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Williams P, Herring TA, Yokota RTC, Maia T, Venkatesan S, Marcus JC, Settergren G, Arnetorp S, Lloyd A, Severens JL, Varni JW, Dixon S, Hamusankwa L, Powell PA, Taylor S, Ware JE, Krol M. The Association Between Physical Distancing Behaviors to Avoid COVID-19 and Health-Related Quality of Life in Immunocompromised and Nonimmunocompromised Individuals: Patient-Informed Protocol for the Observational, Cross-Sectional EAGLE Study. JMIR Res Protoc 2024; 13:e52643. [PMID: 39137022 DOI: 10.2196/52643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 06/12/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Immunocompromised individuals are known to respond inadequately to SARS-CoV-2 vaccines, placing them at high risk of severe or fatal COVID-19. Thus, immunocompromised individuals and their caregivers may still practice varying degrees of social or physical distancing to avoid COVID-19. However, the association between physical distancing to avoid COVID-19 and quality of life has not been comprehensively evaluated in any study. OBJECTIVE We aim to measure physical distancing behaviors among immunocompromised individuals and the association between those behaviors and person-centric outcomes, including health-related quality of life (HRQoL) measures, health state utilities, anxiety and depression, and work and school productivity impairment. METHODS A patient-informed protocol was developed to conduct the EAGLE Study, a large cross-sectional, observational study, and this paper describes that protocol. EAGLE is designed to measure distancing behaviors and outcomes in immunocompromised individuals, including children (aged ≥6 mo) and their caregivers, and nonimmunocompromised adults in the United States and United Kingdom who report no receipt of passive immunization against COVID-19. We previously developed a novel self- and observer-reported instrument, the Physical Distancing Scale for COVID-19 Avoidance (PDS-C19), to measure physical distancing behavior levels cross-sectionally and retrospectively. Using an interim or a randomly selected subset of the study population, the PDS-C19 psychometric properties will be assessed, including structural validity, internal consistency, known-group validity, and convergent validity. Associations (correlations) will be assessed between the PDS-C19 and validated HRQoL-related measures and utilities. Structural equation modeling and regression will be used to assess these associations, adjusting for potential confounders. Participant recruitment and data collection took place from December 2022 to June 2023 using direct-to-patient channels, including panels, clinician referral, patient advocacy groups, and social media, with immunocompromising diagnosis confirmation collected and assessed for a randomly selected 25% of immunocompromised participants. The planned total sample size is 3718 participants and participant-caregiver pairs. Results will be reported by immunocompromised status, immunocompromising condition category, country, age group, and other subgroups. RESULTS All data analyses and reporting were planned to be completed by December 2023. Results are planned to be submitted for publication in peer-reviewed journals in 2024-2025. CONCLUSIONS This study will quantify immunocompromised individuals' physical distancing behaviors to avoid COVID-19 and their association with HRQoL as well as health state utilities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/52643.
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Affiliation(s)
- Paul Williams
- Global Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
- Patient Centered Solutions, IQVIA, Courbevoie, France
| | - Timothy A Herring
- Medical Evidence, Epidemiology, Vaccine & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States
| | | | - Tiago Maia
- Patient Centered Solutions, IQVIA, Porto Salvo, Portugal
| | - Sudhir Venkatesan
- BPM Evidence Statistics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - James C Marcus
- Patient Centered Solutions, IQVIA, Washington, DC, United States
| | - Gabriella Settergren
- Global Evidence Portfolio Delivery, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Sofie Arnetorp
- Health Economic & Payer Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Andrew Lloyd
- Acaster Lloyd Consulting Ltd, London, United Kingdom
| | | | - James W Varni
- Texas A&M University, College Station, TX, United States
| | - Sharon Dixon
- Patient representative, Sulphur Springs, TX, United States
| | | | - Philip A Powell
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, United Kingdom
- Philip A Powell Consulting, Sheffield, United Kingdom
| | - Sylvia Taylor
- Medical Evidence, Vaccine & Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - John E Ware
- John Ware Research Group, Watertown, ME, United States
| | - Marieke Krol
- Patient Centered Solutions, IQVIA, Amsterdam, Netherlands
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Moreno Echevarria F, Caputo M, Camp D, Reddy S, Achenbach CJ. Incidence and risk factors of SARS-CoV-2 breakthrough infection in the early Omicron variant era among vaccinated and boosted individuals in Chicago. PLoS One 2024; 19:e0302338. [PMID: 39102410 PMCID: PMC11299831 DOI: 10.1371/journal.pone.0302338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/22/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND SARS-CoV-2 vaccines are safe and effective against infection and severe COVID-19 disease worldwide. Certain co-morbid conditions cause immune dysfunction and may reduce immune response to vaccination. In contrast, those with co-morbidities may practice infection prevention strategies. Thus, the real-world clinical impact of co-morbidities on SARS-CoV-2 infection in the recent post-vaccination period is not well established. This study was performed to understand the epidemiology of Omicron breakthrough infection and evaluate associations with number of comorbidities in a vaccinated and boosted population. METHODS AND FINDINGS A retrospective clinical cohort study was performed utilizing the Northwestern Medicine Enterprise Data Warehouse. Our study population was identified as fully vaccinated adults with at least one booster. The primary risk factor of interest was the number of co-morbidities. The primary outcome was the incidence and time to the first positive SARS-CoV-2 molecular test in the Omicron predominant era. Multivariable Cox modeling analyses to determine the hazard of SARS-CoV-2 infection were stratified by calendar time (Period 1: January 1 -June 30, 2022; Period 2: July 1 -December 31, 2022) due to violations in the proportional hazards assumption. In total, 133,191 patients were analyzed. During Period 1, having 3+ comorbidities was associated with increased hazard for breakthrough (HR = 1.16 CI 1.08-1.26). During Period 2 of the study, having 2 comorbidities (HR = 1.45 95% CI 1.26-1.67) and having 3+ comorbidities (HR 1.73, 95% CI 1.51-1.97) were associated with increased hazard for Omicron breakthrough. Older age was associated with decreased hazard in Period 1 of follow-up. Interaction terms for calendar time indicated significant changes in hazard for many factors between the first and second halves of the follow-up period. CONCLUSIONS Omicron breakthrough is common with significantly higher risk for our most vulnerable patients with multiple co-morbidities. Age plays an important role in breakthrough infection with the highest incidence among young adults, which may be due to age-related behavioral factors. These findings reflect real-world differences in immunity and exposure risk behaviors for populations vulnerable to COVID-19.
