Racial Diversity In Covid-19 Clinical Trails: A Mixed Quantitative And Qualitative Review

Introduction: Historically, clinical trial patient populations have lacked adequate diversity while studies have shown that differences exist in the biological response of different ethnicities to various healthcare interventions. Minority populations have suffered higher rates of Covid-19 infection, hospitalization, and mortality than their non-Hispanic white counterparts. It is vital that Covid-19 treatment research is appropriately diverse. This paper aims to define the demographic characteristics of COVID-19 therapeutic clinical trials to date. Method(s): A literature search initially returned 117 unique publications, 67 of which met the inclusion criteria and were analyzed. Main variables of interest were reporting of demographic data, percent white, Black, and Asian, and type of study. Statistical analysis was carried out via Stata software. Result(s): Among analyzed studies, 74.63% reported demographics. The demographic representation was 78.87%, 12.27% and 8.86% for white, Black, and Asian populations. Among vaccine related studies, the representation for Black, Asian, and Hispanic individuals was 5.01%, 6.40%, and 13.71%. A qualitative analysis of outlier studies with high (>30%) Black populations revealed that none were vaccine related, 1/3 were in hospitalized patients, and none were related to pharmacologic interventions. Of the studies with low levels (<2%) of Black patients, 4/6 were vaccine related, none were in hospitalized patients, and all were related to pharmacologic interventions. Conclusion(s): This analysis reveals concerning trends in therapeutic clinical trial enrollment to date. In the context of yet another health insult that disproportionately affects minority populations, America's scientific community is not doing enough to produce equitable scientific evidence on Covid-19 treatment.

Family Diabetes Camp Amidst COVID-19: A Community of Practice Model

Studies have found that youth are experiencing higher anxiety levels than prior to COVID-19, and youth with type 1 diabetes are at higher risk. Medical specialty camps are a type of camp that provide opportunities for youth with chronic illnesses to share common goals, increase socialization, improve camper well-being, and increase knowledge of diabetes management. The program evaluation sought to determine the impact of a campers' outcomes of independence and perceived competence and familial impact during COVID-19. Over half the participants were at their first diabetes camp and 71% of the campers felt their perceived competence "increased a little bit" because of camp. Over 95% of parents felt that their participation in camp had increased their diabetes knowledge. Qualitative data from parents revealed 2 themes, camp as a meeting place and learning from others. The findings from this study demonstrate that medical specialty camps influence campers' perceptions of independence and competence and that families play an important role in creating a community of practice.

What is the prevalence and distribution of upper limb weakness early post-stroke?

Background: A growing body of international research suggests the prevalence of upper limb weakness early after stroke is currently lower (40-57%) than widely cited values of 70-80% from two decades ago. Recent work also indicates the distribution of upper limb weakness may be bimodal, with a higher proportion of people with severe or little/no weakness as compared to mild/moderate weakness. Aim: To describe the prevalence and distribution of upper limb weakness early post-stroke. Methods: Patients admitted to a tertiary acute stroke unit with a suspected stroke were screened between November 2018 to February 2020 (interrupted by COVID-19) and April to November 2021. Upper limb weakness was captured via Shoulder Abduction and Finger Extension (SAFE) score (0-10), which was prospectively assessed at first contact by the unit therapist. Data on stroke type, acute medical intervention received, and National Institute of Health Stroke Scale (NIHSS) were also extracted. Results: A total of 662 individuals with confirmed stroke (median NIHSS score 6, IQR 2-13) were administered SAFE a median 1 (IQR 1,2) day after unit admission. Only 46.2% had upper limb weakness (SAFE score ≤9). Three most common SAFE scores were 10 (53.8%), 8 (11.5%) and 0 (9.4%). The subgroup severity distribution was 59.2% little to no impairment (SAFE 9-10), 24.1% mild to moderate impairment (SAFE 5-8), and 16.7% severe impairment (SAFE 0-4). Approximately one third (29.8%) received ≥1 acute interventions (e.g., thrombolysis, thrombectomy). Data collection remains ongoing, and a larger total sample will be presented. Conclusion: The prevalence of upper limb weakness at this single tertiary centre aligns with recent international data. A better understanding of the upper limb weakness profile will help inform service delivery e.g., shifting resources to subgroups which are more common. Furthermore, it can guide researchers in target population selection in trials, which can enhance generalisability of findings.

