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Aims: At our Trust, all severe inpatient hypoglycaemic episodes in individuals with diabetes (defined as a hypoglycaemic episode requiring injectable treatment) are reported to NaDIA-Harms (National Diabetes Inpatient Audit). We conducted a detailed review of the care of all these events to improve patient safety. In this study, we assessed the risk of 12-month mortality following an episode of severe inpatient hypoglycaemia. Method(s): Reportable NaDIA harms of patients admitted during the period 2018-2022 were recorded into a dataset. Applicable patient records were reviewed at 12 months following the event to see how many patients were deceased and details of comorbidities at the time of the severe hypoglycaemic episode were collected. Result(s): To date, of 107 inpatients who experienced a severe hypoglycaemic episode 55% were deceased within 12 months. In patients admitted during the peak of the Covid-19 pandemic recorded as year April 2020/March 2021, 80% of patients who had a NaDIA hypoglycaemic event died within 12 months. Conclusion(s): Mortality rate following an episode of inpatient hypoglycaemia appears to be several-fold higher than previous reported rates of 4.45%-22.1% for community-dwelling individuals who experience a severe hypoglycaemic event. This maybe partially explained by the increased frailty, polypharmacy and multimorbidity among this cohort, but there is evidence linking hypoglycaemia with cardiovascular mortality. Although no causality between severe inpatient hypoglycaemia and death can be inferred from this study because of the observational nature, it does highlight the importance preventing inpatient episodes of hypoglycaemia through effective monitoring and proactive treatment modification.
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Objectives: We estimated the cost-effectiveness of non-pharmaceutical interventions (NPI), vaccines, and the combination of NPI and vaccines in managing the COVID pandemic. Method(s): A dynamic transmission model was constructed to simulate the incidence of COVID infections and deaths among community-dwelling Singapore residents. Using this model, we compared the cost and outcomes of NPI (border control measures, safe distancing and mask wearing) versus no NPI in an unvaccinated and a vaccinated population. The analysis was conducted from the societal perspective over a one year time horizon, with data based on the COVID situation in Singapore during Jan 2021 to Dec 2021. Costs of vaccination, adverse events, masks, self-testing using rapid antigen tests, test-trace-isolate (TTI), outpatient visits, hospitalization, productivity loss and reduced sales receipt from retail and food and beverages industries were included. Health loss from adverse events, TTI and COVID infection and deaths were also included. Result(s): Among the scenarios compared, vaccination combined with NPIs yield the lowest cost (S$7.6 billion), while no vaccination with NPIs had the highest costs (S$49.1 billion). The largest loss in QALYs from the population was seen from the scenario without vaccination or NPIs. Using a dominance approach, vaccination combined with NPIs is cost saving with an ICER of -S$213 billion per QALY, compared to no vaccination with lockdown measures. The results show that NPIs alone without vaccination only delays transmission, but does not significantly change the total number of cases observed in the population. Vaccination is both cost saving and health saving as the difference in cases averted from vaccination and their associated costs, is far greater than the additional costs required to vaccinate the public. Conclusion(s): Both vaccination and NPI are critical strategies for managing the COVID pandemic. In the presence of vaccine, NPIs continue to offer benefits in terms of reduced number of infections and deaths.Copyright © 2023
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Objectives: Self-perceptions of aging (SPA) have been shown to influence healthcare-seeking behaviors among middle-aged and older adults. Negative SPA may intensify the COVID-19 pandemic-related healthcare disruptions in this population. Therefore, this study seeks to evaluate the association between SPA and care deferrals among community-dwelling adults aged >=50 years in the US during the COVID-19 pandemic. Method(s): A cross-sectional study of the eligible sample was conducted using data from the 2020 wave of the Health and Retirement Study. SPA score was measured using a validated eight-item instrument with higher scores indicating negative SPA. The association between SPA and care deferrals during the COVID-19 pandemic was assessed using multivariable logistic regression adjusted for respondents' sociodemographic and clinical characteristics, past COVID-19-related experiences, and COVID-19 worry. Result(s): The final sample consisted of 4,153 community-dwelling adults aged >=50 years. 30% reported care deferrals during the COVID-19 pandemic. Among respondents who deferred care, the majority were aged 50-64 years (46.6%), females (65.4%), and White (64.5%). Most commonly reported care deferrals were dental appointments (74.5%) and physician visits (56.5%). Care deferrals were mainly due to clinic/office rescheduling or cancelling appointments (57.5%), respondent deciding the care could wait (33.8%), and COVID-19 fear (21.8%). Respondents reporting care deferrals reported higher mean SPA scores, indicating negative aging attitudes, compared those who did not defer care (Mean (SD): 3.24 (1.02) vs. 3.05 (1.04), p<0.001). After accounting for covariates, higher SPA scores were associated with significantly higher odds of care deferrals (aOR: 1.20, 95% CI: 1.11 - 1.30, p<0.001). Conclusion(s): This study found that negative SPA were associated with care deferrals during the COVID-19 pandemic among community-dwelling adults aged >=50 years. As healthcare delivery rebounds to pre-pandemic levels, the role of SPA in healthcare-seeking behaviors should be recognized. Health promotion efforts may target positive aging attitudes to encourage timely and proactive use of healthcare.Copyright © 2023
