Impact of the COVID-19 pandemic on the management of risk factors in patients with stable atherosclerotic vascular disease.

Background: Effective control of risk factors in patients with ASCVD is important to reduce recurrent cardiovascular events. However, many ASCVD patients do not have their risk factors controlled, and this may have worsened during the COVID-19 pandemic. Methods: We retrospectively evaluated risk factor control among 24,760 ASCVD patients who had at least 1 outpatient encounter both pre-pandemic and during the first year of the pandemic. Risk factors were uncontrolled if the blood pressure (BP) ≥ 130/80 mm Hg, LDL-C ≥ 70 mg/dL, HgbA1c ≥ 7 for diabetic patients, and patients were current smokers. Results: During the pandemic, many patients had their risk factors unmonitored. BP control worsened (BP ≥ 130/80 mmHg, 64.2 vs 65.7%; p = 0.01), while lipid management improved with more patients on a high-intensity statin (38.9 vs 43.9%; p<0.001) and more achieving an LDL-C < 70 mg/dL, less patients were smoking (7.4 vs 6.7%; p<0.001), and diabetic control was unchanged pre vs during the pandemic. Black (OR 1.53 [1.02-2.31]) and younger aged patients (OR 1.008 [1.001-1.015]) were significantly more likely to have missing or uncontrolled risk factors during the pandemic. Conclusions: During the pandemic risk factors were more likely to be unmonitored. While measured blood pressure control worsened, lipid control and smoking improved. Although some cardiovascular risk factor control improved during the COVID-19 pandemic, overall control of cardiovascular risk factors in patients with ASCVD was suboptimal, especially in Black and younger patients. This puts many ASCVD patients at increased risk of a recurrent cardiovascular event.

Age, gender, and setting's effect on community pharmacists' stress and confidence in the COVID-19 pandemic

Background Reports of increased stress among healthcare workers were commonplace during the early days of the COVID-19 pandemic, but little is known about community pharmacists' experiences. Objective To characterize community pharmacists' stress and confidence during the early COVID-19 pandemic and identify associated factors. Methods Pharmacists who worked in a brick-and-mortar community pharmacy (e.g., big-box, chain, independent, or grocery pharmacies) located in Connecticut and had regular face-to-face interaction with the public were surveyed. Survey items were selected from the Perceived Stress Scale-10 (PSS-10) and adapted from the Emergency Risk-Communication (ERC) framework. Data were analyzed using chi-square and ANOVA. Results Survey results suggested pharmacists experienced moderate levels of stress, as negative responses to PSS-10 items ranged between 6.4% to 43.3%, respectively. Overall, pharmacists had high rates of confidence in their ability to manage the pandemic, agreeing or strongly agreeing that they could manage their own mental health (73.1%), and communicate risks of the pandemic (72.0%). However, 28.0% reported that they had avoided talking about the pandemic because it made them feel "stressed, or nervous.” Women and those working in chain community pharmacies tended to report significantly higher rates of stress to several items in the PSS-10 compared to men and pharmacists working in non-chain settings. Women and chain community pharmacists were also significantly more likely to report overall that they had avoided talking about public health risks because it made them feel anxious, stressed, or depressed (29.4% men vs. 34.5% women χ2 (4) > 22.6, p < 0.01). However, confidence to communicate critical risk messages neither differed between men and women (77.6% men vs. 68.8% women χ2 (4) > 8.3, p = 0.08), nor between chain and non-chain community pharmacists (71.0% chain vs. 73.7% non-chain χ2 (4) > 8.9, p = 0.32). Conclusion Being female, younger age, and employed at a chain pharmacy were associated with higher rates of stress and lower self-confidence among community pharmacists during the COVID-19 pandemic.

Age, gender, and setting's effect on community pharmacists' stress and confidence in the COVID-19 pandemic.

