The impact of a comprehensive coronavirus disease 2019 (COVID-19) infection prevention bundle on non-COVID-19 hospital-acquired respiratory viral infection (HA-RVI) rates.

After implementing a coronavirus disease 2019 (COVID-19) infection prevention bundle, the incidence rate ratio (IRR) of non-severe acute respiratory coronavirus virus 2 (non-SARS-CoV-2) hospital-acquired respiratory viral infection (HA-RVI) was significantly lower than the IRR from the pre-COVID-19 period (IRR, 0.322; 95% CI, 0.266-0.393; P < .01). However, HA-RVIs incidence rates mirrored community RVI trends, suggesting that hospital interventions alone did not significantly affect HA-RVI incidence.

CD4+ T cell calibration of antigen-presenting cells optimizes antiviral CD8+ T cell immunity.

Antiviral CD8+ T cell immunity depends on the integration of various contextual cues, but how antigen-presenting cells (APCs) consolidate these signals for decoding by T cells remains unclear. Here, we describe gradual interferon-α/interferon-ß (IFNα/ß)-induced transcriptional adaptations that endow APCs with the capacity to rapidly activate the transcriptional regulators p65, IRF1 and FOS after CD4+ T cell-mediated CD40 stimulation. While these responses operate through broadly used signaling components, they induce a unique set of co-stimulatory molecules and soluble mediators that cannot be elicited by IFNα/ß or CD40 alone. These responses are critical for the acquisition of antiviral CD8+ T cell effector function, and their activity in APCs from individuals infected with severe acute respiratory syndrome coronavirus 2 correlates with milder disease. These observations uncover a sequential integration process whereby APCs rely on CD4+ T cells to select the innate circuits that guide antiviral CD8+ T cell responses.

Unsupervised high-frequency smartphone-based cognitive assessments are reliable, valid, and feasible in older adults at risk for Alzheimer's disease.

OBJECTIVE: Smartphones have the potential for capturing subtle changes in cognition that characterize preclinical Alzheimer's disease (AD) in older adults. The Ambulatory Research in Cognition (ARC) smartphone application is based on principles from ecological momentary assessment (EMA) and administers brief tests of associative memory, processing speed, and working memory up to 4 times per day over 7 consecutive days. ARC was designed to be administered unsupervised using participants' personal devices in their everyday environments. METHODS: We evaluated the reliability and validity of ARC in a sample of 268 cognitively normal older adults (ages 65-97 years) and 22 individuals with very mild dementia (ages 61-88 years). Participants completed at least one 7-day cycle of ARC testing and conventional cognitive assessments; most also completed cerebrospinal fluid, amyloid and tau positron emission tomography, and structural magnetic resonance imaging studies. RESULTS: First, ARC tasks were reliable as between-person reliability across the 7-day cycle and test-retest reliabilities at 6-month and 1-year follow-ups all exceeded 0.85. Second, ARC demonstrated construct validity as evidenced by correlations with conventional cognitive measures (r = 0.53 between composite scores). Third, ARC measures correlated with AD biomarker burden at baseline to a similar degree as conventional cognitive measures. Finally, the intensive 7-day cycle indicated that ARC was feasible (86.50% approached chose to enroll), well tolerated (80.42% adherence, 4.83% dropout), and was rated favorably by older adult participants. CONCLUSIONS: Overall, the results suggest that ARC is reliable and valid and represents a feasible tool for assessing cognitive changes associated with the earliest stages of AD.

Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy.

