ABSTRACT
This analysis aimed to investigate how age, race/ethnicity, and geographical location contributed to vaccine hesitancy in a sample of New York City (NYC) Metropolitan Transit Authority (MTA) workers. Transport Workers Union, Local 100 members completed online surveys in August 2020 about their COVID-19 history, workplace protections and policies, fear of COVID-19 exposure, vaccination attitudes, and sociodemographic and health characteristics. We conducted univariate and bivariate analyses, followed by multivariate logistic regression, to determine the association between respondent age (younger than 50 vs. 50+) and vaccine hesitancy (willing vs. unwilling/unsure). We also produced spatial visualizations to examine these factors by participants' zip codes. Of 645 respondents, 59% were 50 years or older, 53% were non-White, and 71% expressed vaccine hesitancy. MTA workers ages 50+ were 46% less likely to be vaccine hesitant than their younger counterparts (OR 0.64;95% CI 0.42, 0.97). Compared to Whites, non-Whites (OR 3.95;95% 2.44, 6.39) and those who did not report their race (OR 3.10;95% CI 1.87, 5.12) were significantly more likely to be vaccine hesitant. Those who were not concerned about contracting COVID-19 in the community had 1.83 greater odds (95% CI 1.12, 2.98) of being vaccine hesitant than those who were concerned. Spatial visualizations revealed that the oldest respondents tended to reside in Queens. Zip codes with high vaccine hesitancy were clustered in Brooklyn, where non-White respondents tended to reside. The trends observed in COVID-19 vaccine hesitancy based on race and age persist in a population of high risk, non-healthcare essential workers.
ABSTRACT
Aims: Commercial smell tests are too costly and time-consuming for population surveillance in health emergencies like COVID-19 where smell loss is a concern. To address this need, Parma et al. (2021) developed SCENTinel, a brief test of three olfactory functions: detection, intensity, and identification. We examined the psychometric properties of SCENTinel, hypothesizing that SCENTinel components would be positively intercorrelated and that SCENTinel would be associated with self-reported smell loss and SARS-CoV-2+ results. Method(s): We performed a cross-sectional study of a sample of adults presenting for outpatient SARS-CoV-2 testing at Northwestern Medicine locations. Staff handed out SCENTinel test cards to interested patients who voluntarily self-administered the test at home, completing questions on demographics and COVID-19 symptomatology. After smelling each of three resealable odor patches, participants selected the location of the odor (detection), rated the intensity of the odor, and identified the odor via a 4-alternative-forced-choice task (identification). Data were matched with medical record demographics and SARS-CoV- 2(PCR) results. Result(s): Participants completed 2413 SCENTinel tests;after matching participants to medical record data containing concurrent SARS-CoV-2(PCR) results, 1557 tests (64%) were analyzed. Mean age was 49 (SD = 16), 62% were female, 76% were white. 4-5% tested positive for SARS-CoV-2 infection (ndelta = 50;ndelta + omicron = 74). The SCENTinel components showed moderate-to-high correlations with the overall score, r = 0.35-0.84. Identification and detection were moderately correlated (r = 0.42);intensity was slightly correlated with both (rs = 0.13, 0.08), averaging to Cronbach's alpha 0.44 for SCENTinel-overall. Self-reported smell loss was only related to intensity (r = - 0.11). SARS-CoV-2delta+ was slightly related to SCENTinel-overall (r = - 0.09), entirely driven by intensity (r = - 0.27). Mean intensity scores were much lower for the SARSCoV- 2delta+ group (Cohen's d = - 0.76;Fig. 1). Regressions showed that self-reported smell loss and SCENTinel-overall were both uniquely predictive of SARS-CoV-2delta+. As a screener of SARS-CoV- 2delta+, SCENTinel-overall was highly specific (89%), but not sensitive (28%), with kappa of 0.74 (CI 0.70-0.77). Conclusion(s): SCENTinel components are intercorrelated, but effects were small to moderate. Intensity formed a pattern of associations distinct from detection and identification. SCENTinel-overall was highly specific and predictive of SARS-CoV-2delta+, even controlling for self-reported smell loss. The low sensitivity of SCENTinel could reflect asymptomatic infection. Future directions include optimizing scoring and validation with goldstandard olfaction tests.