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Affiliation(s)
- Fabiola Moreno Echevarria
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Mathew Caputo
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Daniel Camp
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Susheel Reddy
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Chad J. Achenbach
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, Illinois, United States of America
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Seiter JS, Curran T, Elwood RE. Make No Apologies: Fear of Negative Evaluation, Depressive Symptoms, and the Mediating Role of Accounting for COVID-Safe Behavior Amongst People at High-Risk for Severe Illness. HEALTH COMMUNICATION 2024; 39:896-905. [PMID: 36949567 DOI: 10.1080/10410236.2023.2191884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
With the goal of understanding unique and important threats to the mental health of people who are especially vulnerable to severe illness as a result of COVID-19, this study investigated associations between such individuals' fear of negative evaluation, tendency to "account for" practicing COVID-safe behaviors, and depressive symptoms. Grounded in perspectives on self-presentation, normative influence, and cognitive dissonance, we hypothesized that fear of negative evaluation would relate positively to accounting for COVID-safe behaviors, which, in turn, would associate positively with increased depressive symptoms. The results showed that increased fear of negative evaluation predicted an increased use of apologies and excuses, which in turn were positively related to depressive symptoms. Justifications for COVID-safe behaviors were not significantly associated with either fear of evaluation or depressive symptoms. The practical and theoretical implications are discussed.
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Affiliation(s)
- John S Seiter
- Department of Communication Studies and Philosophy, Utah State University
| | - Timothy Curran
- Department of Communication Studies and Philosophy, Utah State University
| | - Rebecca E Elwood
- Department of Communication Studies and Philosophy, Utah State University
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Moreno-Echevarria FM, Caputo MT, Camp DM, Reddy S, Achenbach CJ. Incidence and risk factors of omicron variant SARS-CoV-2 breakthrough infection among vaccinated and boosted individuals. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.03.24305293. [PMID: 38633797 PMCID: PMC11023664 DOI: 10.1101/2024.04.03.24305293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background SARS-CoV-2 vaccines have been shown to be safe and effective against infection and severe COVID-19 disease worldwide. Certain co-morbid conditions cause immune dysfunction and may reduce immune response to vaccination. In contrast, those with co-morbidities may practice infection prevention strategies. Thus, the real-world clinical impact of co-morbidities on SARS-CoV-2 infection in the recent post-vaccination period is not well established. We performed this study to understand the epidemiology of Omicron breakthrough infection and evaluate associations with number of comorbidities in a vaccinated and boosted population. Methods and Findings We performed a retrospective clinical cohort study utilizing the Northwestern Medicine Enterprise Data Warehouse. Our study population was identified as fully vaccinated adults with at least one booster. The primary risk factor of interest was the number of co-morbidities. Our primary outcome was incidence and time to first positive SARS-CoV-2 molecular test in the Omicron predominant era. We performed multivariable analyses stratified by calendar time using Cox modeling to determine hazard of SARS-CoV-2. In total, 133,191 patients were analyzed. Having 3+ comorbidities was associated with increased hazard for breakthrough (HR=1.2 CI 1.2-1.6). During the second half of the study, having 2 comorbidities (HR= 1.1 95% CI 1.02-1.2) and having 3+ comorbidities (HR 1.7, 95% CI 1.5-1.9) were associated with increased hazard for Omicron breakthrough. Older age was associated with decreased hazard in the first 6 months of follow-up. Interaction terms for calendar time indicated significant changes in hazard for many factors between the first and second halves of the follow-up period. Conclusions Omicron breakthrough is common with significantly higher risk for our most vulnerable patients with multiple co-morbidities. Age related behavioral factors play an important role in breakthrough infection with the highest incidence among young adults. Our findings reflect real-world differences in immunity and exposure risk behaviors for populations vulnerable to COVID-19.
