Tag: Pandemic

Study shows long COVID’s hidden effect on women’s sex lives

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From work to school to socializing, COVID-19 has impacted just about every part of our lives-;and now Boston University research has shown that also includes what happens in the bedroom. A study of more than 2,000 cisgender women found the coronavirus disease can impair sexual function, with long COVID having an especially detrimental effect.

If you’re sick with COVID, you’re probably less interested in sex and maybe your body is less prepared to have sex. But what might be surprising to some folks is that long COVID symptoms really may have a physiological and psychological impact on sexual well-being for women.”

Amelia M. Stanton, BU College of Arts & Sciences assistant professor of psychological and brain sciences

Although previous research has investigated the effect of the pandemic on peoples’ sex lives-;particularly in men-;Stanton says this is the first study to highlight long COVID’s fallout on sexual health in women. An expert on sexual and mental health, she helped lead the study with researchers from Middlebury College, McLean Hospital, and the University of Vermont. The findings were recently published in the Journal of Sexual Medicine.

Long COVID and sexual dysfunction

To figure out COVID’s impact on intimacy, Stanton and her colleagues conducted an online survey. Roughly half of the women taking part had reported never having had COVID, the rest said they’d tested positive. Participants were quizzed using the Female Sexual Function Index (FSFI), an established tool that measures factors like arousal and satisfaction with questions such as, “Over the past 4 weeks, how often did you feel sexual desire?” Only women who’d had sex in the previous month were included in the results.

Among those who’d had COVID, levels of desire, arousal, lubrication, and satisfaction were all lower than in those who hadn’t; orgasm and pain scores weren’t significantly different between the two groups. But while women in the COVID group were still classed within the index’s functional range, participants with long COVID had “an average FSFI full scale score in the dysfunctional range,” according to the researchers. They found women with long COVID-;a broad condition with cognitive and physical symptoms that linger for weeks, sometimes months, after an initial infection-;had markedly worse arousal, lubrication, orgasm, and pain scores.

“I hope it’s validating. If women type in ‘sex long COVID,’ something will come up now,” says Stanton, who is also a clinical health psychologist at The Fenway Institute, a Boston clinic focused on the health of sexual and gender minorities. “Sex, sexuality, and sexual function are still relatively taboo subjects. But this offers something patients can bring to their providers and say, ‘This is going on for me,’ and maybe create an open dialogue around sex.”

In their paper, Stanton and her colleagues say the results suggest “that COVID-19 infection may be associated with impairment of both cognitive and physiological aspects of sexual function.” Just as the body and mind might take some time to get back to firing on all cylinders when it comes to work, study, and exercise, the same may apply to sex. They also speculate that wider societal changes caused by the pandemic may be a factor, with fewer social events and kids hanging around at home more reducing opportunities for shared or solo sexual activities.

Talking about sex

While a COVID infection might impact women’s sexual health, previous BU research has found vaccination does not cause infertility, reduce pregnancy chances, or have a significant impact on menstruation.

“COVID-19 vaccination in either partner is unrelated to fertility among couples trying to conceive through intercourse,” Amelia Wesselink, an SPH research assistant professor of epidemiology, told The Brink in 2022 when discussing her study on vaccines and fertility. That same research did, however, find that men who’d tested positive for COVID within the past 60 days had reduced fertility.

Stanton is the principal investigator of BU’s Sexual, Reproductive, and Mental Health Disparities Program-;an effort to explore sexual and mental health in minoritized and marginalized populations-;and says possible future routes for the latest project would be to expand the study’s sexual and gender minority diversity, talk to women for their qualitative experiences, and design tools to help providers better support their patients.

“I’m an interventionist, so I always think about intervention design as a next step,” says Stanton. In other research, she’s working to develop new approaches clinicians can use to talk about sex with their patients, as well as studying how to improve sexual well-being and mental health in low-resource communities.

“I always encourage providers to initiate conversations about sex,” says Stanton. “If they have someone who’s coming in for long COVID, maybe ask, ‘How are you doing sexually?’ Asking that one question could open the door for people to say, ‘You know, I’ve been ashamed to say that this is going on, and I really need help.’ Any way we can iterate to folks that there is hope and there are strategies-;your symptoms are meaningful and relevant, and they’re important to talk about.”

Source:

Journal reference:

Seehuus, M., et al. (2023). The impact of COVID-19 and long COVID on sexual function in cisgender women. The Journal of Sexual Medicine. doi.org/10.1093/jsxmed/qdad155.

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February 10, 2024

Do we simply not care about old people?

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The covid-19 pandemic would be a wake-up call for America, advocates for the elderly predicted: incontrovertible proof that the nation wasn’t doing enough to care for vulnerable older adults.

The death toll was shocking, as were reports of chaos in nursing homes and seniors suffering from isolation, depression, untreated illness, and neglect. Around 900,000 older adults have died of covid-19 to date, accounting for 3 of every 4 Americans who have perished in the pandemic.

But decisive actions that advocates had hoped for haven’t materialized. Today, most people — and government officials — appear to accept covid as a part of ordinary life. Many seniors at high risk aren’t getting antiviral therapies for covid, and most older adults in nursing homes aren’t getting updated vaccines. Efforts to strengthen care quality in nursing homes and assisted living centers have stalled amid debate over costs and the availability of staff. And only a small percentage of people are masking or taking other precautions in public despite a new wave of covid, flu, and respiratory syncytial virus infections hospitalizing and killing seniors.