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Aims: During the COVID-19 pandemic, care for the elderly in the community was greatly limited. Accordingly, the demand for alternative community care have increased to cope with changing situations. In this study, we tried to find out whether the companion robot improved mood state and related problem in depressive or isolated community dwelling elderly. Method(s): For 186 community dwelling elderly who have received social welfare service due to depression or social isolation, we provided companion robot that could support their daily living. The robot was equipped with special program that could recognize and respond to the participant's own emotion. It was part of behavioural activation techniques which is one of powerful treatment for depression. The self-report questionnaires were used to measure changes in cognitive function, depression, suicidality, loneliness, resilience and satisfaction of life. Outcomes were measured before using companion robot and after 3 months, and we compared them. Result(s): The elderly using companion robot for 3 months showed improved cognitive function, depression (p < .001), suicidality (p < .001), and loneliness (p = .033) in the self-report questionnaire. Resilience (p = .749) and satisfaction of life (p = .246) were also improved but not reached significance. Conclusion(s): These findings showed that the use of companion robot with emotional recognition coaching program could help improve depression, cognitive function, loneliness and suicidal ideation. In particular, this effect was also useful for those who were diagnosed with depression. Also if we can put more techniques of behavioural activation programs into robot, it could be useful in community care for depressive and isolated elderly.
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Aims: The impacts of the coronavirus disease of 2019 (COVID-19) pandemic on mental health have been relatively severe. This study examined the influence of the COVID-19 especially on depression and suicidal ideation in community-dwelling elderly in Korea. Method(s): Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea). A total of 2423 elderlies were recruited from 22 counties in Jeollanam-do between April and October 2021. We used self-reported questionnaires, including sociodemographic factors, COVID-19 related stress, suicidal ideation, Geriatric Depression Scale-Short Form Korean Version (GDS-SF). Logistic regression was performed to examine the factors on depression and suicidal ideation. Result(s): Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, the worry of COVID-19 infection and restriction of daily activity due to COVID-19 pandemic were significantly associated with depression. Male sex, poor perceived health status, disability in house chores and depressive symptom are risk factors for suicidal ideation. Conclusion(s): These findings showed that increased risk factor for depression and suicidal ideation in community dwelling elderly during COVID-19 pandemic. We confirmed that feelings of isolation and negative perception of health were risk factors on depression in community dwelling elderly in the context of the COVID -19 pandemic. Also male, poor self-perceived health status, difficulty of independent living and worry and depression are increased the risk of suicidal ideation among the elderly.
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Introduction: Social media has emerged as a useful and potentially costeffective recruitment route for clinical trials particularly during the COVID-19 pandemic. This paper presents recruitment results and lessons learned from using social media for recruitment to the HEADS: UP Helping Ease Anxiety and Depression after Stroke Online randomised control trial. Method(s): We recruited UK-based community-dwelling stroke survivors with self-reported anxiety and depression. Our recruitment strategy included community networks and social media platforms. Result(s): Recruitment over 22 weeks resulted in 120 leads (5.5/week), with social media, primarily Facebook and Twitter, contributing 38 leads (31.7%;1.7/week). We enrolled 64 participants (female n=36 (56.3%), mean age 56.3 yrs, SD=11.2 ), with 28 (43.8%;female n=15 (53.6%), mean age 53.0 yrs, SD=11.3) recruited through social media. Facebook generated 21 (75%) of 28 social media participants, with Twitter contributing 8 (28.6%), including one participant from both Facebook and Twitter (3.6%). Facebook allowed for recruitment from stroke community groups and contact with key group members who posted regularly on our behalf, aiding credibility. Twitter provided the opportunity to recruit without gatekeepers, but required considerable researcher time and effort spent networking (i.e. Following, Liking, requesting Retweets) and developing new content to post, which stretched our limited resources. Conclusion(s): Social media was an effective, integral strategy for recruitment. However, substantial resources were required to develop content and manage our online presence. Future research could benefit from costing researcher time into funding applications and investing time in identifying and making contacts within population-specific pages or groups.