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Affiliation(s)
| | - Mathew T. Caputo
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Daniel M. Camp
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
| | - Susheel Reddy
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
| | - Chad J. Achenbach
- Robert J. Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University
- Department of Medicine, Division of Infectious Diseases, Feinberg School of Medicine, Northwestern University
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
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Vincent W. Willingness to Use Digital Health Screening and Tracking Tools for Public Health in Sexual Minority Populations in a National Probability Sample: Quantitative Intersectional Analysis. J Med Internet Res 2024; 26:e47448. [PMID: 38457790 PMCID: PMC10960216 DOI: 10.2196/47448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Little is known about sexual minority adults' willingness to use digital health tools, such as pandemic-related tools for screening and tracking, outside of HIV prevention and intervention efforts for sexual minority men, specifically. Additionally, given the current cultural climate in the United States, heterosexual and sexual minority adults may differ in their willingness to use digital health tools, and there may be within-group differences among sexual minority adults. OBJECTIVE This study compared sexual minority and heterosexual adults' willingness to use COVID-19-related digital health tools for public health screening and tracking and tested whether sexual minority adults differed from each other by age group, gender, and race or ethnicity. METHODS We analyzed data from a cross-sectional, national probability survey (n=2047) implemented from May 30 to June 8, 2020, in the United States during the height of the public health response to the COVID-19 pandemic. Using latent-variable modeling, heterosexual and sexual minority adults were tested for differences in their willingness to use digital health tools for public health screening and tracking. Among sexual minority adults, specifically, associations with age, gender, and race or ethnicity were assessed. RESULTS On average, sexual minority adults showed greater willingness to use digital health tools for screening and tracking than heterosexual adults (latent factor mean difference 0.46, 95% CI 0.15-0.77). Among sexual minority adults, there were no differences by age group, gender, or race or ethnicity. However, African American (b=0.41, 95% CI 0.19-0.62), Hispanic or Latino (b=0.36, 95% CI 0.18-0.55), and other racial or ethnic minority (b=0.54, 95% CI 0.31-0.77) heterosexual adults showed greater willingness to use digital health tools for screening and tracking than White heterosexual adults. CONCLUSIONS In the United States, sexual minority adults were more willing to use digital health tools for screening and tracking than heterosexual adults. Sexual minority adults did not differ from each other by age, gender, or race or ethnicity in terms of their willingness to use these digital health tools, so no sexual orientation-based or intersectional disparities were identified. Furthermore, White heterosexual adults were less willing to use these tools than racial or ethnic minority heterosexual adults. Findings support the use of digital health tools with sexual minority adults, which could be important for other public health-related concerns (eg, the recent example of mpox). Additional studies are needed regarding the decision-making process of White heterosexual adults regarding the use of digital health tools to address public health crises, including pandemics or outbreaks that disproportionately affect minoritized populations.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, United States
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MILLER CARRIEA, GUIDRY JEANINEP, PERRIN PAULB, CARLYLE KELLIEE, SHEPPARD VANESSAB, FUEMMELER BERNARDF. Adding COVID to cancer: does cancer status influence COVID-19 infection preventive behaviors? JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2024; 65:E4-E10. [PMID: 38706767 PMCID: PMC11066821 DOI: 10.15167/2421-4248/jpmh2024.65.1.2888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/27/2024] [Indexed: 05/07/2024]
Abstract
Introduction A better understanding of how to promote disease mitigation and prevention behaviors among vulnerable populations, such as cancer survivors, is needed. This study aimed to determine patterns of and factors associated with COVID-19-related preventive behaviors among cancer survivors and assess whether the COVID-19 preventive behaviors of cancer survivors differ from the general population. Methods In June 2020, an online survey of adults (N = 897) assessed predictors of COVID-19-related preventive behaviors, including socio-demographics, COVID-19 beliefs and perceptions (Health Belief Model [HBM] variables), and cancer statuses (cancer survivors currently in treatment, cancer survivors not currently in treatment, and individuals with no history of cancer). An average score of respondent engagement in eight preventive behaviors was calculated. Differences in HBM variables and preventive behaviors by cancer status were assessed using ANCOVAs. Hierarchical multiple regression analyzed associations among socio-demographics, HBM constructs, cancer statuses, and engagement in COVID-19 preventive behaviors. Results Participants reported engaging in 3.5 (SD = 0.6) preventive behaviors. Cancer survivors not in treatment engaged in preventive behaviors significantly less than the comparison group. In the final adjusted model, after adding COVID-19 beliefs and perceptions, cancer status was no longer significant. All HBM constructs except perceived susceptibility were significant predictors of preventive behaviors. Conclusions COVID-19 beliefs and perceptions were more robust predictors preventive behaviors than cancer status. Nonetheless, public health organizations and practitioners should communicate the risk and severity of infection among cancer survivors and emphasize the need to engage in protective behaviors for COVID-19 and other infectious diseases with this vulnerable population.
