Eclipsing of older people in the pandemic: Ageist approaches must not underpin guidance for future crises

by Trinity College Dublin

Credit: Pixabay/CC0 Public Domain

A new qualitative study from researchers at the School of Nursing and Midwifery at Trinity College Dublin provides, for the first time, a depth of understanding of the everyday experience of the COVID-19 pandemic for older people in Ireland.

31 oct 2021--As we move into the winter months and the possibility of further restrictive measures to counteract the spread of the virus, the findings from the study provide important evidence that policy makers and government should be mindful of regarding future possible public health restrictions.

The newly launched report, in partnership with Safeguarding Ireland, found that older people made significant efforts to self-protect from COVID-19. However, this was at the expense of their physical and/or mental health. While public health restrictions applied to the entire population, older people were advised to follow guidance which limited their daily lives.

Unlike previous reports, participants gave a first-hand account of their experience, and described their careful efforts to self-protect. The resilience of older people is a dominant feature of the report.

Key findings of the report

• Older people made substantial changes to their daily lives to comply with the COVID-19 shielding guidance.
• COVID-19 had significant impacts on the health of older people in the community.
• Social capital was demonstrated as compensatory measures were adopted to daily lives.
• Older people reported a general stoic approach to living in the pandemic and they demonstrated resilience in multiple ways.
• The use of technology assisted in managing social and practical activities, however, its use, satisfaction and familiarity differed within the participants in the study.
• Older people need more integrated support systems which maintain their personal, health and social needs.
• Consideration needs to be given to pandemic related information to avoid information fatigue, misinformation, and confusion.
• Post-pandemic rehabilitation will be required to focus on restoring lost physical ability and address the consequences of social isolation and loneliness.
• There is a need to ensure that ageist approaches do not underpin guidance. The rights of autonomy and self-determination need to be central considerations in future similar crises.

A selection of participant quotations from the report (all quotes are anonymous)

• "So I go out to the driveway where the car would normally be, we put it out on the road and just when the pandemic lifted or sorry when the lockdown lifted I would go down the footpath and that I miss a lot. Because I could go you know right down the road and I would be out for maybe twenty minutes down pass all my neighbors' houses and back again. And that was great but then when the lockdown comes, I stay inside the gate."
• "I'm in the kitchen and I'm looking at four walls and when I get tired of those four walls, I go into the dining room and I look at a different four walls and then I go to the sitting room and I look at a different four walls again."
• "And I suppose there is that about mortality, the fact that you could get this awful disease, awful virus and you know, the way you would die isn't very nice and your funeral, you know, for all the people, like you'd be on your own. You wouldn't, I mean, I know you have nurses and they're very good and so on. But your family, you would have no family, you know."
• "So you became neurotic about listening to the radio and you were going from one news item on the radio to the next news item on the television and ending up depressed with the fact that you were ending up that you couldn't move or you couldn't go outside the door."
• "You just feel like you're locked in or hemmed in like, and you can't do anything. And I do wake up and I'll say now I'll do this today, I'll go up to the, I'll go down the post office, oh no I can't, here I am. You know you just feel like you're a prisoner, you know every time you think of something to do you have to knock it on the head because you can't do it, you know."
• Commentators indicate that this will not be the last pandemic. We need to ensure that the voices of our growing aging population are heard and that they are supported to limit health decline, loneliness and continue to foster both social capital and inter-generational solidarity.

Globally it is recognized that there has been an eclipsing of older people in the pandemic; their voices have been minimized and support systems impacted (both formal and informal). More robust health policy needs to be developed to ensure any health (physical and/or mental) health decline is limited through programs of support in the home. In addition, information management is needed to avoid information overload or misinformation which can lead to psychological distress.

Amanda Phelan, professor in aging and community nursing and principal investigator of the study said: "Older people have made significant efforts to self-protect in the pandemic, however, there has been consequences for both their physical and mental health. The impact has been most profound in the older age groups due a disproportionate impact in mortality and morbidity rates. We need a short-term plan of engaging in rehabilitation through comprehensive geriatric assessments and care plans. While our study did not highlight safeguarding issues, it is also important to acknowledge that the conditions of the pandemic exacerbated elder abuse risk factors, and this may be occurring in Ireland under the radar of our data. Thus, a focus on awareness, prevention and early intervention are key considerations."

