Martha Stewart has seemingly done it all shes a lifestyle expert, media mogul, and even founded a care center to support the geriatric population.
She recently chatted with Pfizer.com about why she joined the Got Yours? COVID-19 vaccination campaign, how her fathers job at Pfizer impacted her view on science, how she juggles her busy schedule and more!
Pfizer: The first thing we wanted to ask you is why you chose to partner with Pfizer, and if you've had a favorite part of being involved in the Got Yours? campaign thus far?
Martha: I chose to work with Pfizer predominantly because of Pfizer's reputation, and also because I am a firm believer in COVID-19 vaccines. I have many friends in the medical field, both doctors and hospital staff, and we have discussed the importance of vaccines. I mean, this has been going on for three years now and Pfizer has always been leading the way when it comes to helping to protect us from COVID-19, so that's one reason. But the other reason is my dad worked for Pfizer when I was a child and I have a fond childhood memory of the company. That also made me pay attention to what Pfizer was doing in response to COVID-19.
Pfizer: That's great. If we could talk about your dad a little bit, did his work in the pharmaceutical industry impact your views on science at all, from a young age and into the later years of your life?
Martha: I'm one of six. We all went to college and some of us got advanced degrees. We loved our science classes. We were brought up with a very curious nature, and science, as well as medicine, was a big part of it. And being smart about one's health is a part of it for me, especially because at my age I have to really take care of myself. As a result of my interest in science, I founded the Martha Stewart Centers for Living at Mount Sinai. Now that the elderly population over 65, the geriatric population, is growing in the U.S., it's very important that we pay attention and support them. So that's a long-winded, but important, answer about why science is significant to me.
Pfizer: Just to go back to the Got Yours? campaign itself, why is vaccination specifically important to you, and what made you decide to get the COVID-19 vaccine from the beginning of the pandemic up until now?
Martha: As I listened to figures like Dr. Fauci, and particularly to my own doctors, I felt that we had to have a vaccine against this very, very terrible disease. And I saw what was happening around me I kept track of the numbers of deaths in the United States. Every day I wrote them down as a record, and wow, was it frightening. We didn't want anything like that to happen around us we believe in this kind of medicine.
Pfizer: Thanks for sharing that. Its important to look back and see how far weve come, but we must also continue the efforts that got us here. For our last question relating to the campaign specifically, we were wondering if you had a favorite part of shooting the ad for example, chopping a bunch of pineapples?
Martha: It was fun, and you had such a fantastic crew. And I notice stuff like that because I've been doing this a long time. But I was really pleased with the whole thing, and I love how it turned out.
Pfizer: Thats awesome we did too. Our next few questions are related to general health. So, what do you consider the key to a healthy and fulfilling life? You surely have a lot of wisdom to provide.
Martha: First of all, I live a very healthy life. I care very much about staying healthy, living well and aging successfully. So, I eat extremely well. I start my day with exercise. I am now doing Pilates three or four times a week. I also drink eight ounces of my green juice made from my own homegrown vegetables every single morning. And I also have a one-shot cappuccino with whole milk. I don't drink a lot I might have a social drink every now and then. I think all of that helps keep me extremely healthy. My only issue is I've never slept very well. I have an active mind, so I must sleep more. But I really do live the life I write, talk about and show on television.
Pfizer: Also, since you're obviously a great cook, we were wondering if you might have an easy, healthy meal that someone can make themselves if they're not feeling great.
Martha: I think people should, as I said, be conscious of what they eat, especially when you're not feeling well. And for me, that would be a bowl of delicious soup. Soup is so easy to make well, so I have lots of recipes. One of my favorites is a vegetable soup that's simply cut up onions, leeks, carrots, sweet potatoes and a little olive oil and other vegetables, plus vegetable stock made at home. For me, everything's homemade. I rarely open a can and make my own pretty much everything. This weekend I taught my 12-year-old granddaughter how to pickle little peppers, and she was so happy to take home a half a gallon.
Pfizer: That sounds fantastic! Now we just have a few final questions that are more about you, and also the holiday season, so we can get to know you better. We know that your schedule is always jam-packed. How do you find the time to do it all, and do you have any tips you might be able to share?
Martha: I have Dorian working on my calendar, and she tries to keep me along the straight and narrow. It's hard because when you see my calendar in a day it's hideous it's really intimidating actually. So, we have calendar meetings regularly and we go over everything very clearly.
Pfizer: Scheduling is key. Would you share one thing you wish more people knew about you anything that comes to mind.
Martha: That I'm really very serious about the sustainable lifestyle that I lead. I think it's very important for people to know all that its something Im proud of.
Pfizer: Also, as you're known for being a tastemaker, could you share just a few of your favorite things? Your favorite scent, your favorite flower, and your favorite food.
Martha: Oh, for flower its what's in bloom now. It has to be that because I love, love flowers. Today I went into my greenhouse, and I brought in one of the most beautiful orchids that just started to bloom. So that's my favorite flower today. But I don't know what it'll be tomorrow I'll find something else that would be equally beautiful. My favorite scent is one of my favorite perfumes it's a combination of tuberose and gardenia. And my favorite food, is hard to say Japanese food is my favorite cuisine overall, I could eat it pretty much every day!