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Affiliation(s)
- CARRIE A. MILLER
- Family Medicine and Population Health, Virginia Commonwealth University, USA
| | | | - PAUL B. PERRIN
- Departments of Data Science and Psychology, University of Virginia, USA
| | - KELLIE E. CARLYLE
- Department of Social and Behavioral Sciences, Virginia Commonwealth University, USA
| | - VANESSA B. SHEPPARD
- Department of Social and Behavioral Sciences, Virginia Commonwealth University, USA
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Oakes EG, Ellrodt J, Yee J, Guan H, Kubzansky LD, Koenen KC, Costenbader KH. Posttraumatic stress disorder symptoms in systemic autoimmune rheumatic disease patients during the early COVID-19 pandemic. Int J Rheum Dis 2024; 27:e14974. [PMID: 37984371 DOI: 10.1111/1756-185x.14974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
AIM Given reports of increased prevalence of PTSD symptoms at COVID-19 pandemic onset, we aimed to assess the prevalence of posttraumatic stress disorder (PTSD) symptoms at pandemic onset in individuals with and without systemic autoimmune rheumatic disease (SARD). METHODS In May 2020, we invited 6678 patients to complete the Brief Trauma Questionnaire and the Posttraumatic Stress Disorder Checklist (PCL-5), validated PTSD symptom screenings. We compared responses from patients with and without SARD using multivariable logistic regression. RESULTS We received 1473 responses (22% response rate) from 5/2020 to 9/2021 (63 with prior PTSD diagnoses, 138 with SARD history). The SARD population was more female (p .0001) and had a higher baseline prevalence of stress disorders (56% vs. 43%, p .004). SARD subjects reported more experiences with life-threatening illness, 60%, versus 53% among those without SARD (p .13), and more antidepressant or anxiolytic medication use pre-pandemic (78% vs. 59%, p .0001). Adjusting for pre-pandemic PTSD diagnosis, younger age and history of stress disorder were the most significant predictors of PCL-5 positivity. There were no significant differences in PCL-5 score or positivity among those with or without SARD. CONCLUSION In this population, patients with SARD had a higher pre-COVID-19 prevalence of stress-related conditions, but it was not the case that they had an increased risk of PTSD symptoms in the early pandemic. Younger individuals, those with baseline depression, anxiety, or adjustment disorders, and those taking antidepressant or anxiolytic medications were more likely to have PTSD symptoms in the first waves of the COVID-19 pandemic.
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Affiliation(s)
- Emily G Oakes
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jack Ellrodt
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeong Yee
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hongshu Guan
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Laura D Kubzansky
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karestan C Koenen
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Kaugars AS, Zemlak J, Oswald DL. Impact of the COVID-19 Pandemic on U.S. Women's Mental Health. J Womens Health (Larchmt) 2023; 32:1166-1173. [PMID: 37788396 DOI: 10.1089/jwh.2023.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background: Women are more likely than men to be diagnosed with depression and anxiety with rates increasing since the COVID-19 pandemic. This study sought to understand how women's intersecting identities, personal strengths, and COVID-19-related stressors were associated with their anxiety, depression, and post-traumatic stress disorder (PTSD) symptoms early in the pandemic. Methods: During May-June 2020, American women (N = 398) recruited via MTurk completed an online questionnaire assessing mental health (PTSD, anxiety, and depression), demographic characteristics, personal strengths (coping, hope, social support), and experiences with COVID-19-specific stressors. Results: Women who had a child younger than 18 years of age, lived in rural or urban areas (compared with suburban), and identified as sexual minority reported increased levels of PTSD, depression, and anxiety symptoms. Social support and hope (Agency) were associated with fewer mental health symptoms. Engagement in maladaptive coping and greater perception of COVID-19 threat and perceived stress was associated with more PTSD, depression, and anxiety symptoms. COVID-19-related illness events and difficulty accessing living essentials were associated with increased anxiety symptoms. COVID-19-related disruption to living and income were associated with increased PTSD symptoms. Loneliness was associated with increased anxiety and depression symptoms. Conclusions: Results of this study can inform prevention and intervention efforts to address depression and anxiety among women with intersecting identities during times of stress. Specifically, supporting the development of women's resilience and adaptive coping and intervening to address maladaptive coping strategies, such as drinking, provide paths to supporting women's mental health.
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Affiliation(s)
- Astrīda S Kaugars
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
| | - Jessica Zemlak
- College of Nursing, Marquette University, Milwaukee, Wisconsin, USA
| | - Debra L Oswald
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA
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Benton M. Experience and Impact of COVID-19 on a Newly Formed Rural University Medical Office: Survey Study. JMIR Form Res 2023; 7:e48299. [PMID: 37676708 PMCID: PMC10514764 DOI: 10.2196/48299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/27/2023] [Accepted: 08/16/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic had large social effects, particularly in the fields of medicine and medical education. Medical organizations in the United States operate in overlapping contexts with interrelated goals inside multiple organizations, and the context of work strongly influenced how organizations were able to respond to COVID-19 restrictions. OBJECTIVE This research examines the experience and impact of COVID-19 on the implementation of a Health Resources and Services Administration grant in a newly formed university medical office with the interrelated goals of health policy, health outreach, and medical education. The goal is to understand how COVID-19 created different experiences and challenges for leaders and their collaborators working in medical education compared to those working in public health outreach or health policy. METHODS A survey about COVID-19 opportunities and challenges was administered to work unit leaders and their project collaborators. The most common experiences and challenges are shown, direct educational and other respondents' experiences and challenges are compared, and open-ended comment segments are analyzed. RESULTS Helping others adjust to digital work, remoteness, and coordination were common experiences during COVID-19. Common challenges include coordination and an inability to make comparisons to previous program years. On average, respondents had 11.3 (SD 7.8) experiences and 8.3 (SD 6.9) challenges considered in the survey. While all units were influenced by COVID-19 restrictions, medical education units had more experiences and challenges. Those involved directly in medical education experienced 69% (18.6/27) of their possible experiences and 54% (14.7/27) of their possible challenges on average compared to 35% (7/20) and 21% (4.2/20) among other respondents (P<.001). COVID-19 restrictions increased the complexity of project work and presented challenges, especially in terms of coordinating responses and access to locations. CONCLUSIONS The findings suggest that COVID-19 made the overall administration of programs more complex and drew attention from other medical and public health programs. While remoteness is appropriate for some medical education tasks, it is less appropriate for clinical learning. Remoteness presents an especially large challenge to clinical education. Employees now have expectations for remoteness to be built into programs and workplaces. Program administrators will have to integrate remoteness' benefits and drawbacks into their organization for the foreseeable future.