Welcoming the report Safeguarding Ireland, Chairperson Patricia Rickard-Clarke said, "This paper is one that will be of interest to everyone and particularly policy-makers and those involved in the planning and delivery of health and social services for older people. It is a timely and important reminder of responses that are needed, not only to the pandemic itself, but also to the unintended effects of efforts to limit the spread of disease. Health and well-being are not just about being free from disease but also encompass less tangible, but no less important, matters such as social connectedness, interdependencies and independence."

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More information: Exploring Older People's Experiences of Shielding During the COVID-19 Pandemic: www.tcd.ie/tcphi/assets/pdf/ol … people-shielding.pdf

 

Robotic pet boosts mood, behavior and cognition in adults with dementia

by Florida Atlantic University

Study participants smiled and talked to their robotic cats and expressed sentiments such as, “the cat is looking at me like someone who listens to me and loves me.” Credit: Florida Atlantic University

Individuals with Alzheimer's disease or related dementias (ADRD) often experience behavioral and psychological symptoms such as depression, aggression and anxiety. Frequently, these symptoms are treated with antipsychotics, antidepressants and benzodiazepines, which often have side effects.

30oct 2021--While pet therapy is known to be a cost effective and therapeutic intervention for improving mood and behavior in older adults, little is known about pet therapy in adult day centers, despite logistical advantages such as socialization and group activities.

With the help of a cuddly and "furry" companion, researchers from Florida Atlantic University's Christine E. Lynn College of Nursing tested the effectiveness of affordable, interactive robotic pet cats to improve mood, behavior and cognition in older adults with mild to moderate dementia. The non-pharmacological intervention took place over the course of 12 visits in an adult day center. Participants were informed that their pet was a robot and not a live animal. Each of them selected a name for their cat, which was fitted with a collar and a personalized nametag.

For the study, published in the journal Issues in Mental Health Nursing, researchers assessed mood and behavioral symptoms using the Alzheimer's Disease and Related Dementias Mood Scale, the Observed Emotion Rating Scale and the Cornell Scale for Depression in Dementia. They also assessed cognition via the Mini Mental State Examination.

The robotic pet cat responded by purring, meowing, turning their head, rolling over or blinking their eyes. Credit: Florida Atlantic University

Results showed that intervention with a robotic pet cat improved all mood scores over time, with significant improvements in the Observed Emotion Rating Scale and the Cornell Scale of Depression in Dementia. More than half of the participants scored higher on the Mini Mental State Examination post-test than pretest, with slight to moderate improvement in attention/calculation, language and registration. Post-test scores on the Alzheimer's Disease and Related Dementias Mood Scale were six points higher than pretest conditions.

Researchers frequently observed study participants smiling and talking to their robotic cats and expressing sentiments such as, "the cat is looking at me like someone who listens to me and loves me." They believed that the robotic pet was responding to their statements through meowing, turning their head or blinking their eyes and that they were having a conversation with the pet. Several of the caregivers reported that their loved one had slept with the cat, held onto the cat when sitting or consistently played with the cat. One participant even slept with her robotic pet cat while she was hospitalized. 

"Since there is no cure for dementia, our project offers a way to address symptoms naturally and without the use of pharmacological treatments, which may or may not be effective and have possible detrimental side effects," said Bryanna Streit LaRose, D.N.P., A.P.R.N., lead author who conducted the study as a doctoral nursing student at FAU, together with co-authors Lisa Kirk Wiese, Ph.D., R.N., an associate professor and Streit LaRose's faculty chair, and María de los Ángeles Ortega, D.N.P., A.P.R.N., a professor, director of FAU's Louis and Anne Green Memory and Wellness Center and Streit LaRose's community chair on the project, both within the Christine E. Lynn College of Nursing. "Our intervention was affordable, safe, and noninvasive." 

By using therapeutic pets instead of live pets, there was no concern about the safety of the pet, feeding them, taking them outside, or making sure they are up-to-date with their vaccines. In addition, there were no fears about participant safety due to possible pet aggression, allergies, tripping over them and the costs associated with caring for a live animal.

