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Geographic information systems (GIS) and choropleth maps for COVID-19 cases as well as COVID-19 test and vaccination rates proved very valuable to informing decision-making on the local and regional levels of government in Shelby County, Tennessee, USA. The authors have all served on the City of Memphis and Shelby County COVID Joint Task Force and share here their observations about the challenges and promises related to these techniques in the context of a fast-changing environment. As the pandemic unfolded, new virus variants emerged and the population became increasingly vaccinated. Consequently, the use of GIS changed, and maps needed to be continually adapted to the shifting needs of decision makers. The authors describe their approaches to leveraging GIS techniques to monitor the spread of the disease, draw conclusions about the effect of policy measures, and address health disparities. They outline the strengths and weaknesses of choropleth maps, reflect on how best to facilitate interorganizational communication of the derived information, and suggest desirable aspects of educational courses for GIS as well as skill sets in personnel that they came to appreciate as essential. © 2023 Taylor and Francis Group, LLC.
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BackgroundBimekizumab (BKZ), a monoclonal IgG1 antibody that selectively inhibits interleukin (IL)-17F in addition to IL-17A, met all primary/secondary endpoints at Week (Wk) 16 in patients (pts) with active non-radiographic axial spondyloarthritis (nr-axSpA) and radiographic axSpA (r-axSpA;i.e., ankylosing spondylitis), in the parallel phase 3 BE MOBILE 1 and 2 studies, respectively.[1,2]ObjectivesTo assess efficacy and safety of BKZ in these pts up to Wk 52.MethodsBE MOBILE 1 (NCT03928704) and 2 (NCT03928743) both involved a 16-wk placebo (PBO)-controlled and 36-wk maintenance period.[1,2] Pts were randomised to subcutaneous BKZ 160 mg Q4W (BKZ) or to PBO then BKZ from Wk 16 (PBO/BKZ).Results220/254 (86.6%) randomised pts with nr-axSpA and 298/332 (89.8%) with r-axSpA completed Wk 52. Efficacy was sustained to Wk 52 in both studies (Table 1). ASAS40 responses in BKZ-randomised pts increased from Wk 16 (nr-axSpA: 47.7%;r-axSpA: 44.8%;non-responder imputation [NRI]) to Wk 52 (60.9%;58.4%;NRI) with high levels of efficacy across TNFi-naïve and TNFi-IR populations (Table 1). At Wk 52, ASDAS <2.1 was achieved by 61.6% and 57.1%, and ASDAS <1.3 by 25.2% and 23.4%, of BKZ-randomised pts with nr-axSpA and r-axSpA, respectively (Figure 1). Wk 16 reductions from baseline in objective signs of inflammation (MRI, hs-CRP), and improvements in function (BASFI) and ASQoL, were maintained through 52 wks. Efficacy at Wk 52 was similar in PBO/BKZ-treated and BKZ-randomised pts (Table 1).At Wk 52, 75.0% (183/244) of pts with nr-axSpA and 75.5% (249/330) of pts with r-axSpA had ≥1 treatment-emergent adverse event (TEAE) on BKZ;the most frequent (% pts) TEAEs by preferred term (MedDRA v19.0) were nasopharyngitis (nr-axSpa: 12.3%;r-axSpA 9.1%) and upper respiratory tract infection (9.4%;6.4%);few COVID-19 infections were reported (7.0%;2.1%). Incidence (pts/100 pt years) of serious TEAEs were low (4.4;7.1);no major adverse cardiovascular events, active tuberculosis cases, serious COVID-19 infections, or deaths were reported. Most incidences of fungal infection (19.6;14.9;none serious or systemic) were Candida (12.8;8.3) and mild to moderate;two pts in both studies discontinued the study due to Candida infections. Incidence of IBD (1.0;1.0) and uveitis (1.5;2.4) were low.ConclusionAcross the axSpA spectrum, BKZ resulted in sustained efficacy to Wk 52. No new safety signals were observed, consistent with the Wk 24 safety profile.