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Background: Nearly 26% of adults in the U.S. live with disability and are more likely to experience chronic health conditions, barriers to healthcare, and severe COVID-19 illness. Therefore, COVID-19 testing of adults living with disability is important to consider. The purpose of this study was to explore relationships between disability and COVID-19 testing, infection, and related challenges. Method(s): A Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) project in Miami, FL determined disability with a modified version of the Washington Group General Disability Measure. HIV serostatus and COVID-19 vaccination were confirmed with medical records. COVID-19 testing and infection history were self-reported. Statistical analyses included chi-squared tests and multiple binary logistic regression;variance inflation factors were calculated to ensure absence of collinearity. Result(s): A total of 1,689 RADx-UP participants with an average age of 55+/-12.3, 51% male, 49% Black non-Hispanic, 23% living with HIV (86% virally suppressed), and 76% received at least one dose of a COVID-19 vaccine. Nearly 40% were disabled, 37% reported employment disability, and 21% were functionally disabled (disability that interferes with performance of daily activities). Despite recruitment from the same sources, PLWH, compared to those without HIV, were more likely to be disabled (52% vs 36%;p< 0.0001), report employment disability (63% vs 30%;p< 0.0001), and report functional disability (29% vs 18%;p< 0.0001). Those with employment disability were less likely to have ever been tested for COVID-19 compared to those without (81% vs 85%;p=0.026). Employment disability was also associated with lower odds of having ever tested positive for COVID-19 after adjustment for demographics, health insurance, HIV, COVID-19 vaccination, smoking, and lung disease (aOR, 0.62;95% CI, 0.43-0.90;p=0.013). Disability was associated with greater odds of transportation challenges (aOR, 2.33;95% CI, 1.76-3.08;p< 0.0001), illicit drug use (aOR, 1.92;95% CI, 1.49-2.47;p< 0.0001), and smoking (aOR, 1.74;95% CI, 1.39-2.17;p< 0.0001). Compared to those without, those with transportation challenges (14% vs 40%;p< 0.0001) and illicit drug use (18% vs 30%;p=0.001) were more likely to postpone medical care. Conclusion(s): Lower COVID-19 testing rates may contribute to underestimated COVID-19 positivity rates in adults living with disability. Challenges with transportation and substance abuse contribute to less engagement in care.
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Conspiratorial beliefs can endanger individuals and societies by increasing the likelihood of harmful behaviors such as the flouting of public health guidelines. While scholars have identified various correlates of conspiracy beliefs, one factor that has received scant attention is depressive symptoms. We use three large surveys to explore the connection between depression and conspiracy beliefs. We find a consistent association, with the extent of the relationship depending on individual and situational factors. Interestingly, those from relatively advantaged demographic groups (i.e., White, male, high income, educated) exhibit a stronger relationship between depression and conspiracy beliefs than those not from such groups. Furthermore, situational variables that ostensibly increase stress-such as having COVID-19 or parenting during COVID-19-exacerbate the relationship while those that seem to decrease stress, such as social support, vitiate it. The results provide insight about the development of targeted interventions and accentuate the need for theorizing about the mechanisms that lead depression to correlate with conspiracy beliefs.Copyright © 2022 The Authors. Applied Cognitive Psychology published by John Wiley & Sons Ltd.
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BACKGROUND: Data from the COVID-19 pandemic describes increases in drug use and related harms, especially fatal overdose. However, evidence is needed to better understand the pathways from pandemic-related factors to substance use behaviours. Thus, we investigated stockpiling drugs among people who use drugs (PWUD) in five cities in the United States and Canada. METHODS: We used data from two waves of interviews among participants in nine prospective cohorts to estimate the prevalence and correlates of stockpiling drugs in the previous month. Longitudinal correlates were identified using bivariate and multivariate generalized linear mixed-effects modeling analyses. RESULTS: From May 2020 to February 2021, we recruited 1873 individuals who completed 2242 interviews, of whom 217 (11.6%) reported stockpiling drugs in the last month at baseline. In the multivariate model, stockpiling drugs was significantly and positively associated with reporting being greatly impacted by COVID-19 (Adjusted Odds Ratio [AOR]= 1.21, 95% CI: 1.09-1.45), and at least daily use of methamphetamine (AOR = 4.67, 95% CI: 2.75-7.94) in the past month. CONCLUSIONS: We observed that approximately one-in-ten participants reported stocking up on drugs during the COVID-19 pandemic. This behaviour was associated with important drug-related risk factors including high-intensity methamphetamine use. While these correlations need further inquiry, it is possible that addressing the impact of COVID-19 on vulnerable PWUD could help limit drug stockpiling, which may lower rates of high-intensity stimulant use.