Follow-up study of survivors of stage 2 or 3 in-hospital AKI with or without COVID-19

Background: Acute kidney injury (AKI) is a hallmark of hospitalized patients with Coronavirus Disease 2019 (COVID-19) and associated with in-hospital mortality. Recent data suggests glomerular filtration rate (GFR) continues to decline after discharge in COVID-19 AKI survivors, but there are very few reports describing the long-term postdischarge outcomes. Methods: This is an ongoing prospective study of 161 survivors of KDIGO stage 2 or 3 AKI who were admitted at Stony Brook Medicine (SBM) for COVID-19 between March-June 2020. 'CKD' was defined as patient's final outpatient serum creatinine (SCr) value remaining >10% or 50% above baseline (defined as the lowest SCr during hospitalization) and final GFR < 60 ml/min/1.73m2. CKD was divided into 'incident' and 'progressive' based on baseline CKD status. We also investigated the readmission rate with and without AKI and post-discharge mortality. A comparison cohort of 66 AKI survivors concurrently admitted to SBM who tested negative for COVID-19 were also analyzed for all outcomes. Results: COVID-19 AKI survivors were more likely to be non-White, Hispanic, have a lower prevalence of baseline CKD and greater severity of illness (mechanical ventilation, acute respiratory distress syndrome, vasopressor use and greater length of hospital stay) during hospitalization compared to COVID-19 negative survivors (p ≤ 0.01). COVID-19 negative AKI survivors were more likely to have re-hospitalization (p =0.03), although no difference was noted in re-hospitalization with AKI among the 2 groups. 29 out of 161 (18%) of COVID-19 positive AKI survivors died after their discharge from COVID hospitalization as compared to only 1 out of 66 patients (1.5%) of the COVID-19 negative AKI survivors (p<0.001). 42 (26.1%) of COVID-19 positive and 17 (25.8%) of the COVID-19 negative patients had a SCr and eGFR measure > 90 days after discharge. COVID-19 positive AKI survivors (11.9-19.0%) had no difference in the rate of incident or progressive CKD compared with COVID-19 negative AKI survivors (17.6%). Conclusions: COVID-19 positive survivors of Stage 2 or 3 in-hospital AKI were more likely to have greater severity of illness during hospitalization and greater postdischarge mortality compared to COVID-19 negative AKI survivors. We did not find a difference in the rates of incident or progressive CKD at 10 months follow-up.

The feasibility of day case thoracoscopy

Background: Northumbria Healthcare NHS Foundation Trust runs a very successful pleural service catering for patients with malignant pleural fluid, pleural infection and pneumothorax. Local anaesthetic medical thoracoscopy (LAT) is a well-established diagnostic, therapeutic and preventative procedure in undiagnosed pleural effusions. Patients were traditionally admitted for a mean of 3.4 days and had a large bore drain inserted post LAT and pleurodesis was performed. The Covid-19 pandemic has forced us to provide day case LAT with IPC placement without pleurodesis to minise transmission risk. We thus describe our local experience. LAT is performed in theatre under conscious sedation. Methods: All the notes of patients requiring day case LAT between July 2020-Dec 2020 were analysed. Basic demographics were collected as well as diagnoses and what interventions were performed. A descriptive analysis of the data was performed. Results: 13 patients underwent day case LAT. All had negative preoperative Covid-19 swabs. Mean age was 69.7 years (range 24–82). 10 were male and 3 female. Definite diagnoses included 5 lung cancers, 4 mesotheliomas and 2 fibrinous pleuritis. The lung did not deflate, not allowing for biopsies in 2 patients. Non-malignant diagnoses are currently presumed. 10 IPCs and 1 large bore drain were inserted due to 1 immedidate complication (surgical emphysema). 1 patient developed an empyema within 30days. 8 out of the 10 IPCs have already been removed due to pleurodesis occuring (mean number of days 27.5, range 16–72). All patients were discharged on the same day except 1 patient who required a large bore drain and stayed overnight. Conclusions: We have thus transformed our service after more than a decade of providing LAT as an inpatient service. This is a small cohort of patients but proves the feasibility and safety of day case LAT with massive reduction in inpatient stay. The Covid-19 pandemic has transformed our service but for the better. Further qualitative work should elucidate the acceptability of such a pathway for patients. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Anticipated stigma, stereotypes, and COVID-19 testing

