Participation Among Community-Dwelling Older Adults During the COVID-19 Pandemic: A Cross-Sectional Analysis.

OBJECTIVE: Participation in life situations is a critical aspect of health recognized by the World Health Organization. Guidelines to prevent spreading of COVID-19 place older adults at risk for worsening participation. The purpose of this study was to identify the factors associated with participation during the COVID-19 pandemic among community-dwelling older adults living in Hamilton, Ontario, Canada. METHODS: Participants were recruited from identified census dissemination areas in Hamilton. Participants completed surveys either by phone or online during the months of May to August 2020. Measures were organized into factors related to body functions and structures, activities, participation, as well as personal and environmental contextual factors using the International Classification of Functioning, Disability, and Health (ICF) framework. Multivariable regression analysis was conducted to identify factors associated with participation as measured by the Late-Life Disability Instrument's (LLDI) frequency and limitations scales. RESULTS: A total of 272 older adults completed the survey (78 y [SD = 7.3 y]; 70% female). Use of a walking aid, driving status, perceived mental health status, nutrition risk, and physical function explained 48.2% of the variance observed in the LLDI-frequency scale scores. Use of a walking aid, driving status, perceived mental health status, receiving health assistance, and physical function explained 38.5% of the variance observed in the LLDI-limitation scale scores. CONCLUSION: Results highlighted factors across multiple ICF domains that are associated with participation restriction among a sample of community-dwelling older adults during the pandemic. Participation during the pandemic was greatest in those that were able to walk without needing to use a walking aid, being a licensed and current driver, perceiving good to excellent mental health, and having greater physical function. IMPACT: Our findings contribute to the literature on older adult participation during lockdowns, restrictions, pandemics, and/or other similar circumstances.

Utilization of teledermatology services for dermatological diagnoses during the COVID-19 pandemic.

Little is known about trends in teledermatology adoption and use for managing dermatologic patients, especially changes in use influenced by the COVID-19 pandemic. In this retrospective cohort study, we analyzed encounter data from the Healthjump dataset (containing electronic health record data from throughout the USA) for visits from November 2019 to July 2021 with a primary dermatology-related diagnosis. There was a striking rise in teledermatology use with the onset of the pandemic in February 2020, peaking in April 2020 with 2178 teledermatology encounters (32.8% of all encounters). Subsequently, teledermatology use waned. Most teledermatology care was delivered via synchronous means with little use of asynchronous or telephone communication. When compared to those with neoplastic skin diseases, patients with inflammatory skin diseases were more likely to be seen via teledermatology (OR 3.30, 95% CI 3.12-3.49). Certain demographic groups were less likely to receive care via teledermatology, such as men (compared with females, OR 0.76, 95% CI 0.74-0.78) and patients 65 and older (compared with those below 65, OR 0.59, 95% CI 0.57-0.62). Our work shows increased adoption of teledermatology at the onset of the COVID-19 pandemic with decreasing use over time. Future efforts are needed to ensure continued and expanded use of a valuable care modality to reach vulnerable populations.

Method validation for the recovery of the porcine respiratory and reproductive syndrome virus, a potential SARS-CoV-2 surrogate, from stainless steel.

Virus survival on fomites may represent a vehicle for transmission to humans. This study was conducted to optimize and validate a recovery method for the porcine respiratory and reproductive syndrome virus (PRRSV), a potential SARS-CoV-2 surrogate, from stainless steel. Coupons (1.5 × 1.5 cm) inoculated with ca. 7 logs TCID50 of PRRSV were dried for 15 min at room temperature, followed by incubation at 4°C and 35% relative humidity. After 1 h and 24 h, the coupons were processed by four different methods: vortex in DMEM media, vortex in DMEM media with beads, vortex in elution buffer, and shake in elution buffer. The rinsates were processed for titration using the TCID50 method in the MARC-145 cell line. All four methods were equally effective to recover the virus from the soiled SS surfaces (> 79% recovery). The amount of infectious virus recovered after 24 h was similar (P > 0.05) to that recovered after 1 h, indicating that the virus was stable at 4°C for up to 24 h. Using an elution buffer followed by shaking was the least labor-intensive and most economical method. Therefore, this method will be used for future experiments on PRRSV survival and transfer from food-contact surfaces.

