COVID-19 Vaccine Uptake in Individuals with Functional Difficulty, Disability, and Comorbid Conditions: Insights from a National Survey in Bangladesh (preprint)

Background: COVID-19 vaccine coverage among individuals with disabilities is crucial for safeguarding their health and well-being. However, the extent of vaccine coverage among this group remains largely unknown in low- and middle-income countries. This study aims to explore the COVID-19 vaccine coverage among persons with functional difficulty, disability and/or morbidity in Bangladesh. Methods: Data from 9,370 respondents extracted from the 2021 National Household Survey on Persons with Disability were analysed. The outcome variable was the receipt of at least one dose of the COVID-19 vaccine (yes, no). Key explanatory variables included the presence of disability (yes, no), morbidity (yes, no), and both morbidity and disability (yes, no) among persons with functional difficulty. The relationship between the outcome and explanatory variables was determined using multilevel logistic regressions adjusted for covariates. Results: The overall acceptance rate for at least one dose of the COVID-19 vaccine among persons with functional difficulty was 57.37%, among persons with functional difficulty and disability was 48.63% and among persons with functional difficulty and single (57.85%) or multi-morbidity (60.37%). Compared to the respondents with functional difficulty only, the adjusted odds ratio (aOR) of acceptance of at least one dose of the COVID-19 vaccine for individuals with both functional difficulty and disability was 0.73 (95% CI, 0.65-0.82) and 0.77 (95% CI, 0.70-0.87) for individuals with functional difficulty, disability and one or more comorbid conditions. The aOR for individuals with functional difficulty and one or more morbid conditions was significantly higher than that for persons with functional difficulty only. Conclusion: In Bangladesh, COVID-19 vaccine coverage was relatively low among individuals with disabilities. The existing COVID-19 vaccine rollout programs and similar future programs should prioritise individuals with disabilities and include targeted strategies to reach them.

Repeated Hand Grip Strength is an Objective Marker for Disability and Severity of Key Symptoms in Post-COVID ME/CFS (preprint)

Post-COVID Syndrome (PCS) refers to a diverse array of symptoms that persist beyond 3 months of the acute phase of a SARS-CoV-2 infection. The most frequent symptom is fatigue, which can manifest both mentally and physically. In this study, handgrip strength (HGS) parameters were determined as an objective measure of muscle fatigue and fatigability. HGS parameters were correlated with other fre-quent symptoms among 144 female PCS patients suffering from fatigue, exertional intolerance, and cognitive impairment. Seventy-eight patients met the Canadian Consensus Criteria (CCC) for post-infectious myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The severity of disa-bility and key symptoms were evaluated utilizing self-reported questionnaires. Notably, patients di-agnosed with ME/CFS exhibited a higher overall severity of symptoms, including lower physical func-tion (p < 0.001), a greater degree of disability (p < 0.001), more severe fatigue (p < 0.001), post-exertional malaise (p < 0.001), and autonomic dysfunction (p = 0.004). While HGS was similarly impaired in both PCS and ME/CFS patients, the associations between HGS and the severity of symptoms and disability revealed striking differences. We observed significant correlations of HGS parameters with physical function across all patients, but with the key symptoms PEM, fatigue, cog-nitive impairment, and autonomic dysfunction in ME/CFS patients only. This points to a common mechanism for these symptoms in the ME/CFS subtype, distinct from that in other types of PCS. Further HGS provides an objective marker of disease severity in ME/CFS.

Long COVID Disability Burden in US Adults: YLDs and NIH Funding Relative to Other Conditions (preprint)