The robotic pet cats provided participants with an alternative way to express themselves. Credit: Florida Atlantic University

"In addition to improving mood, behaviors and cognition, these robotic pet cats provided our participants with an alternative way to express themselves," said Wiese. "Importantly, improving overall mood and behavior in individuals with Alzheimer's disease and related dementias may also improve quality of life for their caregivers and family members."

The researchers also examined the relationship between the Mini Mental State Examination and subscale post-intervention scores of the Cornell Scale of Depression in Dementia, Observed Emotion Rating Scale and Alzheimer's Disease and Related Dementias Mood Scale. They found multiple significant and strong correlations between the 11 subscales of the Alzheimer's Disease and Related Dementias Mood Scale and Mini Mental State Examination following the intervention. Nine categories regarding pleasant mood/behavior correlated favorably with the Mini Mental State Examination score, indicating a relationship between positive mood/behavior and increased Mini Mental State Examination scores.

"In the United States, one in three older adults dies with Alzheimer's disease or a related dementia and there is currently no cure for the rapidly growing burden," said Safiya George, Ph.D., dean, Christine E. Lynn College of Nursing. "This therapeutic interactive pet intervention has proven to be a safe alternative method to improving mood and behavior in people with dementia who are attending an adult day center."

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More information: Bryanna Streit LaRose et al, Improving Behavioral and Psychological Symptoms and Cognitive Status of Participants With Dementia Through the Use of Therapeutic Interactive Pets, Issues in Mental Health Nursing (2021). DOI: 10.1080/01612840.2021.1979142

Provided by Florida Atlantic University 

 

Largest real-world study of third dose of COVID-19 vaccine effectiveness shows Delta resistance

by Clalit Research Institute

Credit: Pixabay/CC0 Public Domain

The Clalit Research Institute, in collaboration with researchers from Harvard University, analyzed one of the world's largest integrated health record databases to examine the effectiveness of the third dose of the Pfizer/BioNTech BNT162B2 vaccine against the Delta variant of SARS-CoV-2. The study provides the largest peer-reviewed evaluation of the effectiveness of a third "booster" dose of a COVID-19 vaccine in a nationwide mass-vaccination setting. The study was conducted in Israel. It is published in The Lancet journal.

30 oct 2021--Many countries are currently experiencing a resurgence of SARS-CoV-2 infections despite hitherto successful vaccination campaigns. This may be due to the greater infectiousness of the Delta (B.1.617.2) variant of SARS-CoV-2, and to waning immunity of vaccines administered months earlier. In the face of the current resurgence, several countries are planning to administer a third booster dose of mRNA COVID-19 vaccine.

This study suggests that a third vaccine dose is effective in reducing severe COVID-19-related outcomes compared to individuals who have received two vaccine doses at least 5 months ago. It is the first to estimate the effectiveness of a third dose of an mRNA COVID-19 vaccine—BNT162b2 specifically—against severe outcomes with adjustment for various possible confounders, including comorbidities and behavioral factors. The study's large size also allows a more precise assessment of the vaccine's effectiveness across different time periods, different subpopulations (by sex, age and number of comorbidities), and different severe outcomes (which are rarer and thus require greater sample size). A recent clinical trial conducted by BioNTech included a smaller sample size and did not estimate the third-dose's effects for more severe outcomes.

The study took place from July 30, 2021 through Sept 23, 2021, coinciding with Israel's fourth wave of coronavirus infection and illness, during which the Delta (B.1.617.2) variant was the dominant strain in the country for new infections (with very few exceptions).

Researchers reviewed data from 728,321 individuals aged 12 or above who had received the third dose of the BNT162b2 vaccine. These individuals were carefully matched 1:1 with 728,321 individuals who had received only two shots of the BNT162b2 vaccine at least five months prior. The matching was based on an extensive set of demographic, geographic and health-related attributes associated with risk of infection, risk of severe disease, health status and health seeking behavior. Individuals were assigned to each group dynamically based on their changing vaccination status (198,476 individuals moved from the unvaccinated cohort into the vaccinated cohort during the study). Multiple analyses were conducted to ensure that the estimated vaccine effectiveness was robust to potential biases. The study included a total of over 12,000,000 person-days of follow-up.