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Purpose/Objectives: Understand the rates of pediatric obesity in the Inland Empire of Southern California, in the context of COVID quarantine, to improve counseling and treatment of these patients. Design/Methods: A retrospective chart review was performed on all patients seen at a FQHC in Southern California. Patients between 5 and 18, who had a clinic visit between 6/1/2020 to 7/31/2020 for a well-child visit, with at least one other well-child visit in calendar year 2019 and 2018 were included. Patients with congenital heart disease, short gut syndrome, ADHD on stimulant medications, G tube dependence, diseases affecting growth or stature, complex syndromes (CHARGE, VACTERL, DiGeorge), syndromes affected growth, oncologic conditions, intellectual disability, transplant recipients, incomplete BMI data or malnutrition (BMI Z score <= -1) were excluded. BMI values, Z-scores, and percentiles, as well as relative changes from 2018 to 2019, and 2019 to 2020 were analyzed using one-way ANOVA and Tukey post hoc test. Results: There was a statistical difference in BMI between years as determined by a one-way ANOVA (F(2,509) = 2.811, P = 0.05). A Tukey post hoc test revealed that the BMI of students in 2020 was statistically higher (19.87.65, p = 0.05) compared to the BMI in 2018 (18.25.71). There was no statistical difference in BMI between 2020 and 2019, and 2019 and 2018 (Figure 1). When groups were stratified into morbidly obese (BMI >= 99%), obese (BMI >=95% & <99%), overweight (BMI >=85% & <95%), and healthy weight (BMI >=5% & < 85%), patients who were not at a healthy weight increased from 36.8% in 2018 to 40.4% in 2019, to 44.7% in 2020 (Figure 2). As shown in the SANKEY diagram (Figure 3), while there was an initial decline in morbidly obese patients in 2018 to 2019 (-8.3%), there was a relatively large increase from 2019 to 2020 (+45.5%). From 2018 to 2019, 75 out of 141 patients (53.2%) had a decrease in BMI, while in 2019 to 2020 there were 56 out of 141 patients (39.7%) who had a decrease in BMI. Out of the 75 patients who had a decrease in BMI from 2018 to 2019, 49 (65.3%) had a rebound increase in BMI from 2019 to 2020. Conclusion/Discussion: There was a significant increase in overall BMI from 2018 to 2020 with an overall increase in patients who fall into the obese and overweight categories in 2020. 65.3% of patients who had a decreasing BMI from 2018 to 2019 have a rebound increase in BMI in 2020. This can likely be contributed to the COVID-19 pandemic and stay-at-home orders leading to a more sedentary lifestyle. More research should be performed to elicit multifactorial (physical activity, diet, and psychosocial factors) etiology of the worsening obesity epidemic during the COVID-19 pandemic.
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Study question Does prior SARS-CoV-2 infection in women undergoing fertility treatments affect outcomes of fresh ART cycles? Summary answer SARS-CoV-2 infection does not affect fresh ART treatment outcomes. A possible long term negative effect on oocyte yield should be further explored. What is known already There is evidence that the renin–angiotensin–aldosterone system (RAS) is involved in female reproductive processes such as folliculogenesis, steroidogenesis, oocyte maturation and ovulation. The existence of the ACE2 axis and ACE2 markers were confirmed in all stages of follicular maturation in the human ovary, including the granulosa cells and follicular fluid. A single previous study found no evidence that a history of asymptomatic or mild SARS-CoV-2 infection in females caused impairment of fresh ART treatment outcomes. Study design, size, duration Retrospective cohort study, including all SARS-CoV-2 infected women that underwent fresh ART cycles within a year from infection (the first cycle post infection), between October 2020 and June 2021, matched to uninfected controls. Participants/materials, setting, methods Retrospective cohort study, including all SARS-CoV-2 infected women that underwent fresh ART cycles within a year from infection (the first cycle post infection), between October 2020 and June 2021, matched to uninfected controls. Main results and the role of chance 121 infected patients and 121 controls that underwent fresh ART cycles were included. Oocyte yield (12.50 vs. 11.29;p = 0.169) and mature oocyte rate (77.71 vs. 81.76;p = 0.144) in all fresh cycles were similar between groups, as werefertilization rates, number of frozen embryos per cycle and clinical pregnancy rates (42.9% vs. 40.4%;p = 0.737) in fresh cycles with an embryo transfer. Stratification by time from COVID-19 infection by time from infection <90 day, 90-180 days and > 180 days revealed similar results with no difference in pregnancy rates. In a logistic regression model, COVID-19 infection did not affect pregnancy rates except for the small subgroup of patients who recovered more than 180 days prior to retrieval with a negative effect on oocyte yield (p = 0.018, Slope=-4.08, 95%CI 95% CI -0.7.41 – -0.75). Limitations, reasons for caution A retrospective study with data that was not uniformly generated under a study protocol, no antibody testing for the control group. Wider implications of the findings The study findings suggest that COVID-19 infection does not affect treatment outcomes in fresh ART cycles, except for a possible long term negative effect on oocyte yield when retrieval occurs > 180 days post COVID-19 infection. Further studies are warranted in order to support these findings. Trial registration number HMC-0010-21
