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1.
Arthroplasty Today ; : 101081, 2023.
Article in English | ScienceDirect | ID: covidwho-2165087

ABSTRACT

Background In 2020, the COVID-19 pandemic caused cessation of non-emergent total joint arthroplasty (TJA, referring to total hip and total knee arthroplasty) operations between mid-March and April 2020. The purpose of this study is to analyze effects and potential disparities in access to care due to the COVID-19 restrictions. Methods A database was used to examine demographics of patients undergoing TJA from May-December 2019 (Pre-COVID-19) and May-December 2020 (Post-COVID-19 restrictions). Categorical covariates were summarized by reporting counts and percentages and compared using Fisher exact tests. Continuous covariates were summarized by reporting means and standard deviations. Two-sample t-tests were used for continuous covariates. Equality of TJA counts by year were tested using a test of proportions. Results There were more TJA procedures performed during the post-COVID-19 period in 2020 vs pre-COVID19 (1151 vs. 882, p<.001). There was an increase in the relative percentage of THAs vs. TKAs performed in 2020 vs 2019 (26.9% vs 18.8%, p<.001), and an increase in patients with Medicaid with a decrease in private insurance (p=.043). The average length of stay was shorter in 2020 with a greater percentage of TJAs performed outpatient ( p<.001). There were no differences in patient sex, race, BMI, smoking status, or age between the two periods. Conclusions A relative increase in THA procedures, an increase in patients with Medicaid and decrease in private insurance, and a decreased length of stay were seen post COVID-19 restrictions. These trends may reflect pandemic-related changes in insurance status as well as the growing shift to same-day discharge.

2.
Addiction ; 2022 Nov 18.
Article in English | MEDLINE | ID: covidwho-2115820

ABSTRACT

AIMS: To examine whether the March 2020 New York State (NYS) SARS-CoV-2 Emergency Orders were associated with an initial surge in opioid dispensing and a longer-term reduction in access to medications for opioid use disorder (MOUD). DESIGN: Time-series analyses of the dispensing of non-MOUD opioid and MOUD prescriptions using IQVIA's Longitudinal Prescription Claims Database (n=16,087,429) in NYS by week, from 1/1/2018, to 7/31/2020. IQVIA is a multinational company that provides biopharmaceutical development and commercial outsourcing services. SETTING AND PARTICIPANTS: NYS Zone Improvement Plan (ZIP) Codes (n=1,218) in which prescriptions were dispensed. MEASUREMENT: For each ZIP Code, for each week, the following dispensing measures were calculated: total weekly morphine milligram equivalents/day (MME/day); total weekly MME/day dispensed via prescriptions for ≤7 days; and the count of MOUD prescriptions dispensed. Differences in dispensing metrics, comparing each week in 2020 with corresponding weeks in 2019, were calculated for each ZIP Code. RESULTS: During the study period, weekly MME/day per ZIP Code of dispensed non-MOUD opioids steadily declined. Compared with the difference in dispensing between 2019 and 2020 during the first week in 2020, there was a significantly larger drop in dispensed weekly total MME/day beginning March 21 2020 and lasting until the week of April 17 (p<0.05 for each week). Mean weekly total MME/day dispensed from March 21 to April 17, 2020 was 17.07% lower (95% confidence interval [CI] 13.97%, 20.17%) than in the 4 weeks before March 21, almost entirely due to a drop in MME/day dispensed for prescriptions of ≤7 days. There was not a discernable drop in MOUD dispensing associated with the period of the Emergency Orders. CONCLUSIONS AND RELEVANCE: New York State Emergency Orders in March 2020 to reduce SARS-CoV-2 transmission and preserve hospital capacity appeared to be associated with a decline in dispensing of opioids not used as MOUD. Access to MOUD appeared to be unaffected by the Orders, likely because of policy initiatives by the Substance Abuse and Mental Health Services Administration.