In the last week of 2023 and the first two weeks of 2024 alone, 4,810 people 65 and older lost their lives to covid — a group that would fill more than 10 large airliners — according to data provided by the CDC. But the alarm that would attend plane crashes is notably absent. (During the same period, the flu killed an additional 1,201 seniors, and RSV killed 126.)

“It boggles my mind that there isn’t more outrage,” said Alice Bonner, 66, senior adviser for aging at the Institute for Healthcare Improvement. “I’m at the point where I want to say, ‘What the heck? Why aren’t people responding and doing more for older adults?’”

It’s a good question. Do we simply not care?

I put this big-picture question, which rarely gets asked amid debates over budgets and policies, to health care professionals, researchers, and policymakers who are older themselves and have spent many years working in the aging field. Here are some of their responses.

The pandemic made things worse. Prejudice against older adults is nothing new, but “it feels more intense, more hostile” now than previously, said Karl Pillemer, 69, a professor of psychology and gerontology at Cornell University.

“I think the pandemic helped reinforce images of older people as sick, frail, and isolated — as people who aren’t like the rest of us,” he said. “And human nature being what it is, we tend to like people who are similar to us and be less well disposed to ‘the others.’”

“A lot of us felt isolated and threatened during the pandemic. It made us sit there and think, ‘What I really care about is protecting myself, my wife, my brother, my kids, and screw everybody else,’” said W. Andrew Achenbaum, 76, the author of nine books on aging and a professor emeritus at Texas Medical Center in Houston.

In an environment of “us against them,” where everybody wants to blame somebody, Achenbaum continued, “who’s expendable? Older people who aren’t seen as productive, who consume resources believed to be in short supply. It’s really hard to give old people their due when you’re terrified about your own existence.”

Although covid continues to circulate, disproportionately affecting older adults, “people now think the crisis is over, and we have a deep desire to return to normal,” said Edwin Walker, 67, who leads the Administration on Aging at the Department of Health and Human Services. He spoke as an individual, not a government representative.

The upshot is “we didn’t learn the lessons we should have,” and the ageism that surfaced during the pandemic hasn’t abated, he observed.

Ageism is pervasive. “Everyone loves their own parents. But as a society, we don’t value older adults or the people who care for them,” said Robert Kramer, 74, co-founder and strategic adviser at the National Investment Center for Seniors Housing & Care.

Kramer thinks boomers are reaping what they have sown. “We have chased youth and glorified youth. When you spend billions of dollars trying to stay young, look young, act young, you build in an automatic fear and prejudice of the opposite.”

Combine the fear of diminishment, decline, and death that can accompany growing older with the trauma and fear that arose during the pandemic, and “I think covid has pushed us back in whatever progress we were making in addressing the needs of our rapidly aging society. It has further stigmatized aging,” said John Rowe, 79, professor of health policy and aging at Columbia University’s Mailman School of Public Health.

“The message to older adults is: ‘Your time has passed, give up your seat at the table, stop consuming resources, fall in line,’” said Anne Montgomery, 65, a health policy expert at the National Committee to Preserve Social Security and Medicare. She believes, however, that baby boomers can “rewrite and flip that script if we want to and if we work to change systems that embody the values of a deeply ageist society.”

Integration, not separation, is needed. The best way to overcome stigma is “to get to know the people you are stigmatizing,” said G. Allen Power, 70, a geriatrician and the chair in aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada. “But we separate ourselves from older people so we don’t have to think about our own aging and our own mortality.”

The solution: “We have to find ways to better integrate older adults in the community as opposed to moving them to campuses where they are apart from the rest of us,” Power said. “We need to stop seeing older people only through the lens of what services they might need and think instead of all they have to offer society.”

That point is a core precept of the National Academy of Medicine’s 2022 report Global Roadmap for Healthy Longevity. Older people are a “natural resource” who “make substantial contributions to their families and communities,” the report’s authors write in introducing their findings.

Those contributions include financial support to families, caregiving assistance, volunteering, and ongoing participation in the workforce, among other things.

“When older people thrive, all people thrive,” the report concludes.

Future generations will get their turn. That’s a message Kramer conveys in classes he teaches at the University of Southern California, Cornell, and other institutions. “You have far more at stake in changing the way we approach aging than I do,” he tells his students. “You are far more likely, statistically, to live past 100 than I am. If you don’t change society’s attitudes about aging, you will be condemned to lead the last third of your life in social, economic, and cultural irrelevance.”

As for himself and the baby boom generation, Kramer thinks it’s “too late” to effect the meaningful changes he hopes the future will bring.

“I suspect things for people in my generation could get a lot worse in the years ahead,” Pillemer said. “People are greatly underestimating what the cost of caring for the older population is going to be over the next 10 to 20 years, and I think that’s going to cause increased conflict.”

This article was reprinted from khn.org, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – the independent source for health policy research, polling, and journalism.

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February 9, 2024

AI’s ability to detect COVID-19 from coughs faces real-world challenges
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A recent Nature Machine Intelligence study investigated the efficacy of audio-based artificial intelligence (AI) classifiers in predicting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection status. SARS-CoV-2 is the causal organism of the coronavirus disease 2019 (COVID-19) pandemic.

Study: Audio-based AI classifiers show no evidence of improved COVID-19 screening over simple symptoms checkers. Image Credit: Aliaksandra Post / Shutterstock

Background

Since SARS-CoV-2 infection could cause both symptomatic and asymptomatic manifestations, it is important to develop accurate tests to avoid general population quarantine. Previous studies have revealed that AI-based classifiers trained with respiratory audio data could identify SARS-CoV-2 status.

