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Objectives: Social determinants of health (SDoH) including income, education, employment, and housing are known to affect health outcomes;while use in real-world database studies are limited. This study assessed socioeconomic differences in burden of disease and utilization of COVID-19 specific medications in a large cohort of patients in the US. Method(s): A total of 17,682,111 patients having a COVID-19 diagnosis between 4/1/2020 and 4/30/2022 were identified in the IQVIA longitudinal medical and pharmacy claims databases of >277 million patients. For SDoH, a 3-digit zip code median Area Deprivation Index (ADI) (v2.0 University of Wisconsin School of Medicine and Public Health 2015) was calculated for each patient, maintaining patient privacy. The ADI is a validated tool ranking neighborhoods by socioeconomic disadvantage. Medical and pharmacy utilization was assessed and stratified by ADI pentiles, where 0-20 was the least disadvantaged, and 81-100 was the most disadvantaged. Result(s): The proportion of patients having a claim with COVID-19 diagnosis was higher in the most disadvantaged (7.75%) compared to the least disadvantaged group (5.94%) (US overall: 6.37%). Medical claims prior to COVID-19 diagnosis were highest in the least disadvantaged, while prior pharmacy utilization was highest in the most-disadvantaged group. There was sparse use of COVID-19 medications overall;the least disadvantaged patients had the lowest use of COVID-19 specific medications. Casirivimab/imdevimab use was highest in the 61-80 (2.01%) and 81-100 (1.79%) ADI groups, and remdesivir use was highest in the moderately disadvantaged (ADI 41-60 and 61-80) groups (both 2.33%). Utilization of hydroxychloroquine (unapproved for COVID-19) increased from 0.91% in the least to 2.13% in the most disadvantaged groups. Conclusion(s): This study shows unequal burden of COVID-19 prevalence by SDoH, with the most disadvantaged having a higher disease burden and utilization of certain approved and unapproved COVID-19 medications, highlighting the need for further study of the reasons for these disparities.Copyright © 2023
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Objectives: COVID-19 infected over 150 million people and caused over 1 million deaths in the US. This study evaluates several variables thought to be associated with mortality risk in the COVID-19 population. Method(s): The IQVIA longitudinal medical and pharmacy claims databases identified 17,682,111 patients with a COVID-19 diagnosis between 4/1/2020-4/30/2022 from a population of >277 million patients in the US. Patients were linked to Veritas Data Research fact-of-death records (90% complete compared to CDC reporting) and confirmed deaths were flagged. Confirmed mortality rates (CMR) were evaluated by age group, socioeconomic status (SES) using the Area Deprivation Index (v2.0, University of Wisconsin, 2015), co-morbidities and COVID-specific (approved and unapproved) treatments. Result(s): Of the 563,744 patients (3.2%) identified as dead (3.67% in men, 2.85% in women overall), CMR was lowest in patients aged 0-17 (0.08%), highest in age 65-75 (5.92%) and >75 (16.40%). Patients in the lowest 40% of SES had CMR of 4.43% while in the highest 20% was 1.56%. Respiratory failure, pneumonia and sepsis were the most common acute diagnoses accompanying COVID-19 deaths in all SES. In patients with comorbid dementia or Alzheimer's disease, CMR were 21.62% and 23.40% respectively. Additionally, congestive heart failure (15.79%), atrial fibrillation (15.50%), chronic kidney disease (15.30%) and COPD (12.19%) were associated with high CMR. Among patients receiving approved therapies, casirivimab/imdevimab and remdesivir had CMR of 1.41% and 12.63% respectively, while for those receiving unapproved therapies, ivermectin and hydroxychloroquine had CMR of 2.54% and 2.45%. Conclusion(s): Compared to the 1.1% case-mortality rate (Johns Hopkins 2023) among US COVID-19 patients, we found CMR exceeded 3% among those with a medical claim for COVID-19. Advanced age, dementia, and cardio-renal disease were associated with mortality. Patients with the lowest SES had approximately 3 times the confirmed mortality rate compared to those in the highest SES group.Copyright © 2023
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Disparities exist in access to early oral health care, disproportionately impacting minority ethnic groups and populations with low socioeconomic status. Medical dental integration provides an opportunity to create a new dental access point for early prevention and intervention as well as care coordination. The Wisconsin Medical Dental Integration (WI-MDI) model expanded early access to preventive oral health services by integrating dental hygienists (DHs) into pediatric primary care and prenatal care teams to address oral health inequities with the goal of reducing dental disease. This case study will describe how DHs were incorporated into the medical care teams in Wisconsin and how legislation expanding scope of practice made this possible. Since 2019, five federally qualified health systems, one non-profit clinic, and two large health systems have enrolled in the WI-MDI project. Thirteen DHs have worked across nine clinics in the WI-MDI project and over 15,000 patient visits to a medical provider included oral health services provided by DHs from 2019 to 2023. Dental hygienists working in alternative practice models such as those demonstrated in the innovative WI-MDI approach are positioned to reduce oral health disparities through the provision of early and frequent dental prevention, intervention, and care coordination.
