and propose re- commendations for addressing them that, adopted Overcoming Barriers to COVID-19 Vaccination in African Americans: The Need for Cultural Humility Keith C. Ferdinand, MD, FACC, FAHA, FNLA, FASPC ABOUT THE AUTHOR Keith C. Ferdinand is with the Department of Medicine, Tulane University School of Medicine, New Orleans, LA. See also Benjamin, p. 542, and Rodenberg, p. 588. “Rescue work by helicopter was slow. That stopped at dark about 7 o’clock . . . people began to panic. I told Kenneth and Keith and those around me that we may as well make the best of it, for no one knows we are here . . . help won’t come until morning. The rain fell so hard that I had to take off my glasses & hide my head. . . . The water, still slowly rising, had two more inches to go before it reached the rooftop. We learned: that communication [and] coopera- tion are necessary factors for survival in a disaster.” —Letter from Inola Copelin Ferdinand to her sister, Narvalee, after our family and others spent days amid the drowning death of my paternal grand- father and many of her neighbors, abandoned on rooftops in the Lower Ninth Ward, New Orleans, LA, during Hurricane Betsy, September 9, 1965 Racial/ethnic minorities suffer dis- proportionately from US COVID-19–as- sociated deaths.1 The tragically higher COVID-19 mortality among African Americans from multiple conditions, in- cluding cardiovascular diseases (CVD) and certain cancers, highlights deep- rooted, unacceptable failures in US health care. The social determinants of health (limited finances, healthy food, education, health care coverage, job flexibility) make disadvantaged commu- nities more vulnerable to COVID-19 in- fectivity and mortality and amplify higher comorbid conditions.2 The Healthy People 2020 Social Determinants of Health include the Economic Stability domain, with employment as a key issue. Suboptimal job benefits such as health insurance, paid sick leave, and parental leave can affect the health of employed individuals, and African Americans are more likely to work in blue-collar service jobs.3 This toxic gumbo of suboptimal health and adverse environments pro- foundly diminishes overall African American longevity, fueling a decades- long White–Black death gap, with African American men having the shortest life expectancy.2 Although December 2020 Pew Research data note that a growing share of Americans report they probably or definitely will accept COVID-19 vac- cination, African Americans continue to stand out as less inclined to get vacci- nated: 42\% would do so, compared with 63\% of Hispanic and 61\% of White adults.4 MISTRUST: A CRITICAL BARRIER TO OVERCOME Effective public health messaging and mitigation efforts are required to opti- mize acceptance of COVID-19 vaccina- tion and minimize subsequent mortality. Unfortunately, mistrust in orthodox health care is a substantial barrier to COVID-19 vaccine acceptance, and with- out widespread uptake, the societal ben- efits of iFull Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=whsp20 Social Work in Public Health ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/whsp20 Racial Disparities in Healthcare: How COVID-19 Ravaged One of the Wealthiest African American Counties in the United States Darius D.Reed To cite this article: Darius D.Reed (2021) Racial Disparities in Healthcare: How COVID-19 Ravaged One of the Wealthiest African American Counties in the United States, Social Work in Public Health, 36:2, 118-127, DOI: 10.1080/19371918.2020.1868371 To link to this article: https://doi.org/10.1080/19371918.2020.1868371 Published online: 28 Dec 2020. Submit your article to this journal Article views: 509 View related articles View Crossmark data https://www.tandfonline.com/action/journalInformation?journalCode=whsp20 https://www.tandfonline.com/loi/whsp20 https://www.tandfonline.com/action/showCitFormats?doi=10.1080/19371918.2020.1868371 https://doi.org/10.1080/19371918.2020.1868371 https://www.tandfonline.com/action/authorSubmission?journalCode=whsp20&show=instructions https://www.tandfonline.com/action/authorSubmission?journalCode=whsp20&show=instructions https://www.tandfonline.com/doi/mlt/10.1080/19371918.2020.1868371 https://www.tandfonline.com/doi/mlt/10.1080/19371918.2020.1868371 http://crossmark.crossref.org/dialog/?doi=10.1080/19371918.2020.1868371&domain=pdf&date_stamp=2020-12-28 http://crossmark.crossref.org/dialog/?doi=10.1080/19371918.2020.1868371&domain=pdf&date_stamp=2020-12-28 Racial Disparities in Healthcare: How COVID-19 Ravaged One of the Wealthiest African American Counties in the United States Darius D.Reed a,b