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Background: No studies have so far explored differences in frailty between groups of individuals who are vaccinated/unvaccinated against COVID-19. Therefore, this study aimed to investigate frailty progression in community-dwelling individuals requiring care/support who were using outpatient rehabilitation services during the start phase of vaccination programs against COVID-19. Method(s): A longitudinal survey using the Frailty Screening Index was administered in April 2020, September 2020, and June 2021 to 74 older adults (43 males, 31 females;age, 78.2 +/- 7.2;mean +/- standard deviation) requiring long-term care/support and using outpatient rehabilitation services. Participants were divided into the vaccinated (those who had received COVID-19 vaccinations;41 participants) and unvaccinated (those who had not been vaccinated;33 participants) groups. The Frailty Screening Index and frailty rating (robust, pre-frailty/frailty) at each of the three periods were analyzed using the Cochran's Q test. The resulting items and ratings with significant differences underwent post-hoc testing with the Bonferroni correction. Result(s): Concerning the frailty rating (robust, pre-frailty/frailty), pre-frailty/frailty increased significantly only in the unvaccinated group. Its post hoc tests showed that pre-frailty/frailty increased significantly from April 2020 to June 2021 and from September 2020 to June 2021. Conclusion(s):We find a difference in frailty progression between groups of vaccinated and unvaccinated community-dwelling older adults requiring care/support who were using outpatient rehabilitation services at the beginning of coronavirus vaccination programs during the COVID-19 pandemic.Copyright © 2023, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
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INTRODUCTION: The COVID-19 pandemic disrupted access and delivery of routine continuing care for sepsis recovery, including provision of postacute services like skilled nursing facility (SNF) discharge, home healthcare (HH), and outpatient follow up. We hypothesized pandemic-related precautions and care disturbances would disparately impact postacute care for adults with sepsis due to COVID-19 vs non-COVID-19 pneumonia. METHOD(S): ENCOMPASS is an ongoing hybrid trial to test implementation of a multidisciplinary postsepsis transitional care program at 8 diverse hospitals (NCT04495946). In the current study, we analyzed community-dwelling trial participants (i.e., adults with clinically defined sepsis) enrolled July 2020-Nov 2021 with discharge diagnoses of COVID-19 (ICD10 U07.1) or non-COVID-19 pneumonia (ICD10 J13-18). Using EHR data, we examined discharge care setting (SNF or inpatient rehab, HH, or home with self care) and outpatient follow up within 14 days (in-person, virtual, or none) as primary and secondary outcomes. For each outcome, we fit multinomial regression models adjusted for patient (age, insurance), clinical (comorbidity burden, organ failure, length of stay) and community factors (rurality by zip code). RESULT(S): Among 410 participants with COVID-19 (n=151) or non-COVID-19 (n=259) pneumonia (median, at enrollment: age=70, CCI=5, SOFA score=4), 52 (13%) died in hospital and 18 (4%) discharged to hospice. of remaining patients, 134 (39%) were discharged to home with self care, 118 (35%) to HH, and 88 (26%) to SNF or inpatient rehab. Survivors with vs without COVID-19 had similar adjusted odds of discharge to HH (OR=1.17 95%CI=0.65-2.10) and SNF or inpatient rehab (OR=1.60 95%CI=0.81-3.14) compared to home. Outpatient visit completion was similar for COVID-19 and non-COVID-19 survivors (26% vs 30%, p=0.43), but patients with vs without COVID-19 had higher odds of virtual (OR=4.76 95%CI=2.11-10.75) compared to no completed follow-up. CONCLUSION(S): In an ongoing postsepsis care trial, COVID-19 and non-COVID-19 survivors had similar provision of postacute services. COVID-19 was associated with increased virtual outpatient follow up, highlighting the value of telehealth to reduce exposure risk while maintaining close follow up of patients recovering from serious illness during the pandemic.