[1,2]References[1]Deodhar A. Ann Rheum Dis 2022;81:772–3;2.[2]van der Heijde D. Ann Rheum Dis 2022;81:12–3.Table 1.Efficacy at Wk 52Mean (SE), unless statedBE MOBILE 1BE MOBILE 2PBO→BKZ N=126BKZ N=128PBO→BKZ N=111BKZ N=221ASAS40 [NRI] n (%)64 (50.8)78 (60.9)76 (68.5)129 (58.4)ASAS40 in TNFi-naïve [NRI] n (%)58 (53.2)a73 (61.9)b67 (71.3)c108 (58.7)dASAS40 in TNFi-IRe [NRI] n (%)6 (35.3)f5 (50.0)g9 (52.9)f21 (56.8)hASAS20 [NRI] n (%)88 (69.8)94 (73.4)89 (80.2)158 (71.5)ASAS PR [NRI] n (%)38 (30.2)38 (29.7)41 (36.9)66 (29.9)ASAS 5/6 [NRI] n (%)65 (51.6)71 (55.5)74 (66.7)124 (56.1)BASDAI CfB [MI]–3.5 (0.2)–3.9 (0.2)–4.0 (0.2)–3.6 (0.1)BASFI CfB [MI]–2.6 (0.2)–3.0 (0.2)–2.8 (0.2)–2.8 (0.1)ASDAS-MI [NRI] n (%)37 (29.4)47 (36.7)49 (44.1)71 (32.1)Nocturnal spinal pain CfB [MI]–4.1 (0.2)–4.3 (0.3)–4.6 (0.3)–4.1 (0.2)ASQoL CfB [MI]–5.3 (0.4)–5.9 (0.4)–5.6 (0.4)–5.7 (0.3)SF-36 PCS CfB [MI]11.4 (0.9)12.2 (0.9)12.3 (0.9)12.0 (0.6)BASMI CfB [MI]–0.4 (0.1)–0.6 (0.1)–0.7 (0.1)–0.7 (0.1)Total resolution of enthesitisi [NRI] n (%)41 (44.6)j51 (54.3)c31 (46.3)k67 (50.8)lASDAS-CRP CfB [MI]–1.6 (0.1)–1.8 (0.1)–1.9 (0.1)–1.7 (0.1)SPARCC MRI SIJ score CfB [OC]mMean (SD)–6.4 (10.7)n–7.6 (10.5)o–2.8 (6.1)p–4.7 (8.2)qBerlin MRI spine score CfB [OC]mMean (SD)–0.4 (2.0)k–0.7 (2.5)r–2.1 (3.4)p–2.4 (3.9)shs-CRP, mg/L [MI] Median2.21.72.02.3RS. n: a109, b118, c94, d184;eMax 1 TNFi;n: f17, g10, h37;iMASES=0 in pts with MASES >0 at BL;n: j92, k67;l132;mMRI sub-study;n: n70, o82, p48, q90, r79, s89.AcknowledgementsThis study was funded by UCB Ph rma. Medical writing support was provided by Costello Medical, funded by UCB Pharma.Disclosure of InterestsXenofon Baraliakos Speakers bureau: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Paid instructor for: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, BMS, Chugai, Eli Lilly, Galapagos, Gilead, MSD, Novartis, Pfizer and UCB Pharma, Atul Deodhar Speakers bureau: Janssen, Novartis and Pfizer, Consultant of: AbbVie, Amgen, Aurinia, BMS, Eli Lilly, Janssen, MoonLake, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie, BMS, Celgene, Eli Lilly, MoonLake, Novartis, Pfizer and UCB Pharma, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, GSK, Janssen, Eli Lilly, Novartis, Pfizer and UCB Pharma, Employee of: Director of Imaging Rheumatology BV, Marina Magrey Consultant of: AbbVie, Eli Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and UCB Pharma, Walter P Maksymowych Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli Lilly, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: AbbVie and Pfizer;educational grants from AbbVie, Janssen, Novartis and Pfizer, Employee of: Chief Medical Officer for CARE ARTHRITIS, Tetsuya Tomita Speakers bureau: AbbVie, Astellas, BMS, Eisai, Eli Lilly, Janssen, Kyowa Kirin, Mitsubishi-Tanabe, Novartis and Pfizer, Consultant of: AbbVie, Eli Lilly, Gilead, Novartis and Pfizer, Huji Xu Speakers bureau: AbbVie, Janssen, Novartis, Pfizer and UCB Pharma, Consultant of: AbbVie, Beigene, BioMap, IASO, Pfizer and UCB Pharma, Employee of: Clinical investigator for Peking-Tsinghua Center for Life Sciences, Marga Oortgiesen Shareholder of: UCB Pharma, Employee of: UCB Pharma, Ute Massow Employee of: UCB Pharma, Carmen Fleurinck Employee of: UCB Pharma, Alicia Ellis Employee of: UCB Pharma, Thomas Vaux Employee of: UCB Pharma, julie smith Employee of: UCB Pharma, Alexander Marten Employee of: UCB Pharma, Lianne S. Gensler Consultant of: AbbVie, Acelyrin, Eli Lilly, Fresenius Kabi, Janssen, Novartis, Pfizer and UCB Pharma, Grant/research support from: Novartis and UCB Pharma paid to institution.
