Factors associated with anxiety during the first two years of the COVID-19 pandemic in the United States: An analysis of the COVID-19 Citizen Science study

COVID-19 increased the prevalence of clinically significant anxiety in the United States. To investigate contributing factors we analyzed anxiety, reported online via monthly Generalized Anxiety Disorders-7 (GAD-7) surveys between April 2020 and May 2022, in association with self-reported worry about the health effects of COVID-19, economic difficulty, personal COVID-19 experience, and subjective social status. 333,292 anxiety surveys from 50,172 participants (82% non-Hispanic white; 73% female; median age 55, IQR 42-66) showed high levels of anxiety, especially early in the pandemic. Anxiety scores showed strong independent associations with worry about the health effects of COVID-19 for oneself or family members (GAD-7 score +3.28 for highest vs. lowest category; 95% confidence interval: 3.24, 3.33; p<0.0001 for trend) and with difficulty paying for basic living expenses (+2.06; 1.97, 2.15, p<0.0001) in multivariable regression models after adjusting for demographic characteristics, COVID-19 case rates and death rates, and personal COVID-19 experience. High levels of COVID-19 health worry and economic stress were each more common among participants reporting lower subjective social status, and median anxiety scores for those experiencing both were in the range considered indicative of moderate to severe clinical anxiety disorders. In summary, health worry and economic difficulty both contributed to high rates of anxiety during the first two years of the COVID-19 pandemic in the US, especially in disadvantaged socioeconomic groups. Programs to address both health concerns and economic insecurity in vulnerable populations could help mitigate pandemic impacts on anxiety and mental health.

Virulence profiles of Shiga Toxin-Producing Escherichia coli and other potentially diarrheagenic E.coli of bovine origin, in Mendoza, Argentina

This study described a group of strains obtained from a slaughter house in Mendoza, in terms of their pathogenic factors, serotype, antibiotype and molecular profile. Ninety one rectal swabs and one hundred eight plating samples taken from carcasses of healthy cattle intended for meat consumption were analyzed. Both the swab and the plate samples were processed to analyze the samples for the presence of virulence genes by PCR: stx1, stx2, eae and astA. The Stx positive strains were confirmed by citotoxicity assay in Vero cells. The isolates were subsequently investigated for their O:H serotype, antimicrobial susceptibility and molecular profile by Random Amplification of Polymorphic DNA (RAPD). Twelve E.coli strains were identified by their pathogenicity. Nine were from fecal origin and three from carcasses. Three strains carried the stx1 gene, three the stx2 gene, two carried eae and four the astA gene. The detected serotypes were: O172:H-; O150:H8; O91:H21; O178:H19 and O2:H5. The strains showed a similarity around 70% by RAPD. Some of the E.coli strains belonged to serogroups known for certain life-threatening diseases in humans. Their presence in carcasses indicates the high probability of bacterial spread during slaughter and processing.

The dosage of infliximab in the treatment of ankylosing spondylitis: dollars and sense

While it seems clear that anti-TNF treatments do improve the clinical condition of patients with ankylosing spondylitis, there is some evidence that doses much smaller than those formally studied in controlled trials may also be very effective, and we would recommend that this aspect be pursued given the overall costs involved.

Serum heat-labile opsonins in systemic lupus erythematosus

To study possible mechanisms responsible for the increased susceptibility to infection of patients with active systemic lupus erythematosus (SLE), a study of the serum heat-labile opsonic capacity (HLOC) in such patients was undertaken. With leukocytes from normal donors, the sera of 12 of 30 patients with active SLE demonstrated decreased HLOC for E. coli 075. The phagocytic activity was partially restored by normal serum, suggesting that decreased HLOC was responsible for the defective phagocytosis. While 8 of 10 patients with active SLE and concomitant infections showed deficient opsonic capacity to E. coli 075, only 4 of 20 such patients without infections showed the defect (P = 0.01). None of 12 patients with inactive disease had deficient opsonic capacity. Similar results were obtained with S. aureus 502A as the test bacterium. In the patients surviving infection, recovery of normal serum opsonic capacity was rapid and usually coincided with an increase of serum complement to normal levels. In three patients with active SLE and infection, the causative microorganisms were isolated and opsonic capacity for these organisms tested with the individual patients' sera. In each case, sera obtained at the onset of the infectious episode had low opsonic capacity when compared with normal sera. Serum C3 proactivator levels were low in 9 of 11 sera with deficient opsonic capacity. However, similar low values were found in other SLE sera with normal HLOC, suggesting that other factors of the opsonic system were also depleted. Addition of the classical complement components C1, C4, C2, C3, and C5 to sera with deficient HLOC failed to restore activity. Addition of pure C3 proactivator also failed to restore activity. However, addition of C3 proactivator together with 50 degrees C-heated normal serum restored activity, indicating that factors active at the early steps of opsonic activation via the alternative pathway of complement were necessary to restore opsonic activity. These findings indicate that in active SLE, a decrease of components of the alternate pathway of complement activation results in an acquired defect of serum HLOC and perhaps other related complement-mediated functions. This defect may be an important factor in the increased susceptibility to infections of patients with active systemic lupus erythematosus.