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1.
Current developments in nutrition ; 6(Suppl 1):190-190, 2022.
Article in English | EuropePMC | ID: covidwho-1897650

ABSTRACT

Objectives To evaluate changes in weight, eating frequency, and stress during the COVID-19 pandemic among adults in Puerto Rico and examine differences by gender. Methods Individuals were men and women (n = 551 ≥18 yr.) who completed the Puerto Rico Community Engagement Research Alliance Against COVID-19 Disparities online survey from December 30, 2021, to January 28, 2022. Three individual items assessed perceived changes in weight, eating frequency, and stress throughout the pandemic (March 2020 to survey completion), with response options being ‘increased’, ‘decreased’, and ‘no change’. Multiple logistic and multinomial regressions models were used to examine the association between gender and perceived changes in all three outcomes. Models were adjusted for age, education, income, employment, number of children in the household, having to care for someone with COVID-19, marital status, and pre-pandemic obesity. Results Of the total eligible sample with complete data on study variables (n = 524), mean (SD) age was 38.2 (14.5) years, 52.7% had some college education, and 73.3% were women. Over half (53.0%) reported an increase in weight during the pandemic, 42.5% an increase in eating frequency, and 74.2% an increase in stress. In adjusted regression models, women (vs. men) were more likely to report an increase in eating frequency over no change (RRR = 1.55;95% CI = 1.01, 2.39) and marginally significantly more likely to report an increase in weight over no change (RRR = 1.56;95% CI = 0.99, 2.48). In addition, women (vs. men) had twice the odds of reporting an increase in stress levels (OR = 2.14;95% CI = 1.36, 3.36). Conclusions A substantial proportion of the sample reported increases in weight, eating frequency, and stress during the COVID-19 pandemic, and women were disproportionally affected by these pandemic outcomes. Interventions tailored for women are needed to reduce the pandemic impact on weight, eating frequency, and stress in Puerto Rico and preserve overall health. Funding Sources This work has been supported by the National Institute of Health-National Heart, Lung, and Blood Institute (NIH-NHLBI).

4.
J Infect Dis ; 2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1853098

ABSTRACT

BACKGROUND: The study objective was to evaluate 2 and 3 dose COVID-19 mRNA vaccine effectiveness (VE) in preventing COVID-19 hospitalization among adult solid organ transplant (SOT) recipients. METHODS: 21-site case-control analysis of 10,425 adults hospitalized March-December 2021. Cases were hospitalized with COVID-19; controls were hospitalized for an alternative diagnosis (SARS-CoV-2 negative). Participants were classified as: SOT recipient (n=440), other immunocompromising condition (n=1684), or immunocompetent (n=8301). VE against COVID-19 associated hospitalization was calculated as 1-adjusted odds ratio of prior vaccination among cases compared with controls. RESULTS: Among SOT recipients, VE was 29% (95% CI: -19 to 58%) for 2 doses and 77% (95% CI: 48 to 90%) for 3 doses. Among patients with other immunocompromising conditions, VE was 72% (95% CI: 64 to 79%) for 2 doses and 92% (95% CI: 85 to 95%) for 3 doses. Among immunocompetent patients, VE was 88% (95% CI: 87 to 90%) for 2 doses and 96% (95% CI: 83 to 99%) for 3 doses. CONCLUSION: Effectiveness of COVID-19 mRNA vaccines was lower for SOT recipients than immunocompetent people and those with other immunocompromising conditions. Among SOT recipients, vaccination with 3 doses of an mRNA vaccine led to substantially greater protection than 2 doses.

5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-306321

ABSTRACT

Background: Adaptation, a form of modification that aims to improve an intervention’s acceptability and sustainability in a given context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) in order to foster human connection during COVID-19. Methods: We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. Throughout multiple implementations across 25 institutions, we piloted, tracked and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations. Results: When implementing PPE Portraits across settings, from a local assisted living center’s memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to 1) provider convenience and comfort, 2) patient populations, and 3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations related to ease of dissemination included slowing the process down during early development and providing buttons, which could be produced easily at scale. Conclusion: The FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best-practices with accompanying costs and benefits.