aDepartment of Social Work, Indiana Wesleyan University, Marion; bSchool of Social Work, Walden University ABSTRACT The COVID-19 pandemic swept the globe in January of 2020 causing mass panic and extreme hysteria. While pandemics are not new, COVID-19 is emerging as a public health crisis in nearly every household in America. In this paper, I discuss how COVID-19 has ravaged one of the wealthiest African American counties in the United States. Using Public Health Critical Race Praxis (PHCR) I seek to examine how disparities exist in health care and public funding is not equally distributed regardless of wealth and status for minor- itized communities. Using PCHR’s framework I highlight many of the dispa- rities that exist in health care for people of color during this global health crisis and provide implications for improvement in federal, state, and local funding in communities of color. This article advances scholarship on the intersection between public health and social work particularly alluding to the need for increased advocacy for marginalized communities. KEYWORDS Anxiety; COVID-19; public health critical race praxis (PHCR); social work; African Americans; marginalized communities IntCOVID-19 Among African Americans: An Action Plan for Mitigating Disparities Monica E. Peek, MD, MPH, MS, Russell A. Simons, BS, William F. Parker, MD, MS, David A. Ansell, MD, MPH, Selwyn O. Rogers, MD, MPH, and Brownsyne Tucker Edmonds, MD, MPH, MS As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities. However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation. Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois’ mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting. (Am J Public Health. 2021;111: 286–292. https://doi.org/10.2105/AJPH.2020.305990) Since April 2020, striking disparities inCOVID-19 mortality between African Americans and Whites have been re- ported in US cities and states. For ex- ample, 51\% of deaths in South Carolina have been among African Americans despite their representing only 30\% of the population.1 In Chicago, Illinois, Af- rican Americans constituted 70\% of early COVID-19 deaths despite com- posing only 30\% of the population, and deaths continue to cluster in neighbor- hoods where more than 90\% of the residents are African American.2 A national analysis of county-level data confirmed what many scholars pre- dicted: that place matters in COVID-19 racial disparities. Counties with higher proportions of African Americans have higher numbers of COVID-19 cases and deaths; these counties have more crowded living conditions and lower social distancing scores, higher unem- ployment, lower rates of health insurance, and higher burdens of chronic disease.3 Structural racism and residential segregation have forced a disproportionate number of African Americans into low-income neighbor- hoods that are more physically crowded and have fewer resources.4 As a result, social isolation practices can be more challenging to implement; people must travel farther for necessary supplies, often utilizing public transportation, and return to homes with less personal space because of multigenerational living. Individual risk also matters. Although not all African Americans live in racially segregated neighborhoods, all African Americans, to varying degrees, areRESEARCH ARTICLE Open Access Higher comorbidities and early death in hospitalized African-American patients with Covid-19 Raavi Gupta1* , Raag Agrawal2, Zaheer Bukhari2, Absia Jabbar2, Donghai Wang2, John Diks2, Mohamed Alshal2, Dokpe Yvonne Emechebe2, F. Charles Brunicardi3, Jason M. Lazar4, Robert Chamberlain5, Aaliya Burza6 and M. A. Haseeb1 Abstract Background: African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. Methods: We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a 52-day period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population. Results: Of the 1103 consecutive patients who tested positive for COVID-19, 529 required hospitalization and were included in the study. 88\% of patients were Black; and a majority (52\%) were 61–80 years old with a mean body mass index in the “obese” range. 98\% had one or more comorbidities. Hypertension was the most common (79\%) pre-existing condition followed by diabetes mellitus (56\%) and chronic kidney disease (17\%). Patients with chronic kidney disease who received hemodialysis were found to have lower mortality, than those who did not receive it, suggesting benefit from hemodialysis Age > 60 years and coronary artery disease were independent predictors of mortality in multivariate analysis. Cox proportional hazards modeling for time to death demonstrated a significantly high ratio for COPD/Asthma, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil: lymphocyte ratio (8.3:10.0) were predictive of mortality on admission and at 48–96 h. Of the 529 inpatients 48\% died, and one third of them died within the first 3 days of admission. 