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Background: The outbreak of the COVID-19 pandemic, the constant transformation of the SARS-COV-2 virus form, exposure to substantial psychosocial stress, environmental change, and isolation have led to the inference that the overall population's mental health could be affected, resulting in an increase in cases of psychosis. Objective(s): We initiated a systematic review to determine the impact of the SARS-COV-2 virus and its long-term effects-in both symptomatic and asymptomatic cases-on people with or without psychosis. We envisioned that this would give us an insight into effective clinical intervention methods for patients with psychosis during and after the pandemic. Method(s): We selected fifteen papers that met our inclusion criteria, i.e., those that considered participants with or without psychiatric illness and exposed to SARS-COV-2 infection, for this review and were retrieved via Google, Google Scholar, MEDLINE, PubMed, and PsychINFO Database. Key Gap: There is a dearth of research in understanding how COVID-19 affects people with or without a prior personal history of psychosis. Result(s): The systematic review summary provides insight into the state of knowledge. Insights from the systematic review have also been reviewed from the salutogenesis model's perspec-tive. There is moderate evidence of new-onset psychosis during the COVID-19 pandemic in which some antipsychotics treated the psychotic symptoms of patients while treating for COVID-19. Suggestions and recommendations are made for preventive and promotive public health strategies. Conclusion(s): The Salutogenesis model and Positive Psychology Interventions (PPI) provide another preventive and promotive public health management approach.Copyright © 2023 Bentham Science Publishers.
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Tension between the Trump administration and its public health officials burst into the open this week, as President Donald Trump openly criticised his top infectious disease specialist, Anthony Fauci, for testifying in Congress against the reopening of states that have not met the administration's published criteria for ending their lockdowns.1 Dozens of mostly Republican controlled states are lifting restrictions despite failing grades on metrics such as new daily infections and percentage of positive test results. Maskless revellers filled bars across Wisconsin on the night of 13 May, as the state's conservative dominated Supreme Court struck down a lockdown imposed by Democratic governor Tony Evers. White House, April 16, 2020. https://www.whitehouse.gov/openingamerica/ 2 Dyer O. Covid-19: Trump says added deaths are necessary price for reopening US businesses.
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2022 was a year marked with significant anniversaries of hate against the AAPI community both historic and recent, from the 40th anniversary of the hate-driven murder of Chinese American immigrant Vincent Chin to the one-year anniversary of recent mass shootings in Atlanta and Indianapolis. These commemorations, moreover, came amidst a series of hate crimes targeting Sikh men in Richmond Hill, Queens, and a years-long spike in violence against Asian Americans - particularly Asian American women - ignited by the COVID-19 pandemic. One anniversary in 2022, however, is both important on its own right as a marker in the history of targeted violence and useful for contextualizing recent trends of hate in the US: the 10-year remembrance of the shooting at a gurdwara, a Sikh house of worship, in Oak Creek WI.
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Introduction: Our goal was to identify if the cases of influenza declined in the state of Wisconsin during the COVID-19 pandemic and, if so, what factors may have been responsible for this decline. Method(s): Influenza rates during the 2018-2019 and 2020-2021 seasons were compared using data from Respiratory Virus Surveillance Reports from the Wisconsin Department of Health Services and the Centers for Disease Control and Prevention. Result(s): The number of cases and hospitalizations due to influenza decreased significantly during the 2020-2021 influenza season compared to the 2018-2019 season, although mortality rates increased during 2020-2021. Discussion(s): Reducing the burden of illnesses, hospitalizations, and deaths due to influenza on the health care system is imperative. Taking the same preventive measures used during the COVID-19 pandemic, such as wearing masks, physical distancing, and frequent handwashing, should be advised, especially for the most vulnerable patient populations.Copyright © 2023, State Medical Society of Wisconsin. All rights reserved.