6.
BMC Health Serv Res ; 21(1): 1182, 2021 Oct 30.
Article in English | MEDLINE | ID: covidwho-1486089

ABSTRACT

BACKGROUND: Adaptation, a form of modification that aims to improve an intervention's acceptability and sustainability in each context, is essential to successful implementation in some settings. Due to the COVID-19 pandemic, clinicians have rapidly adapted how they deliver patient care. PPE Portraits are a form of adaptation, whereby health workers affix a postcard size portrait of themselves to the front of their personal protective equipment (PPE) to foster human connection during COVID-19. METHODS: We used the expanded framework for reporting adaptations and modifications to evidence-based interventions (FRAME) method to better understand the reasoning behind and results of each adaptation. We hypothesized that using the FRAME in conjunction with design-thinking would lead to emerging best practices and that we would find adaptation similarities across sites. Throughout multiple implementations across 25 institutions, we piloted, tracked, and analyzed adaptations using FRAME and design thinking. For each adaptation, we assessed the stage of implementation, whether the change was planned, decision makers involved, level of delivery impacted, fidelity to original intervention, and the goal and reasoning for adaptation. We added three crucial components to the FRAME: original purpose of the adaptation, unintended consequences, and alternative adaptations. RESULTS: When implementing PPE Portraits across settings, from a local assisted living center's memory unit to a pediatric emergency department, several requests for adaptations arose during early development stages before implementation. Adaptations primarily related to (1) provider convenience and comfort, (2) patient populations, and (3) scale. Providers preferred smaller portraits and rounded (rather than square) laminated edges that could potentially injure a patient. Affixing the portrait with a magnet was rejected given the potential choking hazard the magnetic strip presented for children. Other adaptations, related to ease of dissemination, included slowing the process down during early development and providing buttons, which could be produced easily at scale. CONCLUSIONS: The FRAME was used to curate the reasoning for each adaptation and to inform future dissemination. We look forward to utilizing FRAME including our additions and design thinking, to build out a range of PPE Portrait best practices with accompanying costs and benefits.


Subject(s)
COVID-19 , Personal Protective Equipment , Health Personnel , Humans , Pandemics , SARS-CoV-2
7.
Vaccines (Basel) ; 9(9)2021 Sep 06.
Article in English | MEDLINE | ID: covidwho-1390819

ABSTRACT

Ethnic minority populations are more likely to suffer from chronic comorbidities, making them more susceptible to the poor health outcomes associated with COVID-19 infection. Therefore, ensuring COVID-19 vaccination among vulnerable populations is of utmost importance. We aimed to investigate health behaviors and perceptions of COVID-19 vaccination among adults self-reporting diagnosis of cancer and of other chronic comorbidities in Puerto Rico (PR). This secondary analysis used data from 1911 participants who completed an online survey from December 2020 to February 2021. The Health Belief Model was used to measure perceptions surrounding COVID-19 vaccination among individuals self-reporting diagnosis of cancer and of other chronic comorbidities, and healthy adults. Among study participants, 76% were female, 34% were 50 years or older, 5% self-reported cancer diagnosis, and 70% had other chronic comorbidities. Participants self-reporting a cancer diagnosis had two times higher odds of getting vaccinated than healthy individuals (95% CI: 1.00-4.30). Compared to healthy participants, those self-reporting being diagnosed with cancer and those with chronic conditions other than cancer had significantly higher perceived COVID-19 susceptibility and severity. Our findings elucidate the effect of disease status on health-related decision-making and highlights information needed to be included in education campaigns to increase vaccine uptake among ethnic minority populations.

8.
Hum Vaccin Immunother ; 17(10): 3441-3449, 2021 10 03.
Article in English | MEDLINE | ID: covidwho-1360306

ABSTRACT

Background: Widespread vaccination against COVID-19 is essential to control the pandemic. Estimates of unwillingness and uncertainty toward COVID-19 vaccination and factors associated with it remain unclear among adults in Puerto Rico (PR).Objective: To examine factors associated with uncertainty and unwillingness of COVID-19 vaccination among adults in PR.Methods: The Health Belief Model was used to develop an online survey. Analyses included adjusted logistic regressions (aOR). A total of 1,911 adults completed the survey from December 2020 to February 2021.Results: Overall, 76.2% were females, 33.7% were aged 50 or older, and 82.7% reported an intent to get vaccinated. Individuals who did not perceive that their chances of getting COVID-19 were high (aOR = 2.94; 95%CI = 2.24-3.86), that getting COVID-19 was not a possibility for them (aOR = 2.86; 95%CI = 2.19-3.74), or unafraid of getting COVID-19 (aOR = 3.80; 95%CI = 2.76-5.23) had higher odds of uncertainty and unwillingness to get vaccinated against COVID-19. Participants who perceived that COVID-19 complications were not serious also had higher odds of uncertainty and unwillingness (aOR = 7.50; 95%CI = 3.94-14.3), whereas those who did not perceive that they would get very sick with COVID-19 had 89% increased odds. Those who agreed that they would only take the vaccine if many individuals took it had higher odds of uncertainty and unwillingness (aOR = 3.32; 95%CI = 2.49-4.43). The most reported reasons for uncertainty and unwillingness toward COVID-19 vaccination were vaccine safety (63.8%), efficacy (49.4%), and novelty (45.5%).Discussion: Although COVID-19 vaccination intent was high, the study highlights concern over vaccine safety and efficacy that should be addressed by public health campaigns and interventions to enhance vaccine uptake.