Late Onset of Organizing Pneumonia Following SARS-CoV-2 Infection: A Case Report of Successful Management and Review Literature.

A late consequence of COVID-19, organizing pneumonia is characterized by significant imaging and pathological abnormalities. The goals of this study are to better understand these abnormalities. The use of corticoid continues to be the recommended course of treatment for COVID-19. On the other hand, it is not clear whether or not corticoid has the same impact on organizing pneumonia after COVID-19. A 53-year-old male patient was identified with organized pneumonia following COVID-19 infection. He was diagnosed after experiencing severe respiratory symptoms several days with no improvement. We initiated a high dose of corticoid based on imaging and pathological findings and observed a significant response. In addition, we looked into the research that has been done concerning the diagnosis and treatment of this peculiar ailment. Patients who have been diagnosed with pneumonia after COVID 19 are required to undergo a reevaluation that includes a chest CT scan, and some of these patients may be candidates for an early lung biopsy. The most effective and convincing therapy for COVID-19-induced organizing pneumonia is corticoid treatment at a dose equivalent to 0.5 mg/kg/day of prednisone.

Factors Influencing Mobility During the COVID-19 Pandemic in Community-Dwelling Older Adults.

OBJECTIVE: To describe and identify factors influencing mobility among older adults during the first 5 months of the COVID-19 pandemic. DESIGN: A cross-sectional telesurvey. SETTING: Community dwelling older adults, situated within the first 5 months of the COVID-19 pandemic, in Hamilton, Canada. PARTICIPANTS: A random sample of 2343 older adults were approached to be in the study, of which 247 completed the survey (N=247). Eligible participants were aged ≥65 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mobility was measured using global rating of change items and the Late Life Function Instrument (LLFI). Multivariate linear regression models were used to examine the association between mobility and related factors based on Webber's model. RESULTS: 247 older adults (29% male, mean age 78±7.3 years) completed surveys between May and August 2020. Respectively, 26%, 10%, and 9%, rated their ability to engage in physical activity, housework, and move around their home as worse compared with the start of the pandemic. The mean LLFI score was 60.9±13.4. In the model, walking volume (ß=0.03 95% confidence interval 0.013, 0.047), fall history (ß=-0.04, 95% confidence interval -0.08, -0.04), male sex (ß=0.06, 95% confidence interval 0.02, 0.09), unpleasant neighborhood (ß=-0.06, 95% confidence interval -0.11, -0.02), musculoskeletal pain (ß=-0.07, 95% confidence interval -0.11, -0.03), and self-reported health (ß=0.08, 95% confidence interval 0.03, 0.13) had the strongest associations with LLFI scores and explained 64% of the variance in the LLFI score. CONCLUSIONS: Physical and environmental factors may help explain poorer mobility during lockdowns. Future research should examine these associations longitudinally to see if factors remain consistent over time and could be targeted for rehabilitation.

Disease Recognition in X-ray Images with Doctor Consultation-Inspired Model.

The application of chest X-ray imaging for early disease screening is attracting interest from the computer vision and deep learning community. To date, various deep learning models have been applied in X-ray image analysis. However, models perform inconsistently depending on the dataset. In this paper, we consider each individual model as a medical doctor. We then propose a doctor consultation-inspired method that fuses multiple models. In particular, we consider both early and late fusion mechanisms for consultation. The early fusion mechanism combines the deep learned features from multiple models, whereas the late fusion method combines the confidence scores of all individual models. Experiments on two X-ray imaging datasets demonstrate the superiority of the proposed method relative to baseline. The experimental results also show that early consultation consistently outperforms the late consultation mechanism in both benchmark datasets. In particular, the early doctor consultation-inspired model outperforms all individual models by a large margin, i.e., 3.03 and 1.86 in terms of accuracy in the UIT COVID-19 and chest X-ray datasets, respectively.

A Case of COVID-19-Induced Delayed-Onset Myocarditis.