Although these studies indicated the effectiveness of AI-based classifiers, many challenges surfaced while applying them in real-world settings. Some factors that withheld AI-based classifier applications were sampling biases, unvalidated data on participants’ COVID-19 status, and delay between infection and audio recording. It is imperative to determine whether the audio biomarkers of COVID-19 are unique to SARS-CoV-2 infection or are inappropriate confounding signals.

About the Study

The current study focussed on determining whether audio-based classifiers can be accurately used for COVID-19 screening. A large-scale polymerase chain reaction (PCR) dataset linked to audio-based COVID-19 screening (ABCS) was used. For this study, participants of the Real-time Assessment of Community Transmission (REACT) program and the National Health Service (NHS) Test-and-Trace (T+T) service were invited. All relevant demographic data was extracted from T+T/REACT records.

Participants were asked to complete survey questions and record four audio clips. For audio recordings, they were asked to read a specific sentence, followed by three successive exhalations, making a “ha” sound. Furthermore, the participants were asked to record forced coughs once and three times in succession. All recordings were documented in .wav format. The quality of the audio recordings was assessed, and 5,157 records were removed for quality-related issues.

Human figures represent study participants and their corresponding COVID-19 infection status, with the different colours portraying different demographic or symptomatic features. When participants are randomly split into training and test sets, the randomized split models perform well at COVID-19 detection, achieving AUCs in excess of 0.8; however, matched test set performance is seen to drop to estimated AUC between 0.60 and 0.65, with an AUC of 0.5 representing random classification. Inflated classification performance is also seen in engineered out of distribution test sets such as: the designed test set, in which a select set of demographic groups appear solely in the testing set, and the longitudinal test set, in which there is no overlap in the time of submission between train and test instances. The 95% confidence intervals calculated via the normal approximation method are shown, along with the corresponding n numbers of the train and test sets.

Study Findings

In this study, a respiratory acoustic dataset of 67,842 individuals was collected. Among them, 23,514 individuals tested positive for COVID-19. All data were linked with PCR test results. It must be noted that the most significant number of COVID-19-negative participants were recruited from six REACT rounds compared to the T+T channel.

The dataset considered in this study exhibited promising coverage across England. No significant association between geographical location and COVID-19 status was noted. The highest level of COVID-19 imbalance was found in Cornwall. A previous study indicated recruitment bias in ABCS, particularly linked with age, language, and gender, in both training data and test sets. Despite this bias, the training dataset was balanced in accordance with age and gender across COVID-positive and COVID-negative subgroups.

Consistent with previous studies, the unadjusted analysis conducted in this study exhibited that AI classifiers can predict COVID-19 status with high accuracy. However, when measured confounders were matched, a weak performance of AI classifiers in detecting SARS-CoV-2 status was observed.

Based on the findings, the current study proposed some guidelines to rectify recruitment bias’s effect for future studies. Some of the recommendations are listed below:
1. Audio samples stored in repositories must include details of the study recruitment criteria. In addition, relevant information about the individuals, including their gender, age, time of COVID-19 test, SARS-CoV-2 symptoms, and locations, must be documented along with the audio recording.
2. All confounding factors must be identified and matched to help control recruitment bias.
3. Experimental design must be developed, keeping the possible bias in mind. In most cases, data matching leads to a reduction in sample size. Observational studies recruit participants focusing on the maximized possibility of matching measured confounders.
4. The predictive values of the classifiers must be compared with standard protocol findings.
5. AI classifiers’ predictive accuracy must be assessed. However, the predictive accuracy, sensitivity, and specificity vary depending on the targeted population.
6. The classifiers’ utility must be assessed for each testing outcome.
7. The replication study must be conducted in randomized cohorts. Furthermore, pilot studies must be conducted in real-world settings based on domain-specific utility.
Conclusions

The current study has come with limitations that include the possibility of potential unmeasured confounders across REACT and T+T recruitment channels. For instance, PCR testing for COVID-19 was performed several days after self-screening of symptoms. In contrast, PCR tests in REACT were conducted on a pre-determined date, irrespective of the onset of symptoms. Although the majority of confounders were matched, there is a possibility of the presence of residual predictive variation.

Despite the limitations, this study highlighted the need to develop accurate machine-learning evaluation procedures to obtain unbiased outputs. Furthermore, it revealed that confounding factors are hard to detect and control across many AI applications.
Journal reference:

Coppock, H. et al. (2024) Audio-based AI classifiers show no evidence of improved COVID-19 screening over simple symptoms checkers. Nature Machine Intelligence. 1-14. DOI: 10.1038/s42256-023-00773-8, https://www.nature.com/articles/s42256-023-00773-8
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February 9, 2024
The impact of drinking water quality on mental health and the modifying role of diet
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In a recent study published in BMC Medicine, researchers estimate how exposure to various trace elements in drinking water increases the risk of depression and anxiety.

Study: Association between drinking water quality and mental health and the modifying role of diet: a prospective cohort study. Image Credit: New Africa / Shutterstock.com

Background

Mental health disorders, particularly depression and anxiety, remain a leading cause of both disability and premature death throughout the world. Following the coronavirus disease 2019 (COVID-19) pandemic, the prevalence of both anxiety and depression throughout the world rose by about 25%, thus exemplifying the widespread prevalence of these mental diseases.