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Affiliation(s)
- Mark Benton
- Center for Health Policy, Department of Public Health, University of Missouri, Columbia, MO, United States
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House CL, Rawlins M, Dyer J, Boan P, Musk M. The unique COVID-19 experience in Western Australia: lessons learnt. Intern Med J 2023; 53:1548-1555. [PMID: 37493390 DOI: 10.1111/imj.16172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/14/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Western Australia (WA) was in a unique position to experience coronavirus disease 2019 (COVID-19) in a highly vaccinated and geographically isolated population. AIM To describe the COVID-19 Omicron experience at the only quaternary hospital in WA following border opening from 3 March to 11 May 2022. PARTICIPANTS A total of 158 adults with microbiologically confirmed COVID-19 were admitted to the respiratory or intensive care unit (ICU). OUTCOMES Admission numbers, disease severity, prevalence of COVID-19 deterioration risk factors, immunisation status, severity of infection, immunosuppression and treatment regimen. RESULTS One hundred fifty-eight COVID-19-positive patients were admitted to the respiratory ward (n = 123) and the ICU (n = 35) during the study period. COVID-19 infection was the primary admission reason in 32.9% of patients, 51.3% were male and the median age was 62 years. Aboriginal or Torres Strait Islanders (ATSI) were overrepresented (13.3%). Care was predominantly ward based (77.2%). Nearly half of the patients had mild COVID-19 (49.4%). Dexamethasone was the most common treatment provided to patients (58.2%). The median length of stay was 5.8 days (interquartile range, 5-15). Eight patients died during the study period (5.1%), with three of those deaths attributable to COVID-19. CONCLUSIONS COVID-19 case numbers following WA state border opening were of lower care acuity and disease severity than predicted. Two-thirds of admissions were for other primary diagnoses, with incidental COVID detection. Hospital admissions were overrepresented by partially or unvaccinated patients and by ATSI Australians. An increase in social support along with general and geriatric medicine speciality input were required to treat hospitalised COVID-19 cases in the WA Omicron wave.
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Affiliation(s)
- Caris L House
- Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - John Dyer
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Peter Boan
- Department of Infectious Diseases and Microbiology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Michael Musk
- Advanced Lung Disease and Transplant Unit, Fiona Stanley Hospital, Perth, Western Australia, Australia
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Khouri A, Islam JY, Van Bibber NW, Coghill AE, Suneja G. Cancer treatment delays among cancer patients living with HIV during the COVID-19 pandemic in the United States. Cancer Med 2023; 12:18717-18728. [PMID: 37712718 PMCID: PMC10557907 DOI: 10.1002/cam4.6489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/20/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic led to care disruptions across the cancer continuum. It is unknown if immunosuppressed patients with cancer, who may be at higher risk for complications of SARS-CoV-2 infection, are disproportionately impacted. Thus, we aimed to compare delays in cancer treatment initiation between people living with HIV (PLWH) and cancer, the general cancer population (GCP), and patients with cancer and a history of solid organ transplant (SOT). Comparisons were made across the period 2 years preceding the pandemic versus the first year of the pandemic. METHODS We used data from a real-world electronic health record-derived de-identified database (2018-2021) comprised of US patients with cancer from 800 sites of care across the country. We included patients with 19 different cancer types. We calculated time to cancer treatment initiation (TTI) as the difference between the date of cancer diagnosis and the earliest date that cancer treatment was recorded. RESULTS The sample included 181 PLWH, 65,073 GCP patients, and 195 patients with a SOT. Difference-in-difference regression models adjusted for age, sex, and presence of metastatic disease at cancer diagnosis revealed a significant increase in delayed TTI among PLWH compared to the GCP during COVID-19 versus prior to COVID-19, with delays increasing by approximately 1 month during the pandemic (DID: 32.6 days [8.9-56.3]; p = 0.007). The increase in TTI for PLWH was observed across treatment modalities, including surgery (DID: 55.1 [28.8-81.3], p < 0.001) and systemic therapy (DID: 30.4 [4.6-56.3], p = 0.021). CONCLUSIONS/RELEVANCE PLWH experienced significant delays in cancer treatment initiation after diagnosis during the first year of COVID-19, delays that may negatively impact cancer outcomes. These data warrant patient and provider attention as the pandemic continues to impact the US healthcare system.