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Humanistic geographers distinguish between space and place: "What begins as undifferentiated space becomes place as we get to know it better and endow it with value" [19, page 6]. In this essay, we seek to demonstrate how mathematics education researchers and mathematics instructors may find space and place il-luminating for understanding important aspects of students' learning experiences during the coronavirus pandemic - and possibly beyond. Specifically, after in-tro ducing the terms and relating them to the context of a university mathematics class, we exemplify how home and class places collided for three undergraduate mathematics students forced to deal with the abrupt transition to online educa-tion. We conclude by discussing implications of attending to space and place for designers and researchers of (pandemic) online instruction and make connections to how the pandemic and attending to space and place can serve as a catalyst for reshaping undergraduate mathematics education.
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Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use. © 2023 Taylor & Francis Group, LLC.
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Background The way we deliver undergraduate education has changed during the pandemic. Great Ormond Street Hospital Summer School (GSS) is an annual conference that aims to encourage medical students to consider a career in Paediatrics. Since 2020, the GSS has been delivered virtually, becoming accessible for students from the UK and abroad. Aims We analysed the impact of changing the GSS from fully in person to online and hybrid formats on participation, comparing the data from the last four conferences. Results (See figure 1). Discussion The Covid-19 pandemic encouraged us to think creatively on how we can still provide a high-quality educational experience using online technology. Students from different areas of the UK and abroad joined the GSS without incurring travel and accommodation costs. A significant increase in the percentage of international students was observed in 2021, which demonstrates the interest from those outside the UK. With the development of online fatigue and the slow return of clinical placements, we observed a decrease in the number of registrations in 2021 and 2022 compared to 2020. However, the percentage of international students remained above 20%. The conference gave us the opportunity to inspire, educate and share the innovative work we do at GOSH with a much wider audience. Students described their experiences as insightful and inspiring. With the easing of restrictions in 2022, we designed a hybrid conference, involving 2 online days and 1 day with in person workshops. Our challenge now is to continue engaging with students from inside and outside the UK and bring innovative ways to deliver our online conference.