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This paper examines the experiences of 18 teachers in Wisconsin during the COVID-19 pandemic to address two questions: 1) What do teaching conditions look like during the COVID-19 pandemic? 2) How have educators adapted during the COVID-19 pandemic? This research offers a snapshot of the varied delivery models, safety and mitigation practices, and expectations of eleven school districts in suburban, urban, and rural Wisconsin. It examines the ways teachers adapted their practice to meet the challenging demands of the moment. The implications of this research include the need to advocate for better COVID-19 teaching conditions for all, acknowledge the resilience and adaptability of teachers, and develop teacher agency.
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The first year of the COVID-19 pandemic in 2020 was associated with an "anthropause" in many industries, initially reducing greenhouse gas emissions and other negative anthropogenic influences. However, outdoor recreation has exploded in popularity in response to closures of indoor recreation options, increased free time, and/or increased levels of stress. We tested for the effects of the COVID-19 pandemic on the sale of fishing licenses in Wisconsin and on vehicle counts that were observed at public lake access points in Vilas County, Wisconsin, in 2020. In the summer of 2020, fishing license sales in Wisconsin, USA, increased, particularly among first-time license purchasers for whom cumulative sales in 2020 increased by 71% and 35% compared with the previous 5-year average for Wisconsin residents and nonresidents, respectively. Changes in the vehicle counts at lake access points in the summer of 2020 varied considerably by lake. However, lakes with greater proportions of public shoreline experienced pandemic-associated increases in lake visitors. Our results suggest that the distribution of recreational fishing effort in Wisconsin changed during the pandemic, potentially placing additional harvest pressures on hot spot inland lakes.
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Purpose: The United States has seen a rise in sexually transmitted infections (STIs);the need to increase access for screening is essential to reverse this trend, especially for vulnerable populations such as LGBT+ individuals, people of color, or those at a low socioeconomic status. This study's primary objective is to assess preferences for mail-in STI screening among participants assigned female at birth already established with a primary care clinic. The study aims to provide insight into the need for clinicians to adopt mail-in testing for patients to improve screening access. Methods: Participants were recruited for this cross-sectional study from a clinical database of established patients with a focus on USPSTF recommendations for STI screening such as assigned female at birth (AFAB) and aged 18–24 years. Recruitment was done through a mailer from September to October 2021, inviting participants to complete an online survey. Statistical analyses were conducted using SAS software (SAS Institute Inc., Cary NC), version 9.4. Results: Overall, there was as a higher preference for home testing (61/88 = 0.69, 95% CI 0.59-0.79) among respondents. LGBT+ identity, age, recent clinical encounter, relationship status, living situation, or race and/or ethnicity, were not statistically significant associated with preference for home testing. However, there were lower odds for preferring home collection among participants with less education (OR 0.25, 95% CI 0.08-0.77, p<0.05), who lacked insurance (OR 0.19, 95% CI 0.06-0.67, p<0.05), or were unemployed (OR 0.28, 95% CI 0.08-0.95;p<0.05). Conclusions: Results from this survey indicate the desire for home testing among individuals from all demographics, influenced by social determinants of health such as education level and employment and insurance status. with overall acceptability for self-collection STI screening through mail-in methods (61/88=0.69;95% CI 0.59-0.79). The rising rates of STIs among young adults and delays in routine STI services secondary due to the ongoing COVID-19 pandemic and budget cuts emphasize the importance of new approaches to STI screening. Primary care clinics can expand needed screening by integrating such methods into workflows for established patients. These findings indicate a need for innovative outreach efforts to curb rising rates of STIs in the United States with additional consideration for research specific to LGBT+ health care needs, updated USPSTF recommendations for screening, and inclusive public health messaging. Sources of Support: Dr. Tana Chongsuwat was supported by the University of Wisconsin Primary Care Research Fellowship, funded by grant T32HP10010 from the Health Resources and Services Administration. The study was funded by a small grant by the University of Wisconsin Department of Pediatrics.