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Background: The COVID-19 pandemic has disproportionately impacted people who use illicit drugs and misuse prescription drugs (PWUD), including increased risk for infection with SARS-CoV-2, clinical COVID-19, and poorer health outcomes. The reasons for this disparity are multifactorial and may include numerous social and structural factors. Yet, little is known about COVID-19 testing and vaccinations among PWUD. Methods: This cross-sectional study was conducted in Miami, Florida, USA between March and September 2021 with the support of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative. Participants had to be 18 years of age and older and willing to be tested for COVID-19. Recruitment included convenience and snowball sampling. The RADx-UP survey (available at https://radx-up.org/) was administered via telephone. Results: A total of 931 participants were enrolled in the study;median age was 59 (53, 64) years, 65.5% were Black, 32.1% Hispanic, and 69.2% had a household income of less than $15,000 in 2019. Nearly a third of participants (32.6%) used drugs. Additionally, 37.6% smoked cigarettes, and 5.2% consumed alcohol for four or more days per week. Twenty percent of participants had never been tested for COVID-19. Of those who reported ever being tested, 14.1% reported ever being positive for SARS-CoV-2, with 67.2% of those having moderate-to-severe symptoms and 26.7% reporting being hospitalized due to COVID-19. Overall, 19 (2.2%) participants tested positive for SARS-CoV-2 at the time of the study, which was more frequent among PWUD than drug non-users (4.2% vs. 1.2%, respectively;p=0.004). PWUD, compared to drug non-users, were less likely to be vaccinated against COVID-19 (66.7% vs. 75.2% for any one dose, respectively;p=0.006). Compared to drug non-users, PWUD had 3.62 (95% CI: 1.41, 9.30;p=0.008) times higher odds of being positive for SARS-CoV-2 based on rt-PCR testing at the time of interview, and 0.66 (95% CI: 0.49, 0.89;p=0.006) times lower odds of being at least partially vaccinated against COVID-19. Conclusion: People who use drugs may be at increased risk of contracting SARS-CoV-2 and developing COVID-19, which could be in part related to lower vaccination rates in addition to comorbidities and lifestyle factors. Testing and immunization plans are needed that are specific for PWUD, considering the barriers and facilitators of this population.
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Background: People who use unregulated drugs (PWUD) in Canada and the United States (US) are contending with the intersection of two simultaneous health crises: the COVID-19 pandemic and the longstanding drug poisoning crisis. However, the possible contributions of COVID-related factors to increases in overdoses during the pandemic are not well understood. Our study objectives were to assess the prevalence of non-fatal overdose and identify factors associated with overdose among participants in nine prospective cohorts of PWUD in urban centers in Canada (Vancouver, BC) and the US (Baltimore, MD;Miami, FL;Chicago, IL;Los Angeles, CA) during the COVID-19 pandemic. We further sought to examine the prevalence of and identify factors associated with reporting being highly impacted day-to-day by COVID-19. Methods: Data were derived from the nine cohorts in the NIDA-funded C3PNO consortium between May, 2020 and April, 2021. Multivariable logistic regression was used to identify factors associated with nonfatal overdose and day-to-day impact among participants who had used unregulated drugs in the past month. Results: Among 885 participants, 253 (28.6%) were female and 41 (4.6%) had reported experiencing a non-fatal overdose. Most of the sample reported being worried and approximately half reported being highly impacted day-to-day by the pandemic. In multivariable analyses, individuals who had experienced an overdose were more likely to be female (Adjusted Odds Ratio [AOR]=2.18;95% Confidence Interval [CI]:1.10-4.30);unstably housed/homeless (AOR = 2.16;95% CI: 1.11-4.26);engaged in medications for opioid use disorder (MOUD) (AOR = 2.45;95% CI: 1.19-4.97);and highly impacted day-to-day by COVID-19 (AOR = 2.42;95% CI: 1.22-5.10). In a second multivariable model, highly-impacted individuals were more likely to report higher levels of COVID-related worry (AOR = 1.30;95% CI: 1.23-1.37) and stocking up on drugs (AOR = 1.59, 95% CI: 1.09-2.32) due to the pandemic. Conclusion: Our findings indicate a need for a multi-level approach involving the spectrum of care services to meet the elevated risks of overdose in the context of the dual crises, particularly among women, those unstably housed/homeless and those who reported being highly impacted day-to-day by the pandemic. Efforts to prevent overdose, however, should prioritize addressing the root causes of the drug poisoning crisis, such as the continuous exposure to toxic and contaminated unregulated drug supplies among PWUD.