BackgroundLong COVID (LC) is novel, debilitating and likely chronic. Yet, scant data exist about its disability burden to guide scientific research and public health planning. We estimated Long COVIDs non-fatal disease burden in US adults and its FY2024 actual: burden-commensurate research funding from the National Institutes of Health (NIH) relative to other conditions, and biological sex. MethodsWe present YLDs/100,000 for 70 NIH Research, Condition, and Disease Categories (RCDCs). Prevalence of disabling Long COVID was obtained from cross sectional surveys of representative samples of US adults, from September 2022 to August 2023. Disabling Long COVID was defined as incident symptoms persisting more than 3 months post-COVID, that significantly compromise daily activities. We calculated burden-commensurate funding for the top YLD conditions and for female vs. male dominant conditions. FindingsDisabling Long COVID was reported by 1.5% (n= 10,401) of n=757,580 respondents: Compared to the overall sample, those with disabling LC disproportionately identify as female (64.4% vs. 51.4%) and experiencing disability (80.8% vs. 52.9%) anxiety (57.5% vs. 23.8%) and depression (51.3% vs.18.5%). It ranked in the top 25% of YLDs at 320/100,000, between Alzheimers (279.4/100,000) and asthma (355.7/100,000) but received just 10% of its actual: YLD-commensurate funding. Only 5 conditions received less actual: burden: commensurate funding, including Myalgic Encephalitis/Chronic Fatigue Syndrome (<1%), another post-viral, female-dominant condition. InterpretationLC has debilitated 3.8 million (weighted frequency) US adults. Research funding for it, like other female dominant conditions, lags behind its disability burden. Research in ContextEvidence before this study - We analyzed Long-COVIDs (LC) non-fatal disease burden in the US--represented by YLD (years lived with disability= prevalence x disability weight) -- and National Institutes of Health (NIH) research 2024 funding relative to other conditions. We searched PubMed through 11/28/2023 for Long COVID prevalence (US), and Long COVID disability and disease burden (not US-specific). The keywords "years lived with disability" + "COVID" yielded n= 38 articles (11/29/23); but most referenced "disability-adjusted life years" (DALYs) in other countries. Similarly, "disease burden" + Long COVID yielded 23 papers, but no US YLD data. See Supplement 1 for meta-analyses, systematic reviews and US studies of Long COVID prevalence and impact. We instead sourced YLD data from the US Census Bureaus Household Pulse Survey (HPS) and the Institute for Health Metrics and Evaluation (IHME) /Global Burden of Disease (GBD) Long COVID Study Group. The HPS queries adults about Long COVID-related symptoms and their impact on daily activities. We applied the IHME/GBDs estimated Long COVID disability weight of 0.21 and harmonized it with our LC case definition from the HPS data in consultation with IHME/GBD researchers. To harmonize IHME/GBD disability weights for non-LC diseases/conditions with the NIHs terminology, we consulted with NIH staff. LC definition and measurement affects prevalence and burden estimates; our use of high-quality data sources and transparency in reporting how they were applied reduces the risk of biased assumptions. Added value of this study- Long COVID is a chronic debilitating condition. While there is ample research on COVIDs acute illness and loss of life, there are no population-based data on its disability burden. We provide that data. To guide scientific research and public health planning, we report YLDs associated with disabling Long COVID (i.e., symptoms significantly limit activity), and; compare it to other conditions YLDs, NIH funding, and female-vs. male-dominance. It ranked in the top 25% of YLDs at 320/100,000, between Alzheimers (279.4/100,000) and asthma (355.7/100,000) but received just 10% of its YLD-commensurate funding. Only 5 conditions received less burden-commensurate funding; 3/5 were female-dominant, including Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS) at <1%, another post-viral condition that shares significant overlap with Long COVID. Overall, median funding/YLD was >= 5 times greater for male-vs. female-dominant conditions. Implications of all the available evidence-Nearly 4 million US adults (weighted frequency) live with disabling Long COVID. They disproportionately identify as female and as having a disability, anxiety and depression. Yet NIH funding for diagnostic and treatment research for Long COVID hasnt kept pace with its disability burden.

Correlation between COVID-19 vaccination and inflammatory musculoskeletal disorders (preprint)