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Introduction: The exponential increase of the older segment of the population (1) is coinciding with the growing challenges of a digital society in different socio-cultural contexts (2). Objective(s): This exploratory study aims to analyze older adult perspectives of how smart technology influenced their meaning in life during the Covid-19 Public Health Emergency period, using qualitative research at a cross-national level. Method(s): Three hundred and fifty one community-dwelling older participants aged 65-87 years were included in the study. Participants were Italian, Mexican, Portuguese and Spanish. All the narratives went through a process of content analysis. Result(s): Findings of content analysis produced six themes: Meaningful relations, rewarding activities, spirituality, health and safetyrelated support, self-growth, and physical activity. Smart technology was important in promoting significant relations for Mexican older adults (71.3%), rewarding activities for Portuguese older adults (57.1%), spirituality for Spanish older participants (71.6%), and physical activity for Italian older adults (29.5%). Conclusion(s): This study indicated that smart technology during the Health Emergency period was important for the meaning in life of older populations, mostly by facilitating meaningful relations, rewarding activities and spirituality. Future interventions with older adults during pandemic periods should consider the diversity of themes associated with increasing older adult well-being, from a cross-cultural perspective. 1. von Humboldt S & Leal I. The old and the oldest old: Do they have different perspectives on adjustment to aging?. Int J Gerontol;9:156-160. 2. von Humboldt S et al. Does spirituality really matter? - Astudy on the potential of spirituality to older adult's adjustment to aging. Jpn Psychol Res, 56;114-125.
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SESSION TITLE: Use of Machine Learning and Artificial Intelligence SESSION TYPE: Original Investigations PRESENTED ON: 10/16/22 10:30 am - 11:30 am PURPOSE: The COVID-19 pandemic has significantly impacted the US healthcare system. Between March 1, 2020, and January 2, 2021, a 22.9% increase in all-cause mortality was reported [1]. We used Artificial Intelligence (AI) for data analysis to have a prototype national average by matching various characteristics. This is a novel approach known as Digital Twinning Method (DTM). We intend to compare non-COVID mortality between 2020 and 2019 using this DTM approach. METHODS: Data was collected by a contracted vendor that provided analysis utilizing an AI framework. Mortality rates were calculated at four points of care categorized as 1) In-patient mortality, 2) 30-day on-admission, 3) 30-day on discharge, and 4) 90-day on-admission. Baseline risk predictions were generated using DTM for matching patient demographics such as age, gender, race, Medicare status, and community-dwelling status. Hence, each person was compared to a "twin” with the same risk of hospitalization, death, acute myocardial infarction, or stroke. RESULTS: Our institution had a higher actual non-COVID mortality in 2020 compared to the actual mortality in 2019 across all four points of care studied. The highest increase was noticed in the 90-day on-admission category (9.7% in 2019 vs 12.6% in 2020) followed by 30-day on-admission (5.0% in 2019, to 6.6% in 2020), 30-day on-discharge (4.2% in 2019, to 5.7% in 2020), and in-patient mortality (1.8% in 2019, to 2.6% in 2020). However, when compared to twinned patients at other hospitals, our institution had a lower non-COVID mortality rate across all categories in 2019 and 2020. We utilized the Sign Test to evaluate our repeated-paired-measures for the above four points of care categories during two different conditions, i.e., under a normal healthcare situation (2019) and in the pandemic year (2020). Our two-tailed p-value was 0.0455 with statistical significance at p < 0.05, with M1-M2 (M=measure) difference of -0.8 (in-patient mortality), -1.6 (30 day on-admission), -1.5 (30 day on-discharge), and -2.9 (90 day on-admission) for the four categories. Our z-score was +2 under the formula z = (X - pn) / √npq, signifying positive deviation from the mean. Our study was limited by the unavailable data of patients who may have had COVID but were undiagnosed. CONCLUSIONS: AI is a novel method to obtain reliable data. Based on our results, we conclude that the non-COVID mortality rate at our institution increased during the pandemic. Further studies are needed to specify the underlying causes attributable to the increased mortality. CLINICAL IMPLICATIONS: By leveraging Artificial intelligence in healthcare to analyze big datasets and perform complex analyses, it may be of clinical importance to utilize AI-generated risk prediction models to accurately identify variables that can be controlled in future pandemics to decrease mortality while increasing overall efficiency of the healthcare system. DISCLOSURES: No relevant relationships by Muhammad Mohsin Abid No relevant relationships by Sana Jogezai No relevant relationships by Iqbal Ratnani No relevant relationships by Muhammad Hassan Virk No relevant relationships by Anza Zahid