ABSTRACT
Objective: To present initial validity evidence for MyCog. Background: Cognitive Impairment (CI) affects more than 16 million people, with dementia or severe cognitive decline projected to increase significantly by 2050. MyCog is a brief, standardized iPad-based, self-administered cognitive screening assessment designed for use in diverse clinical settings, among older adults or any patient with a recognized cognitive concern. It will address the need for sensitive measures of CI feasible for use in primary care settings. Design/Methods: Participants were recruited from an ongoing cognitive aging study conducted in academic internal medicine clinic and community health centers. CI was determined based on either a chart diagnosis of dementia or mild cognitive impairment (MCI), or by normative performance on a comprehensive cognitive battery within the prior 18 months. The MyCog assessments, Dimensional Change Card Sort (DCCS) and Picture Sequence Memory (PSM), measure executive function, cognitive flexibility, and episodic memory. We evaluated the efficacy of MyCog as a detection tool using sensitivity, specificity, and receiver operator characteristic (ROC) curves. Results: Of the 80 participants administered the MyCog assessment, 31 were classified as CI. In the sub-sample of participants who expressed concern about their cognition (n = 52), PSM and DCCS demonstrated exceptional ability in detecting CI (the area under the ROC curve, or AUC, = 0.92), with an average administration time of 12 minutes. When only including the first of two PSM trials along with DCCS, time was reduced on an average to <7 minutes, with little change in AUC (0.90). Conclusions: Preliminary validity evidence supports the use of MyCog as a self-administered cognitive screening battery. Given the COVID-19 pandemic, it is important to provide physicians and clinical staff access to well-designed cognitive assessments that can be selfadministered. We are currently validating MyCog in MCI clinical populations, and our next steps include a clinical trial with modified clinic workflows.
ABSTRACT
Background and purpose: Early on in the COVID-19 pandemic, New York City (NYC) vowed to “keep the subways running” despite the lack of plans in place for protecting the health and well-being of transit workers. This study was designed to assess the impact of employment during the early phase of the pandemic on this essential frontline workforce. Methods, settings, and study participants: A convenience sample of members (stratified by job title) of the NYC Transport Workers Union, Local 100, was recruited in August 2020 to participate in an anonymous, cross-sectional, internet-based survey. Results: The demographics of the sample participants (N = 645) reflected union membership, ie, 82 percent male, 29 percent Black;27 percent Hispanic, and 59 percent ≥age 50 years. At the time of the “NYC Pause” (March 22, 2020) when mandatory stay-at-home orders were issued, transit workers had limited worksite protections. Many reported a lack of such basics as face masks (43 percent), hand sanitizer (40 percent), and disposable gloves (34 percent). A high proportion (87 percent) were concerned about getting infected at work. Lack of certain protections was significantly associated with both fear of contagion at work and mental health symptoms. Nearly 24 percent of participants reported a history of COVID-19 infection. Self-reported infection was significantly correlated with lack of certain protections, including respiratory masks (p < 0.001), disposable gloves (p < 0.001), and hand sanitizer (p < 0.001). Infection was also significantly associated with mental health symptoms (p < 0.001). By August 2020, despite participants reporting that many worksite protections were then in place, 72 percent of workers were still fearful for their safety at work, eg, because of potential exposure due to passengers not wearing masks, and risk of verbal abuse and physical assault by passengers angered when asked to wear face masks. Workers who were fearful for their safety at work were more than six times more likely to report mental health symptoms (p < 0.001). Conclusions: Lack of worksite protections before “NYC Pause” (March 22, 2020) was significantly associated with self-reported infection, fear, and mental health symptoms in TWU, Local 100 members. To reduce the risk of adverse impacts associated with bioevents in all essential work groups, and across all essential occupational settings, infection control preparedness, early recognition of risk, and implementation of tailored risk reduction strategies are imperative. Pandemic preparedness is fundamental to protecting the health and well-being of essential workers and crucial in controlling the spread of disease in the community. Bioevent preparedness for all essential frontline workgroups will also help reduce occupational health inequities. Workers at risk, regardless of setting, deserve and have the right to equal protections under federal and state law. © 2021 Weston Medical Publishing. All rights reserved.
ABSTRACT
Objective: We introduce the Mobile Toolbox Battery (MTB), a library of cognitive assessments for at-home smartphone administration. It is designed for safe, remote, and effective data collection, particularly among older adults. Background: Cognitive Impairment (CI) is estimated to affect more than 16 million people (Centers for Disease Control and Prevention, 2011). About 5.8 million Americans are living with dementia, severe cognitive decline, most often due to Alzheimer's Disease, with a projected increase to 13.8 million people aged 65 and older by 2050 (Alzheimer's Association, 2020). There is a clear need for early detection of cognitive impairment due to neurodegenerative brain disease as well as to differentiate it from more benign, age-associated changes. However, there are currently few sensitive assessment tools to meet this need and fewer yet that can be easily and widely deployed across the lifespan, in different research settings, and with diverse participants. Design/Methods: MTB provides a complete research platform for app creation, study management, and data collection for participants 20-85 years old. Available for both iOS and Android devices, we envision the MTB being used in fully remote or follow-up remote studies. The initial core tests With in MTB were designed to measure comparable cognitive skills to those in the well-established NIH Toolbox Cognition Battery, often utilized for in-person research. Results: We present the Mobile Toolbox research platform and its use in conducting remote assessments measuring the constructs of executive function, language, memory, and processing speed. The suite of assessments includes: Flanker, Face-Name (FNAME), Memory for Sequence (MFS), Picture Sequence Memory (PSM), Vocabulary, Number Match, Spelling, and Dimensional Charge Card Sort (DCCS) tests. Conclusions: Given the COVID-19 global pandemic and its associated stay-at-home orders, it is now more important than ever that researchers have access to well-designed cognitive assessments that can be administered entirely remotely.