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Affiliation(s)
- Ashley Khouri
- University of Utah School of MedicineSalt Lake CityUtahUSA
- Huntsman Cancer InstituteSalt Lake CityUtahUSA
| | - Jessica Y. Islam
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Nathan W. Van Bibber
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Anna E. Coghill
- Cancer Epidemiology ProgramH. Lee Moffitt Cancer Center & Research InstituteTampaFloridaUSA
| | - Gita Suneja
- Huntsman Cancer InstituteSalt Lake CityUtahUSA
- Department of Radiation OncologyUniversity of UtahSalt Lake CityUtahUSA
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12
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Nazaruk P, Tkaczyk I, Monticolo M, Jędrzejczak AM, Krata N, Pączek L, Foroncewicz B, Mucha K. Hybrid Immunity Provides the Best COVID-19 Humoral Response in Immunocompromised Patients with or without SARS-CoV-2 Infection History. Vaccines (Basel) 2023; 11:1380. [PMID: 37631947 PMCID: PMC10458920 DOI: 10.3390/vaccines11081380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
Immunization against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly limited the spread of coronavirus disease 2019 (COVID-19) and reduced the associated complications, especially mortality. To prolong immunity, an immune booster was implemented. We evaluated the role of SARS-CoV-2 infection history in the vaccination schedules of kidney and liver transplant recipients and patients with chronic kidney disease (CKD). To this end, we retrospectively analyzed the data of 78 solid organ transplantation (SOT) recipients and 40 patients with immunoglobulin A (IgA) nephropathy as representatives of the CKD group. Patients received two or three doses of the BNT162b2 vaccine. At the follow-up, antibody (Ab) titer, graft function, COVID-19 history, and patients' clinical condition were assessed. Ab level was higher after two doses in patients with a COVID-19 history over three doses in patients with no COVID-19 history. Compared to three doses, subjects who were administered two doses had a longer median time to infection. Positive antibodies, in response to the third dose, were not observed in up to 8.4% of SOT patients. The results show that the vaccination schedule should take into account the vaccine response rate and COVID-19 history. So-called hybrid immunity appears to be most efficient at providing humoral responses against SARS-CoV-2 infection in immunocompromised patients.
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Affiliation(s)
- Paulina Nazaruk
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
| | - Ignacy Tkaczyk
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
| | - Marta Monticolo
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
| | - Anna Maria Jędrzejczak
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
| | - Natalia Krata
- Department of Clinical Immunology, Medical University of Warsaw, 02-006 Warsaw, Poland;
- ProMix Center (ProteogenOmix in Medicine), Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Leszek Pączek
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
- ProMix Center (ProteogenOmix in Medicine), Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Bartosz Foroncewicz
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
- ProMix Center (ProteogenOmix in Medicine), Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
| | - Krzysztof Mucha
- Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland; (P.N.); (I.T.); (M.M.); (A.M.J.); (L.P.); (B.F.)
- ProMix Center (ProteogenOmix in Medicine), Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, 02-006 Warsaw, Poland
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, 02-106 Warsaw, Poland
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13
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Frölke SC, Bouwmans P, Messchendorp AL, Vervoort JP, Abrahams AC, de Vries AP, Nieuwkerk PT, Hemmelder MH, Gansevoort RT, Hilbrands LB, Reinders ME, Sanders JSF, Bemelman FJ, Geerlings SE. Adherence to preventive measures after SARS-CoV-2 vaccination and after awareness of antibody response in kidney transplant recipients in the Netherlands: a nationwide questionnaire study. EClinicalMedicine 2023; 62:102103. [PMID: 37533418 PMCID: PMC10393559 DOI: 10.1016/j.eclinm.2023.102103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Background Kidney transplant recipients (KTRs) were advised to tightly adhere to government recommendations to curb the spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) because of a high risk of morbidity and mortality and decreased immunogenicity after vaccination. The aim of this study was to analyse the change in adherence to preventive measures after vaccination and awareness of antibody response, and to evaluate its effectiveness. Methods In this large-scale, national questionnaire study, questionnaires were sent to 3531 KTRs enrolled in the Dutch RECOVAC studies, retrospectively asking for adherence to nine preventive measures on a 5-point Likert scale before and after SARS-CoV-2 vaccination and after awareness of antibody response. Blood samples were collected 28 days after the second vaccination. Antibody response was categorised as non-responder (≤50 BAU/mL), low-responder (>50 ≤ 300 BAU/mL) or high-responder (>300 BAU/mL), and shared with participants as a correlate of protection. Participants of whom demographics on sex and age, blood samples and completed questionnaires were available, were included. Our study took place between February 2021 and January 2022. The primary outcome of adherence before and after vaccination was assessed between August and October 2021 and compared via the Wilcoxon signed rank sum test. Logistic regression analysis was performed to estimate the association between antibody response and non-adherence, and adherence on acquiring SARS-CoV-2 infection. This study is registered at ClinicalTrials.gov (NCT04841785). Findings In 2939 KTRs (83%) who completed the first questionnaire on adherence to preventive measures, adherence was higher before than after vaccination (4.56, IQR 4.11-4.78 and 4.22, IQR 3.67-4.67, p < 0.001). Adherence after awareness of antibody response was analysed in 2399 KTRs (82%) of whom also blood samples were available, containing 949 non-responders, 500 low-responders and 950 high-responders. Compared to non-responders, low- and high-responders reported higher non-adherence. Higher adherence was associated with lower infection rates before and after vaccination (OR 0.67 [0.51-0.91], p = 0.008 and OR 0.48 [0.28-0.86], p = 0.010). Interpretation Adherence decreased after SARS-CoV-2 vaccination and in KTRs who were aware of a subsequent antibody response compared with those without. Preventive measures in this vulnerable group seem to be effective, regardless of vaccination status. This study starts a debate on sharing antibody results with the patient and future studies should elucidate whether decreased adherence in antibody responders is justified, also in view of future pandemics. Funding The Netherlands Organization for Health Research and Development and the Dutch Kidney Foundation.