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Background: The COVID-19 pandemic disrupted the normal delivery of HIV care, altered social support networks, and caused economic insecurity. People with HIV (PWH) are vulnerable to such disruptions, particularly if they have a history of substance use. We describe engagement in care and adherence to antiretroviral therapy (ART) for PWH during the pandemic. Methods: From May 2020 to February 2021, 773 PWH enrolled in 6 existing cohorts completed 1495 surveys about substance use and engagement in HIV care during the COVID-19 pandemic. We described the prevalence and correlates of having missed a visit with an HIV provider in the past month and having missed a dose of ART in the past week. Results: Thirteen percent of people missed an HIV visit in the past month. Missing a visit was associated with unstable housing, food insecurity, anxiety, low resiliency, disruptions to mental health care, and substance use including cigarette smoking, hazardous alcohol use, cocaine, and cannabis use. Nineteen percent of people reported missing at least one dose of ART in the week prior to their survey. Missing a dose of ART was associated with being a man, low resiliency, disruptions to mental health care, cigarette smoking, hazardous alcohol use, cocaine, and cannabis use, and experiencing disruptions to substance use treatment. Conclusion: Social determinants of health, substance use, and disruptions to mental health and substance use treatment were associated with poorer engagement in HIV care. Close attention to continuity of care during times of social disruption is especially critical for PWH.
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Research Objectives We explored stakeholders’ experiences using videoconferencing to participate in group-based social learning during the COVID-19 pandemic. Design Qualitative thematic analysis. Setting Community-based. Participants We interviewed 8 community-dwelling low-income adults with chronic stroke (≥ 3 months) and mild-to-moderate disability (NIH Stroke Scale ≤16) who enrolled in the ENGAGE Pilot Study (NCT04019275) during the COVID-19 pandemic. Research staff (n=4), peer facilitators (n=2), and occupational therapist facilitators (n=2) were also interviewed. Interventions ENGAGE blends social learning, guided discovery, and skills training to facilitate community and social participation. The 8-session curriculum was adapted for delivery via videoconferencing during the COVID-19 pandemic. Peer and occupational therapy facilitators led the groups. Main Outcome Measures Semi-structured interviews were conducted. Interviews were transcribed, annotated, and coded by 3 researchers. Results were member checked. Results Stakeholders reported that they valued participation in the intervention using videoconferencing and connectedness through shared experiences. Some participants felt more comfortable sharing experiences over videoconferencing than in person. The COVID-19 pandemic prompted participants and facilitators to identify creative approaches to community and social participation. All stakeholders highlighted technical and social components of using videoconferencing that should be included in training at the beginning of remotely delivered interventions. Learning occurred over the duration of the group sessions rather than during one training session. Group facilitators also described strategies for navigating technical challenges and engaging participants during online group sessions. Conclusions Group-based interventions delivered via videoconferencing may facilitate valuable social learning experiences after stroke. Videoconferencing training should address technical skills and social expectations. Future research should explore stakeholder preferences for virtual or face-to-face group interventions, virtual group processes, and optimal training strategies to facilitate technology uptake. Author(s) Disclosures This research was supported by the following: T32 Precision Lifestyle Medicine and Translational Research (PREMIER) Postdoctoral Training Program (NHLBI T32HL134634);NIH CTSA SPIRiT Award (University of Pittsburgh, UL1 TR001857;Washington University in St. Louis, UL1 TR002345).