Purpose: The objective of this study was to test for patient characteristics associated with virtual versus office visits among radiation oncology patients. Methods and Materials: Using the electronic health record, we extracted encounter data and corresponding patient information for the 6 months before and 6 months of COVID-19-enabled virtual visits (October 1, 2019, to March 22, 2020 vs March 23, 2020, to September 1, 2020) at a National Cancer Institute-Designated Cancer Center. Encounters during COVID-19 were categorized as in-person or virtual visits. We compared patient demographic variables including race, age, sex, marital status, preferred language, insurance status, and tumor type during the pre-COVID-19 period as a baseline versus during the COVID-19 period. Multivariable analyses examined associations between these variables and virtual visit use. Results: We analyzed 4974 total encounters (2287 before COVID-19 and 2687 during COVID-19) for 3960 unique patients. All (100%) pre-COVID-19 encounters were in-person. During COVID-19, 21% of encounters were via virtual visits. There were no differences identified in pre- versus during-COVID-19 patient characteristics. However, we found significant differences in patient characteristics for in-person versus virtual encounters during COVID-19. On multivariable analysis, virtual visit use was less common among patients who were Black versus White (odds ratio [OR], 0.75; 95% CI, 0.57-0.99; P = .044) and not married versus married (OR, 0.76; 95% CI, 0.59-0.98; P = .037). Patients with head and neck (OR, 0.63; 95% CI, 0.41-0.97; P = .034), breast (OR, 0.36; 95% CI, 0.21-0.62; P ≤ .001), gastrointestinal/abdominal (OR, 0.31; 95% CI, 0.15-0.63; P = .001), or hematologic malignancy (OR, 0.20; 95% CI, 0.04-0.95; P = .043) diagnoses were less likely to be scheduled for virtual visits relative to patients with genitourinary malignancy. No Spanish-speaking patients engaged in a virtual visit. We did not identify differences in the insurance status or sex of patients scheduled for virtual visits. Conclusions: We found significant differences in virtual visit use by patient sociodemographic and clinical characteristics. Further investigation into implications of differential virtual visit use including social and structural determinants and subsequent clinical outcomes is indicated.

The impact of COVID-19 on emotional, social, and behavioral health in adolescents with preexisting mental health concerns: A qualitative study

Objective: The COVID-19 pandemic has caused a decline in well-being for many adolescents. However, the impact of COVID-19 on mental health outcomes among adolescents remains understudied. The current study qualitatively examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Methods: We enrolled 20 adolescents who were engaged in care through an Adolescent Health Specialty Clinic prior to COVID-19. Participants were 12- to 19 years old who experienced mental health concerns prior to COVID-19 and experienced declining mental health (e.g., new mental health diagnosis or increased severity of previous mental health diagnosis reported during clinical visit or documented in medical chart) during the pandemic. In-depth interviews were conducted, and inductive coding was applied to transcripts to identify emergent themes. Results: Five key themes were identified: manifestations of declining mental health, loss of motivation, changes to social relationships, use of social media, and coping mechanisms. Adverse mental health outcomes were provoked by experiences of loneliness and social isolation, especially due to school closures which disrupted routines, access to educational and social support, and key cultural milestones. The increased uses of social media and illicit substances were notable coping strategies. Conclusions: Findings from this study strengthen our understanding of the key factors influencing the psychosocial well-being of adolescents during the pandemic. Our results may help inform researchers, clinicians, and policymakers to develop guidelines and community-based strategies for mitigating the potentially negative effects of future pandemic-related disruptions to mental health among adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The current study examined the impact of COVID-19 restrictions on adolescents with mental health concerns prior to the pandemic. Results emphasize the importance of obtaining first-hand perspectives from adolescents to optimize their care. Providers should prioritize mental health and substance use screening given the impact of the pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of sedentary behavior and emotional support on prenatal psychological distress and birth outcomes during the COVID-19 pandemic.

