Gen-Z ambassadors: students supporting persons with Alzheimer’s disease and their caregivers in the Rio Grande Valley

Background: Youth participation in policy, research, education and community development initiatives is a right embedded in the United Nations Convention on the Rights of the Child (UNCRC, General Assembly, 1989). However, avenues for youth participation in health promotion and care remains limited. Our Ambassadors program prepares high-school students on the Texas-Mexico border to understand and empathize with persons with Alzheimer’s disease (PwAD) and to empower their family and caregivers, consummating the UNCRC in the service of transformative community change actions. Methods: Our long-term objective is youth participation, defined as practices that involve collaboration between students and various community stakeholders in AD. The initial phase of the program is the design of a curriculum for early high school students to develop the knowledge, skills and attitudes required for that participation. We used a cooperative strategy (a high school students-faculty collaborative), guided by empowerment and ecological theories to achieve optimal youth advancement in the context of the UNCRC social, health and cultural rights of children. Results: The GenZ Ambassadors curricular units were identified through an iterative process in which faculty documented their activities with youth and tested sessions ranging from the biological basis and clinical presentations of AD to family impact, principles of caregiving, youth as change agents, building intergenerational partnerships, and self-reflection exercises. Ambassadors selected settings and strategies designed to empower their peers and to transform communities by skill and confidence building. Discussion: The process implemented and content analysis revealed a variety of themes that benefited persons with AD and their caregivers in the Rio Grande Valley. Several strategies will be tested to generate interactive training materials and culturally and age-competent as well as delivery strategies, including peer-to-peer delivery

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