4.
Microbiol Spectr ; : e0183722, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2117965

ABSTRACT

We investigated the temporal profile of multiple components of the serological response after asymptomatic or mildly symptomatic SARS-CoV-2 infection, in a cohort of 67 previously SARS-CoV-2 naive young adults, up to 8.5 months after infection. We found a significant decrease of spike IgG and neutralization antibody titers from early (11 to 56 days) to late (4 to 8.5 months) time points postinfection. Over the study period, S1-specific IgG levels declined significantly faster than that of the S2-specific IgG. Further, serum antibodies from PCR-confirmed participants cross-recognized S2, but not S1, of the betacoronaviruses HKU1 and OC43, suggesting a greater degree of cross-reactivity of S2 among betacoronaviruses. Antibody-Dependent Natural Killer cell Activation (ADNKA) was detected at the early time point but significantly decreased at the late time point. Induction of serum Antibody-Dependent Monocyte Phagocytosis (ADMP) was detected in all the infected participants, and its levels remained stable over time. Additionally, a reduced percentage of participants had detectable neutralizing activity against the Beta (50%), Gamma (61 to 67%), and Delta (90 to 94%) variants, both early and late postinfection, compared to the ancestral strain (100%). Antibody binding to S1 and RBD of Beta, Gamma, Delta (1.7 to 2.3-fold decrease), and Omicron (10 to 16-fold decrease) variants was also significantly reduced compared to the ancestral SARS-CoV-2 strain. Overall, we found variable temporal profiles of specific components and functionality of the serological response to SARS-CoV-2 in young adults, which is characterized by lasting, but decreased, neutralizing activity and antibody binding to S1, stable ADMP activity, and relatively stable S2-specific IgG levels. IMPORTANCE Adaptive immunity mediated by antibodies is important for controlling SARS-CoV-2 infection. While vaccines against COVID-19 are currently widely distributed, a high proportion of the global population is still unvaccinated. Therefore, understanding the dynamics and maintenance of the naive humoral immune response to SARS-CoV-2 is of great importance. In addition, long-term responses after asymptomatic infection are not well-characterized, given the challenges in identifying such cases. Here, we investigated the longitudinal humoral profile in a well-characterized cohort of young adults with documented asymptomatic or mildly symptomatic SARS-CoV-2 infection. By analyzing samples collected preinfection, early after infection and during late convalescence, we found that, while neutralizing activity decreased over time, high levels of serum S2 IgG and Antibody-Dependent Monocyte Phagocytosis (ADMP) activity were maintained up to 8.5 months after infection. This suggests that a subset of antibodies with specific functions could contribute to long-term protection against SARS-CoV-2 in convalescent unvaccinated individuals.

5.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.12.06.22282077

ABSTRACT

Resolving chromatin remodeling-linked gene expression changes at cell type resolution is important for understanding disease states. We describe MAGICAL, a hierarchical Bayesian approach that leverages paired scRNA-seq and scATAC-seq data from different conditions to map disease-associated transcription factors, chromatin sites, and genes as regulatory circuits. By simultaneously modeling signal variation across cells and conditions in both omics data types, MAGICAL achieved high accuracy on circuit inference. We applied MAGICAL to study Staphylococcus aureus sepsis from peripheral blood mononuclear single-cell data that we generated from infected subjects with bloodstream infection and from uninfected controls. MAGICAL identified sepsis-associated regulatory circuits predominantly in CD14 monocytes, known to be activated by bacterial sepsis. We addressed the challenging problem of distinguishing host regulatory circuit responses to methicillin-resistant- (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) infections. While differential expression analysis failed to show predictive value, MAGICAL identified epigenetic circuit biomarkers that distinguished MRSA from MSSA.