ImportanceEarlier research on COVID-19 vaccines identified a range of adverse reactions related to proinflammatory actions that can lead to an excessive immune response and sustained inflammation. However, no study has been conducted on the association between inflammatory musculoskeletal disorders and COVID-19 vaccines. ObjectiveTo investigate the incidence rates of inflammatory musculoskeletal disorders following COVID-19 vaccination and to compare them with those of unvaccinated individuals. Design, Setting, and ParticipantsThis retrospective nationwide cohort study used data from the Korean National Health Insurance Service (NHIS) database, involving 2,218,715 individuals. Data were collected from January 1, 2021, to 12 weeks after the second dose of vaccine for vaccinated individuals and 12 weeks after September 30, 2021, for unvaccinated individuals. ExposuresStatus was categorized as unvaccinated and vaccinated with mRNA vaccine, viral vector vaccine, and mixing and matching. Main Outcomes and MeasuresThe primary outcome was the occurrence of inflammatory musculoskeletal disorders that were selected as plantar fasciitis (ICD code, M72.2), rotator cuff syndrome (M75.1), adhesive capsulitis (M75.0), herniated intervertebral disc (HIVD) (M50.2/M51.2), spondylosis (M47.9), bursitis (M71.9), Achilles tendinitis (M76.6), and de-Quervain tenosynovitis (M65.4). Multivariate logistic regression analysis was used to determine the risk factors of musculoskeletal disorders after adjusting for potential confounders. ResultsAmong the 2,218,715 individuals, 1,882,640 (84.9%) received two doses of the COVID-19 vaccine, and 336,075 (15.1%) did not. At 12 weeks after vaccination, the incidences of plantar fasciitis (0.14-0.17%), rotator cuff syndrome (0.29-0.42%), adhesive capsulitis (0.29-0.47%), HIVD (0.18-0.23%), spondylosis (0.14-0.23%), bursitis (0.02-0.03%), Achilles tendinitis (0.0-0.05%), and de-Quervain tenosynovitis (0.04-0.05%) were higher in all three vaccinated groups (mRNA, cDNA, and mixing and matching vaccines) when compared to the unvaccinated group. All COVID-19 vaccines were identified as significant risk factors for each inflammatory musculoskeletal disorder (odds ratio, 1.404-3.730), except for mixing and matching vaccines for de-Quervain tenosynovitis. Conclusions and RelevanceThis cohort study found that individuals who received any COVID-19 vaccine were more likely to be diagnosed with inflammatory musculoskeletal disorders than those who did not. This information will be useful in clarifying the adverse reactions to COVID-19 vaccines and informing people about their potential for inflammatory musculoskeletal disorders after vaccination.

Behavioural and Social Predictors of COVID-19 Vaccine Uptake among Persons with Disabilities in Kenya. (preprint)

The uptake of the COVID-19 vaccine by persons with disabilities remains largely unknown in low-and middle-income countries. This evidence gap necessitates disability-focused research to inform improvements in access and inclusion in the last mile of COVID-19 vaccination programs and to support future programs for other vaccine-preventable diseases. We aimed to identify behavioural and social predictors of COVID-19 uptake among persons with disabilities in Kenya. This was a convergent parallel mixed method study that involved questionnaires (792), key informants interviews, and focus group discussions among persons with disabilities and key stakeholders (government actors and professional associations). Data were analysed using STATA statistical analysis software (version 14). Chi-square (X2) and Fishers exact tests were used to test for differences in categorical variables; multivariate regression analysis was employed to ascertain the factors that influence uptake of COVID-19 among persons with disabilities (PWDs) in Kenya. Approximately 59% of persons with disabilities reported to be fully vaccinated, with significant disparities noted among those with cognition (34.2%) and self-care (36.6%) impairments. Confidence in vaccine benefits (Adjusted odds ration [OR]; 11.3, 95% CI; 5.2-24.2), health worker recommendation (OR; 2.6, 95% CI; 1.8-3.7), employment (OR; 2.1, 95% CI; 1.4-3.1), perceived risk (OR; 2.0, 95% CI; 1.3-3.1), age and area of residence were statistically significant predictors of vaccine uptake among PWDs. The primary reasons for low uptake included perceived negative vaccine effects and lack of adequate information. No association was found between having a primary caregiver and/or assistive device, with COVID-19 vaccine uptake. Subsequent vaccination deployments should map and reach PWDs through relevant institutions of PWDs, and localized vaccination campaigns. Related communication strategies should leverage on behaviour change techniques that inspire confidence in vaccines, and on the credibility and trust in health workers to improve vaccine uptake.

Addressing the Human Rights Challenges of Older Persons with Disabilities (preprint)

