A mixed methods study of Aboriginal health workers' and exercise physiologists' experiences of co-designing chronic lung disease 'yarning' education resources.

BACKGROUND: Despite the high incidence of chronic obstructive pulmonary disease (COPD) in Aboriginal communities in Australia, Aboriginal Health Workers (AHWs) have limited knowledge about effective management. AIM: To evaluate an online education program, co-designed with AHWs and exercise physiologists (EPs) or physiotherapists (PTs), to increase knowledge about COPD and its management. METHODS: AHWs and EPs from four Aboriginal Community Controlled Health Services (ACCHS) were recruited. An Aboriginal researcher and a physiotherapist experienced in COPD management and pulmonary rehabilitation (PR) delivered seven online education sessions. These sessions used co-design principles and an Aboriginal pedagogy framework '8 Ways of learning', which incorporates Aboriginal protocols and perspectives to realign teaching techniques and strengthen learning outcomes. Topics covered were: How the lungs work; What is COPD; Medications and how to use inhalers and COPD Action Plans; Why exercise is important; Managing breathlessness; Healthy eating; Managing anxiety and depression. After each session, AHWs with support from EPs, co-designed education 'yarning' resources using Aboriginal ways of learning to ensure topics were culturally safe for the local Aboriginal community and practiced delivering this at the following session. At the end of the program participants completed an anonymous online survey (5-point Likert scale) to assess satisfaction, and a semi-structured interview about their experience of the online education. RESULTS: Of the 12 participants, 11 completed the survey (7 AHWs, 4 EPs). Most (90%) participants strongly agreed or agreed that the online sessions increased knowledge and skills they needed to support Aboriginal patients with COPD. All (100%) participants felt: their cultural perspectives and opinions were valued and that they were encouraged to include cultural knowledge. Most (91%) reported that delivering their own co-designed yarning scripts during the online sessions improved their understanding of the topics. Eleven participants completed semi-structured interviews about participating in online education to co-design Aboriginal 'yarning' resources. Themes identified were: revealing the Aboriginal lung health landscape; participating in online learning; structuring the online education sessions; co-designing with the facilitators. CONCLUSIONS: Online education using co-design and 8 Ways of learning was rated highly by AHWs and EPs for improving COPD knowledge and valuing cultural perspectives. The use of co-design principles supported the cultural adaptation of COPD resources for Aboriginal people with COPD. TRIAL REGISTRATION: PROSPERO (registration number: CRD42019111405).

A unique case report of Vogt‐Koyanagi‐Harada syndrome following COVID‐19 vaccination

Purpose: To report a case of Vogt–Koyanagi–Harada‐like disease (VKH) associated with COVID‐19 vaccination. Methods: Analysis of a single case report in a single tertiary institution. Results: A 48‐year‐old female presented with bilateral progressive blurring of vision 2 days after receiving her first dose of Pfizer‐BioNTech COVID‐19 vaccine. Clinical examination revealed multiple deep yellow lesions in the posterior pole and multifocal serous retinal detachments. Serological test for infective and autoimmune markers were negative. The patient was started on oral corticosteroids and had resolution of symptoms with near‐total improvement in visual acuity. Conclusions: There have been previous cases of vaccine associated uveitis from reported cases of hepatitis B vaccine, human papilloma virus vaccine and influenza vaccine1,2,3,4,5. The exact mechanism of vaccine‐associated uveitis is currently not clear. In this present case, because of the short time interval between COVID‐19 vaccination and the onset of ocular inflammation in our patient, this raises the possibility that COVID‐19 vaccination may be a possible trigger for VKH. References 1. Benage M, Fraunfelder FW. Vaccine‐associated uveitis. Mo Med. 2016;113(1): 48–52. 2. Holt HD, Hinkle DM, Falk NS, Fraunfelder FT, Fraunfelder FW. Human papilloma virus vaccine associated uveitis. Curr Drug Saf 2014;9(1): 65–8. doi:10.2174/15748863113086660062 3. Cunningham ET, Jr., Moorthy RS. Vaccine‐Associated Posterior Uveitis. Retina 2020;40(4): 595–8. doi:10.1097/IAE.0000000000002816 4. Escott S, Tarabishy AB, Davidorf FH. Multifocal choroiditis following simultaneous hepatitis A, typhoid, and yellow fever vaccination. Clin Ophthalmol 2013;7: 363–5. doi:10.2147/OPTH.S37443 5. Fraunfelder FW, Suhler EB, Fraunfelder FT. Hepatitis B vaccine and uveitis: an emerging hypothesis suggested by review of 32 case reports. Cutan Ocul Toxicol 2010;29(1): 26–9. doi:10.3109/15569520903427717

Screening for COVID-19: Patient factors predicting positive PCR test

To inform the efficient allocation of testing resources, we evaluated the characteristics of those tested for COVID-19 to determine predictors of a positive test. Recent travel and exposure to a confirmed case were both highly predictive of positive testing. Symptom-based screening strategies alone may be inadequate to control the ongoing pandemic.