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In addition to being one of the most widespread and lethal diseases in the world, skin cancer is also one of the most common types of cancer. However, due to its complexity and fuzzy nature, the clinical diagnosis process of any disease, including skin cancer, prostate cancer, coronary artery disorders, diabetes, and COVID-19, is frequently accompanied by doubt. In order to address the uncertainty and ambiguity surrounding the diagnosis of skin cancer as well as the heavier burden on the overlay of the network nodes of the fuzzy neural network system that frequently occurs due to insignificant features that are used to predict or diagnose the disease, a fuzzy neural network expert system with an improved Gini index random forest-based feature importance measure algorithm was proposed in this work. A Greater Gini Index Out of the 30 features in the dataset, the five most fitting features of the diagnostic Wisconsin breast cancer database were chosen using a random forest-based feature importance measure algorithm. Two sets of classification models were created using the logistic regression, support vector machine, k-nearest neighbour, random forest, and Gaussian naive Bayes learning algorithms. As a result, models for classification that included all features (30) and models that only used the top five features were used. The efficacy of the two sets of categorization models was assessed, and the results of the assessment were compared. The comparison's results show that the models with the fittest features outperformed those with the most complete features in terms of accuracy, sensitivity, and sensitivity. A fuzzy neural network-based expert system was therefore developed, utilising the five best features, and it achieved 99.83 percent accuracy, 99.86 percent sensitivity, and 99.64 percent specificity. The system built in this study also stands to be the best in terms of accuracy, sensitivity, and specificity when compared to prior research that used fuzzy neural networks or other applicable artificial intelligence techniques on the same dataset for the diagnosis of skin cancer. The z-test was also performed, and the test result demonstrates that the system has significantly improved accuracy for early skin cancer diagnosis. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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Being a deadly disease, breast cancer is becoming the more progressive one in providing higher mortality for females around the world. Thereby, the need for an appropriate strategy is always required for earlier breast cancer diagnosis. The physicians utilize the Computer-Aided Diagnosis (CAD) tool for effective and tireless detection of such cancers. In this regard, the work is intended to design a CAD system for breast cancer diagnosis in a timely manner. The implementation starts with the use of Wisconsin Breast Cancer dataset. After performing preprocessing and visual analysis of the input dataset, feature selection is performed to improve the efficiency of the CAD system. This can be done by using the recently evolved Ebola Optimization Algorithm (EOA). This algorithm is based on an effective approach used in the propagation of the Ebola virus among individuals. After feature selection, the dominant features are then classified with the aid of a mixture Kernel Support Vector Machine (mK-SVM) algorithm. Additionally, the work utilized the Linear SVM, and KNN algorithms for the experimental analysis and comparison. As a result, the mK-SVM together with EOA provides maximum accuracy of 97.19% in classifying the input as either benign severity or malignant case. © 2022 IEEE.
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Introduction: Our institution cares for a largely underserved urban population, treating about 120 children annually with radiation therapy;roughly 10% are referred for proton therapy elsewhere. COVID-19 led to some decreases in medical care due to uncertainties regarding the state of public health. The purpose of this study is to evaluate existing socioeconomic disparities using the University of Wisconsin Area Deprivation Index (ADI) and whether the pandemic impacted this referral pattern. Method(s): Over the last twenty years, approximately 2,275 children have presented to our institution for radiation treatment. A retrospective chart review was conducted and a patient database of demographic and clinical information was created. We used demographic data to obtain the ADI, and compared relative disparity rankings between proton therapy recipients and a random sample of patients from the 25 most common zip codes (representative of over 20% of the total cohort). We compared the number of patients treated only at the closest proton facility before and after the onset of the pandemic. Result(s): The demographic make-up of our patient population is approximately 53.7% Latino, 22.6% White, 9.5% African American, 9.2% Asian, and 5% Other. Of these patients, about 500 had diagnoses typically referred for proton therapy (such as brain tumors, neuroblastoma, sarcomas, and Hodgkin lymphoma). At baseline, we found a statistically significant difference in the median state ADI decile of 3 and 7 for protons and photons, respectively, reflecting lower socioeconomic disadvantage in the proton group. There was a difference in the median household income (based on zip code) of $102,028 and $70,479 between the proton and photon groups (p < 0.0001). There was also a difference in median household income of $57,871 and $76,808 between Latino and Non-Latino patients (p < 0.0001). Demographic data for the proton therapy cohort showed that 46.2% of these patients were White, 15.4% were Latino, 15.4% were African American, 7.7% were Asian, and 15.4% were Other. At the closest proton facility, between 2014-2019, 16 of our patients received radiation therapy. Since the beginning of pandemic associated restrictions in March 2020, 19 patients have received proton therapy at this center. Conclusion(s): Disparities preventing patients from receiving proton therapy have been described. Our work adds granular census block data and uses the ADI which takes into account median family income, unemployment rate, households without access to a vehicle, English language proficiency and more. Those with lower ADI risk rankings were overrepresented in the proton therapy group. Despite the pandemic and added referral challenges, the number of patients able to receive proton therapy did not decrease which we hypothesize may be due to many factors, including the unanticipated flexibility of remote work amongst those with lower ADI rankings. Latinos were least likely to have proton therapy, and further research is needed to ameliorate the disparities and barriers to care which they face.