The World Health Organization has reported that approximately 16% of the global population, over 1.3 billion people worldwide, had some form of disability, and that an additional 190 million people (3.8% of people over 15 years of age) experience serious difficulties in functioning normally on a daily basis. In the US, 61 million, or 26% of, adult Americans have some form of disability, and 2 in 5 adults over the age of 65 have a disability. It has been reported that close to half of all people over the age of 65 in the European Union have some form of disability, putting them at increased risk of neglect, loss of support, abuse and poverty. While the number of persons with disabilities is large, their experiences are diverse and not all people with disabilities are equally disadvantaged. For example, disability does not necessarily imply limited well-being and poverty; however, growing evidence confirms that disability and poverty are highly correlated, and that disability is both a cause and consequence of poverty and disability and poverty reinforce each other in ways that contribute to increased vulnerability and exclusion. While the Convention on the Rights of Persons with Disabilities was adopted in 2006 and went into force in 2008, making it the first binding international instrument addressing the needs of persons with disabilities worldwide, disabled persons of all ages, and particular those who are older, face a number of barriers to inclusion including attitudinal barriers (e.g., stereotypes, prejudices, other forms of paternalistic and patronizing treatment, discrimination, fear, bullying and low expectations of people with disabilities); institutional barriers (i.e., laws, policies, strategies or practices that discriminate against people with disabilities including lack of enforcement and political support for policies); “internalized” barriers (i.e., due to stigma and stereotyping, disabled persons refrain from pro-active behavior in expressing their opinions and claiming their rights); lack of participation including lack of consultation and involvement of people with disabilities in decision making; inadequate data, statistics and evidence on what works; and inaccurate concerns over the costs and difficulties of disability inclusion (e.g., concerns that disability inclusion is too difficult and requires specialist knowledge or require special programs that would unduly burden existing resources). In addition, older people with disabilities face special issues. In her July 2019 report to the UN General Assembly, the UN Special Rapporteur on the Rights of Persons with Disabilities identified several human rights challenges affecting older persons with disabilities, including stigma and stereotypes; direct and indirect discrimination; denial of autonomy and legal capacity; institutionalization and lack of community support; violence and abuse; lack of adequate social protection; and lack of access to palliative care. She argued that “[t]he intersection between older age and disability results in both aggravated forms of discrimination and specific human rights violations against older persons with disabilities” and that older persons with disabilities were subject to a greater extent to loss of power, denial of autonomy, marginalization and cultural devaluation; more prone to social isolation, exclusion, poverty and abuse; and vulnerable to gaps in human rights protection and age-biased interpretations of human rights standards. The Special Rapporteur also pointed to fragmentation of policies for older persons and persons with disabilities as leading to “the invisibility in law and in practice of experiences of disability in later life” which, when combined with a general perception that older persons with disabilities are a “burden” or “less deserving”, leads to members of these groups given lower priority in policies and receiving services that are of a lower quality, especially in situations where there is a scarcity of resources.This work discusses the wide range of topics that should be covered in any comprehensive campaign to address the human rights challenges of persons with disabilities including the intersection of ableism and ageism driven by ignorance and stigmatization, discrimination in the workplace against older persons with disabilities and the lack of employment opportunities for members of that group, access to adequate physical and mental health services, autonomy and legal capacity, abuse, inclusion of older persons with disabilities in the community (i.e., independent living, accessibility, adequate housing, inclusive and sustainable communities and participation), social protection, access to education and justice and protection of older persons with disabilities during emergencies such as the Covid-19 pandemic.

Human Rights of Persons with Disabilities (preprint)

The World Health Organization has reported that approximately 16% of the global population, over 1.3 billion people worldwide, had some form of disability, and that an additional 190 million people (3.8% of people over 15 years of age) experience serious difficulties in functioning normally on a daily basis. In the US, 61 million, or 26% of, adult Americans have some form of disability, and 2 in 5 adults over the age of 65 have a disability. While the Convention on the Rights of Persons with Disabilities was adopted in 2006 and went into force in 2008, making it the first binding international instrument addressing the needs of persons with disabilities worldwide, disabled persons of all ages, and particular those who are older, face a number of barriers to inclusion including attitudinal barriers (e.g., stereotypes, prejudices, other forms of paternalistic and patronizing treatment, discrimination, fear, bullying and low expectations of people with disabilities); institutional barriers (i.e., laws, policies, strategies or practices that discriminate against people with disabilities including lack of enforcement and political support for policies); “internalized” barriers (i.e., due to stigma and stereotyping, disabled persons refrain from pro-active behavior in expressing their opinions and claiming their rights); lack of participation including lack of consultation and involvement of people with disabilities in decision making; inadequate data, statistics and evidence on what works; and inaccurate concerns over the costs and difficulties of disability inclusion (e.g., concerns that disability inclusion is too difficult and requires specialist knowledge or require special programs that would unduly burden existing resources). A comprehensive campaign to address the human rights challenges of persons with disabilities must address a wide range of topics including ableism driven by ignorance and stigmatization, discrimination in the workplace and lack of employment opportunities, access to adequate physical and mental health services, autonomy and legal capacity, abuse, inclusion in the community (i.e., independent living, accessibility, adequate housing, inclusive and sustainable communities and participation), social protection, access to education and justice and protection during emergencies such as the Covid-19 pandemic. Particular attention should be paid to the needs of women, children, people of color and older persons with disabilities. While governments have the primary responsibility for protecting the human rights of persons with disabilities, non-governmental entities, such as businesses, can also play a part in improving the lives of this growing segment of the population.