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The impact of the pandemic shifted the focus of global healthcare systems to treating and preventing COVID-19 infection. In October 2021 the World Health Organisation published a clinical case definition of Post COVID syndrome which included symptoms of post viral infection that had lasted for over 3 months which followed the work of patient led groups naming this condition Long Covid (Callard and Perego 2021). Globally more than 100 million people are living with prolonged symptoms of COVID-19 infection which is creating a huge demand on clinical services. Impact of Post COVID Syndrome: The symptoms of Post COVID syndrome are extensive, can fluctuate, be relapsing - remitting and can have a significant impact on an individuals activities of daily living including work. It was recognised by Greenhalgh et al (2020) that people with prolonged symptoms will require an interprofessional holistic assessment and a paced approach to recovery embracing self-management and peer support strategies. Personalised care approaches to Post COVID Care: The universal personalised care model embeds six evidencebased components of personalised care with well documented benefits in many conditions including asthma and COPD. These approaches must be embedded for people with Post COVID Syndrome and involve people with lived experience. Conclusion(s): Post COVID Syndrome can be a debilitating multisystem relapsing condition which needs a holistic, individualised, personalised approach to care.
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The Bangladesh government issued a lockdown throughout the country from March–May 2020 in response to the COVID-19. The sudden lockdown caused economic ruptures across the country due to job loss. We conducted a comprehensive analysis of the outbreak through 40 in-depth interviews with men and women living in three Dhaka informal settlements from January to November 2021 to identify gaps to mitigate negative downstream effects of global pandemic policies. In this paper, we explore the critical importance of social networks as coping mechanisms for those who lost livelihood due to COVID-19 lockdown. Due to the congested living conditions in informal settlements, many established residents foster close, trusting relationships, and a strong sense of community. Formal and informal networks in urban slums, whether reciprocal or strategic, played an integral role as a way of coping during times of scarcity. We found limited analysis in public health literature on the resilience of these social networks and its impact on health and wellbeing. Our paper attempts to unpack the ways our respondents drew on their own social networks to combat the socio-economic and emotional health challenges brought on by a lack of adequate formalized support as part of the pandemic response. © 2023 by the authors.
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The spread of fake news related to COVID-19 is an infodemic that leads to a public health crisis. Therefore, detecting fake news is crucial for an effective management of the COVID-19 pandemic response. Studies have shown that machine learning models can detect COVID-19 fake news based on the content of news articles. However, the use of biomedical information, which is often featured in COVID-19 news, has not been explored in the development of these models. We present a novel approach for predicting COVID-19 fake news by leveraging biomedical information extraction (BioIE) in combination with machine learning models. We analyzed 1164 COVID-19 news articles and used advanced BioIE algorithms to extract 158 novel features. These features were then used to train 15 machine learning classifiers to predict COVID-19 fake news. Among the 15 classifiers, the random forest model achieved the best performance with an area under the ROC curve (AUC) of 0.882, which is 12.36% to 31.05% higher compared to models trained on traditional features. Furthermore, incorporating BioIE-based features improved the performance of a state-of-the-art multi-modality model (AUC 0.914 vs. 0.887). Our study suggests that incorporating biomedical information into fake news detection models improves their performance, and thus could be a valuable tool in the fight against the COVID-19 infodemic. © 2023 by the authors.
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Winchester Science Centre in Southern England hosts a significant number of informative exhibits pertaining to principles of acoustics;one such example being on the subject of euphony, which seeks to collect evidence from the visiting public by asking questions about their sound environment. In a period of time between the first and third COVID lockdowns, visitors to this exhibit were asked what sounds they noticed more or less of, and what their favourite and least favourite sounds were during this period. The results are shared with two-fold benefit: to assist the public perception of noise and euphony, and to capture the aural response of the public to the 2020 COVID restrictions. This paper explores these results, but also the potential for conducting research from a larger cohort of visitors using a citizen science approach to deliver big data sets, to further explore the perception of sound in the environment with regard to its context. © 2022 Internoise 2022 - 51st International Congress and Exposition on Noise Control Engineering. All rights reserved.