Several factors may increase an individual’s risk of depression or anxiety, including genetics, social environment, and physical environment. Within the physical environment, exposure to heavy metals like cadmium has been shown to increase the risk of depression and anxiety, whereas other elements like manganese, copper, and selenium, all of which combat oxidative stress, have the potential to reduce the risk of depression.

To date, most studies investigating the impact of environmental risk factors on the incidence of depression and anxiety have been cross-sectional. Within China, few longitudinal studies have examined how exposure to metal and nonmetal elements in drinking water may impact the risk of depression and anxiety.

About the study

In the present study, researchers identified people diagnosed with depression and anxiety from the Yinzhou district using International Classification of Disease codes F32 and F41, respectively, in data retrieved from the Yinzhou Health Information System (YHIS). Atomic absorption spectrophotometry (AAS) was used to measure manganese, zinc, copper, iron, aluminum, cadmium, selenium, and fluorine levels in tap water samples collected from 37 sites in the Yinzhou district.

Water samples were collected four times each year, with at least one sample collected each season. Exposures were assigned to participants based on their residential addresses and the location of tap water collection sites. Daily exposure to all trace elements in drinking water was calculated and adjusted based on the daily drinking water intake of participants, as well as their age and gender.

A baseline survey was administered to collect data on participants’ frequency of consuming leafy vegetables, meat, fruits, and fish, with their intake of these dietary components categorized as low, moderate, or high. Data on sociodemographic status, lifestyle, and medical history were also acquired.

Study findings

The final analysis included 24,285 individuals between 2016 and 2021 without a history of depression or anxiety. From these individuals, 765 and 1,316 depression and anxiety cases, respectively, were reported during a median follow-up period of 4.72 and 4.68 years, respectively.

Females, as well as those who never smoked or drank, were more likely to have depression, in addition to a greater risk of hypertension, dyslipidemia, cancer, and stroke. Comparatively, females, less educated individuals, older individuals, never drinkers, non-smokers, and those with a lower income were more likely to have anxiety, diabetes, dyslipidemia, cancer, and stroke, in addition to lower levels of seafood and meat consumption.

Exposure to aluminum in drinking water was more commonly reported in individuals diagnosed with depression, whereas exposure to manganese, iron, and aluminum in drinking water was higher in individuals with anxiety. Individuals with anxiety were also exposed to lower levels of zinc as compared to healthy participants.

Long-term exposure to zinc, iron, aluminum, selenium, and fluorine did not impact the risk of depression. Likewise, long-term exposure to zinc, copper, aluminum, cadmium, and fluorine did not increase the risk of anxiety.

Diet did not have a significant effect on the relationship between the risk of depression and manganese, copper, and cadmium exposure in drinking water. However, the risk of anxiety was greater in individuals who consumed less fruits, more seafood, and meat and who were also exposed to manganese and iron in drinking water. Long-term exposure to copper, selenium, and fluorine was also associated with a greater risk of anxiety in individuals who consumed less leafy vegetables and fruits.

Lower socioeconomic level was associated with increased exposure to heavy metals, particularly copper, in drinking water. Additionally, older, low-income, and less educated individuals who were exposed to cadmium in drinking water were also at a greater risk of depression.

Higher education levels were more commonly observed in anxious individuals who were exposed to manganese and selenium in drinking water. Comparatively, exposure to iron in drinking water was also more common in older and less educated individuals with anxiety.

Conclusions

The present study findings underscore the need to improve the quality of drinking water and adopt healthy dietary habits to reduce the burden of depression and anxiety, as these measures may contribute to the pathophysiology of depression and anxiety. Public health policies should also address the inequitable effect of exposure to various trace elements in drinking water in relation to the increased risk of mental diseases among people in low socioeconomic strata.
Journal reference:

Zhou, S., Su, M., Shen, P. et al. (2024). Association between drinking water quality and mental health and the modifying role of diet: a prospective cohort study. BMC Medicine 22(53). doi:10.1186/s12916-024-03269-3
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February 8, 2024
Hunters key to early detection of zoonotic diseases, study finds
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To prevent future health crises, monitoring the emergence of zoonotic diseases in wild meat value chains is essential. In this regard, the role of community hunters is crucial, as they can report early signs of possible disease in game animals.

Study: An experimental game to assess hunter’s participation in zoonotic diseases surveillance. Image Credit: Virrage Images / Shutterstock.com

Background

Since the mid-twentieth century, zoonotic diseases have caused 60% of emerging disease events. More recently, wildlife has been suspected to be the original reservoir of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal agent of the coronavirus disease 2019 (COVID-19) pandemic.

Wild animal hunting and trade facilitate human-wildlife interactions and spillover events. Community-based surveillance can provide early warning and aid in limiting the spread of a zoonotic disease. However, research has shown that local communities perceive the risk of disease transmission from animals to humans differently.

About the study

In a recent study published in BMC Public Health, researchers designed an experimental game (EG) to better understand the response of community hunters when encountered with signs of zoonotic diseases in game animals.

EGs provide important insights into the decision-making of a group of individuals. These “players” are confronted with hypothetical scenarios and are asked to choose among different options. Observations from EGs are compared to game theoretical predictions, which assume players to be rational utility-maximizers.

In the forested area of Gabon in central Africa, an EG was developed and tested that mimicked the implementation of a community-based surveillance system. Voluntary reports of hunters were used to monitor zoonotic diseases in wildlife.