The 2022 Disability Data Report (preprint)

Realizing the rights of persons with disabilities Achieving rights as stipulated in the United Nations Convention on the Rights of Persons with Disabilities (CRPD) and the Sustainable Development Goals (SDGs) requires quality, timely and policy-relevant disability data. This Report first reviews disability questions in national population censuses and household surveys globally from 2009 to 2021 to assess if they can identify persons with disabilities. Only 21% of the datasets under review have disability questions that meet international standards of comparability, i.e., those that collect information on functional difficulties (e.g. difficulty seeing, hearing, walking). Only 10% of datasets have the internationally-tested and comparable Washington Group Short Set (WG-SS) of questions. Including the WG-SS in many MICS6 (round 6 of the Multiple Indicator Cluster Survey) datasets has improved data availability for many countries. Much work remains for national surveys and population censuses to have functional difficulty questions. International programs, for instance, through COVID-19 High-Frequency Phone Surveys or the Survey of Income and Living Conditions, could help to improve the availability of disability questions in many countries and inform policy. Second, this Report disaggregates 32 indicators by disability status using data from MICS6 for women aged 18 to 49 in 35 countries. Disability status is measured through the functional difficulty questions of the WG-SS.We find inequalities associated with functional difficulties in all areas of wellbeing, particularly educational attainment, information and communication technology, sexual and reproductive health, multidimensional poverty, reporting being discriminated against, feeling safe, and subjective wellbeing. While most of the countries under study have ratified the CRPD, results suggest that more data collection, research and policy work are needed to address intersectional disadvantages and improve the situation of women with disabilities worldwide.For some indicators, there is a graded association between the severity of functional difficulty and of disadvantage. In other words, women with some functional difficulty are, on average worse off than women with no difficulty but better off than women who report a lot of difficulty or unable to do in at least one domain.In the countries under study, less than 20% of women with seeing difficulties use glasses, while only 2% of women with hearing difficulties use hearing aids. This result suggests a lack of assistive technology and related services that requires policy attention.Overall, the disadvantages that women with disabilities face within their economies and societies highlight the need for policies, data and research that support their rights and wellbeing.

Hyperkinetic movement disorders following SARS-CoV-2 infection and vaccination - an update.

The aim of this review was to summarise current knowledge regarding hyperkinetic movement disorders related to SARS-CoV-2 infection and vaccination in terms of phenomenology, epidemiology, pathogenesis and treatment. After a thorough review of the PubMed and Google Scholar databases (2020-2022), we identified myoclonus and ataxia sometimes accompanied by opsoclonus (AMS) as the two most frequent COVID-19 sequelae, with chorea, tremor and dystonia being very rare. The pathogenesis seems to be variable, but in the majority of AMS cases it was autoimmunological, with good response and recovery after corticosteroids or intravenous immunoglobulins infusions. Vaccination may be complicated by hyperkinetic movement disorders (e.g. tremor, dystonia), but this is very rare. Patients with Deep Brain Simulation depletion should not be postponed due to lockdowns as this may result in fatal outcomes.

COVID19-associated new-onset movement disorders: a follow-up study.

BACKGROUND: Neurological symptoms are common manifestation in acute COVID-19. This includes hyper- and hypokinetic movement disorders. Data on their outcome, however, is limited. METHODS: Cases with new-onset COVID-19-associated movement disorders were identified by searching the literature. Authors were contacted for outcome data which were reviewed and analyzed. RESULTS: Movement disorders began 12.6 days on average after the initial onset of COVID-19. 92% of patients required hospital admission (mean duration 23 days). In a fraction of patients (6 of 27; 22%; 4 males/2 females, mean age 66.8 years) the movement disorder (ataxia, myoclonus, tremor, parkinsonism) was still present after a follow-up period of 7.5 ± 3 weeks. Severe COVID-19 in general and development of encephalopathy were risk factors, albeit not strong predictors, for the persistence. CONCLUSIONS: The prognosis of new-onset COVID-19-associated movement disorder appears to be generally good. The majority recovered without residual symptoms within several weeks or months. Permanent cases may be due to unmasking of a previous subclinical movement disorder or due to vascular/demyelinating damage. Given the relatively low response rate of one third only and the heterogeneity of mechanisms firm conclusions on the (long-term) outome cannot, however, be drawn.