Pfizer: Fabulous! Our last question is about the holiday season, which can be a good time for people to get vaccinated before being with loved ones. Were wondering what your favorite holiday traditions are and what you love most about this time of year.
Martha: The holiday season should be a happy time. However, we're stressed out this year because of what's going on in the world. Many of us are distracted from the holidays and the happiness of what the season should be. I recommend you try to make the most of it. Be with your family and your friends. You can't erase what's going on around us, but you can encompass a lot of compassion for what's going on and help in any ways you can.
Pfizer: Thats great advice. Thank you so much, Martha, for taking the time.
Martha: My pleasure!
If youre interested in learning more about COVID-19 vaccines or scheduling an appointment, you can visit VaxAssist.com.
Although vaccination against SARS-CoV-2, influenza, and RSV reduces severe disease from these respiratory viruses in populations at high risk, coverage with each of the three vaccines, especially updated (20232024) COVID-19 and RSV vaccines, was low among nursing home residents. Compared with COVID-19 vaccination coverage among adults aged 65 years and RSV vaccination coverage among adults aged 60 years reported by the National Immunization Survey (NIS) Adult COVID-19 Module (37.4% and 17.0%, respectively), COVID-19 and RSV vaccination coverage reported to NHSN was lower among nursing home residents (33.1% and 9.8%, respectively). In contrast, influenza vaccination coverage among nursing home residents (72.0%) was slightly higher than that among the general adult population aged 65 years (69.3%) (5). Although data from NHSN and NIS cannot be directly compared because of different methodology and populations, these directional differences deserve further exploration.
Vaccine fatigue, defined as inaction toward vaccine information or instruction attributable to perceived burden and burnout (6), inaccurate health information, and vaccine hesitancy (7) contribute to lack of vaccine demand, especially in areas with a high SVI (8). For all three vaccines, coverage among nursing home residents was lowest in the most socially vulnerable counties. Lower coverage in areas with higher social vulnerability might be related to challenges to vaccine access and cost and payment barriers associated with COVID-19 vaccine commercialization.
The low RSV vaccination coverage relative to the other two vaccines might be driven by the relative recency of the recommendation, vaccine fatigue associated with the introduction of a fourth respiratory vaccine (in addition to influenza, COVID-19, and pneumococcal), implementation challenges with adding new vaccines, and the recommendation being based on shared clinical decision-making between a patient (or patients guardian) and a health care provider (4). Facilities have had limited time to train providers to implement a shared clinical decision-making recommendation and develop processes and policies to support RSV vaccine administration. Nursing home staff members might also be less familiar with the risk for RSV outbreaks and severe disease among residents (9). Increasing awareness of RSV as a cause of disease among nursing home residents might facilitate increased coverage.
In addition, these data highlight the success that can be achieved through surveillance and coordinated public health efforts to address barriers. During the 20232024 season, influenza vaccination coverage among nursing home residents was significantly higher than updated (202324) COVID-19 vaccination and RSV vaccination coverage. Annual influenza vaccination has been universally recommended since the 201011 influenza season,**** and CMS requires nursing homes to educate residents about and offer both influenza and COVID-19 vaccination. Notably, coverage with all three vaccines was highest in small nursing homes, suggesting that medical directors and other providers at these small facilities with lower patient-to-provider ratios might be best able to build trust with residents and families and mitigate barriers to vaccination coverage. HHS Region 8, driven largely by North Dakota and South Dakota, achieved relatively high coverage among nursing home residents with all three vaccinations because of robust relationships and frequent, persistent, clear communication among nursing homes, health care systems, state and local health departments, and pharmacies; similar strategies might have the potential to improve vaccination coverage in other states. CDC is also engaged in efforts to increase vaccination coverage, including sharing NHSN surveillance data with state and local health departments and CMS Quality Innovation Networks-Quality Improvement Organizations to guide targeted outreach and educational efforts in nursing homes with lower vaccination coverage, contacting facilities with high coverage to learn about and promote successful strategies employed, working with national organizations that represent nursing homes to help educate staff members and residents, responding to barriers by developing a Healthcare Provider Toolkit to facilitate vaccination and conduct webinars with partners, collaborating with CMS leaders to communicate reported billing barriers, and collaborating with CMS Quality Innovation Networks-Quality Improvement Organizations to increase vaccine confidence and demand.
The findings in this report are subject to at least three limitations. First, although it is mandatory for facilities to report COVID-19 vaccination coverage to NHSN, reporting of influenza and RSV vaccination coverage is optional, and the proportion of facilities reporting was low. Facilities that elected to report these data might be more likely to offer influenza or RSV vaccines. However, similarities in distribution of a small number of important facility demographics suggest that facilities voluntarily reporting these data might be representative of all facilities. Second, this analysis was conducted using aggregate, facility-level data reported to NHSN; therefore, vaccination coverage could not be directly examined by person-level covariates such as age, race, and ethnicity. Further, this limitation means that RSV vaccination coverage was calculated among all residents, not just the approximately 91% of residents aged 60 years (10). It is likely that RSV vaccination coverage among residents aged 60 years was higher than the overall coverage. Finally, NHSN does not collect data on the outcome of shared clinical decision-making discussions or reasons for declining vaccination.