Abstract. BACKGROUND: Studies have reported mixed findings regarding the impact of the coronavirus disease 2019 (COVID-19) pandemic on pregnant women and birth outcomes. This study used a quasi-experimental design to account for potential confounding by sociodemographic characteristics. METHODS: Data were drawn from 16 prenatal cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) program. Women exposed to the pandemic (delivered between 12 March 2020 and 30 May 2021) (n = 501) were propensity-score matched on maternal age, race and ethnicity, and child assigned sex at birth with 501 women who delivered before 11 March 2020. Participants reported on perceived stress, depressive symptoms, sedentary behavior, and emotional support during pregnancy. Infant gestational age (GA) at birth and birthweight were gathered from medical record abstraction or maternal report. RESULTS: After adjusting for propensity matching and covariates (maternal education, public assistance, employment status, prepregnancy body mass index), results showed a small effect of pandemic exposure on shorter GA at birth, but no effect on birthweight adjusted for GA. Women who were pregnant during the pandemic reported higher levels of prenatal stress and depressive symptoms, but neither mediated the association between pandemic exposure and GA. Sedentary behavior and emotional support were each associated with prenatal stress and depressive symptoms in opposite directions, but no moderation effects were revealed. CONCLUSIONS: There was no strong evidence for an association between pandemic exposure and adverse birth outcomes. Furthermore, results highlight the importance of reducing maternal sedentary behavior and encouraging emotional support for optimizing maternal health regardless of pandemic conditions.

Why "sex as a biological variable" conflicts with precision medicine initiatives.

Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A "sex contextualist" approach to gender-inclusive medicine better aligns with this aim.

Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program.

OBJECTIVE: We sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic. STUDY DESIGN: Data of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes. RESULTS: Symptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life. CONCLUSION: In this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic. KEY POINTS: · COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..

Disability-Adjusted Life Years for Drug Overdose Crisis and COVID-19 Are Comparable During the Two Years of Pandemic in the United States.

OBJECTIVES: The drug overdose crisis with shifting patterns from primarily opioid to polysubstance uses and COVID-19 infections are two concurrent public health crises in the United States, affecting the population of sizes in different magnitudes (approximately <10 million for substance use disorder (SUD) and drug overdoses vs. 80 million for COVID-19 within two years of the pandemic). Our objective is to compare the relative scale of disease burden for the two crises within a common framework, which could help inform policymakers with resource allocation and prioritization strategies. METHODS: We calculated disability-adjusted life years (DALYs) for SUD (including opioids and stimulants) and COVID-19 infections, respectively. We collected estimates for SUD prevalence, overdose deaths, COVID-19 cases and deaths, disability weights, and life expectancy from multiple publicly available sources. We then compared age distributions of estimated DALYs. RESULTS: We estimated a total burden of 13.83 million DALYs for SUD and drug overdoses and 15.03 million DALYs for COVID-19 in two years since March 2020. COVID-19 burden was dominated by the fatal burden (>95% of total DALYs), whereas SUD burden was attributed to both fatal (53%) and non-fatal burdens (47%). The highest disease burden was among individuals aged 30-39 for SUD (27%) and 50-64 for COVID-19 (31%). CONCLUSIONS: Despite the smaller size of the affected population, SUD and drug overdoses resulted in comparable disease burden to the COVID-19 pandemic. Additional resources supporting evidence-based interventions in prevention and treatment may be warranted to ameliorate SUD and drug overdoses during both the pandemic and post-pandemic recovery.