6.
Sci Med Footb ; : 1-11, 2022 Nov 15.
Article in English | MEDLINE | ID: covidwho-2097223

ABSTRACT

OBJECTIVES: The primary aim of this study was to compare injury rates pre- and post-COVID-19 lockdown in sub-elite football (soccer) players by analysing the full season and the first month of each season between 2018 and 2020. Secondary aims were to describe the incidence, location and type of injuries and to compare injuries by age group and sex. DESIGN: Descriptive epidemiological study. METHODS: A de-identified insurance database was retrospectively coded using the Orchard Sports Injury Classification System. Injury incidence per 1000 hours as well as incidence rate ratios (IRR) with confidence intervals were calculated. RESULTS: No significant difference was found in the overall incidence rate in 2020 compared with the 2018 and 2019 seasons (IRR, 1.04 [95% CI, 0.96-1.13]; p = 0.294). However, overall injuries increased by 26% (IRR: 1.26 [95% CI 1.07-1.47]; p < 0.005) and joint sprains increased by 45% (IRR: 1.45 [95% CI 1.14-1.84]; p < 0.005) in the first month of 2020 compared with 2018-2019. Between 2018 and 2020, there were 4149 injury insurance claims, with anterior cruciate ligament (ACL) ruptures accounting for 19% of all injuries. When comparing sex, female players had significantly more ankle sprains whilst male players suffered more dental injuries. CONCLUSIONS: This study adds to a growing body of evidence investigating injury rates post-COVID-19 lockdowns in sport. Sub-elite players appear to be at higher risk of joint injuries within the first month of training following a period of lockdown. Overall, stakeholders involved in sub-elite football should prioritise knee and ankle joint injury prevention.

7.
Cell Syst ; 13(11): 924-931.e4, 2022 Nov 16.
Article in English | MEDLINE | ID: covidwho-2095148

ABSTRACT

Male sex is a major risk factor for SARS-CoV-2 infection severity. To understand the basis for this sex difference, we studied SARS-CoV-2 infection in a young adult cohort of United States Marine recruits. Among 2,641 male and 244 female unvaccinated and seronegative recruits studied longitudinally, SARS-CoV-2 infections occurred in 1,033 males and 137 females. We identified sex differences in symptoms, viral load, blood transcriptome, RNA splicing, and proteomic signatures. Females had higher pre-infection expression of antiviral interferon-stimulated gene (ISG) programs. Causal mediation analysis implicated ISG differences in number of symptoms, levels of ISGs, and differential splicing of CD45 lymphocyte phosphatase during infection. Our results indicate that the antiviral innate immunity set point causally contributes to sex differences in response to SARS-CoV-2 infection. A record of this paper's transparent peer review process is included in the supplemental information.


Subject(s)
COVID-19 , Immunity, Innate , Sex Characteristics , Female , Humans , Male , Young Adult , COVID-19/immunology , Interferons , Proteomics , SARS-CoV-2
8.
Int J Mol Sci ; 23(20)2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2082255

ABSTRACT

The SARS-CoV-2 virus can utilize host cell proteases to facilitate cell entry, whereby the Spike (S) protein is cleaved at two specific sites to enable membrane fusion. Furin, transmembrane protease serine 2 (TMPRSS2), and cathepsin L (CatL) are the major proteases implicated, and are thus targets for anti-viral therapy. The human serpin (serine protease inhibitor) alpha-1 antitrypsin (A1AT) shows inhibitory activity for TMPRSS2, and has previously been found to suppress cell infection with SARS-CoV-2. Here, we have generated modified serpin inhibitors with increased specificity for these cellular proteases. Using SerpinB3 (SCCA-1), a cross-class inhibitor of CatL, as a scaffold, we have designed and produced reactive centre loop (RCL) variants to more specifically target both furin and TMPRSS2. Two further variants were generated by substituting the RCL P7-P1 with the spike protein S1/S2 cleavage site from either SARS-CoV-2 alpha or delta (P681R) sequences. Altered inhibitory specificity of purified recombinant proteins was verified in protease assays, with attenuated CatL inhibition and gain of furin or TMPRSS2 inhibition, as predicted, and modified serpins were shown to block S protein cleavage in vitro. Furthermore, the serpin variants were able to inhibit S-pseudoparticle entry into A549-ACE2-TMPRSS2 cells and suppress SARS-CoV-2 replication in Vero E6 cells expressing TMPRSS2. The construct designed to inhibit TMPRSS2 (B3-TMP) was most potent. It was more effective than A1AT for TMPRSS2 enzyme inhibition (with an eighteen-fold improvement in the second order inhibition rate constant) and for blocking SARS-CoV-2 viral replication. These findings advance the potential for serpin RCL mutagenesis to generate new inhibitors, and may lead to novel anti-viral biological molecules.


