Psychosocial impacts of the COVID-19 pandemic from a cross-sectional Survey of people living with HIV in Washington, DC

BACKGROUND

COVID-19 has not only taken a staggering toll in terms of cases and lives lost, but also in its psychosocial effects. We assessed the psychosocial impacts of the COVID-19 pandemic in a large cohort of people with HIV (PWH) in Washington DC and evaluated the association of various demographic and clinical characteristics with psychosocial impacts.

METHODS

From October 2020 to December 2021, DC Cohort participants were invited to complete a survey capturing psychosocial outcomes influenced by the COVID-19 pandemic. Some demographic variables were also collected in the survey, and survey results were matched to additional demographic data and laboratory data from the DC Cohort database. Data analyses included descriptive statistics and multivariable logistic regression models to evaluate the association between demographic and clinical characteristics and psychosocial impacts, assessed individually and in overarching categories (financial/employment, mental health, decreased social connection, and substance use).

RESULTS

Of 891 participants, the median age was 46 years old, 65% were male, and 76% were of non-Hispanic Black race/ethnicity. The most commonly reported psychosocial impact categories were mental health (78% of sample) and financial/employment (56% of sample). In our sample, older age was protective against all adverse psychosocial impacts. Additionally, those who were more educated reported fewer financial impacts but more mental health impacts, decreased social connection, and increased substance use. Males reported increased substance use compared with females.

CONCLUSIONS

The COVID-19 pandemic has had substantial psychosocial impacts on PWH, and resiliency may have helped shield older adults from some of these effects. As the pandemic continues, measures to aid groups vulnerable to these psychosocial impacts are critical to help ensure continued success towards healthy living with HIV.

Injuries related to electric scooter and bicycle use in a Washington, DC, emergency department

OBJECTIVE

E-scooter use has grown rapidly in the United States. Its rise in popularity has coincided with the promotion of cycling in many cities, but more needs to be known about how these transportation modes compare to determine if cycling should serve as an appropriate benchmark for policy decisions and safety expectations regarding e-scooters.

METHODS

We examined characteristics of adults seeking treatment in a Washington, DC, emergency department (ED) for injuries associated with riding e-scooters during 2019 (n = 99) or bicycles during 2015-2017 (n = 337).

RESULTS

E-scooter incidents less frequently involved moving vehicles (13.1% vs. 37.7%) or occurred on roads (24.5% vs. 50.7%) than cycling incidents. A smaller proportion of injured e-scooter riders were ages 30-49 (32.3% vs. 48.4%) and a larger proportion were 50 and older (34.3% vs. 22.6%) or female (45.5% vs. 29.1%). Distal lower extremity injuries were more common among e-scooter riders (13.1% vs. 3.0%; RR, 2.76; 95% CI, 1.79-3.54), and injuries to the proximal upper extremity (9.1% vs. 20.5%; RR, 0.49; 95% CI, 0.24-0.92) or chest, abdomen, and spine (3.0% vs. 14.0%; RR, 0.24; 95% CI, 0.07-0.70) were less common. Head injury rates were similar, but e-scooter riders more often experienced concussion with loss of consciousness (4.0% vs. 0.6%; RR, 3.03; 95% CI, 1.20-4.09) and were far less likely to wear helmets (2.0% vs. 66.4%). Estimated ED presentation rates per million miles traveled citywide were higher among e-scooter riders than cyclists (RR, 3.76; 95% CI, 3.08-4.59).

CONCLUSIONS

E-scooters and bicycles are both popular forms of micromobility, but the characteristics of riders injured on them, the ways in which they become injured, and the types of injuries they sustain differ substantially. E-scooter rider injury rates, though currently high, may decrease as they gain experience; however, if the number of new users continues to climb, they will persist in using the ED more often than cyclists per mile that they travel.

Severity of e-scooter rider injuries associated with trip characteristics

INTRODUCTION

E-scooter rider injuries have been growing, but little is known about how trip and incident characteristics contribute to their severity.

METHOD

We enrolled 105 adults injured while riding e-scooters who presented to an emergency department in Washington, DC, during 2019. Enrolled participants completed an interview during the emergency department visit, and their charts were abstracted to document their injuries and treatment. Logistic regression examined the association of incident location and circumstances with the likelihood of sustaining an injury on the Abbreviated Injury Scale (AIS) ≥ 2, while controlling for rider characteristics.