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Background: Racial and ethnic minorities have well-established disparities in cancer prevention, detection, treatment, and survival. A diverse oncology workforce improves the gap in cancer care for vulnerable populations. However, physicians, researchers, and others who are Underrepresented in Medicine (UIM) face unique challenges in obtaining mentorship and sponsorship, and there is a lack of safe spaces for them to thrive, forcing many to leave medicine entirely. To further efforts in improving the care of vulnerable populations and to create a welcoming environment for UIM medical trainees, the Florez Lab (formerly known as the Duma Lab) was founded by Dr. Narjust Florez in 2019 at the University of Wisconsin. Subsequently, Dr. Florez moved to Dana-Farber Cancer Institute and expanded the lab's reach. Here, we describe the history and legacy of our innovative group. Method(s): The Florez Lab is composed of 39 members, mostly UIM from different backgrounds and locations;members range from college students to faculty. It began as an allfemale team but now includes #HeforShe member allies. Several members joined as trainees, but are now junior faculty at NCI designated cancer centers and pay it forward by mentoring the next generation of the Florez Lab. We focus on social justice issues in medicine, including discrimination and gender bias in academic and clinical medicine, global oncology, and cancer health disparities, with a focus on thoracic oncology. Result(s): To date, the Florez Lab has secured research funding from several institutions and organizations, and has published 15 original articles, 11 editorials, 4 review articles, and 2 book chapters in addition to over 20 poster presentations at national and international conferences. Members have presented research findings at a wide array of national and international conferences, including the American Society of Clinical Oncology (ASCO) Annual Meeting and the World Conference on Lung Cancer, and the American Association for Cancer Research (AACR) Annual Meeting. The lab collaborates with multiple organizations, including the COVID-19 and Cancer Consortium (CCC19), ASCO Health Equity Committee, and the Lancet Commission: Women & Cancer. The lab is far-reaching;the #DumaLab and #FlorezLab hashtag is used on Twitter to amplify published work and advocacy efforts in improving the diversity of the oncology workforce and clinical trial enrollment. In 2021 the Florez Lab began a collaboration with Medscape and is the first lab to have a dedicated column, where we discuss issues related to social justice in medicine and cancer health disparities;the column has reached over 60,000 readers in less than one year. Conclusion(s): The success of the Florez Lab illustrates the importance of providing opportunities for, supporting, and amplifying the success of UIM trainees. Results indicate that the collaboration of UIM trainees is productive, meaningful, and necessary. Efforts should be made to continue supporting UIM trainees from all backgrounds and levels.
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BACKGROUND: Work-related exposures play an important role in SARS-CoV-2 transmission, yet few studies have measured the risk of COVID-19 across occupations and industries. METHODS: During September 2020 - May 2021, the Wisconsin Department of Health Services collected occupation and industry data as part of routine COVID-19 case investigations. Adults aged 18-64 years with confirmed or probable COVID-19 in Wisconsin were assigned standardized occupation and industry codes. Cumulative incidence rates were weighted for non-response and calculated using full-time equivalent (FTE) workforce denominators from the 2020 American Community Survey. RESULTS: An estimated 11.6% of workers (347,013 of 2.98 million) in Wisconsin, ages 18-64 years, had COVID-19 from September 2020 to May 2021. The highest incidence by occupation (per 100 full-time equivalents) occurred among personal care and services workers (22.4), healthcare practitioners and support staff (20.7), and protective services workers (20.7). High risk sub-groups included nursing assistants and personal care aides (28.8), childcare workers (25.8), food and beverage service workers (25.3), personal appearance workers (24.4), and law enforcement workers (24.1). By industry, incidence was highest in healthcare (18.6); the highest risk sub-sectors were nursing care facilities (30.5) and warehousing (28.5). CONCLUSIONS: This analysis represents one of the most complete examinations to date of COVID-19 incidence by occupation and industry. Our approach demonstrates the value of standardized occupational data collection by public health, and may be a model for improved occupational surveillance elsewhere. Workers at higher risk of SARS-CoV-2 exposure may benefit from targeted workplace COVID-19 vaccination and mitigation efforts.