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Systemic immunoglobulin light-chain (AL) amyloidosis is a plasma cell disorder that can cause cardiomyopathy due to the extracellular deposition of amyloid in the heart. When left untreated, median survival is 6 months. We report a case of AL amyloidosis diagnosed on pathology of the explanted heart after transplantation in a patient who presented in cardiogenic shock. A 54-year-old woman with a recent diagnosis of nonischemic cardiomyopathy attributed to COVID-19 vaccine-associated myocarditis presented to a community hospital in cardiogenic shock. Right heart catheterization revealed elevated filling pressures (right atrium 19 mmHg, pulmonary capillary wedge 43 mmHg) and reduced cardiac index (2.1 L/min/m2). Echocardiography showed normal left ventricular size and wall thickness with severely reduced systolic function (ejection fraction 20%), findings that were unchanged from a study performed 3 months prior. The patient was started on inotropic support with milrinone and dobutamine and transferred to our institution. Shortly after transfer, she became unstable and we instituted mechanical circulatory support with venoarterial extracorporeal membrane oxygenation. Expedited heart transplant evaluation was completed and she was listed at status 1 priority. She was discharged on post-operative day 10 after uncomplicated heart transplantation. Pathology of the explanted heart revealed kappa AL amyloidosis. The patient was referred to oncology and began daratumumab monotherapy 3 months post-transplant with improvement in the light chain burden. Surveillance endomyocardial biopsies have not shown evidence of amyloidosis and the patient is doing well clinically. Early diagnosis and treatment of AL amyloidosis are vital to prevent progression of cardiomyopathy and may obviate the need for heart transplantation. For those who undergo heart transplantation, continued treatment directed at the plasma cell clone with chemotherapy or stem cell transplantation is essential to ensuring long-term success of the allograft. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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Background: Interest in organ preservation (OP) strategies for rectal cancer (RC) patients persists. The efficacy of long course chemoradiation (LCRT) vs. short course radiation therapy (SCRT) relative to OP is unknown. We compared OP rates between SCRT and LCRT total neoadjuvant therapy (TNT) strategies. Method(s): During the COVID-19 pandemic we established an institutional SCRT mandate with no exceptions. For comparison, we identified RC patients treated with LCRT immediately before and after the mandate period. After completion of TNT, patients were restaged by clinical exam, endoscopy, and MRI. A watch and wait (WW) approach was recommended for patients with a clinical complete response (cCR), defined by the MSK regression schema. Total mesorectal excision (TME) was recommended for non-cCR patients. OP was defined as alive, TME-free, and with no evidence of disease in the pelvis. We performed survival analysis for: local regrowth rate, OP, disease-free survival (DFS), and overall survival (OS). Result(s): We identified 563 consecutive patients with RC treated with TNT, of whom 231 were excluded due to either metastatic disease, synchronous/metachronous malignancies, or non-adenocarcinoma histology (Jan. 2018-Jan. 2021). Patient and tumor characteristics were similar in the LCRT (n = 256) and SCRT (n = 76) cohorts. No significant differences in high-risk features were noted. Most patients had clinical stage III disease (82% in LCRT vs. 83% in SCRT). Induction chemotherapy followed by consolidative radiation was the most common treatment order (78% (LCRT) vs. 70% (SCRT)). The median interval from end of TNT to clinical restaging was 8 weeks (LCRT) and 9 weeks (SCRT). The cCR rate was 46% in both cohorts. The cCR rate was numerically higher in patients treated with radiation first, as compared to chemotherapy first (53% vs. 44% (LCRT) and 52% vs. 43% (SCRT)). Among patients with a cCR, the likelihood of WW management was similar (98% (LCRT) vs. 94% (SCRT)). From start of TNT, the median follow-up was 32 and 28 months respectively for LCRT and SCRT. The 2-year OS (95% vs. 92%), DFS (78% vs 70%), and distant recurrence (20% vs. 21%) rates were similar. Among all patients, the 2-year OP rate was 40% (95% CI 35-47%) for LCRT and 29% (95% CI 20-42%) with SCRT. In those patients managed by WW, the 2-year local regrowth rate was 20% (95% CI 12-27%) with LCRT vs. 36% (95% CI 16-52%) with SCRT. Conclusion(s): In this nonrandomized comparison, while cCR rates were similar, we observed a numerically higher OP rate with LCRT-TNT than with SCRT-TNT. The ongoing ACO/ARO/AIO-18.1 trial, hypothesizing that LCRT-TNT will increase OP rates relative to SCRT-TNT, should definitively answer this question.