Background: Reports of increased stress among healthcare workers were commonplace during the early days of the COVID-19 pandemic, but little is known about community pharmacists' experiences. Objective: To characterize community pharmacists' stress and confidence during the early COVID-19 pandemic and identify associated factors. Methods: Pharmacists who worked in a brick-and-mortar community pharmacy (e.g., big-box, chain, independent, or grocery pharmacies) located in Connecticut and had regular face-to-face interaction with the public were surveyed. Survey items were selected from the Perceived Stress Scale-10 (PSS-10) and adapted from the Emergency Risk-Communication (ERC) framework. Data were analyzed using chi-square and ANOVA. Results: Survey results suggested pharmacists experienced moderate levels of stress, as negative responses to PSS-10 items ranged between 6.4% to 43.3%, respectively. Overall, pharmacists had high rates of confidence in their ability to manage the pandemic, agreeing or strongly agreeing that they could manage their own mental health (73.1%), and communicate the risks of the pandemic (72.0%). However, 28.0% reported that they had avoided talking about the pandemic because it made them feel "stressed, or nervous." Women and those working in chain community pharmacies tended to report significantly higher rates of stress to several items in the PSS-10 compared to men and pharmacists working in non-chain settings. Women and chain community pharmacists were also significantly more likely to report overall that they had avoided talking about public health risks because it made them feel anxious, stressed, or depressed (29.4% men vs. 34.5% women χ2 (4) > 22.6, p < 0.01). However, confidence to communicate critical risk messages neither differed between men and women (77.6% men vs. 68.8% women χ2 (4) > 8.3, p = 0.08), nor between chain and non-chain community pharmacists (71.0% chain vs. 73.7% non-chain χ2 (4) > 8.9, p = 0.32). Conclusion: Being female, younger age, and employed at a chain pharmacy were associated with higher rates of stress and lower self-confidence among community pharmacists during the COVID-19 pandemic.

Using the 5C model to understand COVID-19 vaccine hesitancy across a National and South Carolina sample.

Vaccine hesitancy is a serious threat to global health; however, significant COVID-19 vaccine hesitancy exists throughout the United States. The 5C model, which postulates five person-level determinants for vaccine hesitancy - confidence, complacency, constraints, risk calculation, and collective responsibility - provides one theoretical way of understanding COVID-19 vaccine hesitancy. The present study examined the effects of these 5C drivers of vaccine behavior on early vaccine adoption and vaccine intentions above and beyond theoretically salient demographic characteristics and compared these associations across a National sample (n = 1634) and a statewide sample from South Carolina (n = 784) - a state with documented low levels of COVID-19 vaccination uptake. This study used quantitative and qualitative data collected in October 2020 to January 2021 from the MFour-Mobile Research Panel, a large, representative non-probability sample of adult smartphone users. Overall, the South Carolina sample reported lower COVID-19 vaccine intentions and higher levels of 5C barriers to vaccine uptake compared to the National sample. Findings further indicated that both demographic characteristics (race) and certain drivers of vaccine behavior (confidence and collective responsibility) are associated with vaccine trust and intentions across samples above and beyond other variables. Qualitative data indicated that COVID-19 vaccine hesitancy was driven by fears about the quick vaccine development, limited research, and potential side effects. Although there are some limitations to the cross-sectional survey data, the present study offers valuable insight into factors associated with early COVID-19 vaccine hesitancy across the United States.

AN INTRAINDIVIDUAL VARIABILITY OF SLEEP HEALTH AND PERCEIVED STRESS IN COLLEGE STUDENTS DURING THE COVID-19 PANDEMIC

Introduction: Pandemic-related societal response and uncertainty have generated marked changes in sleep-wake patterns and psychosocial well-being especially among first year college students. The current study sough to describe the changes in the sleep health domains determined from Actigraph and self-report, and examine the associations between the repeated-measure and intraindividual variability (IIV) of these domains and perceived stress in young college students over the course of a semester in the midst of an on-going COVID-19 pandemic (i.e., Fall, 2020). Methods: A repeated measure design at 1-month interval across a 3-month period was conducted among a group of diverse racial and ethnic groups of college students (N=23, 78.3% female, age range 17-18). Participants completed a 7-days of wrist Actigraph, daily sleep diaries, and other surveys at each interval. A multidimensional sleep health was determined using Actigraph and daily sleep diary measures of sleep duration, efficiency, timing and regularity, and self-reported surveys of sleep satisfaction and alertness during daytime. Participants also completed the Perceived Stress Scale. Non-parametric tests were used to assess the changes in sleep health across 3 intervals, and a series of linear mixed effects model and regression analysis were conducted to assess associations between stress and subjective sleep health, adjusting for sex. Results: Actigraph-determined sleep timing and regularity, and sleep diary-determined sleep timing and alertness during daytime demonstrated statistically significant changes between given timepoints. Among the sleep diary-determined sleep health domains, greater perceived stress was associated with more irregular (B=2.25 [.873.62], p<.001), more dissatisfied (B=.04 [.02.19], p<.01), and sleepier during daytime (B=.18 [.05.31], p<.001), across 3 timepoints. Moreover, greater perceived stress was associated with greater IIV (i.e., fluctuations) in sleep satisfaction, but no significance was found among IIV of other domains. Conclusion: This study aids understanding of the relationship between stress and sleep health in this population, and offers insight to future research questions that can facilitate intervention development to promote both mental and sleep health among young college students.