There is an urgent need to protect nursing home residents against severe outcomes of respiratory illnesses through continuing effective strategies to increase updated COVID-19 vaccination and influenza vaccination coverage and discussing RSV vaccination as an option among nursing home residents during the ongoing 202324 respiratory virus season. Health care providers should counsel residents that immunizations are the most effective way to prevent severe outcomes from COVID-19, influenza, and RSV and offer recommended immunizations. It is important for nursing homes to collaborate with state and local health departments, federal agencies, and partners to address low vaccination coverage. Because vaccination coverage varied by vaccine type, region, SVI, and facility size, ongoing surveillance of vaccination coverage among nursing home residents remains essential to help guide timely efforts to increase vaccination in this population at high risk and address inequities.
A CDC study released Dec. 21 found low COVID-19 and flu vaccination coverage for most adults, and low RSV vaccination coverage for adults aged 60 and older. Antiviral treatments are also being underused, and COVID-19 rebound can happen whether patients receive any, the study said. Among other findings, the report said that most nursing home residents have not received an updated COVID-19 vaccine or RSV vaccine for residents aged 60 and older using shared clinical decision-making.
The holidays are here, and County Health and Human Services is asking San Diegans to add a few things to their list to promote a healthy holiday season.
The County reports rapidly rising cases of COVID-19, flu and RSV along with associated hospitalizations. Wastewater surveillance, which measures the amount of COVID-19 virus in sewage, is also showing sharp increases, particularly in the South Bay and north coastal areas of the County. These measurements are a good indicator of cases to come.
As always, vaccinations are the best protection and COVID-19 and flu vaccines are widely available at local pharmacies or medical providers.
Testing for COVID-19 and flu is also recommended. Doctors can prescribe medications to help people from getting severely sick, especially older adults or people with underlying medical conditions.
Everyone ages six months and older is eligible for the updated COVID-19 vaccine regardless of prior vaccination history as long as it has been two months since the last dose of any COVID-19 vaccine.
The flu vaccine is recommended yearly for everyone six months and older, especially people at higher risk for getting seriously sick like young children, older adults, pregnant people and people with certain health conditions.
RSV or Respiratory Syncytial Virus is a common respiratory virus that can cause grave illness in young children and older adults with underlying illnesses. Pregnant people and people 60 years or older should talk with their doctor about whether the RSV vaccine is right for them.
Staying current on your vaccines is the best way to protect yourself and your loved ones from getting sick, said Wilma J. Wooten, M.D., M.P.H., County public health officer. Its not too late to go get your COVID-19 and flu vaccines as these viruses have not yet peaked this season.
In addition to pharmacies and other locations, vaccines are also available at County public health clinics.Check onlinefor the days and hours sites will be open.
Beyond vaccination and staying home when sick, San Diegans can take other precautions to protect themselves and others against COVID-19, the flu and RSV with these measures:
The County Health and Human Services Agency publishes theRespiratory Virus Surveillance Reportweekly.
The main findings of the current study were as follows: (1) at rest, patients with Long COVID presented altered time and non-linear index of HRV suggesting high HR, lower parasympathetic tone (rMSSD; SD1), lower variability of RR intervals (RR tri index) and total variability (SD2) as well as impaired fluctuation analysis with increased risk of sudden death (alpha 1) compared to controls; (2) patients with Long COVID responded to the M-RSA with an increase in time index of HRV, however this response were significantly lower compared to controls, reinforcing lower parasympathetic tone (rMSSD), lower variability of RR intervals (RR tri index) and lower HR dynamics.
Different methods of autonomic assessment have been used in contemporary literature (pupillometry, microneurography, negative lower body pressure, cold pressor test, Ewing protocol, Holter, etc.) however, their use in clinical settings is limited16. To our knowledge, no studies with Long COVID patients have investigated heart rate variability in different postures and M-RSA with the device Pro-Trainer 5 with POLAR software, an accessible tool both in terms of cost and practicality, in addition to presenting good accuracy both at rest and during exercise17. Our study is the first to use the Pro-Trainer and this is of great clinical relevance in the context of diagnosing autonomic dysfunction and cardiovascular risk.
Research has demonstrated COVID-19 not only affects the cardiovascular system in its acute phase but can have prolonged negative effects4. Most patients with COVID-19 recover completely without sequela, while some patients continue to have diverse symptoms, including autonomic dysfunction, for longer than 12weeks without an alternative diagnosis12,18. Long COVID symptoms of inappropriate palpitations, fatigue, orthostatic intolerance, dizziness, brain fog, nausea, anxiety, hyperhidrosis and syncope have been reported; there is currently a lack of evidence to indicate how long these autonomic symptoms will last9.