Both subsistence and commercial hunters were included in the EG. The key aim was to identify the characteristics of hunters, surveillance, and epidemiological processes that could influence their probability of participating in wildlife disease surveillance.

A total of 88 hunters were divided into nine groups, each comprising five to 13 players. Over 21 rounds of the EG were performed, each of which involved a hunting trip simulation where the payers were likely to capture a wild animal with clinical signs of zoonotic disease.

When signs of the zoonotic disease were visible, the participants were asked to report or sell/consume the animal. Reporting meant lower hunting revenue but also a lower probability of the spread of a zoonotic disease, which could benefit the entire community.

Key findings

A false alert, defined as a flagged case not caused by a zoonotic disease, led to reduced case reports in the subsequent round. Concerning hunter characteristics, those who engaged in agricultural activity, in addition to hunting, flagged suspected cases more often than their counterparts. The number of potential case reports rose with each round, thus suggesting a greater inclination to report throughout the game.

In the game-theoretic model, participation in surveillance was associated with positive externalities. Relevant information benefits the community as a whole; however, it comes at a cost for the reporting player, which could lead to sub-optimal participation in reporting. The game sessions corroborated this theoretical hypothesis.

The subsequent reduction in reports followed by a false report was due to false reports reducing the anticipated benefit of reporting. Prior research has shown that from a societal point of view, false alerts are acceptable as long their costs do not exceed the benefits of accurate disease detection.

In the future, community engagement programs should highlight the utility of periodic false alerts. This will help maintain regular surveillance and its proper functioning in the event a zoonotic disease emerges.

Players engaging in agricultural work were more likely to flag suspected cases of zoonotic disease than their counterparts. For these hunters, agriculture often accounts for a significant portion of household income, thereby reducing their reliance on hunting revenue to support their families. Thus, economic dependence on wild meat likely governs the decision to participate in surveillance systems.

Conclusions

The current study highlights the usefulness of EGs in enhancing our understanding of hunters’ willingness to participate in zoonotic disease surveillance. Extending the game to include all potential actors of surveillance along the wild meat value chains could provide helpful information to better manage the risks stemming from zoonotic diseases.
Journal reference:

Pouliquen, A., Mapeyi, G. A. B., Vanthomme, G., et al. (2024) An experimental game to assess hunter’s participation in zoonotic diseases surveillance. BMC Public Health 24(342). doi:10.1186/s12889-024-17696-7
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February 8, 2024
Trust in doctors key to boosting vaccination rates

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“Trust me, I’m a doctor.”

While this expression has become an advertising slogan and meme, physicians and nurses continually rank among the most trusted professions in the U.S.

Now, a new study by researchers at the NYU School of Global Public Health shows that how Americans view the medical profession shapes whether they are likely to get vaccinated against COVID-19.

Among people who were hesitant or initially didn’t want a COVID-19 vaccine, those who trust the medical profession were more likely to ultimately get vaccinated. In addition,

people who were vaccinated and reported trusting their own doctor were more likely to get a booster.

In contrast, trust in public officials-;including national, state, and local leaders-;did not shift behaviors around vaccination.

“Our research suggests mobilizing the medical community is critical for addressing reluctance, uncertainty, and distrust of vaccines,” said Diana Silver, professor of public health policy and management at the NYU School of Global Public Health and the lead author of the study, published in the February issue of Preventive Medicine Reports.

Trust in government institutions, experts, and the medical community emerged as flashpoints in the polarized context of the COVID-19 pandemic. Medical professionals, including doctors and nurses, have long played a critical role in educating their patients about vaccination and administering vaccines, but the COVID-19 pandemic brought about new questions on the relationship among experts, trust, and attitudes toward vaccines.

The NYU researchers analyzed data collected by Social Science Research Solutions from 1,967 U.S. adults who were surveyed twice, once in April 2021 and again in June 2022. Participants were asked about their levels of trust in the medical profession, their own doctor, and national, state, and local officials. They also answered questions about their views on the COVID-19 vaccine and whether they were vaccinated (in 2021 and/or 2022) and boosted (in 2022).

A divide in public trust

Levels of trust varied considerably between those who were vaccinated or eager to be vaccinated and those who were hesitant or refused to be vaccinated. Among individuals who were vaccinated or eager to do so, 88% reported high levels of trust in their own doctors and 70% had high levels of trust in state and local officials. In contrast, vaccine-hesitant individuals were far less trusting of officials: 46% reported high levels of trust in their own doctors and about 25% had high levels of trust in state and local officials. This pattern was the same for trust in federal officials and the medical profession.

Among those hesitant to get vaccinated in 2021, trust in the medical profession was associated with ultimately deciding to get vaccinated by 2022. And for those who were vaccinated or eager to be in 2021, trust in one’s own doctor was linked to seeking a booster by 2022.

The research also revealed how COVID-19 vaccines have been politicized: holding trust in officials and other factors constant, Republicans and Independents were far less likely to ultimately choose to be vaccinated or seek booster shots than Democrats.

The researchers conclude that engaging the medical profession in communicating the benefits of vaccines will be needed in future pandemics.

The primary care workforce may, in particular, play an important role, given that many have long-standing relationships with their patients and have built trust.”

Diana Silver, professor of public health policy and management, NYU School of Global Public Health

Additional study authors include David Abramson of NYU School of Global Public Health and NYU alumnae Rachael Piltch-Loeb and Yeerae Kim. The authors were supported by a grant from the National Science Foundation (#2049886).