Impact of active and latent concerns about COVID-19 on attention.

The interactions between emotion and attention are complex due to the multifaceted nature of attention. Adding to this complexity, the COVID-19 pandemic has altered the emotional landscape, broadly heightening health and financial concerns. Can the heightened concerns about COVID-19 impair one or more of the components of attention? To explore the connection between heightened concerns about COVID-19 and attention, in a preregistered study, we collected survey responses from 234 participants assessing levels of concerns surrounding COVID-19, followed by four psychophysics tasks hypothesized to tap into different aspects of attention: visual search, working memory, sustained attention, and cognitive control. We also measured task-unrelated thoughts. Results showed that task-unrelated thoughts, but not survey reports of concern levels, negatively correlated with sustained attention and cognitive control, while visual search and working memory remained robust to task-unrelated thoughts and survey-indicated concern levels. As a whole, these findings suggest that being concerned about COVID-19 does not interfere with cognitive function unless the concerns are active in the form of task-unrelated thoughts.

Mental Health Consequences of the COVID-19 Pandemic Among Older Adults With Chronic Conditions

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. This cross-sectional qualitative study evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. Participants included a total of 492 adults (M = 64.95 years, SD = 8.91, range = 50 – 94) from Michigan (82.1%) and 33 other U.S. states who reported a diagnosis of at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. Participants provided open-ended responses to a question about the pandemic’s impact on how they were taking care of their mental health. The data were coded to ascertain relevant concepts and were reduced to develop major themes. We determined four main themes. The pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction;(2) pandemic-related routine changes;(3) pandemic-related stress;and (4) pandemic-related changes to mental health care. Taken as a whole, this study indicates that older adults with chronic conditions encountered a variety of challenges to managing their mental health in the early months of the COVID-19 pandemic, but also demonstrated considerable resilience. These findings identify potential risk and protective factors to target as part of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

Health Impacts of the COVID-19 Pandemic Among Older Adults With Chronic Conditions

The COVID-19 pandemic may have adverse health implications, particularly among older adults with chronic conditions who are at increased risk of severe illness. This cross-sectional study examined the early health impacts of the pandemic among adults aged 50 and older with chronic conditions. Participants included 700 adults (M = 64.60 years, SD = 8.85, range = 50 – 94) from Michigan (82.4%) and 33 other U.S. states who reported at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. Of these, 488 also provided open-ended responses. Individuals reported lower illness self-efficacy, less consumption of fruits, vegetables, and fried foods, and lower physical activity, along with greater alcohol use since the pandemic. About half (42.7%) reported worsened sleep. One in five (20.1%) reported at least some difficulty obtaining medications and over half (60.4%) reported at least some difficulty receiving routine care. Almost two-thirds (63.9%) had delayed preventative care and one in five (19.3%) had delayed essential medical treatment. Nearly half (42.6%) avoided contacting care providers about a physical health concern and one in eight (12.9%) avoided reporting mental health concerns. Qualitative data revealed that the pandemic has influenced how participants cared for their physical health through following guidelines related to COVID-19;coping with daily routine changes;greater awareness of self-care;mental health impacts;and health care disruptions. Older adults with chronic conditions report distinct pandemic-related challenges for self-care and health care that should be addressed in interventions to maintain their health and functioning.

Do concerns about COVID-19 impair sustained attention?

The novel coronavirus disease 2019 (COVID-19) has considerably heightened health and financial concerns for many individuals. Similar concerns, such as those associated with poverty, impair performance on cognitive control tasks. If ongoing concerns about COVID-19 substantially increase the tendency to mind wander in tasks requiring sustained attention, these worries could degrade performance on a wide range of tasks, leading, for example, to increased traffic accidents, diminished educational achievement, and lower workplace productivity. In two pre-registered experiments, we investigated the degree to which young adults' concerns about COVID-19 correlated with their ability to sustain attention. Experiment 1 tested mainly European participants during an early phase of the pandemic. After completing a survey probing COVID-related concerns, participants engaged in a continuous performance task (CPT) over two, 4-min blocks, during which they responded to city scenes that occurred 90% of the time and withheld responses to mountain scenes that occurred 10% of the time. Despite large and stable individual differences, performance on the scene CPT did not significantly correlate with the severity of COVID-related concerns obtained from the survey. Experiment 2 tested US participants during a later phase of the pandemic. Once again, CPT performance did not significantly correlate with COVID concerns expressed in a pre-task survey. However, participants who had more task-unrelated thoughts performed more poorly on the CPT. These findings suggest that although COVID-19 increased anxiety in a broad swath of society, young adults are able to hold these concerns in a latent format, minimizing their impact on performance in a demanding sustained attention task.