Population-Based Correlates of Covid-19 infection: an analysis From the Dfw Covid-19 Prevalence Study

BACKGROUND: COVID-19 has resulted in over 1 million deaths in the U.S. as of June 2022, with continued surges after vaccine availability. Information on related attitudes and behaviors are needed to inform public health strategies. We aimed to estimate the prevalence of COVID-19, risk factors of infection, and related attitudes and behaviors in a racially, ethnically, and socioeconomically diverse urban population. METHODS: The DFW COVID-19 Prevalence Study Protocol 1 was conducted from July 2020 to March 2021 on a randomly selected sample of adults aged 18-89 years, living in Dallas or Tarrant Counties, Texas. Participants were asked to complete a 15-minute questionnaire and COVID-19 PCR and antibody testing. COVID-19 prevalence estimates were calculated with survey-weighted data. RESULTS: Of 2969 adults who completed the questionnaire (7.4% weighted response), 1772 (53.9% weighted) completed COVID-19 testing. Overall, 11.5% of adults had evidence of COVID-19 infection, with a higher prevalence among Hispanic and non-Hispanic Black persons, essential workers, those in low-income neighborhoods, and those with lower education attainment compared to their counterparts. We observed differences in attitudes and behaviors by race and ethnicity, with non-Hispanic White persons being less likely to believe in the importance of mask wearing, and racial and ethnic minorities more likely to attend social gatherings. CONCLUSION: Over 10% of an urban population was infected with COVID-19 early during the pandemic. Differences in attitudes and behaviors likely contribute to sociodemographic disparities in COVID-19 prevalence

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

SELF-COMPASSION IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: RELATIONSHIP OF SELF-COMPASSION TO PSYCHOLOGICAL AND PHYSICAL OUTCOMES

Abstract Background Adolescents and young adults (AYA) with Inflammatory Bowel Disease (IBD) are at increased risk for poor psychological and physical well-being. Self-compassion (i.e., understanding and acceptance towards oneself) has been associated with better psychological and physical outcomes in AYA with chronic health conditions. There is limited research exploring self-compassion in AYA with IBD. Aims To examine: 1) the reliability of a Self-Compassion Scale (SCS-SF), and 2) how self-compassion relates to physical (i.e., pain interference, fatigue) and psychological (i.e., stress, anxiety, depression) outcomes in a sample of AYA with IBD. Methods This study was a collaboration with ImproveCareNow, and all procedures were approved by Stanford’s Institutional Review Board. Study participants included 85 AYA (mean=18 yrs) with IBD (52% Crohn’s; 55% female; 61% White). Participants completed a one-time online survey. The internal reliability of SCS-SF was a = 0.88, indicating high internal consistency. Hierarchical linear regression (HLR) analyses examined the unique contribution of self-compassion to pain interference, fatigue, physical stress, psychological stress, anxiety, and depression after controlling for significant demographic and medical variables (sex, IBD diagnosis, mental health diagnosis). Results The overall HLR models were significant for all dependent variables. For physical outcomes, the overall model examining pain interference was significant (F(3, 72) = 4.517; P = 0.003), with sex, IBD diagnosis, and mental health diagnosis accounting for 13% of the variance in pain interference. Self-compassion accounted for an additional 20% of the variance in pain interference over and above demographic/medical variables. For psychological outcomes, the overall model examining anxiety was significant (F(3, 73) = 15.54; P &amp;lt; 0.001), with sex, IBD diagnosis, and mental health diagnosis accounting for 33% of the variance in anxiety. Self-compassion accounted for an additional 46% of the variance in anxiety over and above demographic/medical variables. HLR also demonstrated that self-compassion was a significant independent predictor of pain interference (b = -0.30, P = 0.015), fatigue (b = -0.38, P = 0.001), psychological stress (b = -0.51, P = &amp;lt; 0.001), anxiety (b = -0.41, P = &amp;lt; 0.001), and depression (b = -0.59, P = &amp;lt; 0.001). Participants reporting higher levels of self-compassion had less pain interference, fatigue, stress, anxiety, and depression. Conclusion Preliminary results suggest self-compassion may be an important factor in explaining the variability of key physical and psychological outcomes among AYA with IBD. Research should investigate self-compassion in diverse IBD populations, and explore if feelings of kindness and acceptance towards oneself can be a protective factor for AYA by supporting positive coping and adjustment to IBD. </jats:sec

FEAR OF THE COVID-19 PANDEMIC IN ADOLESCENTS AND YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE: RELATIONSHIP TO PSYCHOLOGICAL AND PHYSICAL OUTCOMES