Subject(s)
COVID-19 , Serpins , Humans , SARS-CoV-2 , Furin/genetics , Furin/metabolism , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/metabolism , Serpins/genetics , Serpins/pharmacology , Cathepsin L/metabolism , Angiotensin-Converting Enzyme 2 , Virus Internalization , COVID-19/drug therapy , Antiviral Agents/pharmacology , Mutagenesis , Recombinant Proteins , Serine , Serine Endopeptidases/genetics
10.
Journal of Development Studies ; : 1-20, 2022.
Article in English | Academic Search Complete | ID: covidwho-2077284

ABSTRACT

Disasters are a primary influence in the global development landscape given their unequal impacts across society and calls for transformative change in their aftermath. Recovering from disasters is one component of development that is coming under scrutiny. This is especially so in the context of the COVID-19 pandemic, whose scale, scope, and cascading effects mean that the uncertain prospects for recovery will be complicated and endure long term. COVID-19 has forced a reappraisal of what recovery encompasses, who it is for, and how it can better enable preparedness for future disasters. Drawing upon interviews with a global community of experts specializing in different areas of disaster governance, this paper focuses on the lessons emerging for recovery-related theory and practice deriving from the pandemic. We elaborate a multi-dimensional framework to support those working on local recovery planning within communities and operating across different sectors. The framework captures the interconnected issues across six principal domains—communities, economic, infrastructure, environment, health, and governance—representing key impact areas around which strategies and multifaceted actions can be developed. We suggest a three-step process using a systems approach to develop a recovery strategy that operationalizes the framework and addresses the complexity of long-term recovery for development. [ FROM AUTHOR]

11.
J Oral Maxillofac Surg ; 2022 Sep 24.
Article in English | MEDLINE | ID: covidwho-2041965

ABSTRACT

PURPOSE: Granuloma and delayed inflammatory reaction to hyaluronic acid facial esthetic fillers occurs rarely. More recently, these reactions have been reported with increasing frequency and have been associated with COVID-19 infection. The purpose of the study is to determine if delayed filler granulomas are more common after the start of the COVID-19 pandemic. MATERIALS AND METHODS: A retrospective cohort study including of all patients treated with dermal filler at 4 offices of a single cosmetic surgery practice between August 1, 2018 and October 31, 2021 was performed. The primary outcome variable was granuloma formation. The primary predictor variable was time period, either pre-COVID (8/1/18 to 2/29/20) or post-COVID (3/1/20 to 10/31/21). Other study variables recorded were age, amounts of dermal fillers used, and types of dermal filler used. Data were analyzed using chi-squared test, t-tests, and logistic regression. RESULTS: Over the study period, 3,255 patients receiving 8,067 syringes of filler over 6,800 sessions were reviewed. The average patient age was 46.8 ± 13.7 years and 2,583 sessions were performed in the pre-COVID time period and 4,217 sessions in the post-COVID time period. There were 11 granulomas in 9 subjects receiving filler in the post-COVID time period and 0 granulomas in the pre-COVID time period (0.3% vs 0.0%, respectively, P = .009). Juvederm Vollure was used in 64% of patients who developed granulomas but only accounted for 26% of filler administrations in the post-COVID time period and 28% in the cohort overall (P = .02). CONCLUSIONS: Granuloma formation is a rare complication of hyaluronic acid filler injection that appears to be occurring with more frequency following the COVID-19 pandemic. Practitioners who administer dermal fillers should be aware of this complication and its apparent increased incidence.