Recognition and Cleavage of Human tRNA Methyltransferase TRMT1 by the SARS-CoV-2 Main Protease (preprint)

The SARS-CoV-2 main protease (Mpro) plays a crucial role in the production of functional viral proteins during infection and, like many viral proteases, can also target and cleave host proteins to subvert their cellular functions. Here, we show that the human tRNA methyltransferase TRMT1 can be recognized and cleaved by SARS-CoV-2 Mpro. TRMT1 installs the N2,N2-dimethylguanosine (m2,2G) modification at the G26 position of mammalian tRNA, which promotes global protein synthesis, cellular redox homeostasis, and has links to neurological disability. We find that Mpro can cleave endogenous TRMT1 in human cell lysate, resulting in removal of the TRMT1 zinc finger domain that is required for tRNA modification activity in cells. Evolutionary analysis shows that the TRMT1 cleavage site is highly conserved in mammals, except in Muroidea, where TRMT1 may be resistant to cleavage. In primates, regions outside of the cleavage site with rapid evolution could indicate possible adaptation to ancient viral pathogens. To visualize how Mpro recognizes the TRMT1 cleavage sequence, we determined the structure of a TRMT1 peptide in complex with Mpro, which reveals a substrate binding conformation distinct from the majority of available SARS-CoV-2 Mpro-peptide complexes. Kinetic parameters for peptide cleavage showed that while TRMT1(526-536) is cleaved much slower than the Mpro nsp4/5 autoprocessing sequence, it is proteolyzed with comparable efficiency to the Mpro-targeted nsp8/9 viral cleavage site. Mutagenesis studies and molecular dynamics simulations together indicate that kinetic discrimination occurs during a later step of Mpro-mediated proteolysis that follows substrate binding. Our results provide new information about the structural basis for Mpro substrate recognition and cleavage that could help inform future therapeutic design and raise the possibility that proteolysis of human TRMT1 during SARS-CoV-2 infection may impact protein translation or oxidative stress response and contribute to viral pathogenesis.

Diagnosis of COVID-19 based on Chest Radiography (preprint)

The Coronavirus disease 2019 (COVID-19) was first identified in Wuhan, China, in early December 2019 and now becoming a pandemic. When COVID-19 patients undergo radiography examination, radiologists can observe the present of radiographic abnormalities from their chest X-ray (CXR) images. In this study, a deep convolutional neural network (CNN) model was proposed to aid radiologists in diagnosing COVID-19 patients. First, this work conducted a comparative study on the performance of modified VGG-16, ResNet-50 and DenseNet-121 to classify CXR images into normal, COVID-19 and viral pneumonia. Then, the impact of image augmentation on the classification results was evaluated. The publicly available COVID-19 Radiography Database was used throughout this study. After comparison, ResNet-50 achieved the highest accuracy with 95.88%. Next, after training ResNet-50 with rotation, translation, horizontal flip, intensity shift and zoom augmented dataset, the accuracy dropped to 80.95%. Furthermore, an ablation study on the effect of image augmentation on the classification results found that the combinations of rotation and intensity shift augmentation methods obtained an accuracy higher than baseline, which is 96.14%. Finally, ResNet-50 with rotation and intensity shift augmentations performed the best and was proposed as the final classification model in this work. These findings demonstrated that the proposed classification model can provide a promising result for COVID-19 diagnosis.

The overall impact on the daily life of people with disabilities in Mainland China: two cross-sectional studies (preprint)

Background COVID-2019 has become a public health crisis, and as a vulnerable group, people with disabilities (PWDs) might be more seriously affected. However, the overall impact of COVID-19 on PWDs is unclear in Mainland China. Thus, we aimed to analyze the overall impact on PWDs from the early remission stage to the regular control stage of the COVID-19 pandemic in Mainland China.Methods In March 2020 and March 2021, anonymous questionnaires were distributed in the WeChat group of the PWDs using a convenient sampling method. The personal and family characteristics, perceived risk of COVID-19 infection, and the overall impact of COVID-19 on daily life and medical services needs were collected. The descriptive analysis, chi-square test, and multiple logistic regression analysis were used.Results 311 and 1083 PWDs were enrolled in 2020 and 2021, respectively. In 2020, 82.0% of the participants reported a negative impact on their daily life, and the proportion of big impact was 20.3%. In 2021, 73.1% of PWDs reported a negative impact on their daily life. Multivariate analysis found the impact on medical services needs was the common associated factor of the overall impact on daily life in 2020 and 2021, and PWDs with lower annual household income or chronic diseases were more likely to suffer bigger negative effects in 2020, while being in quarantine or not at work, having items in shortage and with less disability severity (without multiple disabilities or spinal cord injury) were the associated factors in 2021. Based on the matching method, we found that the overall impact on the daily life of PWDs decreased in 2021.Conclusions A majority of the PWDs reported a negative impact on their daily life in Mainland China at the early remission stage of the COVID-19 pandemic, and the impact has significantly weakened during the normal control period in 2021. It is recommended to fulfill the medical service needs of PWDs in a timely manner, and those being in quarantine or not at work, without SCI or multiple disabilities, and reporting some items in shortage suffered a bigger major overall COVID-19 impact on daily life.