159/529patients received invasive mechanical ventilation, of which 86\% died and of the remaining 370 patients, 30\% died. Conclusions: COVID-19 patients in our predominantly Black neighborhood had higher in-hospital mortality, likely due to higher prevalence of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients. Keywords: Health disparities, COVID-19, African-Americans, Dialysis, ACE inhibitors, Angiotensin II receptor blockers, Comorbidities, Chronic kidney disease © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, dAfrican Americans and COVID-19: Beliefs, behaviors and vulnerability to infection Elyria Kempa, Gregory N. Pricea, Nicole R. Fullera and Edna Faye Kempb aCollege of Business Administration, University of New Orleans, New Orleans, LA, USA; bKemp Dentistry, Indianapolis, IN, USA ABSTRACT In the United States, during the early outbreak of the coronavirus (COVID-19) pandemic, African Americans experienced disproportionately high rates of infection and mortality relative to their share of the United States population. New Orleans, Louisiana was one of the places most heavily affected by the coronavirus during its early outbreak. The study that follows explores the attitudes of African Americans in New Orleans toward the virus, social and normative conditions which affected individual behaviors, as well as access to healthcare services and COVID-19 testing. In part one of the study, qualitative responses were collected from a sample of African Americans in the New Orleans area to garner perspective about their attitudes and behaviors related to the coronavirus outbreak. Part two of the study builds on findings from Study 1 with parameter estimates from a Logit regression to examine how social, economic and physical conditions determine vulnerability to COVID-19 infection among African Americans. Implications for how healthcare organizations can address the needs of vulnerable populations during a health-related crisis are discussed. ARTICLE HISTORY Received 13 May 2020 Accepted 22 July 2020 KEYWORDS Health equity; Social determinants of health; African Americans; COVID-19; Theory of planned behavior In 2020, the World Health Organization declared the novel coronavirus, or COVID-19, a global health emer- gency as it spread ferociously across the globe [1]. The first confirmed case of the virus appeared in January 2020 in the United States [2]. Within months, the virus sickened many and resulted in thousands of deaths. As more data emerges regarding the impact of COVID-19 in the United States, it has become evident that the virus has affected racial and ethnic minorities at an alarmingly high rate. Specifically, African Amer- icans have experienced disproportionately higher rates of infection and mortality than their representative share of the United States population [3,4]. In early May 2020, African Americans accounted for approxi- mately 34\% of total COVID-19 deaths in states where they represent only about 13\% of the state’s population [3]. Some states reported even more egregious dispar- ities. For example, in Louisiana blacks accounted for 70\% of the deaths from COVID-19, but only 33\% of the population. Similarly, in Alabama, blacks accounted for 44\% of COVID-19 deaths, yet only make up 26\% of the state’s population [5]. Some officials have linked the disproportionate numbers regarding the effect of the virus on African Americans to individual behavior (i.e. including practi- cing unhealthy behaviors and suffering from comor- bidities whichPerspective T h e N EW ENGL A N D JOU R NA L o f M EDICI N E november 26, 2020 n engl j med 383;22 nejm.org november 26, 2020 e121(1) The only way out of today’s misery is for peo-ple to become worthy of each other’s trust.