The mechanism of dissemination and development of COVID-19 in the human body, the immune system response, and the action of the virus on the Autonomic Nervous System (ANS), are obscure topics. Infection by the COVID-19 virus can generate inflammatory responses, once the immune system is active, which can lead to systemic damage19 including autonomic dysfunction mediated by the virus. Some studies have reported the association between autonomic dysfunction, neurotropism, hematogenous route or neuronal dissemination20,21. In this sense, the conflicting results in the current scenario refers to the increase in sympathetic activity at rest, which can lead to premature death22; contrasting with in young males and adult patients after COVID-19 showing increase of the parasympathetic nervous system activity demonstrating increased HRV indices than controls18. The findings of the current study differ from this concern [i.e., high HR, lower parasympathetic tone (rMSSD; SD1) and lower RR tri index and total variability (SD2) and increased risk of sudden death (alpha 1)]. We hypothesize that the differences found in our study are related to the clinical characteristics of the sample in relation to the literature [i.e., restricted to young men and/or young adults with a predominance of females, non-hospitalized and/or non-symptomatic patients12,18. These alterations in HR modulation trigger the emergence of cardiovascular diseases and inadequate adaptations of the ANS23, altering the homeostatic state of the body.
In this sense, patients with Long COVID may present with dysautonomia characterized by an imbalance of HRV, which is reflected in the band potencies of 0.150.4Hz13, and highlights that this dysautonomia could explain the persistent symptoms observed in patients with Long COVID13. In our study, we observed similar results with a lower complexity of HRV in patients with Long COVID [lower variability of RR intervals (RR tri index) and total variability (SD2) and impaired fluctuation analysis with increased risk of sudden death (alpha 1)] compared to controls.
In a Mayo Clinic study including patients with symptoms related to postinfectious autonomic dysfunction after COVID-19, 63% were found to have abnormal findings on standardized tests of autonomic function, such as cardiovagal function analyzing heart rate responses to deep breathing and the Valsalva maneuver12. The most common post-COVID-19 autonomic manifestation was orthostatic intolerance, and the remaining changes ranged from symptomatic postural orthostatic tachycardia to severe autonomic dysfunction24. Our observation and clinical data suggest that Long COVID patients have the highest Mean HR in the first few days and weeks of the convalescent phase. Regarding M-RSA, our findings suggest that patients after hospitalization had a worse cardiac autonomic modulation, with lower parasympathetic tone (rMSSD), lower variability of RR intervals (RR tri index) and lower HR dynamics. Autonomous innervation is the primary extrinsic control mechanism that regulates HRV and cardiac performance. Thus, this autonomic dysregulation likely represents the cause and effect of the different stages of COVID-19, the severe inflammatory system response syndrome (SIRS)11 and its compensatory anti-inflammatory response until Long COVID which can be influenced by frequency and depth of breathing. Many patients have restrictive pulmonary conditions after infection, but only 15% have restrictive and obstructive patterns25, and these changes can directly influence the ability to perform M-RSA. We highlight that M-RSA was performed in a controlled environment with a metronome, where there is control of the RR and the stimulus for deep breathing, providing good capacity to evaluate the parasympathetic modulation response.
We found that HRV is markedly impaired in the presence of Long COVID. Therefore, strategies aimed at improving autonomic control index can improve the cardiovascular risk in these patients, as well as symptomatological and pulmonary function changes, since the cardiorespiratory interaction is closely associated with peripheral oxygen supply and symptoms of persistent fatigue. These results, therefore, emphasize the multifactorial nature of the cardiopulmonary impairment present in these patients, associated with the symptomatological manifestations (i.e., dyspnea and feeling of fatigue) present in these patients. Our findings provide a rationale for improving fatigability with interventions aimed at improving cardiac and respiratory system autonomic control, through pharmacological and non-pharmacological measures aimed at reducing the cardiovascular risk in these patients. For example, cardiorespiratory rehabilitation can reduce muscle fatigue and improve cardiac autonomic function in other chronic conditions and has been the focus of numerous studies in patients with Long COVID. Future clinical trials on the impact of these interventions on cardiocirculatory and autonomic responses should look more carefully at the relevance of peripheral and respiratory muscle performance enhancing cardiac autonomic control in this patient population.
This was a single-center study with a small sample size. Asymptomatic patients with COVID-19 were not included. Patients' breathing characteristics and drug treatment were not measured and standardized in this study and the patients were referred to LARECARE in different times after COVID-19 infection. The differences in age and BMI between the Long COVID and control group can be considered a confounding factor, so we performed a linear regression analysis to verify the influence of both variables on the HRV indexes and no significant difference was found, demonstrating that age did not influence the main outcome of the study. Moreover, there was no follow-up of the patients over time to verify whether or not HRV dysfunction persists.
Data source
This study used data from the TriNetX Research Network, a collaborative health research platform that aggregates de-identified patient-level data from electronic health records, including demographic data, diagnoses, procedures, medications, laboratory data, genomic data, and types of healthcare organization (HCO) visits. TriNetX contains data from over 120 HCOs globally, typically academic health centers that collect data from their affiliated facilities, including main and satellite hospitals and outpatient clinics. For the present analysis, we used the Research Network, which contains the data of over 107 million patients from 76 HCOs. The TriNetX platform includes built-in tools for analyzing patient-level data, and the results are provided to researchers in an aggregate form. Detailed information on the database can be found online [11]. Written informed consent was not required because TriNetX contains anonymized data. The Institutional Review Board of the Chi Mei Medical Center approved the study protocol (no. 11202-002).