Trends in Incident Pediatric Diabetes and the COVID-19 Pandemic

Objectives To identify trends in presentation and incidence of pediatric new-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) during the COVID-19 pandemic. Methods Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded over a three-year time period from April 1, 2018 until March 31, 2021. Time periods were separated as follows: April 1, 2018- March 31, 2019, April 1, 2019- March 31, 2020, and April 1, 2020- March 31, 2021. The final time period represents the COVID-19 pandemic. Microsoft Excel (2016) was used to calculate descriptive statistics (eg. Mean, standard deviations) and perform statistical analysis of continuous variables (eg. ANOVA). Statistical analysis of categorical variables (eg. sex, race, ethnicity) was performed by Chi-squared test or Fisher's exact test using R studio version 3.5.2. Cochran Armitage tests were performed to assess for trends in severity of diabetic patients from 2018 to 2020 and to determine if COVID-19 impacted diabetes severity using R (version 1.4.1106) and the DescTools package. Results In total, 207 patients were diagnosed with incident diabetes from April 2018 through March 2021, 108 with T1D and 86 with T2D. During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46;an increase of 48%. The number of patients with T1D presenting with mild diabetic ketoacidosis (DKA) significantly increased from 6% to 23% (p-value = 0.027). Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The rate of patients with T2D presenting in DKA increased overall from 12% (n=2) in 2018 and 6% (n=1) in 2019, to 23% in 2020 (n=12), an increase of 91.7% from 2018 to 2020 . Furthermore, patients with T2D presenting with mild DKA increased by 116%. Prior to the pandemic, incident cases of T2D accounted for 35% of all newly diagnosed pediatric diabetes cases. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the childhood diabetes trends with profound individual and community health consequences.

Barriers to and solutions for representative inclusion across the lifespan and in life course research: The need for structural competency highlighted by the COVID-19 pandemic.

Exclusion of special populations (older adults; pregnant women, children, and adolescents; individuals of lower socioeconomic status and/or who live in rural communities; people from racial and ethnic minority groups; individuals from sexual or gender minority groups; and individuals with disabilities) in research is a pervasive problem, despite efforts and policy changes by the National Institutes of Health and other organizations. These populations are adversely impacted by social determinants of health (SDOH) that reduce access and ability to participate in biomedical research. In March 2020, the Northwestern University Clinical and Translational Sciences Institute hosted the "Lifespan and Life Course Research: integrating strategies" "Un-Meeting" to discuss barriers and solutions to underrepresentation of special populations in biomedical research. The COVID-19 pandemic highlighted how exclusion of representative populations in research can increase health inequities. We applied findings of this meeting to perform a literature review of barriers and solutions to recruitment and retention of representative populations in research and to discuss how findings are important to research conducted during the ongoing COVID-19 pandemic. We highlight the role of SDOH, review barriers and solutions to underrepresentation, and discuss the importance of a structural competency framework to improve research participation and retention among special populations.

Trends in Incident Pediatric Diabetes and the COVID-19 Pandemic

Objectives To identify trends in presentation and incidence of pediatric new-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) during the COVID-19 pandemic. Methods Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded over a three-year time period from April 1, 2018 until March 31, 2021. Time periods were separated as follows: April 1, 2018- March 31, 2019, April 1, 2019- March 31, 2020, and April 1, 2020- March 31, 2021. The final time period represents the COVID-19 pandemic. Microsoft Excel (2016) was used to calculate descriptive statistics (eg. Mean, standard deviations) and perform statistical analysis of continuous variables (eg. ANOVA). Statistical analysis of categorical variables (eg. sex, race, ethnicity) was performed by Chi-squared test or Fisher's exact test using R studio version 3.5.2. Cochran Armitage tests were performed to assess for trends in severity of diabetic patients from 2018 to 2020 and to determine if COVID-19 impacted diabetes severity using R (version 1.4.1106) and the DescTools package. Results In total, 207 patients were diagnosed with incident diabetes from April 2018 through March 2021, 108 with T1D and 86 with T2D. During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46;an increase of 48%. The number of patients with T1D presenting with mild diabetic ketoacidosis (DKA) significantly increased from 6% to 23% (p-value = 0.027). Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The rate of patients with T2D presenting in DKA increased overall from 12% (n=2) in 2018 and 6% (n=1) in 2019, to 23% in 2020 (n=12), an increase of 91.7% from 2018 to 2020 . Furthermore, patients with T2D presenting with mild DKA increased by 116%. Prior to the pandemic, incident cases of T2D accounted for 35% of all newly diagnosed pediatric diabetes cases. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the childhood diabetes trends with profound individual and community health consequences.