The results show that, compared with individuals who received only two doses five months prior, individuals who received three doses of the vaccine (7 days or more after the third dose) had 93% lower risk of COVID-19-related hospitalization, 92% lower risk of severe COVID-19 disease, and 81% lower risk of COVID-19-related death. Vaccine effectiveness was found to be similar for different sexes, age groups (ages 40-69 and 70+) and number of comorbidities.

The study also included a population-level analysis which found that infection rates began to drop for each age group 7-10 days after that age group became eligible for the third dose.

"These results show convincingly that the third dose of the vaccine is highly effective against severe COVID-19-related outcomes in different age groups and population subgroups, one week after the third dose. These data should facilitate informed policy decision-making," said Prof. Ran Balicer, senior author of the study, Director of the Clalit Research Institute and Chief Innovation Officer for Clalit.

Prof. Ben Reis, Director of the Predictive Medicine Group at the Boston Children's Hospital Computational Health Informatics Program and Harvard Medical School, said that "to date, one of the main drivers of vaccine hesitancy has been a lack of information regarding the effectiveness of the vaccine. This careful epidemiological study provides reliable information on third-dose vaccine effectiveness, which we hope will be helpful to those who have not yet decided about vaccination with a third dose."

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More information: Ran Balicer et al, Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study, The Lancet, 2021.

Provided by Clalit Research Institute

 

Cheap antidepressant shows promise treating early COVID-19

by Carla K. Johnson

This 2020 electron microscope image provided by the National Institute of Allergy and Infectious Diseases - Rocky Mountain Laboratories shows SARS-CoV-2 virus particles which cause COVID-19, isolated from a patient in the U.S., emerging from the surface of cells cultured in a lab. According to a study released in The Lancet Global Health on Wednesday, Oct. 27, 2021, Fluvoxamine, a cheap antidepressant, reduced the need for hospitalization among high-risk adults with COVID-19. Credit: NIAID-RML via AP

A cheap antidepressant reduced the need for hospitalization among high-risk adults with COVID-19 in a study hunting for existing drugs that could be repurposed to treat coronavirus.

30 oct 2021--Researchers tested the pill used for depression and obsessive-compulsive disorder because it was known to reduce inflammation and looked promising in smaller studies.

They've shared the results with the U.S. National Institutes of Health, which publishes treatment guidelines, and they hope for a World Health Organization recommendation.

"If WHO recommends this, you will see it widely taken up," said study co-author Dr. Edward Mills of McMaster University in Hamilton, Ontario, adding that many poor nations have the drug readily available. "We hope it will lead to a lot of lives saved."

The pill, called fluvoxamine, would cost $4 for a course of COVID-19 treatment. By comparison, antibody IV treatments cost about $2,000 and Merck's experimental antiviral pill for COVID-19 is about $700 per course. Some experts predict various treatments eventually will be used in combination to fight the coronavirus.

Researchers tested the antidepressant in nearly 1,500 Brazilians recently infected with coronavirus who were at risk of severe illness because of other health problems, such as diabetes. About half took the antidepressant at home for 10 days, the rest got dummy pills. They were tracked for four weeks to see who landed in the hospital or spent extended time in an emergency room when hospitals were full.

In the group that took the drug, 11% needed hospitalization or an extended ER stay, compared to 16% of those on dummy pills.

The results, published Wednesday in the journal Lancet Global Health, were so strong that independent experts monitoring the study recommended stopping it early because the results were clear.

Questions remain about the best dosing, whether lower risk patients might also benefit and whether the pill should be combined with other treatments.

The larger project looked at eight existing drugs to see if they could work against the pandemic virus. The project is still testing a hepatitis drug, but all the others—including metformin, hydroxychloroquine and ivermectin—haven't panned out.

The cheap generic and Merck's COVID-19 pill work in different ways and "may be complementary," said Dr. Paul Sax of Brigham and Women's Hospital and Harvard Medical School, who was not involved in the study. Earlier this month, Merck asked regulators in the U.S. and Europe to authorize its antiviral pill.

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More information: Gilmar Reis et al, Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial, The Lancet Global Health (2021). DOI: 10.1016/S2214-109X(21)00448-4

 

Dementia makes it hard to detect pain in new nursing home residents

by Anne-S. Helvik, Norwegian University of Science and Technology

Detecting pain in residents with dementia is a necessary first step in treating it with non-drug or drug remedies. That's the first step in improving the quality of life of nursing home residents. Credit: Shutterstock

An assessment tool can make it easier for healthcare professionals to identify pain in residents with dementia. The right treatment can improve residents' quality of life.