We compared the risk of post-COVID-19 conditions between patients with and without an IDD. The IDD group comprised patients aged18 years with a diagnosis of IDD before testing positive for SARS-CoV-2 or receiving a COVID-19 diagnosis (Table S1). We created exclusive categories for patients with commonly reported IDDs using International Classification of Diseases (ICD-10) codes: intellectual disability, ICD-10 F70-79; Down syndrome, ICD-10 Q90.9; and cerebral palsy, ICD-10 G80, as previous described [1, 12,13,14,15].
The non-IDD group was identified using identical criteria but without any IDD diagnosis (Table S2). To ensure a 180-day follow-up for each patient, at least two medical encounters with HCOs were required between March 1, 2020, and October 1, 2022. Patients diagnosed with post-COVID-19 conditions within 1 year before the index date or those requiring initial hospitalization were excluded Index date was defined as the date of diagnosing COVID-19 and only first episode of SARS-CoV-2 infection was included (Table S3).
The primary outcome of this study was a composite outcome consisting of 12 clinical features of post-COVID-19 conditions observed 90180 days after the index event. The follow up period was used based on the definition of post-COVID-19 conditions by World Health Organization the symptoms persist for 3 months after the initial infection. These features include chest/throat pain, abnormal breathing, abdominal symptoms, fatigue/malaise, anxiety/depression, headache, cognitive dysfunction, myalgia, loss of taste or smell, sleep disturbance, cough, and palpitations [16,17,18] and were identified using ICD-10 code (Table S4). In addition to these clinical features, survival and time-to-event outcomes following the index event were also evaluated using Kaplan-Meier and log rank testing to provide further insights into the potential progression and duration of these post-COVID-19 conditions in individuals with IDD versus the general population.
The secondary outcomes encompassed the components of the primary outcome, specifically post-acute COVID-19 conditions, such as chest/throat pain, abnormal breathing, abdominal symptoms, fatigue/malaise, anxiety/depression, headache, cognitive dysfunction, myalgia, loss of taste or smell, sleep disturbance, cough, and palpitations between 90 and 180days after the index date.
We considered 39 variables to adjust for imbalances in baseline characteristics between the IDD and non-IDD groups. We utilized a list of both confirmed and suspected risk factors for COVID-19 and more severe cases of the illness, which included demographics (such as age, sex, and ethnicity), adverse socioeconomic determinants of health (including problems related to education and literacy, problems related to employment and unemployment, and problems related to housing and economic circumstances, as defined by ICD-10), and comorbidities (such as obesity, hypertension, diabetes mellitus, chronic kidney disease [CKD], asthma, chronic lower respiratory diseases, ischemic heart disease, neoplasm, chronic liver diseases, stroke, dementia, rheumatoid arthritis, lupus, psoriasis, human immunodeficiency virus [HIV] infection, mood disorders, and psychotic disorders) [19,20,21]. We compiled all baseline characteristics and underlying conditions using the most recent data within the three years before the index date. If multiple data points were available within this period, we chose the one closest to the index date.
We used the built-in propensity score-matching function of the TriNetX platform to ensure a 1:1 match between the participants in the IDD and non-IDD groups. This was enabled by employing a nearest-neighbor greedy matching algorithm with a caliper width of 0.1 pooled standard deviation. The propensity score was assigned as the probability of exposure to IDD or non-IDD patients with the covariates included in the regression model and then used to balance the differences between groups. Standardized differences were computed to assess the inequality and the confounding effect between groups. Any differences in absolute values<0.1 indicated a good match between groups [22]. To evaluate the survival and the time-to-event data, we employed the Kaplan-Meier survival analysis. The differences between survival curves were analyzed using the log-rank test. We used Cox proportional hazard models to calculate the hazard ratios, which involved adjusting for potential confounding variables. The hazard ratios, with corresponding confidence intervals, were derived to examine the relative risk of post-COVID-19 conditions in the IDD population compared to the control group. All tests were two-sided, and p-values less than 0.05 were considered statistically significant.
For the subgroup analysis, we compared the risks of post-COVID-19 conditions between IDD and non-IDD groups. This comparison was stratified by age (1864 and65 years), sex, vaccine status (unvaccinated or vaccinated with at least one dose 14 days before the SARS-CoV-2 infection), and race (white and non-white).
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Baseline characteristics
From February 2020 to July 2021, 107 patients with severe COVID-19 pneumonia were enrolled. Of these, 1 patient were excluded analysis because of missing data. Ultimately, a total of 106 patients were evaluated in this study (Fig.1). Table 1 shows individual baseline clinical and outcome data in the present study population. The median age was 66years (interquartile range [IQR]: 55 to 72). Of these patients, 77 (73%) were male and 29 (27%) were female. Hemodynamics indicated by blood pressure (BP) and heart rate (HR) was preserved at hospital arrival. More than 80% of the study population was diagnosed as pneumonia. Comorbidity was shown, including interstitial pneumonia, chronic obstructive pulmonary disease, hypertension, diabetes, chronic kidney disease, heart failure, and liver cirrhosis. More than 50% (n=59/106) required MV for severe respiratory failure 0.5h (IQR: 0.3 to 1.4) after hospital admission (vented group), while the remaining patients did not during hospitalization (unvented group).
Patients flow. A total of 107 patients participated in the study. Finally, 106 patients were analyzed; 85 were used for training-data and 21 for test-data.