BACKGROUND COVID-19 is a pandemic caused by a coronavirus that has only recently been discovered. The disorder is characterized by persistent respiratory system malfunction, which can range from modest difficulty breathing to potentially lethal complications such as acute respiratory distress syndrome. Additional organs are affected as a result of its presence. An adverse impact of COVID-19 infection is myocarditis, which is a condition that affects the heart muscle. CASE REPORT We describe the case of a 38-year-old woman who was hospitalized at University Medical Center Ho Chi Minh City following a 15-day fever, a 3-day bout of dyspnea, and a positive nasal PCR SAR-CoV-2 test. The Lake Louise criteria were used to determine that the patient had a high probability of having myocarditis. She was then treated with oxygen treatment, vasoconstrictor medicines, inotropic therapy, and cornerstone heart failure medications, and was discharged 2 weeks later after a complete recovery. CONCLUSIONS Myocarditis has been identified as a cause of death in COVID-19, although it is not known how common the ailment is in the general population. Early detection and complete treatment, which should include support for the cardiovascular system, are consequently critical for successful outcomes. Magnetic resonance imaging (MRI) of the cardiovascular system (cardiac MRI) is the most important noninvasive method for diagnosing myocarditis.

A Case of Rebound Inflammation in a 38-Year-Old Man with Severe COVID-19 Pneumonia Following Cessation of Dexamethasone Therapy.

BACKGROUND Since the initial COVID-19 cases in 2019, the pandemic has expanded globally. Clinical data showed that dexamethasone treatment at a dose of 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who were receiving respiratory support decreased 28-day mortality in COVID-19 patients. Recent reports, on the other hand, have indicated that both steroid resistance and rebound events occur. We report a case of rebound inflammation after the termination of dexamethasone medication in a 38-year-old man with severe COVID-19 pneumonia, which improved after the reintroduction of dexamethasone. CASE REPORT A 38-year-old male patient with no past medical history of note presented with new onset of dyspnea. He was subsequently diagnosed with severe coronavirus disease 2019 (COVID-19). Initially, the patient was clinically improved following a 3-day course of 16 mg of dexamethasone daily. Shortly after discontinuing corticosteroids, the patient's clinical condition deteriorated, necessitating increased oxygen support. Following the reintroduction of corticosteroids, the patient gradually improved and responded favorably in terms of respiratory function, symptoms, and imaging, after which he was successfully discharged. CONCLUSIONS This case exemplifies the previously observed rebound effects of discontinuing dexamethasone medication in individuals with severe COVID-19 pneumonia. The timing and length of dexamethasone medication should be tailored to the individual patient. In addition, monitoring lung function should be part of the gradual withdrawal of dexamethasone to avoid rebound lung inflammation and the long-term effects of increasing lung fibrosis.

Impact of the COVID-19 Pandemic on Participation in Community-Dwelling Older Adults: A Cross-Sectional Analysis

Public health guidelines to prevent spreading COVID-19 place older adults at risk of loneliness and social isolation. Evidence suggests that participation protects older adults from such detrimental outcomes, therefore we aimed to identify the factors associated with participation in life roles among older adults living in the community during the COVID-19 pandemic. We conducted a telesurvey on a random sample of community-dwelling older adults living in Hamilton, Ontario, Canada, between May and July 2020. Outcome measures included participation in life roles, physical function, physical activity, mobility, mental health, nutrition, and demographics. We conducted two multivariate regression analyses with the Late Life Disability Instrument’s (LLDI) frequency and limitations scales as the dependent variables. Candidate factors were organized by International Classification of Functioning, Disability, and Health (ICF) framework domains;personal factors, body functions and structures, activities, and environmental factors. A total of 272 older adults completed the telesurvey (mean age 78 ±7.3 yrs, 70% female). Age, using walking aids, driving status, household income, education, mental health, nutrition, physical function, and dwelling type explained 47.1% (p<0.001) of the variance observed in LLDI frequency scores. Using walking aids, driving status, receiving health assistance, mental health, and physical function explained 33.9% (p<0.001) of the variance observed in LLDI limitation scores. These findings highlight factors from multiple ICF domains that are associated with participation limitation and frequency among older adults during the pandemic. Our findings have implications for developing public health initiatives to mitigate the effects of the pandemic on the participation of older adults.