12.
iScience ; 25(10): 105202, 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2041844

ABSTRACT

The ongoing evolution of SARS-CoV-2 requires monitoring the capability of immune responses to cross-recognize Variants of Concern (VOC). In this cross-sectional study, we examined serological and cell-mediated immune memory to SARS-CoV-2 variants, including Omicron, among a cohort of 18-21-year-old Marines with a history of either asymptomatic or mild SARS-CoV-2 infection 6 to 14 months earlier. Among the 210 participants in the study, 169 were unvaccinated while 41 received 2 doses of mRNA-based COVID-19 vaccines. Vaccination of previously infected participants strongly boosted neutralizing and binding activity and memory B and T cell responses including the recognition of Omicron, compared to infected but unvaccinated participants. Additionally, no measurable differences were observed in immune memory in healthy young adults with previous symptomatic or asymptomatic infections, for ancestral or variant strains. These results provide mechanistic immunological insights into population-based differences observed in immunity against Omicron and other variants among individuals with different clinical histories.

13.
Can J Cardiol ; 38(11): 1676-1683, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2035864

ABSTRACT

BACKGROUND: Acute myocarditis is a rare complication of mRNA-based COVID-19 vaccination. Little is known about the natural history of this complication. METHODS: Baseline and convalescent (≥ 90 days) cardiac magnetic resonance (CMR) imaging assessments were performed in 20 consecutive patients meeting Updated Lake Louise Criteria for acute myocarditis within 10 days of mRNA-based vaccination. CMR-based changes in left ventricular volumes, mass, ejection fraction (LVEF), markers of tissue inflammation (native T1 and T2 mapping), and fibrosis (late gadolinium enhancement [LGE] and extracellular volume [ECV]) were assessed between baseline and convalescence. Cardiac symptoms and clinical outcomes were captured. RESULTS: Median age was 23.1 years (range 18-39 years), and 17 (85%) were male. Convalescent evaluations were performed at a median (IQR) 3.7 (3.3-6.2) months. The LVEF showed a mean 3% absolute improvement, accompanied by a 7% reduction in LV end-diastolic volume and 5% reduction in LV mass (all P < 0.015). Global LGE burden was reduced by 66% (P < 0.001). Absolute reductions in global T2, native T1, and ECV of 2.1 ms, 58 ms, and 2.9%, repectively, were documented (all P ≤ 0.001). Of 5 patients demonstrating LVEF ≤ 50% at baseline, all recovered to above this threshold in convalescence. A total of 18 (90%) patients showed persistence of abnormal LGE although mean fibrosis burden was < 5% of LV mass in 85% of cases. No patient experienced major clinical outcomes. CONCLUSIONS: COVID-19 mRNA vaccine-associated myocarditis showed rapid improvements in CMR-based markers of edema, contractile function, and global LGE burden beyond 3 months of recovery in this young patient cohort. However, regional fibrosis following edema resolution was commonly observed, justifying need for ongoing surveillance.


Subject(s)
COVID-19 , Heart Injuries , Myocarditis , Humans , Male , Adolescent , Young Adult , Adult , Female , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/pathology , COVID-19 Vaccines/adverse effects , Contrast Media , Gadolinium , COVID-19/epidemiology , COVID-19/prevention & control , Convalescence , Ventricular Function, Left , Stroke Volume , Predictive Value of Tests , Fibrosis , RNA, Messenger , Magnetic Resonance Imaging, Cine , Myocardium/pathology
14.
Curr Opin Ophthalmol ; 33(6): 501-506, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2018260

ABSTRACT

PURPOSE OF REVIEW: The current article will update and review the clinical and radiological manifestations and management of rhino-orbital mucormycosis (ROM). RECENT FINDINGS: There has been an increase in cases of ROM worldwide, especially in India. Immunosuppression (especially diabetes mellitus) is a known predisposing risk factor for ROM. Delayed diagnosis and treatment of ROM can be vision or life-threatening. This article reviews the clinical and radiologic features, treatment, and prognosis of ROM with special emphasis on new and emerging therapies. SUMMARY: ROM is an angioinvasive fungal infection that affects the sinuses and orbits and may present to ophthalmologists. Clinicians should have a high index of suspicion for ROM, especially in patients with poorly controlled diabetes mellitus or other immunosuppression. Corticosteroid treatment (including the recent COVID-19 pandemic) may be a predisposing risk factor for ROM.