RESULTS

The most common locations of e-scooter injuries in our study sample occurred on the sidewalk (58%) or road (23%). Accounting for other trip and rider attributes, e-scooter riders injured on the road were about twice as likely as those injured elsewhere to sustain AIS ≥ 2 injuries (RR, 1.96; 95% CI, 1.23-2.36) and those who rode at least weekly more often sustained AIS ≥ 2 injuries compared with less frequent riders (RR, 1.86; 95% CI, 1.11-2.32).

CONCLUSIONS

Greater injury severity for riders injured on the road may reflect higher travel speeds. Practical applications: Injury severity associated with riding in the road is one factor that jurisdictions can consider when setting policy on where e-scooters should be encouraged to ride, but the risk of any crash or fall associated with facilities should also be examined. Although injuries are of lower severity on sidewalks, sharing sidewalks with slower moving pedestrians could potentially lead to more conflicts.

Laboratory Reconstructions of Bicycle Helmet Damage: Investigation of Cyclist Head Impacts Using Oblique Impacts and Computed Tomography

Although head injuries are common in cycling, exact conditions associated with cyclist head impacts are difficult to determine. Previous studies have attempted to reverse engineer cyclist head impacts by reconstructing bicycle helmet residual damage, but they have been limited by simplified damage assessment and testing. The present study seeks to enhance knowledge of cyclist head impact conditions by reconstructing helmet damage using advanced impact testing and damage quantification techniques. Damage to 18 helmets from cyclists treated in emergency departments was quantified using computed tomography and reconstructed using oblique impacts. Damage metrics were related to normal and tangential velocities from impact tests as well as peak linear accelerations (PLA) and peak rotational velocities (PRV) using case-specific regression models. Models then allowed original impact conditions and kinematics to be estimated for each case. Helmets were most frequently damaged at the front and sides, often near the rim. Concussion was the most common, non-superficial head injury. Normal velocity and PLA distributions were similar to previous studies, with median values of 3.4 m/s and 102.5 g. Associated tangential velocity and PRV medians were 3.8 m/s and 22.3 rad/s. Results can inform future oblique impact testing conditions, enabling improved helmet evaluation and design.

Not all protected bike lanes are the same: Infrastructure and risk of cyclist collisions and falls leading to emergency department visits in three U.S. cities

OBJECTIVE

Protected bike lanes separated from the roadway by physical barriers are relatively new in the United States. This study examined the risk of collisions or falls leading to emergency department visits associated with bicycle facilities (e.g., protected bike lanes, conventional bike lanes demarcated by painted lines, sharrows) and other roadway characteristics in three U.S. cities.

METHODS

We prospectively recruited 604 patients from emergency departments in Washington, DC; New York City; and Portland, Oregon during 2015-2017 who fell or crashed while cycling. We used a case-crossover design and conditional logistic regression to compare each fall or crash site with a randomly selected control location along the route leading to the incident. We validated the presence of site characteristics described by participants using Google Street View and city GIS inventories of bicycle facilities and other roadway features.

RESULTS

Compared with cycling on lanes of major roads without bicycle facilities, the risk of crashing or falling was lower on conventional bike lanes (adjusted OR = 0.53; 95 % CI = 0.33, 0.86) and local roads with (adjusted OR = 0.31; 95 % CI = 0.13, 0.75) or without bicycle facilities or traffic calming (adjusted OR = 0.39; 95 % CI = 0.23, 0.65). Protected bike lanes with heavy separation (tall, continuous barriers or grade and horizontal separation) were associated with lower risk (adjusted OR = 0.10; 95 % CI = 0.01, 0.95), but those with lighter separation (e.g., parked cars, posts, low curb) had similar risk to major roads when one way (adjusted OR = 1.19; 95 % CI = 0.46, 3.10) and higher risk when they were two way (adjusted OR = 11.38; 95 % CI = 1.40, 92.57); this risk increase was primarily driven by one lane in Washington. Risk increased in the presence of streetcar or train tracks relative to their absence (adjusted OR = 26.65; 95 % CI = 3.23, 220.17), on downhill relative to flat grades (adjusted OR = 1.92; 95 % CI = 1.38, 2.66), and when temporary features like construction or parked cars blocked the cyclist's path relative to when they did not (adjusted OR = 2.23; 95 % CI = 1.46, 3.39).

CONCLUSIONS

Certain bicycle facilities are safer for cyclists than riding on major roads. Protected bike lanes vary in how well they shield riders from crashes and falls. Heavier separation, less frequent intersections with roads and driveways, and less complexity appear to contribute to reduced risk in protected bike lanes. Future research should systematically examine the characteristics that reduce risk in protected lanes to guide design. Planners should minimize conflict points when choosing where to place protected bike lanes and should implement countermeasures to increase visibility at these locations when they are unavoidable.