STRATEGIES FOR ENHANCING RECRUITMENT OF ADULTS FOR RANDOMIZED CONTROLLED TRIAL AMONG HETEROGENOUS SAMPLE OF CANCER SURVIVORS WITH INSOMNIA AMID THE COVID PANDEMIC

Introduction: Challenges associated with recruiting participants in a longitudinal research study have been recognized yet remain a major barrier for researchers. The current study details strategies used in recruiting a heterogenous sample of cancer survivors with insomnia from multiple clinical sites, referral sources and outreach. Methods: Enrollment goals were 158 participants over 3 years (June 2019 to May 2022). Recruitment strategies included 1) face-to-face (FTF) recruitment at hospital clinics;2) posting recruitment flyers in clinical settings;3) completion of insomnia screening instrument at community clinic sites;4) research registries;5) institutional social media outreach;6) community events;7) PI interview and request for study volunteers in local newspaper;and 8) ongoing engagement and communication with recruited participants. Results: 108 of 158 participants have been recruited and completed baseline surveys;9 participants dropped out. To date, 42 of 49 (85.7%) participants have completed the 12-month study. June 2019 through December 2019 FTF recruitment occurred, where 104 were eligible and 32 (30.76%) were enrolled. Due to changes in study personnel and the COVID pandemic restricting access to in-person recruitment and enrollment, the study pivoted to develop protocols for electronic consent and enrollment using video conferencing. In addition, research databases, institutional social media, community events and local newspaper were utilized, where 76 of 239 (31.79%) interested participants enrolled. The most effective recruitment strategies included on-site FTF recruitment (57.9%) and local newspaper interview (13.88%). The local newspaper interview was the most cost-effective considering personnel costs associated with FTF recruitment. Conclusion: Despite the onset of the COVID pandemic during the recruitment phase, we were able to pivot and employ innovative techniques to meet our targeted enrollment goal for the projected study deadline. FTF recruitment, perceived value by clinic staff in benefitting cancer survivors, and participants' acceptance of video-conferencing were significant contributors. The importance of building and maintaining relationships with providers and nurses in local clinical sites cannot be underestimated.

Improving health and wellbeing across HIV/ GUM departments in the UK

Background: Sexual Health staff support patients at times of high emotional stress. This can impact on staff health and wellbeing. The GMC states that 'staff wellbeing significantly improves productivity, care quality, patient safety, patient satisfaction, financial performance and sustainability of our health service.' Research demonstrates that multilevel interventions- both organisational changes as well as wellbeing activities, help to reduce burnout. As well as emphasising the importance of always considering wellbeing in management meetings (rota/ IT systems/ staff issues), I launched a quality improvement project, evaluating whether we could improve staff wellbeing by introducing healthy and fun activities. Method: In June 2019, 30/120 of our staff and then in October 2020, 36/120 of our staff, completed a survey which rated their wellbeing in relation to work, and indicated which activities they would like the department to provide. I established a Wellbeing Committee with volunteers from the department, and invited our city Mayor to launch our wellbeing events (meditation, yoga, fruit in staffroom, craft groups, sports events, Balint-style group, sea-swim club, gin club). Results: The second survey showed that happiness ratings at the beginning of work days, satisfaction at the end of work days, how well they got on with their colleagues and how supported they feel in challenging work situations, improved after the implementation of wellbeing initiatives. Staff gave valuable feedback such as “not having to talk about work and doing something fun improves relationships between staff.” Conclusion: This is an ongoing, long-term quality improvement project. The impact of covid and how redeployment and virtual working are affecting staff wellbeing may be reflected in our results. I have spread our ideas across GUM departments by speaking at regional training days and communicating online with colleagues from different regions. Our wellbeing ideas have also been taken on by different specialties in the Trust. It is our aim to continue to strengthen and consolidate our wellbeing activities locally and nationally.