Source:

Journal reference:

Silver, D., et al. (2024). One year later: What role did trust in public officials and the medical profession play in decisions to get a booster and to overcome vaccine hesitancy? Preventive Medicine Reports. doi.org/10.1016/j.pmedr.2024.102626.

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February 7, 2024
Study reveals high insomnia rates in non-hospitalized COVID-19 survivors

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In a recent study published in Frontiers in Public Health, researchers investigated insomnia prevalence and its association with anxiety and depression in the non-hospitalized coronavirus disease 2019 (COVID-19)-recovered community.

Study: Sleep quality among non-hospitalized COVID-19 survivors: a national cross-sectional study. Image Credit: Stock-Asso/Shutterstock.com

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has afflicted millions globally since late 2019, with most cases resolved by mid-2023. Common symptoms include coughing, weariness, fever, dyspnea, musculoskeletal issues, gastrointestinal complaints, anosmia, dysgeusia, and vertigo. Post-infection and long-term physical and psychological difficulties are serious public health concerns.

Insomnia is a prevalent complaint, particularly among hospitalized COVID-19 patients. High-risk variables include being female, younger, and more educated, as well as having anxiety, depression, or post-traumatic stress disorder. Poor mental health is associated with insufficient sleep, and chronic disorders such as obstructive sleep apnea (OSA) can affect glycemic control, neurocognitive impairment, and aberrant functional pulmonary alterations.

About the study

In the current nationwide cross-sectional study, researchers investigated insomnia prevalence among COVID-19 survivors with no or moderate symptoms who did not require hospitalization throughout the recovery period (six months) and discovered relevant variables.

Between June and September 2022, the team conducted a web-based survey among 1,056 COVID-19-recovered individuals who recovered within six months of acute SARS-CoV-2 infection and did not need hospitalization. They used the Depression Anxiety and Stress Scale-14 (DASS-14) and the Insomnia Severity Index (ISI). They obtained data on demographics such as age, marital status, sex, educational attainment, occupation, employment status, and comorbidities.

The team asked the respondents to rate their SARS-CoV-2 infection severity and duration (days from the initial SARS-CoV-2-positive to the initial SARS-CoV-2-negative report). In addition, the respondents compared their sleep quality, sleep initiation, and total sleep duration in the previous two weeks with the time before confirming the SARS-CoV-2 infection.

The team used multivariate logistic regressions to determine odds ratios (OR) for the relationships between anxiety and depression scores and insomnia levels among the survey respondents. They included adult COVID-19 survivors (who recovered as confirmed using polymerase chain reaction (PCR) within six months and did not require COVID-19-associated hospitalization) in Vietnam’s general population. They excluded individuals diagnosed with insomnia or psychological disorders before the study.

Results

The study included 1,056 individuals, with the majority being married (64%), female (69%), and having attended university (69%). After the SARS-CoV-2 infection, almost a third of respondents reported shorter sleep duration, worsened sleep quality, and more difficulties falling asleep, and half of them reported more nocturnal awakenings. Insomnia prevalence was 76%, with 23% of patients reporting severe insomnia.

Individuals with anxiety (OR, 3.9) or depression (OR, 3.5) had a significantly increased risk of having insomnia. Other characteristics that increased the likelihood of sleeplessness included higher educational attainment and pre-existing medical conditions, but COVID-19 duration and symptoms had no significant relationship.

Individuals who were divorced or widowed, female, had postgraduate education, were not actively employed, or suffered from chronic medical conditions had higher mean ISI ratings than their peers. Concerning COVID-19, 92% of infected individuals experienced symptoms (mean, 11 weeks). Although these symptomatic individuals showed higher ISI scores (15.2), there was no significant difference compared to individuals without symptoms.

The mean scores for anxiety and depression were 7.6 and 6.4, respectively, with 439 (42%) and 291 (28%) individuals reporting relevant symptoms, respectively. Individuals with symptoms of anxiety (18.7) and depression (19.1) scored significantly higher on the ISI compared to those without (12.4 and 13.5, respectively). Participants experiencing insomnia scored higher on anxiety (9.2) and depression (7.8) than the overall group mean.

In univariate analysis, those who were wedded and had a university degree were significantly less likely to experience insomnia than single and formally-educated individuals. Students were significantly more likely to experience insomnia compared to healthcare workers. Individuals with a history of chronic medical conditions were significantly more likely to suffer from insomnia following COVID-19 compared to healthy individuals. After controlling for variables, healthcare professionals had a significantly increased likelihood of insomnia (OR, 1.6) than workers in other professions; however, there were no differences compared to those who did not work or were students.

Conclusion

Overall, the study findings highlighted insomnia prevalence among COVID-19 survivors, with more than 75% reporting it. This percentage is much higher than that of the general population (10% to 20%) and hospitalized survivors (12% to 47%). Individuals with chronic medical conditions are more likely to suffer from insomnia, which is underreported. Public health researchers should anticipate a greater frequency of insomnia and sleep disorders in this group, which can last for one-third of healed patients up to one year after infection.

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February 7, 2024
Media stories on parental vaccine hesitancy drive a false narrative, distort reality

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Media stories focusing on vaccine hesitancy can distort reality and drive a false narrative that a large percentage of parents are refusing to get their children vaccinated, according to an editorial in the New England Journal of Medicine by two pediatricians from the University of Colorado Anschutz Medical Campus.