Subject(s)
COVID-19 , Eye Diseases , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Mucormycosis/therapy , Orbital Diseases/diagnosis , Orbital Diseases/therapy , Pandemics
15.
Respir Care ; 67(7): 781-788, 2022 07.
Article in English | MEDLINE | ID: covidwho-1988238

ABSTRACT

BACKGROUND: High-frequency percussive ventilation (HFPV) is an alternative mode of mechanical ventilation that has been shown to improve gas exchange in subjects with severe respiratory failure. We hypothesized that HFPV use would improve ventilation and oxygenation in intubated children with acute bronchiolitis. METHODS: In this single-center prospective cohort study we included mechanically ventilated children in the pediatric ICU with bronchiolitis 1-24 months old who were transitioned to HFPV from conventional invasive mechanical ventilation from November 2018-April 2020. Patients with congenital heart disease, on extracorporeal membrane oxygenation (ECMO), and with HFPV duration < 12 h were excluded. Subject gas exchange metrics and ventilator parameters were compared before and after HFPV initiation. RESULTS: Forty-one of 192 (21%) patients intubated with bronchiolitis underwent HFPV, and 35 met inclusion criteria. Median age of cohort was 4 months, and 60% were previously healthy. All subjects with available oxygenation saturation index (OSI) measurements pre-HFPV met pediatric ARDS criteria (31/35, 89%). Mean CO2 decreased from 65.4 in the 24 h pre-HFPV to 51 (P < .001) in the 24 h post initiation. SpO2 /FIO2 was significantly improved at 24 h post-HFPV (153.3 to 209.7, P = .001), whereas the decrease in mean OSI at 24 h did not meet statistical significance (11.9 to 10.2, P = .15). The mean peak inspiratory pressure (PIP) decreased post-HFPV from 29.7 to 25.0 at 24 h (P < .001). No subjects developed an air leak or hemodynamic instability secondary to HFPV. Two subjects required ECMO, and of these, one subject died. CONCLUSIONS: HFPV was associated with significant improvement in ventilation and decreased exposure to high PIPs for mechanically ventilated children with bronchiolitis in our cohort and had a potential association with improved oxygenation. Our study shows that HFPV may be an effective alternative mode of ventilation in patients with bronchiolitis who have poor gas exchange on conventional invasive mechanical ventilation.


Subject(s)
Bronchiolitis, Viral , High-Frequency Ventilation , Respiratory Distress Syndrome , Bronchiolitis, Viral/complications , Bronchiolitis, Viral/therapy , Child , Child, Preschool , Humans , Infant , Prospective Studies , Respiration, Artificial
16.
Epidemiology ; 33(6): 797-807, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-1985142

ABSTRACT

BACKGROUND: Marine recruits training at Parris Island experienced an unexpectedly high rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, despite preventive measures including a supervised, 2-week, pre-entry quarantine. We characterize SARS-CoV-2 transmission in this cohort. METHODS: Between May and November 2020, we monitored 2,469 unvaccinated, mostly male, Marine recruits prospectively during basic training. If participants tested negative for SARS-CoV-2 by quantitative polymerase chain reaction (qPCR) at the end of quarantine, they were transferred to the training site in segregated companies and underwent biweekly testing for 6 weeks. We assessed the effects of coronavirus disease 2019 (COVID-19) prevention measures on other respiratory infections with passive surveillance data, performed phylogenetic analysis, and modeled transmission dynamics and testing regimens. RESULTS: Preventive measures were associated with drastically lower rates of other respiratory illnesses. However, among the trainees, 1,107 (44.8%) tested SARS-CoV-2-positive, with either mild or no symptoms. Phylogenetic analysis of viral genomes from 580 participants revealed that all cases but one were linked to five independent introductions, each characterized by accumulation of mutations across and within companies, and similar viral isolates in individuals from the same company. Variation in company transmission rates (mean reproduction number R 0 ; 5.5 [95% confidence interval [CI], 5.0, 6.1]) could be accounted for by multiple initial cases within a company and superspreader events. Simulations indicate that frequent rapid-report testing with case isolation may minimize outbreaks. CONCLUSIONS: Transmission of wild-type SARS-CoV-2 among Marine recruits was approximately twice that seen in the community. Insights from SARS-CoV-2 outbreak dynamics and mutations spread in a remote, congregate setting may inform effective mitigation strategies.