O17.5 Blood borne viruses screening (BBVS) for temporarily housed rough sleepers in Brighton & Hove during the Covid-19 pandemic

BackgroundAt the start of the Coronavirus pandemic the UK Government pledged to house all rough-sleepers in temporary accommodation. This provided healthcare workers with a unique opportunity to access this ‘hard-to-find’ group, offer blood borne viruses screening (BBVS) and link clients testing positive into individualised treatment.ApproachA collaborative working group (HIV clinicians, HIV prevention specialists, hepatitis C outreach nurses and rough-sleepers health-engagement workers) established comprehensive risk-assessments, PPE supplies and dried blood spot procurement. Two experienced outreach workers worked along-side trusted homeless key-workers to offer BBVS (HIV, hepatitis B&C) in hotels, a hostel and student halls over 13-weeks (Jun-Sep 2020). Clients were offered £5 food-voucher for participating.Outcomes270 clients were housed during this time, 256 (95%) were offered BBVS;192 (72%) tested. 148 (77%) tested ‘mainly due to the incentive’. Of the 192 testers the median age (range) was 40y (18–69). Clients were mainly male 161 (83%);white-British 164 (85%) and heterosexual 179 (93%). 54 (28%) stated previous IVDU;39 (20%) other drug use and 92 (48%) prison as risk-factors. 70 (36%) had not previously tested. 31 (16%) were hepatitis C antibody positive;13 (7%) RNA positive. To date 4 have started treatment;5 deferred;3 did not engage with services despite being aware of the diagnosis;1 left the area. No new HIV diagnoses (two clients re-engaged with care). Most clients considered the service good or excellent, and would recommend (99%). Challenges included lab delays due to competing Covid-19 testing and engaging disenfranchised clients.Innovation and SignificanceThis project brought together a multidisciplinary collaboration, drawing on specialist knowledge to meet complex needs. Despite challenges during a pandemic, we obtained a useful snap-shot of BBV rates. Offering an incentive to a cohort sensitised to BBVS was important. New outreach testing opportunities were identified which will be progressed in 2021.

SARS-CoV-2 replication in hepatocyte cell lines

Background: A high proportion of patients with COVID-19 demonstrate liver enzyme abnormalities which have been attributed to a variety of etiologies including sepsis, coagulopathy with ischemic injury, and drug effects. We sought to determine the potential for replication and injury due to SARS-CoV-2 infection of hepatocyte cells. Methods: SARS-CoV-2 viral stocks were obtained from ATCC and expanded in Vero E6 cells. The virus was diluted to a multiplicity of infection of 0.1 plaque forming units and placed in medium overlying confluent cells. HepG2 andHuh7.5 hepatocyte cell lines were utilized, with Vero E6 cells (kidney) and WI-38 (lung) cell cultures serving as infection controls. For each cell line, uninfected cells were also maintained for comparison. Infection experiments were run in triplicate. Plaque assays were used to determine supernatant viral titer on days 2 through 8 post infection. Cell culture morphology was monitored by light microscopy. Results: All cell lines demonstrated significant replication potential with multi-log increase in plaque-forming units by day 3 post-infection. Rapid replication was observed through day 5. This was associated with the presence of severe cell injury with loss of attachment of the monolayer, suggesting that hepatocyte cell death limited overall levels of viral replication. Conclusion: Both HepG2 and Huh7.5 cell lines support active replication of SARS-CoV-2, leading to multi-log increases in viral titer. Replication in these cell lines is accompanied by severe injury leading to loss of attachment and cell death. These findings support the concept that SARS-CoV-2 infection may be associated with liver enzyme abnormalities due to acute viral-induced liver injury. (Table Presented).

Preparing Students for a More Public Health-Aware Market in Response to COVID-19.

The COVID-19 pandemic has made the public more aware of public health and the role its professionals play in addressing the pandemic. Schools and programs in public health have a new opportunity to recruit, train, and sustain the public health workforce. Academic public health can further educate the public and prepare students for meaningful careers through interprofessional education and practice-based learning.