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Detailed contemporary knowledge of the characteristics of the surgical population, national anaesthetic workload, anaesthetic techniques and behaviours are essential to monitor productivity, inform policy and direct research themes. Every 3-4 years, the Royal College of Anaesthetists, as part of its National Audit Projects (NAP), performs a snapshot activity survey in all UK hospitals delivering anaesthesia, collecting patient-level encounter data from all cases under the care of an anaesthetist. During November 2021, as part of NAP7, anaesthetists recorded details of all cases undertaken over 4 days at their site through an online survey capturing anonymous patient characteristics and anaesthetic details. Of 416 hospital sites invited to participate, 352 (85%) completed the activity survey. From these, 24,177 reports were returned, of which 24,172 (99%) were included in the final dataset. The work patterns by day of the week, time of day and surgical specialty were similar to previous NAP activity surveys. However, in non-obstetric patients, between NAP5 (2013) and NAP7 (2021) activity surveys, the estimated median age of patients increased by 2.3 years from median (IQR) of 50.5 (28.4-69.1) to 52.8 (32.1-69.2) years. The median (IQR) BMI increased from 24.9 (21.5-29.5) to 26.7 (22.3-31.7) kg.m-2 . The proportion of patients who scored as ASA physical status 1 decreased from 37% in NAP5 to 24% in NAP7. The use of total intravenous anaesthesia increased from 8% of general anaesthesia cases to 26% between NAP5 and NAP7. Some changes may reflect the impact of the COVID-19 pandemic on the anaesthetic population, though patients with confirmed COVID-19 accounted for only 149 (1%) cases. These data show a rising burden of age, obesity and comorbidity in patients requiring anaesthesia care, likely to impact UK peri-operative services significantly.
Subject(s)
Anesthetics , COVID-19 , Humans , Child, Preschool , Workload , Pandemics , COVID-19/epidemiology , Anesthesia, General/methods , United Kingdom/epidemiologyABSTRACT
Aim: The aim of this study was to investigate the change if any, in the motivations of women seeking a UTx and determine the impact of the COVID-19 pandemic. Methods: A cross-sectional survey. Results: 59% of women answered they were more motivated in achieving a pregnancy following the COVID-19 pandemic. 80% strongly agreed or agreed the pandemic had no impact on their motivation for a UTx, and 75% strongly agreed or agreed their desire for a baby strongly outweighs the risks of undergoing a UTx during a pandemic. Conclusion: Women continue to express a high level of motivation and desire for a UTx despite the risks imposed by the COVID-19 pandemic.