Subject(s)
COVID-19 , Disease Outbreaks , Military Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Disease Outbreaks/prevention & control , Female , Humans , Male , Military Personnel/statistics & numerical data , Phylogeny , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , United States/epidemiology
17.
Respir Care ; 67(12): 1578-1587, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1975121

ABSTRACT

BACKGROUND: Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist's (RT) experience of burnout, and a thorough exploration of RTs' perception of factors associated with burnout has not been reported. The aim of this qualitative study was to understand the factors associated with burnout as experienced by RTs amid the COVID-19 pandemic. METHODS: We performed a post hoc, qualitative analysis of free-text responses from a survey of burnout prevalence in RTs. RESULTS: There were 1,114 total and 220 free-text responses. Five overarching themes emerged from the analysis: staffing, workload, physical/emotional consequences, lack of effective leadership, and lack of respect. Respondents discussed feelings of anxiety, depression, and compassion fatigue as well as concerns that lack of adequate staffing, high workload assignments, and inadequate support from leadership contributed to feelings of burnout. Specific instances of higher patient acuity, surge in critically ill patients, rapidly evolving changes in treatment recommendations, and minimal training and preparation for an extended scope of practice were reported as stressors that led to burnout. Some respondents stated that they felt a lack of respect for both the RT profession and the contribution of RTs to patient care. CONCLUSIONS: Themes associated with burnout in RTs included staffing, workload, physical and emotional exhaustion, lack of effective leadership, and lack of respect. These results provide potential targets for interventions to combat burnout among RTs.


Subject(s)
Burnout, Professional , COVID-19 , Humans , COVID-19/epidemiology , Pandemics , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Job Satisfaction , Workload/psychology , Surveys and Questionnaires
18.
J Infect Dis ; 2022 Jul 27.
Article in English | MEDLINE | ID: covidwho-1961061

ABSTRACT

BACKGROUND: The development of memory B cells after asymptomatic SARS-CoV-2 infection is not well understood. METHODS: We compared Spike antibody titers, pseudovirus neutralizing antibody titers, and memory B cell responses among SARS-CoV-2 PCR positive Marine recruits who either reported asymptomatic or symptomatic infection. RESULTS: 36 asymptomatic participants exhibited similar Spike IgG titers, Spike IgA titers, and pseudovirus neutralization titers compared to 30 symptomatic participants. Pseudovirus neutralization and Spike IgG titers showed significant positive correlations with frequency of memory B cells. CONCLUSIONS: Among young adults, asymptomatic SARS-CoV-2 infection induced antibody and memory B cell responses comparable to mild symptomatic infection.

19.
Child Obes ; 2022 Jul 19.
Article in English | MEDLINE | ID: covidwho-1937619

ABSTRACT

Background: Societal changes during the COVID-19 pandemic may affect children's health behaviors and exacerbate disparities. This study aimed to describe children's health behaviors during the COVID-19 pandemic, how they vary by sociodemographic characteristics, and the extent to which parent coping strategies mitigate the impact of pandemic-related financial strain on these behaviors. Methods: This study used pooled data from 50 cohorts in the Environmental influences on Child Health Outcomes Program. Children or parent proxies reported sociodemographic characteristics, health behaviors, and parent coping strategies. Results: Of 3315 children aged 3-17 years, 49% were female and 57% were non-Hispanic white. Children of parents who reported food access as a source of stress were 35% less likely to engage in a higher level of physical activity. Children of parents who changed their work schedule to care for their children had 82 fewer min/day of screen time and 13 more min/day of sleep compared with children of parents who maintained their schedule. Parents changing their work schedule were also associated with a 31% lower odds of the child consuming sugar-sweetened beverages. Conclusions: Parents experiencing pandemic-related financial strain may need additional support to promote healthy behaviors. Understanding how changes in parent work schedules support shorter screen time and longer sleep duration can inform future interventions.

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