Testing for COVID-19 is important for identifying, tracing, and treating COVID-19 cases as well as informing policy decisions. Evidence from other disease epidemics suggests that anticipated stigma and stereotypes are barriers to testing for disease. Anticipated stigma may undermine testing due to labeling avoidance (i.e., efforts to avoid receiving the label of a stigmatized status) and stereotypes may undermine testing by reducing perceived vulnerability to disease. Given the importance of scaling up COVID-19 testing, the current study explored the potential roles of anticipated stigma and stereotypes in COVID-19 testing. A cross-sectional, online survey was conducted with 845 United States adults in April 2020. Measures were adapted from previous studies of stigma associated with infectious diseases, and participants were asked about the likelihood that they would seek a COVID-19 test if one were to be ordered by their doctor. Analyses demonstrated that participants who anticipated greater COVID-19 stigma and endorsed COVID-19 stereotypes to a greater degree reported that they would be less likely to seek a COVID-19 test. Notably, endorsement of anticipated stigma and stereotypes was low, and knowledge and fear were stronger predictors of testing than stigma. Nonetheless, results provide preliminary evidence that anticipated stigma and stereotypes may represent barriers to testing in the context of COVID-19, similar to other diseases. As COVID-19 tests become more widely available, efforts may be needed to address COVID-19 stigma alongside other barriers such as access and knowledge to maximize testing efforts. (PsycInfo Database Record (c) 2020 APA, all rights reserved)

COVID-19 conspiracy beliefs, health behaviors, and policy support.

Conspiracy theories have been proliferating during the COVID-19 pandemic. Evidence suggests that belief in conspiracy theories undermines engagement in pro-health behaviors and support for public health policies. Moreover, previous work suggests that inoculating messages from opinion leaders that expose conspiracy theories as false before people are exposed to them can help to prevent belief in new conspiracies. Goals of this study were to: (a) explore associations between COVID-19 conspiracy beliefs with SARS-CoV-2 vaccine intentions, cooperation with public health recommendations, and support for public health policies among U.S. adults and (b) investigate trusted sources of COVID-19 information to inform strategies to address conspiracy beliefs. A cross-sectional, online survey was conducted with 845 U.S. adults in April 2020. Data were analyzed using analyses of variance and multivariable regressions. One-third (33%) of participants believed one or more conspiracies about COVID-19. Participants who believed conspiracies reported that their intentions to vaccinate were 3.9 times lower and indicated less support for COVID-19 public health policies than participants who disbelieved conspiracies. There were no differences in cooperation with public health recommendations by conspiracy belief endorsement in the multivariable regression analysis. Although there were some key differences in trusted sources of COVID-19 information, doctor(s) were the most trusted source of information about COVID-19 overall with 90% of participants trusting doctor(s). Doctor(s) may play a role in addressing COVID-19 conspiracy theories before people are exposed to them to promote COVID-19 prevention efforts.

Family Matters: Decade Review from Journal of Family and Economic Issues.

This article reviews research regarding economic influences on a variety of family matters published in Journal of Family and Economic Issues from 2010 to 2019. As finances permeate nearly every facet of everyday life, scholarly research related to finances and family issues has spanned a wide array of topics. We briefly review research focused on the following 11 areas related to finances and family matters: (a) family formation decisions, (b) gender and relational power in family finances and relationships, (c) finances and fathers, (d) finances and mothers, (e) finances and parenting, (f) finances and elderly family members, (g) finances and couple relationships, (h) supporting family members financially, (i) how economic policy affects family, (j) economic roots of migration by family members, and (k) family financial socialization. As we enter a new decade, emphasis to directions for future research is given and integrated throughout. Recommendations specific to each of these topics are integrated into the discussion of the topic. Additional and more general recommendations for future research are offered as we conclude our review.