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Introduction: The COVID pandemic has altered health care delivery, including clinical research, by introduction of measures to reduce COVID. How these measures affect clinical research participation is unclear. Objectives: The purpose of this survey was to document research volunteer's attitudes toward COVID infection control procedures. Methods: Our research program implemented the following: 1. Staff wore masks, disposable gowns, face shields and gloves when with subjects. 2. Subjects were asked if they tested positive or were experiencing COVID symptoms;upon entry their temperature was measured, and hand sanitizer used. 3. Disinfecting was expanded to all scanner room surfaces in contact with humans between each visit. 4. Only 1 subject was allowed in the research office at a time. Staff, when possible, remained > 6 feet away from other persons. As part of a study evaluating total body DXA, community dwelling volunteers completed a self-administered health care delivery preference survey from Dec 2020 to May 2021. A 5-point scale was used to capture responses to 10 questions (Table 1). Responses were tested using Chi Square with age and sex comparisons assessed by ANOVA. Results: Eighty-two adults (41F/41M) mean (SD) age 50.9 (18.3) yrs (range 18-79) without sex difference participated. Participants strongly agreed (84%;p < 0.001) they were more comfortable seeing effort to prevent COVID-19;72% agreed 1 subject, without a companion, should be seen, and 81% strongly agreed masks be required. Seeing staff clean visit space was important to 66%, more so among women (33%) than men (21% (p = 0.007)). Most subjects (83%) reported comfort having elective procedures and did not feel “unclean” or “diseased” (87%) by procedures. Some, 26%, preferred a non-hospital setting, 66% were neutral;those age 50+ (17%) preferred this more (p = 0.004) than younger subjects (5%). Finally, 91% preferred to have a brief test description before visit arrival. Conclusions: In this university-based study, most subjects favored masking, cleaning and limiting personal contact for research visits. Notably, no information regarding vaccination status was exchanged and the study began just as vaccines became available and ended just after all US citizens over age 16 were eligible for vaccination. Thus, it is unknown if vaccination status might alter research participation perception. However, people do prefer that steps are taken to reduce infection in research settings. It seems likely that this would be the case in clinical care settings.
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BACKGROUND: Vaccination uptake is a crucial component of public health and primary care, particularly amid the Covid-19 pandemic. The Centers for Disease Control and Prevention (CDC) recommends nearly universal yearly influenza vaccinations for all persons older than 6 months old, but uptake remains suboptimal. We sought to determine if individuals who report more frequent risk-taking behaviors, including excessive alcohol use, smoking, and driving without wearing a seatbelt, would be less likely to report recent influenza vaccination. METHODS: We used data from the BRFSS, a nationally representative telephone survey of community-dwelling adults conducted by the CDC, from 2011, 2015, and 2019. Risky behaviors queried and defined by the BRFSS included: 1) heavy alcohol use (>14 drinks per week for men or >7 drinks per week for women in the past 30 days);2) binge drinking (>5 drinks in one setting for men or >4 drinks for women in the past 30 days);3) current smoking (someday or everyday smoker);and 4) not wearing a seatbelt nearly always. Seatbelt data was only available for 2011 and 2015. We present weighted prevalence ratios (PR) derived from generalized linear models adjusted for age, race, sex, census region, year, and having a personal physician. We defined current influenza vaccination as receipt of a nasal or injected vaccine within the last year. RESULTS: Across the three included years, 1,217,271 people had data available for our variables of interest. A total of 40.1% (95% confidence interval [CI] 39.9% - 40.3%) of respondents reported influenza vaccination within the past year. All four of the risky behaviors were individually and independently associated with lower rates of vaccination (Heavy alcohol use: PR 0.94, 95% CI 0.91 - 0.97;Binge drinking: PR 0.91, 95% CI 0.89 - 0.93;Current smoking: PR 0.79, 95% CI 0.77 - 0.80;Seatbelt: PR 0.76, 95% CI 0.74 - 0.78), and the presence of multiple risk factors further lowered rates of influenza vaccination. When restricted to the smoking and alcohol risk factors for all three years, the likelihood of influenza vaccination was 14% lower (PR 0.86, 95% CI 0.85 - 0.87) for each additional risk factor present. We observed a statisically significant dose-dependent decrease in likelihood of vaccination from 0.76 (PR 95% CI 0.74 - 0.77) with any one risk factor present to 0.65 (PR 95% CI 0.63 - 0.68) with any two risk factors present, down to 0.50 (PR 95% CI 0.47 - 0.53) if all three risk factors were present. When we examined all four risk factors across the two years where data was available, the likelihood of influenza vaccination dropped by an average of 15% (PR 0.85, 95% CI 0.84 - 0.86) with each additional risk factor present. CONCLUSIONS: In this contemporary, nationally-representative analysis of American adults, risk-taking behavior was associated with lower rates of influenza vaccination. This analysis may provide a useful framework for physician counseling and public health efforts to expand vaccination.