Factors Influencing Consumer Behavior towards Online Shopping in Saudi Arabia Amid COVID-19: Implications for E-Businesses Post Pandemic

The coronavirus disease 2019 (COVID-19) has significantly reshaped consumer behaviors in Saudi Arabia, as in most other countries worldwide, and it has played a critical role in rising commercial online activities. The purpose of this study is to test the factors affecting online shopping amid COVID-19 in Saudi Arabia. The five main factors identified from the literature review towards online shopping namely, product variety, convenience, payment method, trust, and psychological factors were analyzed and examined in the Saudi context. The research collected data online through a pre-tested instrument, which was directed to online Saudi consumers via different electronic tools, e.g., email and social media platforms. The results of a statistical analysis showed that only three factors have a direct significant impact on online shopping amid the COVID-19 pandemic. These factors were product variety, payment method, and psychological factors. Convenient and trust factors failed to have a significant impact on consumers' decisions to shop online amid COVID-19. Both factors were less important for consumers, since shopping online amid COVID-19 has become most common among people. The result will assist e-commerce businesses to better meet consumer demands by adjusting their marketing strategies, especially in times of crisis.

Universal masking in hospitals in the COVID-19 era: Is it time to consider shielding?

With concerns for presymptomatic transmission of COVID-19 and increasing burden of contact tracing and employee furloughs, several hospitals have supplemented pre-existing infection prevention measures with universal masking of all personnel in hospitals. Other hospitals are currently faced with the dilemma of whether or not to proceed with universal masking in a time of critical mask shortages. We summarize the rationale behind a universal masking policy in healthcare settings, important considerations before implementing such a policy and the challenges with universal masking. We also discusses proposed solutions such as universal face shields.

How Cumulative Statistics Can Mislead: The Temporal Dynamism of Sex Disparities in COVID-19 Mortality in New York State.

Overall, men have died from COVID-19 at slightly higher rates than women. But cumulative estimates of mortality by sex may be misleading. We analyze New York State COVID-19 mortality by sex between March 2020 and August 2021, demonstrating that 72.7% of the total difference in the number of COVID-19 deaths between women and men was accrued in the first seven weeks of the pandemic. Thus, while the initial surge in COVID-19 mortality was characterized by stark sex disparities, this article shows that disparities were greatly attenuated in subsequent phases of the pandemic. Investigating changes over time could help illuminate how contextual factors contributed to the development of apparent sex disparities in COVID-19 outcomes.

The impact of COVID-19 on student learning during the transition from remote to in-person learning: using mind mapping to identify and address faculty concerns.

The COVID-19 pandemic led to the suspension of in-person learning at many higher education institutions (HEIs) in March 2020. In response, HEIs transitioned most courses to online formats immediately and continued this mode of instruction through the 2020-2021 academic year. In fall 2021, numerous HEIs resumed in-person courses and some hybrid courses, and faculty began noting academic-related behavior deficiencies not previously observed in students. Focus groups of teaching faculty (n = 8) from one university department were conducted to gather information on changes in student academic-related behaviors attributed to the disruption of teaching and learning due to COVID-19 and to compare observed deficiencies with the university's undergraduate learning goals. Mind mapping software was utilized to capture themes and subthemes. Identified themes were related to problem-solving skills, grades, time management, attendance, and interpersonal communication, both in terms of student-to-student and student-to-faculty communication. For these identified areas, outcomes during the return to in-person learning were mostly undesirable. Based on these identified issues, suggested modifications that HEIs could use to modify course content and delivery to offset skill gaps and improve interpersonal communication were identified. Furthermore, observations may indicate that fully remote learning inhibited student learning and skill development during the 2020-2021 academic year. Future work should examine the effectiveness of the proposed modifications on student success.NEW & NOTEWORTHY This article contains information gathered from mind map-driven faculty focus group observations of student academic-related deficiencies resulting from transitioning from remote to in-person learning and how said deficiencies compare to university undergraduate learning goals.