COVID-19 Detection Based on Self-Supervised Transfer Learning Using Chest X-Ray Images (preprint)

Purpose: Considering several patients screened due to COVID-19 pandemic, computer-aided detection has strong potential in assisting clinical workflow efficiency and reducing the incidence of infections among radiologists and healthcare providers. Since many confirmed COVID-19 cases present radiological findings of pneumonia, radiologic examinations can be useful for fast detection. Therefore, chest radiography can be used to fast screen COVID-19 during the patient triage, thereby determining the priority of patient's care to help saturated medical facilities in a pandemic situation. Methods: In this paper, we propose a new learning scheme called self-supervised transfer learning for detecting COVID-19 from chest X-ray (CXR) images. We compared six self-supervised learning (SSL) methods (Cross, BYOL, SimSiam, SimCLR, PIRL-jigsaw, and PIRL-rotation) with the proposed method. Additionally, we compared six pretrained DCNNs (ResNet18, ResNet50, ResNet101, CheXNet, DenseNet201, and InceptionV3) with the proposed method. We provide quantitative evaluation on the largest open COVID-19 CXR dataset and qualitative results for visual inspection. Results: Our method achieved a harmonic mean (HM) score of 0.985, AUC of 0.999, and four-class accuracy of 0.953. We also used the visualization technique Grad-CAM++ to generate visual explanations of different classes of CXR images with the proposed method to increase the interpretability. Conclusions: Our method shows that the knowledge learned from natural images using transfer learning is beneficial for SSL of the CXR images and boosts the performance of representation learning for COVID-19 detection. Our method promises to reduce the incidence of infections among radiologists and healthcare providers.

Linked Patient and Provider Impressions of Outpatient Teleneurology Encounters (preprint)

Background and Objectives Teleneurology is common in clinical practice partly due to the SARS CoV-2 pandemic. Impressions about teleneurology from patients and providers alike are generally favorable; some of the reported benefits include ease of access to specialized healthcare, savings of time and money, and similar quality of care as an in-person visit. However, comparisons between patient and provider impressions about the same teleneurology encounter have not been described. Here we describe patient impressions about a teleneurology encounter and evaluate concordance with provider impressions about the same encounter. Methods Patients and providers at the University of Pennsylvania Hospital Neurology Department were surveyed about their impressions of teleneurology between April 27 th and June 16 th , 2020. A convenience sample of patients, whose providers completed a questionnaire, were contacted by telephone to solicit their impressions the same encounter. Unique questionnaires for patients and providers focused on similar themes, such as adequacy of technology, assessment of history obtained, and overall quality of the visit. Summaries of patient responses are reported with the raw percent agreement between patients and providers for similar questions. Results One hundred thirty-seven patients completed the survey; 64 (47%) were male and 73 were (53%) female. Sixty-six (47%) patients had a primary diagnosis of PD, 42 (30%) a non-PD movement disorder, and 29 (21%) a non-movement disorder neurological disease. One hundred one (76%) were established patient visits and 36 (26%) were new patient visits. Provider responses from 8 different physicians were included. The majority of patients responded that the ease of joining their visit, their comfort engaging with their physicians during their visit, understanding their plan of care after their visit, and the quality of care from their teleneurology visit were satisfactory. Patients and providers agreed about their impressions of the quality of the history obtained (87% agreement), patient-provider relationship (88% agreement), and overall quality of their experience (70% agreement). Discussion Patients had favorable impressions about their clinical experience with teleneurology and expressed an interest in incorporating telemedicine visits into their ongoing care. Patients and providers were highly concordant for the history obtained, patient-provider relationship, and overall quality.