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Background: Older individuals face a high risk of mobility and body composition decline, which can affect their independence. In light of a current uncertain healthcare situation created by the coronavirus (COVID-19) pandemic, healthcare paradigm has been shifted with increased demand for a practical measure to promote standard home healthcare services for all individuals, including older adults. Objective: This study explored the feasibility and validity of seated push-up tests (SPUTs) as clinical measures to reflect the body composition, muscle strength, and mobility among community-dwelling older individuals, aged ≥65 years (n=82). Methods: Participants were cross-sectionally assessed using SPUTs with various demanding forms, including the 1-Time SPUT (1SPUT) along with its upper limb loading SPUT (ULL-SPUT), 5-Time SPUT (5SPUT), 10-Time SPUT (10SPUT), and 1-min SPUT (1minSPUT) and standard measures. Results: Participants who passed and failed a 1SPUT showed significant differences in the outcomes of all standard measures (p<0.05). The ULL-SPUT significantly correlated to all body composition, muscle strength, and mobility (r=0.247-0.785;p<0.05). Outcomes of 1minSPUT significantly correlated with muscle strength and mobility outcomes (r=0.306-0.526;p<0.05). Participants reported no adverse effects following the SPUTs. Conclusion: The findings suggest the use of the 1SPUT, ULL-SPUT, and 1minSPUT as practical measures to reflect the body composition, muscle strength, and mobility of older individuals, according to their functional levels. The tests may especially clinically benefit those with lower limb limitations and those in settings with limited space and equipment.
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Background: This descriptive study of virtual contingency management tested changes of levels of PEth in blood and urinary EtG repeatedly across the study period at weekly, then monthly, intervals to evaluate incentives and the success of the intervention for alcohol use disorders. PEth in human red blood cells and uEtG aremetabolites of ethanol withmean half-lives during abstinence of approximately 7 days and several hours, respectively. The primary purpose of this analysis was to evaluate mean PEth levels when uEtG was either negative (undetectable) or positive. Also, increase or decrease of PEth levels when uEtG status changed was also tested. Methods: Community-dwelling participants (N = 11) with alcohol use disorders and baseline PEth levels ≥20ng/mL were recruited. Blood and urine samples were collected weekly for six weeks, monthly thereafter. Zoom-based supervision was used for participant, self-administered blood collection with TASSO-M20 devices. PEth was a continuous variable quantified with HPLC/MS/MS. uEtG levels were qualitatively tested with dip stick cards and reported as negative (undetectable) or positive (≥300 ng/mL). Results: Participants had from 6 to 17 virtual visits (total 11 subjects = 115 visits). Mean (SD) PEth level when uEtG levels ≥300 ng/mL (N = 63) was statistically greater than mean (SD) PEth level when uEtG levels were <300 ng/mL (undetectable;N = 45)], 856 (801) versus 91.2 (186) ng/mL, respectively (p <0.0001). Only 19/115 PEth values overlapped between the two uEtG groups. Change in direction of uEtG (up or down) between visits closely matched direction of PEth 19/23 times. uEtG levels did not change during 35 pairs of visits, but significant changes in PEth levels were still observed. Significant visit to visit changes in PEth occurred. xConclusions: Strong agreement existed between blood PEth and uEtG to indicate increase or decrease changes in alcohol consumption between virtual visits. The few discrepancies were likely related to the significant differences in the half-lives of the two direct biomarkers. Repeated within subject measurements at regular intervals enabled identification of changes in drinking between virtual visits. It should be noted that collection of blood with TASSO devices were self-administered by the participants to facilitate the continuation of this study during the COVID pandemic.