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Affiliation(s)
- Sophie C. Frölke
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Pim Bouwmans
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - A. Lianne Messchendorp
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Johanna P.M. Vervoort
- Dutch Kidney Patient Association (NVN), Bussum, the Netherlands
- Global Health Unit, Department of Health Sciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Alferso C. Abrahams
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aiko P.J. de Vries
- Department of Medicine, Division of Nephrology, Leiden University Medical Centre, Leiden, the Netherlands
- Leiden Transplant Centre, Leiden, the Netherlands
| | - Pythia T. Nieuwkerk
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Marc H. Hemmelder
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Ron T. Gansevoort
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Luuk B. Hilbrands
- Department of Nephrology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Marlies E.J. Reinders
- Department of Internal Medicine, Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Jan-Stephan F. Sanders
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Frederike J. Bemelman
- Amsterdam UMC Location University of Amsterdam, Renal Transplant Unit, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Suzanne E. Geerlings
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
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14
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Shoham S, Batista C, Ben Amor Y, Ergonul O, Hassanain M, Hotez P, Kang G, Kim JH, Lall B, Larson HJ, Naniche D, Sheahan T, Strub-Wourgaft N, Sow SO, Wilder-Smith A, Yadav P, Bottazzi ME. Vaccines and therapeutics for immunocompromised patients with COVID-19. EClinicalMedicine 2023; 59:101965. [PMID: 37070102 PMCID: PMC10091856 DOI: 10.1016/j.eclinm.2023.101965] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
The COVID-19 pandemic has disproportionately impacted immunocompromised patients. This diverse group is at increased risk for impaired vaccine responses, progression to severe disease, prolonged hospitalizations and deaths. At particular risk are people with deficiencies in lymphocyte number or function such as transplant recipients and those with hematologic malignancies. Such patients' immune responses to vaccination and infection are frequently impaired leaving them more vulnerable to prolonged high viral loads and severe complications of COVID-19. Those in turn, have implications for disease progression and persistence, development of immune escape variants and transmission of infection. Data to guide vaccination and treatment approaches in immunocompromised people are generally lacking and extrapolated from other populations. The large clinical trials leading to authorisation and approval of SARS-CoV-2 vaccines and therapeutics included very few immunocompromised participants. While experience is accumulating, studies focused on the special circumstances of immunocompromised patients are needed to inform prevention and treatment approaches.
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Affiliation(s)
- Shmuel Shoham
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Carolina Batista
- Médecins Sans Frontières, Rio de Janeiro, Brazil
- Baraka Impact Finance, Geneva, Switzerland
| | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, NY, USA
| | - Onder Ergonul
- Koc University Research Center for Infectious Diseases, Istanbul, Turkey
| | - Mazen Hassanain
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Peter Hotez
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Bhavna Lall
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
| | | | - Denise Naniche
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
| | - Timothy Sheahan
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Nathalie Strub-Wourgaft
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Samba O. Sow
- Center for Vaccine Development, Bamako, Mali
- University of Maryland, MD, USA
| | - Annelies Wilder-Smith
- London School of Hygiene & Tropical Medicine, London, UK
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Prashant Yadav
- Center for Global Development, Washington, DC, USA
- Harvard Medical School, Boston, MA, USA
- Technology and Operations Management, INSEAD, Fontainebleau, France
| | - Maria Elena Bottazzi
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
| | - Lancet Commission on COVID-19 Vaccines and Therapeutics Task Force
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Médecins Sans Frontières, Rio de Janeiro, Brazil
- Baraka Impact Finance, Geneva, Switzerland
- Center for Sustainable Development, Columbia University, New York, NY, USA
- Koc University Research Center for Infectious Diseases, Istanbul, Turkey
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Texas Children's Hospital Center for Vaccine Development, Baylor College of Medicine, Houston, TX, USA
- Christian Medical College, Vellore, India
- International Vaccine Institute, Seoul, South Korea
- University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX, USA
- London School of Hygiene & Tropical Medicine, London, UK
- ISGlobal, Barcelona Institute for Global Health, Hospital Clinic, University of Barcelona, Spain
- University of North Carolina, Gillings School of Global Public Health, Chapel Hill, NC, USA
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
- Center for Vaccine Development, Bamako, Mali
- University of Maryland, MD, USA
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Center for Global Development, Washington, DC, USA
- Harvard Medical School, Boston, MA, USA
- Technology and Operations Management, INSEAD, Fontainebleau, France
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15
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Camacho-Rivera M, Albury J, Chen K, Ye Z, Islam JY. Burden of Food Insecurity and Mental Health Symptoms among Adults with Cardiometabolic Conditions during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10077. [PMID: 36011710 PMCID: PMC9408010 DOI: 10.3390/ijerph191610077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 06/15/2023]
Abstract
Our study objectives were to (1) identify the national prevalence and patterns of food insecurity among adults with and without a history of CMCs and (2) determine associations between food insecurity and mental health outcomes among adults with CMCs during the early COVID-19 pandemic period (April−June 2020). We computed prevalence ratios with Poisson regression using the robust estimation of standard errors to identify disparities in the report of food insecurity across demographic groups and by CMC history. Among adults with CMCs, we estimated associations between food insecurity and self-reported mental health symptoms using multinomial logistic regression. Overall, people with CMCs were more likely to be older, White, without employment in the past 7 days, and from the South or an urban environment. We found that the determinants of food insecurity among individuals with cardiometabolic conditions include having: <60 years of age, female sex, Black or Hispanic race/ethnicity, an educational degree lower than a baccalaureate, a household income of <$100,000, and either Medicaid, Indian Health Insurance, or no insurance. Individuals with CMCs and food insecurity also had significantly higher odds of adverse mental health symptoms. The continued clinical screening of food insecurity and mental health, as well as public health interventions, targeted toward individuals with CMCs, should be prioritized as we move through the COVID-19 pandemic.