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COVID-19 has accelerated changes that were already underway in the American economy, such as the increasing displacement of workers by automation, the exponential evolution of industries due to technical advancements (the Fourth Industrial Revolution), and a widening skills gap and attainment deficit in the American workforce. As a result, adult workers and their employers will increasingly demand efficient, reputable, and customizable pathways to quickly reskill and upskill. This paper will use the UW Flexible Option as a case study for how traditional universities can build competency-based programs to help adults rapidly meet changing workforce needs. The UW Flexible Option's design is an exemplar of wrap-around support services, a flexible academic calendar, integrated and efficient curriculum design, effective assessment of competence against articulated learning outcomes, project-based learning tied to workplace competencies, and tuition policies and financial aid delivery tailored to adult learners. The design will be explored through a case study of one of our programs, the Bachelor of Science in Business Administration. Massive economic change will soon displace workers on a scale not yet seen, and higher education has a responsibility to ensure those individuals get back into the workforce with the appropriate skills. Institutions of higher education will need to innovate to rise to the occasion, and competency-based education is one such pathway.
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The pandemic-fueled expansion of online learning will certainly persist beyond the pandemic, and schools must ensure that the transition creates accessible, high-quality options for all students. Most recently, the surge in COVID-19 Omicron variant cases and persistent ambiguity around whether and how to close schools reinforces the fact that we have failed to build intentional on-ramps to virtual education. State and local leaders can employ evidence from past online learning efforts, emerging best practices, and data from the pandemic to understand how to build a path forward that capitalizes on the potential of online learning, while avoiding the pitfalls. Virtual learning is not going away, but it must improve, especially for students of color and those facing economic insecurity. The bottom line is that students cannot afford to repeat the emergency distance learning that took place in 2020 and 2021. This brief provides a guide for education leaders and policymakers building a path to sustainable and quality virtual learning. It includes four steps school system leaders can take in the short and longer term to harness the potential of online learning, avoid pitfalls that made it ineffective, and ensure students have equitable access to high-quality learning opportunities that meet their needs.
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The COVID-19 pandemic rapidly changed the context of higher education during the Spring 2020 semester. As the virus began to spread across the United States, colleges and universities canceled inperson classes and activities, closed campus, and moved all operations online. Within the communication discipline, introductory communication course (ICC) administrators and instructors were not only dealing with these challenges, but they were also navigating the transition of large multi-section, often standardized, courses online at large institutions. This research project used semistructured, in-depth interviews with 18 ICC administrators from institutions located in 14 states across the Midwest, mid-Atlantic, Southeastern, and West Coast regions of the U.S. to explore how they engaged in relationship management with their instructors and how their approach to relationship management informed their transition to remote learning due to COVID-19. The analysis results in four emerging themes: (1) rhetorical approaches to relationship management, (2) relational approaches to relationship management, (3) relationship management [right arrow] positive outcomes, and (4) relationship management as central to navigating COVID-19. Based on these findings we suggest a rhetorical/relational goals approach to course administration and offer practical implications ICC administrators can implement to engage in successful relationship management during times of crisis.