There were not any significant differences of age, sex, body mass index (BMI), and smoking between vented group and unvented group. With regarding to hemodynamics at hospital arrival, BP and HR did not show any significant differences between the 2 groups. However, respiratory status, as indicated by S/F ratio, was significantly worse before intubation in the vented group compared with in the unvented group. Alternatively, there were no significant differences in the prevalence of comorbidities between the two groups. Comparisons of laboratory data between the 2 groups showed significant increases in aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), blood urea nitrogen (BUN), C-reactive protein (CRP), and BG and decreases in the lymphocyte counts in the vented group (Table 2).
We evaluated the associations of significant nine variables in the univariate analysis, including S/F ratio, lymphocyte count, AST, ALT, ALP, LDH, BUN, BG, and CRP with the use of MV using the area under receiver operating characteristic curve (AUROC) obtained from a 10-split crossover test. The combination of these nine variables showed an AUC of 0.89 [0.751.00] with a sensitivity of 0.91, specificity of 0.81, positive predictive value (PPV) of 0.90, and negative predictive value (NPV) of 0.83 (Table 3).
The beta regression coefficient selected from a multivariable logistic regression model using these variables is shown in the supplemental Fig. 1. Based on significant beta regression coefficient with>0.5 of their values, we identified the top four variables to predict MV use, including S/F ratio, BG, lymphocyte counts, and ALT. The combination of the four variables showed higher accuracy (AUC of 0.89 [0.830.95]) compared to S/F ratio or BG alone (AUC of 0.84 [0.760.91] or AUC of 0.75 [0.660.91], respectively) (Fig.2, Table 4), with a sensitivity of 1.00, specificity of 0.82, PPV of 0.85, and NPV of 1.00 (Table 4).
The need for MV prediction using simplified logistic regression. The area under the receiver operating characteristic curve (AUROC) of the logistic regression models (blue; S/F+Lym+ALT+BG, orange; S/F green; S/F+BG, red; BG.). S/F, SpO2 /FiO2 ratio; BG, blood glucose; Lym, lymphocyte counts; ALT, alanine aminotransferase.
We further evaluated a predictive value of combing S/F ratio and BG, which can be easily and immediately measured, on the use of MV. The accuracy of this combination in the prediction (AUC: 0.88 [0.820.94) was nearly equal to that of the combing 4 variables, with a sensitivity of 1.00, specificity of 0.73, PPV of 0.79, and NPV of 1.00 and tended to be higher than the S/F ratio alone, despite no significant difference (Table 4). The concurrent evaluation of S/F ratio and BG is likely to allow accurately and easily predict the impending MV use in not only ER but also ambulance and home.
Clinical utility of combining BG level and S/F ratio at hospital admission was tested with KaplanMeier event-incidence curves of MV use that were constructed according to above or below optimal cutoffs defined by AUROC analysis (BG: 138mg/dL, S/F ratio: 300). In high-risk patients with low S/F ratio ( 300), MV use rate at the 3-day follow-up period did not show a significant difference between low BG (<138mg/dL) and high BG ( 138mg/dL) (n=11/14 (79%) vs. n=34/37 (92%), respectively, P=0.48). However, in patients with high S/F ratio (>300), those with high BG had a significantly higher MV use rate compared to those with low BG (n=10/20 (50%) vs. n=4/35 (11%), respectively, P<0.01) (Fig.3). Importantly, this suggests that measuring BG level at hospital admission allows identifying patients at high risk for impending MV use from population with preserved respiratory status, which supports a better accuracy of combining BG and S/F ratio than S/F ratio alone.
Mechanical ventilation (MV) use at the 3-day follow-up period. KaplanMeier event-incidence curves of MV use that were constructed according to above or below optimal cutoffs (blood glucose [BG]: 138mg/dL, SpO2 /FiO2 ratio [S/F ratio]: 300).
With more cases of JN.1, the newest sub-variant of COVID-19, being reported from various states, and an uptick of respiratory illnesses because of winter temperatures, doctors are insisting on a preventive healthcare routine for the elderly and co-morbid.
Dr Kiran G Kulirankal, Assistant Professor, Division of Infectious Diseases, Amrita Hospital, says while JN.1 doesnt seem to be a dangerous variant as of now, dipping temperatures and flu season could be a risk factor for the elderly and co-morbid patients.
With the new sub-variant circulating, what would you advise elderly and co-morbid patients?
In the context of JN.1, elderly individuals above 60, and those with co-morbid conditions, such as patients on immunosuppressants, suffering malignancy, chronic kidney and liver diseases, as well as pregnant women, should exercise heightened caution. The risks associated with this sub-variant include the potential for increased mortality and morbidity. Thats why this group should prioritise preventive measures such as consistent mask-wearing and strict adherence to hand hygiene as well as social distancing guidelines. They should avoid crowded places and protect themselves with N95 masks should their presence be mandatory at a gathering. The vulnerable group should not embrace others, not mix their clothes or share personal effects like towels and bed linen with others.
So far, the new sub-variant has not exhibited any signs of severe pneumonia. During this flu season, testing will be required to distinguish Covid from the ongoing influenza epidemic. Its important that the anti-viral treatment be given at the earliest.
With colder temperatures and flu alongside, how risky is the situation for the elderly and co-morbid patients?