30 oct 2021--We know very little about the incidence of pain among the elderly in nursing homes. Norway does not have a requirement in place for pain to be assessed before or during nursing home admission, nor once a person has been admitted.

In some countries, the absence of pain is seen as an indicator of the quality of care and treatment that the nursing home is providing to its residents. Can Norway achieve this as well?

Assessing whether—or where and to what extent—a resident is in pain can be especially challenging among the elderly with dementia. Individuals with severe dementia often find it difficult to express themselves verbally about their condition.

Instead, nurses and health professionals need to observe the resident and look for signs of pain. Such signs might include painful sounds, exclamations, facial expressions like grimacing or the resident reacting by trying to avoid touch and movement.

Our research team has developed a pain assessment tool based on observation that can be used for all stages of dementia. Using this tool, we wanted to study the incidence and severity of pain among the elderly with dementia who are admitted to Norwegian nursing homes.

We found that 36 percent of the almost one thousand (953) elderly people with dementia who were examined after hospitalization had pain that fundamentally affected their everyday life. In other words, the incidence of pain is high.

Both residents who were already on painkillers and those who were not experienced pain of this nature. About half of all the residents were on one or more types of painkillers.

Other non-pharmacological pain relief therapies, such as cognitive behavioral therapy, exercise, massage, pressure relief and environmental music therapy, were not investigated in this study.

Pain has a negative effect on residents' quality of life, and intense pain can reduce their quality of life even more. Lack of pain treatment can lead to aggression and restlessness, but also apathy, mood disorders and more.

Detecting pain in residents with dementia serves as a necessary first step to determine appropriate medication or non-drug therapies for the pain. Such measures will increase the quality of care and treatment and in turn improve the quality of life of nursing home residents.

Regularly assessing pain in residents should be considered a requirement for operating nursing homes and an integral part of the quality assessment. In Norway today, a large proportion of nursing home residents have dementia, with percentages as high as 85 percent. The incidence and severity of dementia have increased among nursing home residents over the last 20 years.

The use of an assessment tool based on observing signs of pain in people with moderate and severe dementia is timely. This tool offers healthcare professionals a better basis for providing both pharmacological and non-pharmacological therapies for pain.

Treatment of pain in the elderly with dementia is challenging, and the first choice should be non-pharmacological treatment, possibly combined with painkillers.

Introducing regular pain assessment and protocols for treatment, as well as drug reviews that shed light on pain and pain-reducing measures for this group of the elderly, is important in order to reduce the incidence and severity of pain in the residents. Assessing and treating this population group requires competence, resources and continuity in their care and treatment.

More information: Anne-Sofie Helvik et al, Pain in nursing home residents with dementia and its association to quality of life, Aging & Mental Health (2021). DOI: 10.1080/13607863.2021.1947968

Provided by Norwegian University of Science and Technology 

 

Study shows medicinal cannabis products can help with depression and improve quality of life

by Bob Yirka , Medical Xpress

Figure 1. Cannabis Users (n = 368) had reduced depression, but not anxiety, relative to Controls (n = 170) on the HADS at baseline. A greater proportion of Cannabis Users also scored below the HADS cutoff for clinical concern (scores ≥ 8) relative to Controls. Scores ranging from 8 to 10, 11 to 14, and 15 to 21 represent approximate cutoffs for mild, moderate, and severe cases, respectively (83). ***p < 0.001. Credit: DOI: 10.3389/fpsyt.2021.729800

A team of researchers affiliated with multiple institutions in the U.S. has found evidence that medicinal cannabis products relieve depression and improve the quality of life. In their paper published in the journal Frontiers in Psychiatry, the group describes their study involving online surveys about the benefits of cannabis products.