Abstract BACKGROUND The fear of contracting COVID-19 has taken a significant toll on the psychological and physical health of adolescents and young adults (AYA), especially those with chronic health conditions. AYA with Inflammatory Bowel Disease (IBD) are at increased risk for poor psychological and physical well-being. However, to date, there is no published research examining the Fear of COVID-19 Scale (FCV-19S) in AYA with IBD. AIMS To assess: 1) the reliability of the Fear of COVID-19 Scale in AYA with IBD, and 2) how the fear of COVID-19 relates to key psychological (i.e., anxiety, depression) and physical (i.e., fatigue, pain, disease activity) outcomes in AYA with IBD. METHODS This ongoing study is a collaboration between Stanford University and ImproveCareNow. Participants included 64 AYA with IBD (M=18.7 years old; 52% Ulcerative Colitis; 60% female; 60% White). Participants completed a one-time online survey. Correlation analyses examined the association between fear of COVID-19, outcome variables (i.e., anxiety, depression, fatigue, pain, disease activity), and demographic variables. Multiple linear regression (MLR) analyses (using the F test) further examined the association between fear of COVID-19, outcome variables, and significant demographic variables (i.e., age, sex). RESULTS The internal reliability of FCV-19S was measured using Crohnbach’s alpha (α=0.88), indicating high internal consistency. Correlation analyses demonstrated that fear of COVID-19 was significantly associated with anxiety, depression, and fatigue (Table 1). The overall MLR models were significant for anxiety (P&amp;lt;0.001), depression (P=0.002), and fatigue (P=0.031), but not for pain and disease activity. Fear of COVID-19, age, and sex accounted for 29% of the variance in anxiety, 27% of the variance in depression, and 17% of the variance in fatigue. Fear of COVID-19 was not a significant independent predictor of outcomes (Table 2). Female sex was a significant independent predictor for greater levels of anxiety (b=-0.31, P=0.016) and depression (b=-0.35, P=0.008). Older age was a significant independent predictor for greater levels of depression (b=0.29, P=0.031). CONCLUSION Preliminary results suggest that FCV-19S can be reliably assessed in AYA with IBD. Analyses indicate that fear of COVID-19 is associated with anxiety, depression, and fatigue in AYA with IBD. While COVID-19 fear may be important in explaining these outcomes, female sex independently predicted increased anxiety and depression, and older age independently predicted depression. This highlights the importance of assessing relevant demographic variables (e.g., female sex, young adults) when considering predictors of adjustment in AYA with IBD. Research should further investigate fear of COVID-19 in larger, more diverse IBD populations to better understand its relationship to key IBD outcomes. </jats:sec

Effectiveness of team-focused CPR on in-hospital CPR quality and outcomes

Objective: We sought to identify changes in neurological outcome over time following initial training and subsequent implementation of team-focused CPR in an inpatient setting where responders practice specific roles with emphasis on minimally interrupted chest compressions and early defibrillation. Methods: This retrospective pre- vs post-intervention study was conducted at an urban 900-bed teaching hospital and Level I Cardiac Resuscitation Center. We included adult patients suffering in-hospital cardiac arrest occurring in non-emergency department and non-intensive care unit areas who received CPR and/or defibrillation. We compared survival with good neurological outcome at time of hospital discharge in the one-year periods before and after implementation of team-focused CPR. To investigate skill degradation, we compared cumulative survival with good neurological outcome in 3-month intervals against the before team-focused CPR baseline. Trained research associates abstracted explicitly defined variables from electronic health records using a standardized form and data dictionary to achieve consistency between collaborators. Results: Of 296 IHCAs, 207 patients met inclusion criteria and were analyzed. In 104 patients before team-focused CPR initiation, survival with good neurological outcome was 21%. In the 12-month period following team-focused CPR initiation, survival with good neurological outcome was 31% in 101 patients, risk difference 9.9% (95% CI −2 to 22%; p = 0.14). By quarterly time intervals, following team-focused CPR implementation, the cumulative survival with good neurological outcome at 3 months was 42%; at 6 months 37%; at 9 months 31%; and at 12 months 31%. Conclusion: In our single-institution implementation of team-focused CPR for in-hospital cardiac arrest, outcomes significantly improved at 6 months before declining towards baseline

The motivation and process for developing a consortium‐wide time and motion study to estimate resource implications of innovations in the use of genome sequencing to inform patient care

Abstract Costs of implementing genomic testing innovations extend beyond the cost of sequencing, affecting personnel and infrastructure for which little data are available. We developed a time and motion (T&M) study within the Clinical Sequencing Evidence‐Generating Research (CSER) consortium to address this gap, and herein describe challenges of conducting T&M studies within a research consortium and the approaches we developed to overcome them. CSER investigators created a subgroup to carry out the T&M study (authors). We describe logistical and administrative challenges associated with resource use data collection across heterogeneous projects conducted in real‐world clinical settings, and our solutions for completing this study and harmonizing data across projects. We delineate processes for feasible data collection on workflow, personnel, and resources required to deliver genetic testing innovations in each CSER project. A critical early step involved developing detailed project‐specific process flow diagrams of innovation implementation in projects' clinical settings. Analyzing diagrams across sites, we identified common process‐step themes, used to organize project‐specific data collection and cross‐project analysis. Given the heterogeneity of innovations, study design, and workflows, which affect resources required to deliver genetic testing innovations, flexibility was necessary to harmonize data collection. Despite its challenges, this heterogeneity provides rich insights about variation in clinical processes and resource implications for implementing genetic testing innovations