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Background: Social isolation and loneliness contribute to cognitive decline, and social isolation represents a key modifiable risk factor for dementia. Substantial interruptions in social engagement due to the COVID-19 pandemic have heightened awareness of this issue, but common later-life events may also reduce social connectedness. The neurocognitive impacts of such disruptions are unclear. Using the validated NIH Emotion Toolbox, we examined perceived social support and changes in perceived support as predictors of cognitive function in a sample of middle aged and older adults. Method(s): 672 participants from the Wisconsin Alzheimer's Disease Research Center (ADRC) completed cognitive tests and Emotion Toolbox questionnaires at 2+ visits between 2017 and 2021 (mean interim = 1.7 years). Predictors comprised t-scores on three perceived social support scales: Emotional Support, Instrumental Support, and Loneliness. Cross-sectional analyses examined associations between social support and cognitive outcomes including memory (RAVLT Immediate and Delayed Recall) and processing speed/executive function (Trails A&B times). Using median t scores from the first and last available visit to categorize social support as high or low (for Loneliness, low loneliness was categorized as "high" social support), support over time was classified as stable-high, stable-low, or "change" (high-low or low-high). Mixed-effects regression models examined the demographic-adjusted predictor-outcome relationships between social support and cognition across visits. Result(s): In this ADRC sample (mean age 65.2, SD = 9.2;Table 1), all three social support scores associated cross-sectionally (Table 2) with Trails A and B performance. Relative to stable-high participants, those reporting either stable-low or declines from high to low social support exhibited poorer performance on measures of processing speed/executive function. Conversely, participants in the low-high group performed comparably on cognitive tests to those in the stable-high group (Table 3;Figure 1). Conclusion(s): Social support associated with processing speed/executive function in this sample. Participants who reported a change in social support performed comparably to those with either stable high or stable low support, suggesting that processing speed/executive function associated with social support may be modifiable in the shorter term. These findings underscore the cognitive cost of social isolation and highlight the substantial benefits of maintaining - and improving - social connections among middle aged and older adults. Copyright © 2022 the Alzheimer's Association.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: Pneumothorax and pneumomediastinum (PTX/PM) has been associated with patients hospitalized with COVID-19 infections. The aim of our study was to assess the risk factors, hospital length of stay, and mortality of PTX/PM among hospitalized patients with COVID-19 infection in a matched case-controlled study. METHODS: Adult patients with confirmed COVID-19 infections who were hospitalized at 5 Mayo Clinic hospitals (Minnesota, Arizona, Florida, Wisconsin) between March 2020 and January 2022 were retrospectively screened. PTX and or PM in at least two consecutive imaging studies were included. They were matched to control patients based on age, gender, hospital admission period, severity on admission day and the day preceding the incident. Summary statistics, Mann Whitney-U, and chi-square tests were performed RESULTS: A total of 197 patients were included in the descriptive analyses.The median age was 61 years and the majority were men (70.8%). Patients with underlying pulmonary comorbidities was 2.27 (OR 1.42-3.62, p value < 0.001) times more likely to develop PTX/PM. Ten percent of the total cases had these complications present upon hospital admission.Patients who developed PTX/PM had a longer hospital length of stay compared to controls, 20 versus 12 days, OR 4.53 (p=0.002). On the day prior to developing PTX/PM, 42 (31%) of patients had been on high-flow nasal cannula only and 14 on non-invasive ventilation (10.4%). The highest recorded positive end-expiratory pressure, plateau, and driving pressures were recorded in our case group on the day before the complication and all were significantly higher than matched controls. In-hospital mortality in patients whose COVID-19 course was complicated by PTX/PM was 44.2% vs. those without, 21.1%, adjusted OR 2.71 (p=0.001). Sixty two percent were treated conservatively without any intervention. CONCLUSIONS: We have demonstrated in the largest study to date, that patients who were hospitalized with COVID-19 infection and had a PTX/PM had a longer hospital length of stay, were associated with higher mechanical ventilatory pressures, and had a higher in-hospital mortality, when compared with matched controls. CLINICAL IMPLICATIONS: Complications of PTX/PM in patients with COVID-19 infections can occur spontaneously and in barotrauma. Pre-existing lung disease is a risk factor for the development of these complications. Patients with PTX/PM have a longer hospital length of stay and higher in-hospital mortality which is in contrast with existing published data. DISCLOSURES: No relevant relationships by Natalya Azadeh No relevant relationships by Meghan Brown No relevant relationships by Rodrigo Cartin-Ceba No relevant relationships by Anusha Devarajan No relevant relationships by Juan Pablo Domecq No relevant relationships by Sandeep Khosa No relevant relationships by Amos Lal No relevant relationships by Shahraz Qamar No relevant relationships by Kenneth Sakata No relevant relationships by Mayank Sharma No relevant relationships by Nikhil Sharma No relevant relationships by Jamil Taji No relevant relationships by Fahimeh Talaei No relevant relationships by Aysun Tekin No relevant relationships by Diana Valencia Morales No relevant relationships by Stephanie Welle