Subject(s)
COVID-19 , Vaccines , Adult , Attitude , COVID-19 Vaccines , Cross-Sectional Studies , Female , Humans , Perception , Puerto Rico , SARS-CoV-2 , Uncertainty , Vaccination
9.
Nutr Metab Cardiovasc Dis ; 31(11): 3085-3094, 2021 10 28.
Article in English | MEDLINE | ID: covidwho-1331123

ABSTRACT

BACKGROUND AND AIMS: The recent COVID-19 pandemic has further increased the importance of reducing obesity and prediabetes/diabetes. We aimed to evaluate the association between adiposity and regression of prediabetes/diabetes. METHODS AND RESULTS: The San Juan Overweight Adults Longitudinal Study (SOALS) included 1351 individuals with overweight/obesity, aged 40-65, free of major cardiovascular diseases and physician diagnosed diabetes. From the 1012 participants with baseline prediabetes/diabetes, 598 who completed the follow-up were included. Over the follow-up, 25% regressed from prediabetes to normoglycemia or from diabetes to prediabetes or normoglycemia. Poisson regression with robust standard error was used to estimate the relative risk (RR) adjusting for major confounders. Higher neck circumference (NC) was associated with regression of prediabetes/diabetes (RR = 0.45 comparing extreme tertiles; 95% CI:0.30-0.66); RR was 0.49 (95% CI:0.34-0.73) for waist circumference (WC) and 0.64 (95% CI:0.44-0.92) for BMI. Significant associations were found using median cut-offs or continuous measures for weight and BMI. Greater reduction in BMI (comparing extreme tertiles) was significantly associated with regression of prediabetes/diabetes (RR = 1.44; 95% CI:1.02-2.02). Continuous measures of change in adiposity (except for NC) were also associated with regression of prediabetes/diabetes for BMI and weight. Participants who reduced BMI (>5%) increased prediabetes/diabetes regression (RR = 1.61; 95% CI:1.15-2.25) compared to those who did not; similarly for weight (RR = 1.55; 95% CI: 1.10-2.19). Additional analysis for body fat percentage showing slightly weaker results than BMI/weight further supported our findings. CONCLUSION: Lower baseline adiposity and higher reduction in adiposity were associated with regression of prediabetes/diabetes among individuals with overweight/obesity.


Subject(s)
Adiposity , Diabetes Mellitus, Type 2/epidemiology , Obesity/epidemiology , Overweight/epidemiology , Prediabetic State/epidemiology , Adult , Aged , Body Mass Index , COVID-19/epidemiology , Female , Humans , Longitudinal Studies , Male , Middle Aged , Poisson Distribution , Risk Factors , SARS-CoV-2 , Waist Circumference
10.
Int J Environ Res Public Health ; 17(13)2020 07 05.
Article in English | MEDLINE | ID: covidwho-637646

ABSTRACT

Alliances between the government and academic communities can be a key component of the public health response to an emergency such as the coronavirus disease 2019 (COVID-19) pandemic. The Governor of Puerto Rico designated the Puerto Rico Medical Task Force (MTF) COVID-19 to provide direct guidance and evaluation of the government response to the epidemic in Puerto Rico. Several work groups were formed within the MTF to create protocols and provide evidence-based recommendations on different public health aspects. The collaboration between the academia and the government enhanced the Puerto Rican public health response and contributed to the reduction seen in the contagion curve. Healthcare services and hospitals have not reached their maximum patient care capacity and the death toll has been controlled. Incorporating a national MTF with members of the academia into the government structure was beneficial during the COVID-19 response in Puerto Rico. A similar strategy could serve as a model for other states or territories and countries in similar scenarios.


Subject(s)
Advisory Committees , Coronavirus Infections/mortality , Pneumonia, Viral/mortality , Public Health/methods , Betacoronavirus , COVID-19 , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Puerto Rico/epidemiology , SARS-CoV-2 , Schools, Medical
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