30 oct 2021--Prior research findings regarding the use of cannabis-based products to treat depression and anxiety have been mixed. Some patients have shown improvements while others have not. Prior research has also found that other drugs developed to treat depression and anxiety also have mixed results—some have seen improvements while others have not, and some patients have found that they cannot tolerate the side effects of the drugs. Also, some people have begun using medicinally approved cannabis products to help with their depression, anxiety, chronic pain or sleep disorder, regardless of the research track record—either independently, or with assistance from a doctor. In this new effort, the researchers conducted a study to gauge the opinions of people who use such products, rather than focusing on reports from the medical community regarding how well they thought they worked.

The study was carried out over four years. At the onset, the researchers received responses from 368 people who reported using cannabis products to reduce their depression and/or anxiety, or to help them sleep. As a control group, they also received responses from 170 people who were not using cannabis products but who were considering doing so due to their problems with depression or anxiety.

The researchers found that those people taking cannabis products (mostly those containing CBD rather than THC) reported lower levels of depression than the control group, although they saw no difference in anxiety. They also found those taking cannabis products reported a higher quality of life and better sleep than the control group. The researchers also found reduced levels of depression later on in those who continued to take cannabis products and also in those who began using them during the study. And interestingly, they also found that those who began taking the products during the study also reported improvements in anxiety and quality of life.

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More information: Erin L. Martin et al, Antidepressant and Anxiolytic Effects of Medicinal Cannabis Use in an Observational Trial, Frontiers in Psychiatry (2021). DOI: 10.3389/fpsyt.2021.729800

 

Prozac pegged as potential 1st treatment for leading cause of blindness

by University of Virginia

Bradley D. Gelfand, PhD, and collaborators have found early evidence that the drug fluoxetine may be effective against atrophic (or “dry”) age-related macular degeneration, a condition that affects nearly 200 million people worldwide. The drug has shown promise in the scientists' lab tests and animal models, and the researchers bolstered by their results by examining two huge insurance databases encompassing more than 100 million Americans. Credit: Dan Addison, UVA Communications

An antidepressant best known as Prozac could offer the first treatment for the leading cause of blindness among people over 50, new research from the University of Virginia School of Medicine suggests.

30 oct 2021--UVA's Bradley D. Gelfand, Ph.D., and collaborators have found early evidence that the drug fluoxetine may be effective against atrophic (or "dry") age-related macular degeneration, a condition that affects nearly 200 million people worldwide. The drug has shown promise in the scientists' lab tests and animal models, and the researchers bolstered by their results by examining two huge insurance databases encompassing more than 100 million Americans. That analysis concluded that patients taking fluoxetine were less likely to develop atrophic macular degeneration (AMD).

Based on their findings, the researchers are urging clinical trials to test the drug in patients with AMD. If successful, they believe the drug could be administered either orally or via a long-lasting implant in the eye.

"These findings are an exciting example of the promise of drug repurposing, using existing medicines in new and unexpected ways," said Gelfand, of UVA's Center for Advanced Vision Science. "Ultimately, the best way to test whether fluoxetine benefits macular degeneration is to run a prospective clinical trial."

Fluoxetine and AMD

The researchers believe fluoxetine works against AMD by binding with a particular agent of the immune system known as an inflammasome. This inflammasome, NLRP3-ASC, triggers the breakdown of the pigmented layer of the eye's retina.

After conducting extensive bench research, Gelfand and his team tested fluoxetine and eight other depression drugs in lab mice to see what effect, if any, the drugs would have in a model of AMD. Fluoxetine slowed the progression of the disease, but the others did not, the scientists found.

Encouraged by their findings, the researchers looked at fluoxetine use among patients over age 50 in two enormous insurance databases. People taking the drug had a "significantly" slower rate of developing dry AMD, the researchers report in a new scientific paper outlining their findings.

They note that their approach, combining bench research with big-data analysis, could potentially facilitate the repurposing of existing drugs for many conditions, speeding new treatments to patients.

"Traditional approaches to drug development can be expensive and time-consuming: On average, a new FDA-approved drug takes 10-12 years and costs $2.8 billion (present-day dollars) to develop," the researchers wrote. "Our identification of the unrecognized therapeutic activity of an existing FDA-approved drug using big data mining, coupled with demonstrating its efficacy in a disease-relevant model, could greatly accelerate and reduce the cost of drug development."

Gelfand was involved earlier this year in using a similar approach to determine that HIV drugs known as nucleoside reverse transcriptase inhibitors, or NRTIs, may be useful against dry macular degeneration as well.