The combination of colder temperatures and the concurrent flu season elevates the risk for the elderly and individuals with co-morbid conditions. Given their heightened susceptibility to severe outcomes from Covid-19, the added complications from the flu make the situation more precarious. It is crucial for these individuals to take extra precautions, including regular testing to distinguish between COVID-19 and influenza, and to seek prompt medical attention if symptoms arise.
Will past vaccinations, which were aimed against the ancestral strain, continue to be protective?
Past vaccination, along with past infection, may prevent the disease from progressing to its severe form. However, the elderly and the immunocompromised need to be cautious as an infection may complicate their already compromised health parameters and may lead to increased mortality and morbidity.
Will they be needing a fourth vaccine?
There are no guidelines yet for a fourth vaccine. Staying up to date with mandated vaccinations, including influenza, are crucial components of their routine. Seeking guidance from doctors for personalized advice is highly recommended.
Are there any unknown co-morbid conditions that can be aggravated by the latest bout of infection?
Ongoing research is essential to identify any emerging risk factors. Staying informed through updates from healthcare authorities and continuous research will help uncover any potential unknown co-morbid conditions that may raise the risk of Covid infection.
IE Online Media Services Pvt Ltd
First published on: 20-12-2023 at 11:09 IST
The University of Arizona Health Sciences announced major funding for a Phoenix-based health sciences hub, reported on major research in the areas of long COVID-19 and firefighter sleep patterns, and celebrated the establishment of the College of Health Sciences. From investigating critical health care issues to training the next generation of health care workers, UArizona Health Sciences researchers, staff, physician-scientists and students worked together to create healthier communities for all.
Here are the top 10 UArizona Health Sciences news releases of 2023:
New study will examine irritable bowel syndrome as long COVID symptom (Sept. 28)
Researchers with the ongoingArizona CoVHORT research studyat the UArizonaMel and Enid Zuckerman College of Public Healthwere awarded $3.2 million by the National Institute of Diabetes and Digestive and Kidney Diseases for a five-year study of gastrointestinal symptoms, specifically irritable bowel syndrome, as a condition of long COVID.
We have an outstanding team of researchers, staff and students working on the CoVHORT study and investigating a range of long COVID symptoms, said lead researcher Kristen Pogreba-Brown, PhD, MPH, associate professor of epidemiology at the Zuckerman College of PublicHealthand member of the BIO5 Institute. And, we have a large, diverse group of participants, so we gather crucial data that deliver answers about specific symptoms, such as irritable bowel syndrome, and help find effective treatments.
Study uncovers reasons Americans did not get booster vaccines (Oct. 2)
In September 2022, new bivalent COVID-19 boosters became available in the United States, but less than 20% of the eligible population ultimately received one. A study led by researchers in the Zuckerman College of Public Health identified why so many Americans did not receive a booster.
Our results indicate that we have a lot more work to do in terms of educating the public and health care providers about the importance of staying up to date on COVID-19 boosters, said first authorElizabeth Jacobs, PhD, professor of epidemiology at the Zuckerman College of Public Health, who led the research with associate professor of epidemiologyKristen Pogreba-Brown, PhD, MPH.
Study shows how morphine may contribute to bone loss and cancer-induced bone pain (July 5)
Opioids such as morphine are the gold standard for treating cancer-induced bone pain, but new UArizona Health Sciences research uncovered a mechanism by which chronic morphine use may increase bone loss and pain. Nearly 70% of patients with prostate and breast cancers and 30%-40% of patients with lung cancer develop bone metastases. The most frequent and important symptom of bone metastasis is pain.
These findings suggest that chronic morphine for the treatment of things like metastatic cancer may not be the best, since it may be actually decreasing bone density, said senior authorTodd Vanderah, PhD, director of theUArizona Health Sciences Comprehensive Pain and Addiction Center, professor and head of theDepartment of Pharmacologyin theUArizona College of Medicine Tucsonand member of theBIO5 Instituteand theUArizona Cancer Center. This does not mean doctors should remove opioids from their treatment plans, but it does highlight a need to develop alternative therapies that can lower the risk of side effects from opioids.
Study shows millions of people live with co-occuring chronic pain and mental health symptoms (Sept. 21)
UArizona Health Sciences researchers found that nearly 1 in 20 adults in the United States experience the co-occurrence of chronic pain and anxiety or depression, resulting in functional limitations in daily life. The paper, published in the journal PAIN, is one of the few to examine the national prevalence of chronic pain with anxiety or depression symptoms in adults. The results shed light on the fact that millions of people may be experiencing symptoms that can limit their ability to work, complete daily tasks and socialize.
The studys findings highlight an underappreciated population and health care need the interdependency between mental health and chronic pain, said the papers lead author,Jennifer S. De La Rosa, PhD, assistant research professor in theCollege of Medicine TucsonsDepartment of Family and Community Medicine anddirector of strategy for the Comprehensive Pain and Addiction Center, which funded the study. This work is so exciting because it offers the opportunity to use team-based interdisciplinary approaches to medicine, leveraging what is known across disciplines to meet the needs of these individuals.
Urgent Care data show Valley fever season has begun in Arizona (July 27)
A team in theValley Fever Center for Excellenceat the College of Medicine Tucsonhas created a forecasting tool to determine when the illness is spiking in the community. Data for July indicated that Arizona was in Valley fever season that month.