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Introduction: Mood disorder is a significant problem following stroke, affecting survivors (approximately 33%) up to 5 years post-stroke. Mindfulness Based Stress Reduction (MBSR) group-based courses are effective in helping people self-manage symptoms of anxiety and depression. In earlier co-creation work we developed HEADS: UP (Helping Ease Anxiety and Depression after Stroke), a 9-week stroke-specific MBSR course designed to mitigate effects of stroke which make mastery of MBSR skills challenging. Methods: In two non-randomised mixed-methods feasibility studies we further adapted HEADS: UP: face-to-face (study 1);online, in response to COVID-19 restrictions (study 2). We used community networks and social media to recruit stroke survivors (SS) with self-reported anxiety and depression. Quantitative and qualitative data were collected pre-/ post-intervention. Both studies received ethical approval. Results: We enrolled 21 community-dwelling participants. Study 1: 13 SS (female n=4, 30.8%;mean age 63.3 years). Study 2: 9 SS (female n=5, 55.6%;mean age 54.2 years). Qualitative data informed changes to research processes and HEADS: UP course materials. Participants found the course accessible and beneficial, “It's helped dramatically;I can't explain how much.” Conclusions: Stroke survivors found a stroke-specific psychological self-management intervention, HEADS: UP (face-to-face, online) acceptable, feasible and beneficial. (Table Presented).
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Background: Social media can be a useful tool in clinical trial recruitment strategy and could become increasingly important as established recruitment methods may be impaired by the COVID-19 pandemic, i.e. flyers, posters. The HEADS: UP randomized control trial utilised multiple social media platforms to access and recruit stroke survivors alongside additional, non-social media routes in response to COVID-19 pandemic restrictions. Aim: To assess the effectiveness of recruitment to the HEADS: UP clinical trial through social media. Methods: We recruited community-dwelling stroke survivors (SS) with self-reported anxiety and depression using community networks and social media. Social media recruitment allowed for direct communication with potential participants through the development of Twitter (@ HeadsUpStroke), YouTube and Reddit accounts. Facebook posts were shared on the researchers' personal accounts and UK-based stroke organization Facebook pages and groups. Results: Recruitment lasted 16 weeks and resulted in 120 leads (7.5/ week). Where recruitment source was known, social media contributed 36 leads (2.3/week). We enrolled 64 participants (female n=36, mean age 56.3 years) of which 28 were recruited through social media (43.8%;female n=15;mean age 53.0 years). Facebook was the most effective route (n=21, 75%). The least effective route was Reddit. One lead contacted the primary investigator using LinkedIn, a platform we had not included in our strategy. Costs totaled £50 (£1.79/enrolled social media participant). Conclusions: The use of social media for recruitment of stroke survivors to a psychological self-management intervention trial was both effective and low-cost, significantly contributing to overall recruitment and supplementing established research methods.
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Backgrounds: Sarcopenia is a geriatric condition characterized by a progressive loss of muscle mass and function, having high personal, social and economic burdens when untreated. Sarcopenia increases risk of falls and fractures;impairs ability to perform activities of daily living;is associated with cardiac and respiratory disease and cognitive impairment;leads to mobility disorders;and contributes to lowered quality of life, loss of independence or need for long-term care placement, and death. It is recognized as one of the five pillars of frailty. As of today, to our knowledge, only exercise and nutrition interventions seem somewhat effective interventions. Objectives: SARA-INT study is a Phase 2 study to develop a viable option to treat community-dwelling seniors suffering from age-related sarcopenia, including sarcopenic obesity. Methods: SARA-INT is a randomized double-blind three-arm study (BIO101 175 mg bid / BIO101 350 mg bid / placebo) with planned treatment duration of 6 Months;due to COVID-related measures, 49 patients continued up to 9 months of treatment. Main eligibility criteria for sarcopenia were meeting FNIH criteria and Short Physical Performance Battery (SPPB) score ≤ 8/12 in men and women aged ≥ 65 years. Primary analysis was the gait speed from the 400-meter walking test (400MWT) at month 6/9 in the FAS with secondary analyses at other timepoints, secondary endpoints were other physical activity assessments, muscle strength, muscle mass and Patient Reported Outcomes (PROs). Results: 233 participants were randomized in the study, 232 and 156 participants were included in the Full Analysis Set (FAS) and Per-Protocol (PP) populations, respectively. Due to COVID-19 pandemic, end-of-treatment assessments are missing for approximately half of the participants, impacting the treatment effect detection. In the primary analysis (at month 6/9 in the FAS population) of the primary parameter, the improvement in 400MWT compared to placebo was not statistically significant (0.0363 (0.03098) m/s and 0.0385 (0.02985) m/s in the BIO101 175 mg and 350 mg groups, p=0.2437 and p=0.2000, respectively). BIO101 350 mg bid treatment after 6 months showed a clinically relevant improvement in the 400MWT of 0.07 m/s in the FAS population (not significant) and of 0.09 m/s in the PP population (nominally statistically significant, p=0.008);this is close to the Minimal Clinically Important Difference (MCID) in sarcopenia (0.1 m/s). BIO101 350mg bid treatment effect on the 400MWT is confirmed in pre-defined sub-populations at higher risk of mobility disability such as slow walkers, obese and those with chair stand sub-score ≤2 from SPPB;trends were observed with other independent endpoints. BIO101 showed no difference in adverse events or safety laboratory parameters versus placebo (), and no severe adverse event associated with BIO101 treatment. Conclusions: After 6 to 9 months of treatment, BIO101 at 350 mg bid showed promising results with a clinically relevant improvement in the 400MWT gait speed, the primary endpoint of the study, confirmed in sub-populations at higher risk of mobility disability. BIO101 showed a very good safety profile at the doses of 175 and 350 mg bid. Biophytis is preparing to start a phase 3 program with BIO101 at 350 mg bid in 2022, targeting a similar patient population. Conflicts of interests: CT, WD, CM, RL, PD, RvM and SV are employees of Biophytis SA, AZ, and SA are employees of Biophytis Inc., JM is president of the Scientific Advisory Board of Biophytis, SDS is employee of BlueCompanion Ltd.