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Accurately quantifying industry resilience is essential to devising effective recovery strategies. Previous research into industry resilience has either quantified the concept with single metrics aggregated across large geographies (e.g., visitation) or used metrics comparing the relative concentration of an industry within a region to the national average (e.g., location quotients). The former set of metrics prohibits spatially targeted recovery efforts while the latter fails during national crises. We propose the measurement of tourism and outdoor recreation industry resilience to COVID-19 based on growth rates in employment, wages, and establishments using publicly accessible time-series data on all counties in the United States. We use these indicators to characterize the spatio-temporal patterns of industry resilience across the country. The indicators can serve as a useful reference for diagnosing and monitoring industry resilience as well as developing targeted policies, programs, and promotion efforts that facilitate more localized response efforts. © 2022 Elsevier Ltd
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Trust in political actors and institutions has long been seen as essential for effective democratic governance. During the COVID-19 pandemic, trust was widely identified as key for mitigation of the crisis through its influence on compliance with public policy, vaccination and many other social attitudes and behaviours. We study whether trust did indeed predict these outcomes through a meta-analysis of 67 studies and 426 individual effect sizes derived from nearly 1.5 million observations worldwide. Political trust as an explanatory variable has small to moderate correlations with outcomes such as vaccine uptake, belief in conspiracy theories, and compliance. These correlations are heterogenous, and we show that trust in health authorities is more strongly related to vaccination than trust in the government;but compliance is more strongly related to the government than other institutions. Moreover, the unique case of the United States indicates that trust in President Trump had negative effects across all observed outcomes, except in increasing conspiracy beliefs. Our analysis also shows that research design features (such as response scales) and publication bias do not importantly change the results. These results indicate that trust was important for the management of the pandemic and supports existing work highlighting the importance of political trust.
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Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, "Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that "virtual” recruitment methods (social media, websites, email) would surpass "traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: "Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity;however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment.
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Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Medical care is estimated to account for 10-20% of health outcomes, while other modifiable factors explain as much as 80-90% of outcomes. These disparities may thus be driven by multiple factors including social determinants of health, differences in treatment or follow up, or attitudes and behaviors of care teams. As part of a larger project, we conducted a qualitative study to understand cancer survivor preferences for and experiences with social needs screening and referrals. The results of this assessment will inform the delivery of social risk screening for breast and prostate cancer survivors in the multi-site study. Semi-structured interviews were conducted in English between March and April 2022 with breast and prostate cancer survivors from two cancer institutes in Washington DC. Patients were purposively recruited to ensure diversity in age, race, and cancer stage (I-III). Each interview lasted 60 minutes. Transcripts were reviewed for consensus and preferences for social needs screening. Thirteen survivors participated in the interviews. Participants were mostly breast cancer survivors (n=10), African American (n=6), were equal in stages I and II at time of diagnosis (n=5), and ranged in age from 34 to 81 with a median age of 64. Most patients (n=7) did not report social needs screening during their treatment, though all patients welcomed having these conversations with their care team. The majority of patients (n=9) desired face-to-face conversations as opposed to on paper (n=1) or through the patient portal (n=1). Similarly, most patients (n=7) did not mind who on their care team held the conversations. There was difference in opinion on how often social needs should be discussed, with four participants suggesting every appointment to another patient suggesting once at diagnosis. When asked about the needs patients experienced during treatment, food insecurity and nutrition were most cited (n=6), followed by transportation (n=4) and emotional resources (n=4). Only one patient reported not desiring social needs referrals during treatment. Other avenues for seeking out social resources included self-initiated research online or through books (n=2), and another patient described utilizing their local church (n=1). Finally, patients also spoke about challenges in receiving treatment and transitioning to survivorship due to the COVID-19 pandemic, including hospital staff turnover and care team inconsistency (n=1), bringing loved ones to appointments (n=1), and transportation challenges for individuals who relied on public transport to and from the clinic (n=1). This research reveals important insight to the perspective on social needs screening among a group of breast and prostate cancer survivors in the Washington DC region and highlights the ways in which patients have experienced and desire screening for social needs. In future work we will expand the number of interviews and apply these findings into practice.
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Adults over the age of 60 tend to have higher well-being than younger adults, and high well-being is associated with a range of favorable mental and physical health outcomes. Resilience is related to the maintenance of well-being in the presence of challenging circumstances and stressors. Chronic health conditions are common in older adults and represent a stressor. Using longitudinal data, we address two research questions: 1) Are chronic health conditions and resilience predictive of changes in well-being before and during Covid-19? 2) Does the number of chronic health conditions and resilience interact in predicting changes in well-being before and during Covid-19? To answer these questions, we analyzed data from participants in the Health and Retirement Study (HRS) who completed both the 2016 and 2020 waves (N = 2276). On average, these participants were age 71.44 (SD = 7.35) and reported 2.40 chronic conditions. In unadjusted models, both the number of chronic conditions (β = -.21) and resilience (β = .09) were related to changes in well-being (R2 = .32). When covariates were added, these values were attenuated but remained statistically significant. The interaction between resilience and chronic health conditions was not statistically significant. Though the number of chronic health conditions and resilience play an important role in well-being for older adults, high resilience does not moderate the relationship between the number of chronic health conditions and changes in well-being. Further investigations using longitudinal data are needed to understand the relationship between resilience and well-being for those with chronic health conditions.