The article, published online Saturday in the Perspective section of the prestigious medical journal, said stories indicating widespread vaccine hesitancy among parents are at odds with the facts and can have long-term consequences.

The algorithms that shape our media diets have been promoting the idea that parental hesitancy about routine childhood vaccines has become commonplace in the United States. The data, however, are undeniable: apart from important challenges with influenza and Covid19 vaccination, the vast majority of parents in the United States continue to choose to have their children vaccinated according to the vaccination schedule recommended by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics.”

Sean O’Leary, MD, MPH, and David Higgins, MD, MPH, of the University of Colorado School of Medicine and Children’s Hospital Colorado

According to the authors, a recent poll from the Pew Research Center found 88% of adults have robust confidence in the value of childhood vaccines such as those for measles, mumps, and rubella. The poll also showed little change in the numbers of adults who say the value of vaccines outweigh any associated risk.

At the same time, a recent study from the CDC showed 93% of kindergarten students received state-required vaccines. Another study revealed that vaccination coverage for children at age 2 remained high and stable throughout the pandemic,

“The headlines say vaccine resistance is through the roof, the sky is falling,” said O’Leary, professor of pediatrics and infectious diseases at the CU School of Medicine and Children’s Hospital Colorado. “There is a real risk of the community buying into this and treating it as the norm.”

Higgins, a fellow and instructor in pediatrics at the CU School of Medicine and the Adult & Child Center for Outcomes Research & Delivery Science (ACCORDS) at the CU School of Medicine, said constant focus on vaccine hesitancy could become a “dangerous, self-fulfilling prophecy.”

He said perceived social norms, or what people consider typical behavior, can powerfully influence their health care decisions.

“The most important thing we can do is normalize vaccinations. That’s what the majority of parents do, vaccinate their children,” Higgins said. “We in the scientific community need to better communicate the value of vaccinations.”

Studies show that vaccine recommendations from physicians are more effective when framed in a way that presumes parents want their kids vaccinated. If clinicians expect resistance, the recommendations may be less effective.

“Legitimate inquiries about vaccines don’t necessarily indicate major parental vaccine hesitancy. In our experience, most parents with such inquiries aren’t `antivaccine;’ they believe vaccines are essential to their child’s health. One of the best parts of being a pediatrician is partnering with parents to address these goodfaith questions,” the authors wrote.

O’Leary, chair of the Committee on Infectious Diseases for the American Academy of Pediatrics, said not only do most adults support vaccinating their children, but since the onset of the pandemic and contrary to many media stories, pediatricians have told him that parents who had previously refused to vaccinate their kids are coming in to get the inoculations.

Neither doctor is suggesting that vaccine hesitancy isn’t a significant health threat in the U.S.

“We believe it will be essential to double down on efforts to increase confidence and trust in vaccines, including in populations that have experienced mistreatment by the medical community,” O’Leary and Higgins wrote. “Because of the complexity of this issue, addressing parental vaccine hesitancy requires partnerships among academic experts in various disciplines, community leaders, policymakers, public health professionals and parents.”

Source:

University of Colorado Anschutz Medical Campus

Journal reference:

Higgins, D. M., & O’Leary, S. T. (2024). The Risks of Normalizing Parental Vaccine Hesitancy. The New England Journal of Medicine. doi.org/10.1056/nejmp2313742.

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February 7, 2024
U.S. adults face distress, unequal mental health care access during the COVID-19 era

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U.S. adults experienced considerable psychological distress and adverse mental health effects as a result of the COVID-19 pandemic according to a study at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Based on insurance claims, mental health care provider surveys, and electronic health records the research further revealed a decline in in-person outpatient mental health visits during the acute phase of the pandemic. Findings are reported in the Annals of Internal Medicine.

The trends and patterns we observed in the United States align with reports globally concluding that several mental health problems, including depression, and generalized anxiety disorder, have become more prevalent during than before the pandemic.”

Mark Olfson, MD, MPH, Professor of Epidemiology at Columbia Mailman School of Public Health, and Dollard Professor of Psychiatry, Medicine & Law at Columbia University Irving Medical Center

To characterize the psychological distress experienced, determine the level of outpatient mental health care, and describe patterns of in-person versus telemental health care, the researchers studied the responses of adults from the Medical Expenditure Panel Surveys by the Agency for Healthcare Research and Quality Component, a nationally representative survey of over 85,000 people. Psychological distress was measured with a 6-point scale range and outpatient mental health care use was determined via computer-assisted personal interviews.

The rate of serious psychological distress among adults increased from 3.5 percent to 4.2 percent from 2018 to 2021. While outpatient mental health care increased overall as well — from 11.2 percent to 12.4 percent, the rate among adults with serious psychological distress decreased from 46.5 percent to 40.4 percent. Young adults (aged 18 to 44 years significantly increased outpatient mental health care but this pattern was not observed for the middle-aged (aged 45 to 64 years) and older adults (aged >65 years). Similarly, more employed adults reported outpatient mental health treatment care compared to the unemployed.

In 2021, 33 percent of mental health outpatients received at least one video visit. The likelihood of receiving in-person, telephone, or video mental health care varied across sociodemographic groups; percentages of video care were higher for younger adults than for middle-aged or older adults, women compared with men, college graduates compared with adults with less education, the seriously distressed, lower-income, unemployed, and rural patients.