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Background: The psychological well-being of older adults may have been negatively affected by the outbreak of the COVID- 19 epidemic due to the presence of comorbidity, increased risk of complications, mortality, and difficulty in adapting to mhealth and social isolation. The study aimed to investigate the anxiety level of community older adults during the COVID-19 epidemic and explore its associated factors, so that there can be more evidence-based advice to improve the mental health status for the older adults. Methods: Online questionnaires and face to face communication were used to investigate 320 community older adults, who were selected randomly. The questionnaires were used to investigate the sociodemographic characteristics, anxiety and resilience level of the participants. One-way ANOVA, correlation and regression analysis were performed to explore the factors associated with the anxiety among the older adults. Results: The mean of the anxiety among the all participants is 44.03±10.89 and 128 persons (40%) suffer from the anxiety (mild anxiety: 84.38%, moderate anxiety: 14.06%, severe anxiety: 14.06%). The mean of resilience is 56.68±18.26, and the three dimensions of CD-RISC is negative correlation with the anxiety. The SAS can be influenced by the chronic disease history (P=0.045), physical health conditions (P=0.024), economic income (P=0.026), the health education of the COVID-19 epidemic (P<0.001) and the level of resilience (P=0.002). Conclusions: The morbidity and score of the anxiety among the community older adults are higher during the COVID-19 epidemic than the usual. While the score of the CD-RISC is lower than the previous studies. Anxiety emerged as a prominent issue for community- dwelling older adults during the COVID-19 epidemic. Interventions that targeted resilience may have the potential to reduce anxiety level and improve the psychological well-being of the older adults.
ABSTRACT
Background: The spread of COVID-19 has affected the physical and emotional health of individuals globally. While studies have focused on the virus and its effect on health, the emotional impact of COVID-19 on older adults has not been well studied. Methods: We administered an anonymous survey to discern the emotional impact of the current pandemic on community-dwelling adults living in central Arkansas. Participants were surveyed about stress levels and coping strategies as well as their perception of pandemic media coverage. Results: 124 adults (80% women, 20% men) over age 18 completed the survey. 72% were white and 23% were African American. 71% were aged ≥60 years, while 29% were under 60 years old. 30% of younger adults were unemployed or retired, vs. 76% of older adults. 72% of younger adults selected shortages at the store as the greatest stressor, whereas only 45% of older adults selected this option. Also, 78% of younger adults reported that family support helped them deal with stress while only 52% of older adults chose family support and relied equally on friends. Approximately half of older adults, 53% found TV and newspaper coverage on COVID- 19 useful. In contrast, only 31% of younger adults found the media coverage useful and 42% stated that it actually increased their anxiety. These age differences in perspectives and emotional impact were found to be significant (p<0.05). Conclusions: The spread of COVID-19 has brought about new stressors and definitions of social support that has impacted emotional health. Our findings showed some interesting age-associated differences in stress management. Commodity shortages created more stress for younger versus older adults. The majority of younger adults leaned on family support to help them deal with the pandemic stress, while approximately half the older adults coped by talking with their friends. For the most part, younger adults found media coverage of COVID-19 anxiety-provoking while older adults found it to be useful and informative. There might be many underlying reasons why older adults perceived less stress, but it is important to realize that a circle of friends and frequent communication can help older adults perceive less stress than younger adults even during a pandemic.