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Self-perceptions of aging have important implications for health and well-being in later life. Early life experiences, cultural and societal notions about age, and one's present health and situational context may contribute to one's expectations and perceptions of their own aging (e.g., Levy, 2009;Diehl et al., 2014;2021). However, self-perceptions of aging may also predict people's responses in the face of current or future challenges. This symposium takes a closer look at self-perceptions of aging in the context of different types of life challenges. Hu and Larkina discuss early life informal caregiving experiences as antecedents of negative self-perceptions of aging in later life. Koffer and Giasson discuss how ten-year longitudinal associations between subjective age and future loneliness differ among current caregivers and non-caregivers. Mejia and colleagues discuss the role of self-perceptions of aging in adaptation to life following a fall, highlighting potential protective effects of positive self-perceptions of aging and sense of control. Finally, Giasson and colleagues discuss positive self-perceptions of aging as predictors of preventive health behavior and resilience in the context of the COVID-19 pandemic. Dr. Jacqui Smith will conclude the session with an integration of common themes, practical implications, and future research directions that emerge from the four studies.
ABSTRACT
Background: The SARS-CoV-2 pandemic has had an unprecedented impact on healthcare systems, and cancer patients were amongst the most vulnerable. CONTACT is a national multidisciplinary study assessing the impact of the SARS-CoV-2 pandemic upon diagnostic and treatment pathways among patients with pancreatic ductal adenocarcinoma (PDAC). Method(s): A novel, mixed prospective and retrospective design, with retrospective case identification of both cohorts, and trainee-performed data collection. The treatment of consecutive patients with newly diagnosed PDAC from a pre-COVID cohort (07/01/ 2019-03/03/2019) were compared to a cohort diagnosed during the first wave of SARS-CoV-2 in the UK ('COVID' cohort, 16/03/2020-10/05/ 2020), with 12-month follow-up. Result(s): Among 984 patients (pre-COVID: N=483, COVID: N=501), across 96 hospitals, the COVID cohort were less likely to receive staging investigations other than CT scan (148/501, 29.5% vs 180/486, 37.2%;p=0.01). Among patients treated with curative intent, there was a reduction in the proportion of patients recommended surgery (42/77, 54.5% vs 72/94, 76.6%, p=0.001) and increase in the proportion recommended neoadjuvant therapy (35/77, 45.5% vs 22/94, 23.4%, p=0.002). Among patients within a non-curative pathway, fewer patients were recommended (201/424, 47.4% vs 223/389, 57.3%, p=0.004) or received palliative therapy (87/424, 20.5% vs 103/389, 26.5%, p=0.045). Ultimately, fewer patients in the COVID cohort underwent resection surgery (29/501, 6.4% vs 45/483, 9.3%, OR 0.64, 95%CI: 0.37- 0.97, p=0.036), whilst more patients received no treatment whatsoever (347/ 501, 69.3% vs 286/483, 59.2% p=0.009). There was no difference in median survival between the COVID and pre-COVID cohorts, (105 days, IQR: 86-124 vs 130 days, IQR: 108-157, p=0.093). Conclusion(s): The CONTACT study confirms alarming reduction in the staging and treatment provided to patients with PDAC diagnosed during the SARS-CoV-2 pandemic. Restoration of cancer services to pre-pandemic standards must be urgently addressed.