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Background Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. Methods In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. Findings Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. Interpretation Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. Funding British Heart Foundation Data Science Centre, led by Health Data Research UK.

BackgroundBlack women are four times more likely to die than White women due to complications during pregnancy or childbirth in the U.K. This cohort are also more prone to Hypertensive Disorders in Pregnancy (HDP). Outside of pregnancy, there are race based differences in the management of hypertension as Calcium-Channel Blockers (CCB) are more effective in reducing blood pressure in Black patients. It is unclear whether these differences in anti-hypertensive management extend to the management of hypertension in pregnancy. The primary objective was to address this gap in evidence by undertaking a systematic review of randomised control trials, where one treatment arm comprised of CCBs, investigating pharmacological management of HDP to assess whether CCBs are the most effective anti-hypertensive agent in Black pregnant women.MethodsThe following electronic databases were searched: MEDLINE and Embase. We used MeSH and free text terms in conjunction to increase sensitivity to potentially relevant studies. Inclusion criteria included: (1) study involved drug treatment of HDP; (2) study was of randomised control trial design; (3) one of the treatment arms involved CCBs (4) English full-text and (5) outcome data was stratified by race, and included Black women. Information regarding baseline participant data, type of anti-hypertensive, and clinical outcomes was extracted from each study.ResultsThis review highlighted four randomised control trials, which published race or ethnicity demographics, with only one trial that stratified HDP outcomes by ethnicity. ConclusionsThere is a lack of evidence to draw definite conclusions as to whether CCBs are the most effective anti-hypertensive agent for Black patients with HDP, highlighting the need for further research in this area. However, this review demonstrates some evidence to support the hypothesis that CCBs could be more effective in the management of HDP in Black patients and that Labetalol, which is the current first-line management of HDP, may not represent the gold standard of treatment in this cohort.

The novel coronavirus (COVID-19) emerged in the United States toward the close of 2019. CBOs were forced to either change their hours of operation or completely close their doors to avoid further widespread dissemination of the virus. The abrupt changes among CBOs posed some challenges for people living with HIV/AIDS (PLWHA), especially Black women living with HIV/AIDS (BWLHA). For this reason, this study aimed to explore the impact of the global pandemic on BWLHA receiving services from CBO service providers. A qualitative inquiry was used to examine the narratives of two CBOs’ service providers (i.e., Narrators 1 and 2). Hill-Collins's (1990) Black Feminist Theory was utilized to frame the research. Three approaches to narrative analysis also were employed to analyze participants' stories. Such narratives helped to underscore the trauma experienced by BWLHA. The stories also reflected feelings of loneliness, anxiety, and depression among the women. Meditation and advocacy were forms of learning provided for the women. The participation in "sister circles" was recognized as a system of support. Implications for practice suggested that CBOs' service providers develop collective trauma care plans that are comprehensive, specific to client’s needs, and informed by adult learning principles to help BWLHA navigate trauma events.

Background: Black women are four times more likely to die than White women due to complications during pregnancy or childbirth in the U.K. This cohort are also more prone to Hypertensive Disorders in Pregnancy (HDP). Outside of pregnancy, there are race based differences in the management of hypertension as Calcium-Channel Blockers (CCB) 9 are more effective in reducing blood pressure in Black patients. It is unclear whether these differences in anti-hypertensive management extend to the management of hypertension in pregnancy. The primary objective was to address this gap in evidence by undertaking a systematic review of all randomised control trials investigating pharmacological management of HDP to assess whether CCBs are the most effective anti-hypertensive agent in Black pregnant women. Methods: The following electronic databases were searched: PubMed, MEDLINE and Embase. We used MeSH and free text terms in conjunction to increase sensitivity to potentially relevant studies. Inclusion criteria included: (1) study involved treatment of HDP; (2) study was of a randomised control trial design; (3) one of the treatment arms involved CCBs and (4) English full-text. Information regarding baseline participant data, type of anti-hypertensive, and clinical outcomes was extracted from each study. Results: This review highlighted four randomised control trials, which published race or ethnicity demographics, with only one trial that stratified HDP outcomes by ethnicity. Conclusions: There is a lack of evidence to draw definite conclusions as to whether CCBs are the most effective anti-hypertensive agent for Black patients with HDP, highlighting the need for further research in this area. However, this review demonstrates some evidence to support the hypothesis that CCBs could be more effective in the management of HDP in Black patients and that Labetalol, which is the current first-line management of HDP, may not represent the gold standard of treatment in this cohort.

BackgroundMortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 with all and common causes of death, stratifying by age and sex. We also calculated deaths as a proportion of the population by age and sex.MethodsCOVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14-16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia, cardiovascular disease combining ischaemic heart disease and stroke, chronic obstructive pulmonary disease, cancer, road traffic accidents and dementia.FindingsDeaths related to COVID-19, while modest overall, varied considerably by age. Deaths as a percentage of all cause deaths during the time period under study ranged from InterpretationMortality rates from COVID-19 remains low including when compared to other common causes of death and will likely decline further while control measures are maintained. These data may help people contextualise their risk and policy makers in decision-making.