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Affiliation(s)
- Marlene Camacho-Rivera
- Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jonathan Albury
- CUNY School of Medicine, The City College of New York, New York, NY 10031, USA
| | - Karen Chen
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Zachary Ye
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Jessica Y. Islam
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33028, USA
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16
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Sinko L, Rajabi S, Sinko A, Merchant R. Capturing lifestyle changes and emotional experiences while having a compromised immune system during the COVID-19 pandemic: A photo-elicitation study. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2411-2430. [PMID: 34990025 PMCID: PMC9015441 DOI: 10.1002/jcop.22784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 10/28/2021] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
This study aimed to describe lifestyle and emotional changes individuals with compromised immune systems experienced during the early months of the coronavirus disease 2019 pandemic. A survey was distributed to online support organizations for those with chronic illness and a national research volunteer registry from April to June 2020. Participants were asked to document their experiences via three photo-elicitation prompts, followed by reflection and Likert scale questions. Forty-seven individuals responded with 282 photos submitted. Lifestyle changes noted include shifts in wellness strategies, health management, routine, stressors, and time perception. Participants described significant distress stemming from deteriorating mental health, safety fears, isolation, health management, and longing. Wellness strategies documented included finding comfort, connection, and escape, managing uncertainty, maintaining physical health, and building resilience. These findings can increase a sense of community for immunocompromised individuals who are struggling in isolation and enhance knowledge of their day-to-day health needs during times of increased stress and health risk.
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Affiliation(s)
- Laura Sinko
- Department of NursingTemple University College of Public HealthPhiladelphiaPennsylvaniaUSA
| | - Samira Rajabi
- Department of Media Studies, College of Media Communication and InformationUniversity of Colorado BoulderBoulderColoradoUSA
| | - Alyssa Sinko
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Raina Merchant
- Department of Emergency Medicine, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Mohanraj L, Elswick RK, Buch M, Knight JM, Guidry J. Perceptions and Experiences of Hematopoietic Cell Transplantation Patients During the COVID-19 Pandemic. Semin Oncol Nurs 2022; 38:151257. [PMID: 35379527 PMCID: PMC8907028 DOI: 10.1016/j.soncn.2022.151257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/18/2022] [Accepted: 03/04/2022] [Indexed: 11/15/2022]
Abstract
Objectives Data Sources Conclusion Implication for Nursing Practice
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Affiliation(s)
- Lathika Mohanraj
- Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, 1100 E Leigh Street, Richmond, Virginia, 23298, USA.
| | - R K Elswick
- Department of Family and Community Health Nursing, School of Nursing, Virginia Commonwealth University, 1100 E Leigh Street, Richmond, Virginia, 23298, USA; Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Box 980032, Richmond, Virginia, 23298, USA.
| | - Molly Buch
- NSABP Foundation Inc, Pittsburgh, Pennsylvania, 15212, USA.
| | - Jennifer M Knight
- Departments of Psychiatry, Medicine, and Microbiology & Immunology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin, 53226, USA.
| | - Jeanine Guidry
- Richard T. Robertson School of Media and Culture, Virginia Commonwealth University, Box 842034, Richmond, Virginia, 23284, USA.
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18
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Simpson SA, Loh RM, Cabrera M, Cahn M, Gross A, Hadley A, Lawrence RE. The Impact of the COVID-19 Pandemic on Psychiatric Emergency Service Volume and Hospital Admissions. J Acad Consult Liaison Psychiatry 2021; 62:588-594. [PMID: 34058432 PMCID: PMC8163698 DOI: 10.1016/j.jaclp.2021.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/06/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
Background During the COVID-19 pandemic, there have been an increasing number of emergency department visits for behavioral health reasons, even as overall emergency department volumes have decreased. The impact of the pandemic and related public health interventions on specialized psychiatric emergency services has not been described. These services provide high-intensity care for severely ill patients who are likely to be homeless and underserved. Objective We describe the change in total volume and psychiatric hospitalization rates among three psychiatric emergency services across the United States. Methods Changes in volumes and hospitalization were assessed for statistical significance using a seasonal autoregressive integrated moving average with exogenous factors model from January 2018 to December 2020. Results The pandemic's impact on volumes and hospitalization varied by site. In Denver (CO), there was a statistically significant 9% decrease in overall volumes, although an 18% increase in hospitalizations was not significant. In New York City (NY), there was a significant 7% decrease in volumes as well as a significant 6% decrease in hospitalizations. In Portland (OR), volumes decreased by 4% and hospitalizations increased by 6% although differences did not reach statistical significance. Conclusions There has been a decrease in volume at these services after the pandemic, but there are substantial variations in the magnitude of change and demand for hospitalization by region. These findings suggest a need to understand where patients in crisis are seeking care and how systems of care must adapt to changing utilization in the pandemic era.
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Affiliation(s)
- Scott A Simpson
- Department of Behavioral Health Services, Denver Health, Denver, CO.
| | - Ryan M Loh
- Department of Behavioral Health Services, Denver Health, Denver, CO
| | | | - Megan Cahn
- Legacy Research Institute, Legacy Health, Portland, OR
| | - Anne Gross
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR
| | - Allison Hadley
- Department of Psychiatry, Oregon Health Sciences University, Portland, OR
| | - Ryan E Lawrence
- Department of Psychiatry, Columbia University Medical Center, New York City, NY
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