— Albert Schweitzer As the race to develop a vaccine for Covid-19 has reached phase 3 clinical trials, concerns are in- creasing about the low rates of trial participation in important subgroups, including Black com- munities. Recent data show that although Black people make up 13\% of the U.S. population, they account for 21\% of deaths from Covid-19 but only 3\% of enrollees in vaccine trials. This problem threatens both the validity and the generalizability of the trial re- sults and is of particular concern in vaccine trials, in which differ- ences in lifetime environmental exposures can result in differenc- es in immunologic responses that could affect both safety and effi- cacy. Despite long-standing calls from the Food and Drug Admin- istration (FDA) and the National Institutes of Health (NIH) to im- prove the participation of under- represented subgroups in drug trials, the problem persists.1 What are the barriers to great- er participation of Black people in Covid-19 trials? Although they are multiple, a critical factor is the deep and justified lack of trust that many Black Americans have for the health care system in gen- eral and clinical research in par- ticular. This distrust is often traced to the legacy of the infamous syphi- lis study at Tuskegee, in which investigators withheld treatment from hundreds of Black men in order to study the natural history of the disease. But the distrust is far more deeply rooted, in centuries of well-documented examples of racist exploitation by American physicians and researchers.2 How can these long-standing barriers to trust be overcome? The presidents of Dillard and Xavier Universities, two of the 104 his- torically Black colleges and uni- versities (HBCUs) in the United States, recently wrote to their com- munities saying that they them- selves were participating in one of the vaccine trials and asking their students, faculty, and staff to consider doing the same. The pushback from parents of some students came quickly. One wrote on Xavier’s Facebook page, “Our children are not lab rats for drug companies. I cannot believe that Xavier is participating in this. This is very disturbing given the history of drug trials in the black and brown communities.”3 Presidents of the four histori- cally Black U.S. medical schools recently called for measures to in- crease the participation of Black Trustworthiness before Trust — Covid-19 Vaccine Trials and the Black Community Rueben C. Warren, D.D.S., Dr.P.H., M.Div., Lachlan Forrow, M.D., David Augustin Hodge, Sr., D.Min., Ph.D., and Robert D. Truog, M.D. Trustworthiness before Trust P E R S P E C T I V E e121(2) Trustworthiness before Trust n engl j med 383;22 Rubic_Print_Format Course Code Class Code Assignment Title Total Points NRS-493 NRS-493-O504 PICOT Question Paper 50.0 Criteria Percentage Unsatisfactory (0.00\%) Less Than Satisfactory (75.00\%) Satisfactory (79.00\%) Good (89.00\%) Excellent (100.00\%) Comments Points Earned Content 80.0\% PICOT Question 20.0\% A PICOT question is not presented. An incomplete PICOT question is presented. The PICOT does not follow the correct format. A PICOT question is presented. The PICOT generally follows the correct format. A PICOT question is presented. Some detail is needed for clarity. A PICOT question is presented and provides a clear framework for the capstone project change proposal. Nursing Intervention 20.0\% The intervention and comparison are omitted The intervention used to address the problem is not based on a nursing practice intervention. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are omitted. A nursing intervention used to address the problem is presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are summarized. Some information is needed. There are minor inaccuracies. A nursing intervention used to address the problem is presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are discussed. A nursing intervention used to address the problem is clearly presented. A comparison of the nursing intervention to a patient population not currently receiving the nursing intervention, and timeframe needed to implement the change process, are thoroughly discussed. Clinical Problem and Patient Outcome 20.0\% The clinical problem and how it can result in a positive patient outcome are omitted. The clinical problem and how it can result in a positive patient outcome are incomplete. The clinical problem and how it can result in a positive patient outcome are summarized. More information and rationale are needed. The clinical problem and how it can result in a positive patient outcome are presented. Some minor detail is needed for clarity. The clinical problem and how it can result in a positive patient outcome are thoroughly discussed. Strong rationale is offered for support. PICOT Problem 20.0\% The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is omitted. The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is incomplete. The PICOT problem as it relates to evidence-based solution, nursing intervention, patent care, health care agency, and nursing practice is summarized. More information and rationale are needed.