The occurrence of chronic heart and kidney diseases among the South Asian populations has been rising exponentially over the years. Research has been carried out in the past to explain the increased susceptibility with no resultant strong evidence. Various possible causes have been suggested with a previous hypothesis suggestive of high heat cooking techniques being responsible for increased production of neo-formed contaminants such as advanced glycation end products (AGEs) and trans-fatty acids (TFAs) leading to increased chronic heart diseases among the South Asian diaspora (India, Pakistan, Bangladesh, Sri Lanka in South Asia and overseas). The aim of this study proposes the high-heating cooking techniques and subsequent NFCs also to be responsible for the development of chronic kidney ailments among the South Asians.Review of the literature was conducted to ascertain the burden of accumulation and actions of AGEs and TFAs on kidney structure and functions. The varied high-heat cooking techniques including reheating of oils, food processing and kinds of food sources and their association with increased NFCs production and kidney damage were explored.Higher NFCs content of AGEs/TFAs in reheated oils at elevated temperatures and TFAs among processed and fast foods of South Asians was associated with elevated diabetic complications and CKDs progression in few animal and human studies but the research on the actual burden of NFCs in the renal tissues of South Asians was lacking.We hypothesize the high heat cooked foods generating increased levels of NFCs to be responsible for the preponderance of higher risk of CKDs among South Asians. Scientific exploration of the hypothesis to obtain quantifiable evidence of NFCs is suggested.

Race‐neutral philosophies often depend on the illusion of a universal humanist orientation. This philosophical position, while common, often misses what is concretely at stake in the diagnosis and analyses of anti‐Black racism in the United States. This article argues that racism is part of a deliberate strategy of academic philosophy to keep the discipline white. When one considers the demographic underrepresentation of Blacks compared to other groups in the academy, the use of universal pretenses to negate the experiences of racial minorities, and the sociological realities of race and racism in America, academic philosophy emerges as one of many ideological stratagems used to deny the realities of death and dying in our society. The authors argue that race neutrality and colorblindness cloak the societal consequences and disciplinary practices that allow segregation, violence, and anti‐Black death to continue unabated.

Over the last two decades, Black women have been disproportionately impacted by the obesity epidemic in the USA. According to the Centers for Disease Control and Prevention (CDC), 56.6% of Black women are overweight or obese compared with 44.4% Hispanic and 32.8% of white women. Social scientists and public health researchers have argued that increasing educational attainment would lead to overall improvements in health outcomes. Using the National Health and Nutrition Examination Survey (NHANES), a nationally representative cross-sectional survey, Cycles 1999–2010, I examined how educational attainment impacts Black women’s rate of obesity and C-reactive protein levels (N = 2685). Multiple linear regression was used to analyze the association between body mass index (BMI) and educational attainment. C-reactive protein, inflammation response, was used to measure the body’s reaction to being exposed to stress. The results demonstrated that educational attainment among Black women does not decrease their risk of being obese or levels of C-reactive protein. This article provides evidence to support a need to increase awareness of health disparities that disproportionately impact Black women. Electronic supplementary material The online version of this article (10.1007/s40615-019-00663-z) contains supplementary material, which is available to authorized users.

People who provide health and social care services, transport, food, and other essential services have maintained the economy, vital services, and crucial support systems during the COVID-19 pandemic, and many of these workers have been disproportionately impacted by COVID-19 Davies and Pearson-Stuttard advocate a total health approach that includes “physical, mental, and social health and also the underlying drivers that influence all those aspects of our lives” to address society's health needs before people become ill The authors recommended “three innovative new societal contracts: new shared values between the private sector, civil society and our nation's total health;a new 21st century public health system that includes monitoring with surveillance and health security;and an expanded NHS [the UK National Health Service] that provides a health and care system that encompasses acute and chronic illness along with social care” [ ]a total health approach will improve not only the overall health of the society but also productivity

Objectives: Mortality statistics on the COVID-19 pandemic have led to widespread concern and fear. To contextualise these data, we compared mortality related to COVID-19 during the first wave of the pandemic across seven countries in Europe with all and common causes of death, stratifying by age and sex. We also calculated deaths as a proportion of the population by age and sex. Study design: Analysis of population mortality data. Methods: COVID-19 related mortality and population statistics from seven European countries were extracted: England and Wales, Italy, Germany, Spain, France, Portugal and Netherlands. Available data spanned 14–16 weeks since the first recorded deaths in each country, except Spain, where only comparable stratified data over an 8-week time period was available. The Global Burden of Disease database provided data on all deaths and those from pneumonia, cardiovascular disease combining ischaemic heart disease and stroke, chronic obstructive pulmonary disease, cancer, road traffic accidents and dementia in 2017. Results: Deaths related to COVID-19, while modest overall, varied considerably by age. Deaths as a percentage of all cause deaths during the time period under study ranged from