“Thanks to a rapid pivot to telemental health care, there was an overall increase during the pandemic of adults receiving outpatient mental health care in the United States. However, the percentage of adults with serious psychological distress who received outpatient mental health treatment significantly declined. Several groups also had difficulty accessing telemental health care including older individuals and those with lower incomes and less education,” observed Olfson. “These patterns underscore critical challenges to extend the reach and access of telemental health services via easy-to-use and affordable service options.”

“Increasing our understanding of the patterns we observed in terms of access to outpatient mental health care including in-person, telephone-administered, and internet-administered outpatient mental health services could inform ongoing public policy discussions and clinical interventions,” noted Olfson. “Identifying low-cost means of connecting lower-income patients to telemental health should be a priority, as well as increasing public investment to make access to high-speed broadband universal.”

“The national profile of adults who receive outpatient mental health care via telemental health – the younger adult, the employed, higher-income, and privately insured adults, raises concerns about disparities in access to virtual mental health care,” said Olfson. “Unless progress is made in reducing these barriers, primary care clinicians will continue to encounter challenges in connecting their older, unemployed, and lower income patients to video-delivered outpatient mental health care.”

Co-authors are Chandler McClellan and Samuel H. Zuvekas, Agency for Healthcare Research and Quality; Melanie Wall, Columbia Mailman School of Public Health; and Carlos Blanco, National Institute on Drug Abuse.

Source:

Columbia University’s Mailman School of Public Health

Journal reference:

Olfson, M., et al. (2024). Trends in Psychological Distress and Outpatient Mental Health Care of Adults During the COVID-19 Era. Annals of Internal Medicine. doi.org/10.7326/m23-2824.

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February 6, 2024
Retrospective study shows decrease in kindergarten readiness

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Primary care screening visits for young children serve as useful sources of data for assessing social and developmental markers. It is not clear how these screening data can be used to predict whether children are school ready.

Study: Early Correlates of School Readiness Before and During the COVID-19 Pandemic Linking Health and School Data. Image Credit: FamVeld/Shutterstock.com

A new study appeared in JAMA Pediatrics that explored associations between school district early Kindergarten Readiness Assessment (KRA) and electronic health records (EHR) data and linked KRA scores with the changes occurring during the coronavirus disease 2019 (COVID-19) pandemic.

Background

Childhood is a watershed period for developing social skills, healthy physical and brain development, and becoming ready for school. Multiple factors may interfere with the acquisition of these skills which are essential in school life, such as social training, emotional regulation, as well as math and literacy skills. These may include socioeconomic and racial characteristics.

In some regions, up to 4 out of 10 new kindergartners are not ready to enter school. Since there has been no systematic attempt to identify which children are at risk of entering kindergarten without readiness, it is not clear how and which risk factors can be modified to change this situation.

The COVID-19 pandemic negatively impacted learning in school-age children, but its effect on development in children under five years remains to be described. This motivated the current study that uses KRA scores before and during the pandemic with the EHR data from a cohort of students in a large school district with about 36,000 students.

The KRA scores are linked to reading proficiency in the third grade and include four skill categories: preliteracy, premath, motor skills, and social-emotional skills.

What did the study show?

The study included over 3,000 patients who were screened at primary care level. The mean age was 67 months, with the majority being Black (80%) vs 8% Whites. The passing KRA score was set at 270.

When correlated with the pandemic dates, the mean KRA scores were significantly lower in 2021, at 260, vs ~263 in 2019 and 2018. About a fifth of students scored above passing levels in 2021, demonstrating school readiness, vs ~30% in 2019 and 32% in 2018.

About one in four parents said they rarely read to their child, that is, one or less days a week, at least once during the period of the study. About 27% of children were unable to meet ASQ scores at least once, while 12% of the children sometimes experienced food insecurity.

The risk factors for a low KRA score were one or more failures in the ASQ between 18 and 54 months, being Hispanic, not speaking the language of the healthcare professional during screening visits, being male and being seldom read to, as well as having food insecurity. Only 23% of boys were school-ready vs 32% of girls.

Having Medicaid insurance, indicative of low socioeconomic status, was associated with school readiness in ~27% of children, vs ~51% if Medicaid was never used.

Other socioeconomic factors, like housing insecurity, race, depression among the caregivers, and difficulty of any sort in obtaining benefits, did not show an association with the KRA scores.

“To interpret our findings using a hypothetical clinical example, starting with the expected score of 270.8 in the adjusted model (equivalent to demonstrating readiness): a boy who is Medicaid insured, who once failed an ASQ, who infrequently reported food insecurity, and was not read to as an infant lost an average of 15 points on the KRA, placing him in bottom category of emerging readiness (score below 257).”

What are the implications?

This is among the earliest studies to report that there might have been “a deleterious association of the COVID-19 pandemic with early learning and development.” It is also one of the largest studies to correlate primary care data to outcomes in public schools.

While other researchers have found conflicting evidence regarding childhood development during the pandemic, multiple factors have been at work, impacting the validity of observed associations. For example, school enrolment was lower during the period. However, the association of lower school readiness with not being read to as an infant has been well documented, as well as with low developmental scores and food insecurity.

Danger signals picked up in this way could help provide appropriate interventions in early life, whether by speech and language therapy, promoting learning by enrolment in good early childhood education programs, or facilitating library access.

“These findings suggest substantial untapped potential for primary care pediatrics and school districts to work more closely together given that risks for kindergarten readiness are evident much earlier in primary care.”

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February 6, 2024