A randomised controlled trial of clinical and cost-effectiveness of the PASS Plus intervention for young children with autism spectrum disorder in New Delhi, India: Study protocol for the COMPASS trial. (preprint)

Background: Autism Spectrum Disorders (ASD) is a neurodevelopmental disability affecting at least 5 million children in South Asia. Majority of these children are without access to evidence-based care. The UK Pre-school Autism Communication Therapy (PACT) is the only intervention to have shown sustained impact on autism symptoms. It was systematically adapted for non-specialist community delivery in South Asia; as the 'Parent-mediated Autism Social Communication Intervention for non-Specialists (PASS) and extended ‘PASS Plus’ interventions. RCTs of both showed feasibility, acceptability and positive effect on parent and child dyadic outcomes. Methods: The Communication-centred Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS) trial is now a scale-up two centre, two arm single (rater) blinded random allocation parallel group study of the PASS Plus intervention in addition to treatment as usual (TAU) compared to TAU alone, plus health economic evaluation – embedded in the India health system. 240 children (approximately 120 intervention/120 TAU) with ASD aged 2-9 years will be recruited from two tertiary care government hospitals in New Delhi, India. Accredited Social Health Activists will be one of the intervention delivery agents. Families will undertake up to 12 communication sessions over 8 months and will be offered the Plus modules which address coexisting problems. The trial’s primary endpoint is at 9 months from randomization, with follow-up at 15 months. The primary outcome is autism symptom severity; secondary outcomes include parent-child communication, child adaptation, quality of life and parental wellbeing. Primary analysis will follow intention-to-treat principles using linear mixed model regressions with group allocation and repeated measures as random effects. The primary cost-effectiveness analysis will use a societal perspective over the 15-month period of intervention and follow-up. Discussion: If clinically and cost effective, this programme will fill an important gap of scalable interventions delivered by non specialist health workers within the current care pathways for autistic children and their families in low resource contexts. The programme has been implemented through the COVID-19 pandemic when restrictions were in place; intervention delivery and evaluation processes have been adapted to address these conditions. Trial Registration: ISRCTN; ISRCTN21454676; Registered 22 June 2018; https://www.isrctn.com/ISRCTN21454676?q=21454676;

Impact of Rotational Thromboelastometry (ROTEM) on Clinical Course and Outcomes of COVID -19 Critically Ill Patients: A Retrospective Single Center Observational Study (preprint)

BACKGROUND The severity of coagulation derangement correlates with poor prognosis in COVID-19 patients. However, the clinical impact of coagulation alterations detected with rotational thromboelastometry (ROTEM) in intensive care unit (ICU) COVID-19 patients is not completely defined. The study aimed to identify the correlation between ROTEM parameters and adverse ICU outcomes. The relationship between COVID-19 associated coagulopathy (CAC) and ROTEM alterations and possible risk factors for ICU mortality were also investigated.  METHODS COVID-19 patients admitted to ICU between October 1, 2020 and May 31, 2021, were retrospectively enrolled. The sample was subsequently divided into subgroups (survivors vs. non-survivors, mechanical ventilation (MV) vs. non-invasive ventilation (NIV), venous thromboembolism (VTE) vs. NO-VTE, CAC vs. NO-CAC) among which ROTEM parameters and standard coagulation tests were compared.  RESULTS One hundred ICU patients were enrolled. High D-dimer (DD) (5089 ± 1035 ng/ml) and fibrinogen levels (640 ± 112 mg/dl) and an increase in maximum clot firmness (MCF) were revealed. The non-survivors (n=50, 50%) had higher DD levels and lower platelet counts as well as lower clot lysis rates than survivors. EXTEM maximum lysis (ML) resulted lower in the MV subgroup than in NIV treated patients. Patients with thrombotic complications had higher DD levels than patients without VTE whereas ROTEM parameters were not different. Similarly no coagulation or ROTEM differences were identified in the subgroup of CAC patients (n=29, 29%). Reduced ML values in EXTEM and INTEM resulted as possible risk factors for ICU mortality.  CONCLUSIONS In critically ill COVID-19 patients, hypofibrinolysis and not hypercoagulability seems to be correlated with unfavourable ICU prognosis.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

PURPOSE OF REVIEW: The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). RECENT FINDINGS: As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. SUMMARY: COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

[Ataxia, Involuntary Movement and Paroxysmal Motor Abnormality Associated with COVID-19 Infection].

The new coronavirus SARS-CoV-2 infection (COVID-19) has caused many casualties, mainly respiratory infections. However, it has also caused several neurological disorders including encephalitis/encephalopathy, demyelinating disease, Gullain-Barré sydrome etc. In addition, it has been clarified that movement disorders develop within a few days to weeks after infection. Vaccination for COVID-19 has progressed, but autoimmune neurological complications have also been reported. Although a causal relationship is suspected over time, this paper describes the pathophysiology of movement disorders such as myoclonus, opsoclonus, parkinsonism, and cerebellar ataxia, which are relatively common in COVID-19 infections, and their relevance to the SARS-CoV-2 vaccine.