Right now, if youre diagnosed with pneumonia, there is about a 1 in 5 chance that your pneumonia is caused by Valley fever, saidJohn Galgiani, MD, director of the Valley Fever Center for Excellence, professor of medicine and member of the BIO5 Institute. If you live in Arizona and you get pneumonia, you should be tested for Valley fever.
$4M NIH grant will test worksite sleep health coaching for Arizona firefighters (Aug. 7)
A $4 million award from the National Heart, Lung and Blood Institute, a division of the National Institutes of Health, will allow researchers in theZuckerman College of Public Healthto identify key factors for the successful implementation of workplace sleep coaching to improve sleep health in Arizona firefighters. Almost half of career firefighters report short sleep and poor sleep quality, and about 37% of firefighters screen positive for sleep disorders like sleep apnea, insomnia or shift-work disorder.
Other studies have showed us that firefighters personal circumstances and shift schedules often dictate their sleep, said principal investigatorPatricia Haynes, PhD, CBSM, DBSM, whoseprevious researchfound that more recovery sleep in firefighters during off days is associated with less stress and irritability.
US Army Medical Research grant funds study of green light therapy for postsurgical pain (Sept. 14)
UArizona Health Sciences Comprehensive Pain and Addiction Centerresearchers will use a $2.4 million grant from the United States Army Medical Research Acquisition Activity to determine the effectiveness of green light therapy on postsurgical pain and inflammation. The number of surgeries in the U.S. exceeded 40 million in 2010 and has steadily increased since then. At the same time, the opioid crisis continues to have devastating effects throughout the country. Despite the risks associated with opioids, they remain the most prescribed medications for managing surgical pain.
Patients with anxiety, depression or sleep disturbances can experience exaggerated pain, necessitating higher doses of opioids to control their postsurgical pain. Military members and veterans have anxiety, depression and sleep disturbance at rates three to four times greater than civilians. Sadly, they are also at higher risk of opioid use disorder and dependence, said pain management physicianMohab Ibrahim, MD, PhD, medical director for the Comprehensive Pain and Addiction Center, professor of anesthesiology in theCollege of Medicine Tucson and director of the Pain Management Clinic. Finding a therapy that can decrease reliance on opioids for postsurgical pain would be transformative.
CAMI receives $4M financial investment from Maricopa County (July 18)
The University of Arizona Health SciencesCenter for Advanced Molecular and Immunological Therapiesreceived a strong vote of support from the Maricopa County Board of Supervisors with the June 28 approval of $4 million in funding for the life sciences innovation hub being developed on the Phoenix Bioscience Core in downtown Phoenix. The Center for Advanced Molecular and Immunological Therapies, or CAMI, builds on the idea that the most effective defense against health issues is the bodys natural immune system.
The Center for Advanced Molecular and Immunological Therapies is designed to respond to health crises that have arisen and will arise in the future, to advance health care activities within the region and to provide additional fuel to the local economys engine, said Michael D. Dake, MD, senior vice president for the University of Arizona Health Sciences. This financial investment from the Maricopa County Board of Supervisors will catalyze advancements in both health sciences and economics as CAMI becomes the anchor for an innovation district that will establish Phoenix as a national hub for cell- and gene-based therapy research, startup activity, and corporate engagement.
Future primary care doctors receive scholarships for medical school (Sept. 28)
Twenty-five aspiring physicians are the latest to benefit from theUArizona Health SciencesPrimary Care Physician Scholarship Program, which continues to address two critical issues in health care: Arizonas shortage of primary care physicians and a rising amount of debt for medical students. The program awarded scholarships to 14 students in theCollege of Medicine Tucsonand 11 in theUArizona College of Medicine Phoenix. The scholarships, which are awarded annually, are available to incoming and current students. They allow medical students to pursue careers in primary care without worrying about how they will repay medical school debt.
Ive seen and felt the physician shortage in primary care said Marin Carter, a second-year medical student in the College of Medicine Tucson who worked in Flagstaff at a Federally Qualified Health Center prior to medical school and participated in a Rural Health Professions Program this past summer. I believe that everyone should have access to the quality primary care my family has received, and I want to provide that to the community. Theres so much value in preventive medicine and longitudinal care.
ABOR approves establishment of College of Health Sciences at UArizona Health Sciences (June 16)
UArizona Health Sciences is addressing critical health care needs within Arizona with the launch of a newCollege of Health Sciences, which was approved by the Arizona Board of Regents at its meeting in Flagstaff, Arizona, June 14-15.
The College of Health Sciences will help fill much-needed positions in many crucial health care professions, while at the same time keeping education costs down for students, saidKevin C. Lohenry, PhD, PA-C, interim dean of the College of Health Sciences and assistant vice president of interprofessional education for UArizona Health Sciences. By creating a culture of health and wellness coupled with student success, the College of Health Sciences will play a strong role in training students to serve the needs of Arizonas diverse and rural communities with compassionate and culturally sensitive care as health professionals and through inclusive and innovative translational research as scientists.
For more information on UArizona Health Sciences impact in 2023, view the annual report at annualreports.healthsciences.arizona.edu.