"While we have had a great deal of success with the approach of using real-world patient data, we may have only begun to scratch the surface of finding new uses for old drugs," said Gelfand, of UVA's departments of ophthalmology and biomedical engineering. "It is tempting to think about all the untapped therapeutic potential of medicines sitting on pharmacy shelves."

Findings Published

The researchers have published their findings in the scientific journal PNAS. The first author of the paper is Meenakshi Ambati, a senior at Albemarle High School who won several national and international science competition awards for the work. As a volunteer in Gelfand's laboratory, she initially employed bench laboratory techniques. When the pandemic all but shut down normal laboratory operations, she was able to continue working on computational analyses, which ultimately gave the overall study its multi-pronged approach.

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More information: Meenakshi Ambati et al, Identification of fluoxetine as a direct NLRP3 inhibitor to treat atrophic macular degeneration, Proceedings of the National Academy of Sciences (2021). DOI: 10.1073/pnas.2102975118

Provided by University of Virginia 

 

New study provides robust evidence that COVID-19 is a seasonal infection

by Barcelona Institute for Global Health

Credit: Unsplash/CC0 Public Domain

A new study led by the Barcelona Institute for Global Health (ISGlobal) provides robust evidence that COVID-19 is a seasonal infection linked to low temperatures and humidity, much like seasonal influenza. The results, published in Nature Computational Science, also support the considerable contribution of airborne SARS-CoV-2 transmission and the need to shift to measures that promote "air hygiene."

A key question regarding SARS-CoV-2 is whether it is behaving, or will behave, as a seasonal virus like influenza, or whether it will be equally transmitted during any time of the year. A first theoretical modeling study suggested that climate was not a driver in COVID-19 transmission, given the high number of susceptible individuals with no immunity to the virus. However, some observations suggested that the initial propagation of COVID-19 in China occurred in a latitude between 30 and 50 degrees N, with low humidity levels and low temperatures (between 5 degrees and 11 degrees C).

"The question of whether COVID-19 is a genuine seasonal disease becomes increasingly central, with implications for determining effective intervention measures," explains Xavier Rodó, director of the Climate and Health program at ISGlobal and coordinator of the study. To answer this question, Rodó and his team first analyzed the association of temperature and humidity in the initial phase of SARS-CoV-2 spread in 162 countries across five continents, before changes in human behavior and public health policies were put into place. The results show a negative relationship between the transmission rate (R0) and both temperature and humidity at the global scale: higher transmission rates were associated with lower temperatures and humidity.

The team then analyzed how this association between climate and disease evolved over time, and whether it was consistent at different geographical scales. For this, they used a statistical method that was specifically developed to identify similar patterns of variation (i.e. a pattern-recognition tool) at different windows of time. Again, they found a strong negative association for short time windows between disease (number of cases) and climate (temperature and humidity), with consistent patterns during the first, second and third waves of the pandemic at different spatial scales: worldwide, countries, down to individual regions within highly affected countries (Lombardy, Thüringen and Catalonia) and even to the city level (Barcelona).

The first epidemic waves waned as temperature and humidity rose, and the second wave rose as temperatures and humidity fell. However, this pattern was broken during summertime in all continents. "This could be explained by several factors, including mass gatherings of young people, tourism, and air conditioning, among others," explains Alejandro Fontal, researcher at ISGlobal and first author of the study.

When adapting the model to analyze transient correlations at all scales in countries in the Southern Hemisphere, where the virus arrived later, the same negative correlation was observed. The climate effects were most evident at temperatures between 12 degrees and 18 degrees C and humidity levels between 4 and 12 g/m3, although the authors warn that these ranges are still indicative, given the short records available.

Finally, using an epidemiological model, the research team showed that incorporating temperature into the transmission rate works better for predicting the rise and fall of the different waves, particularly the first and third ones in Europe. "Altogether, our findings support the view of COVID-19 as a true seasonal low-temperature infection, similar to influenza and to the more benign circulating coronaviruses," says Rodó.

This seasonality could contribute importantly to the transmission of SARS-CoV-2, since low humidity conditions have been shown to reduce the size of aerosols, and thereby increase airborne transmission of seasonal viruses such as influenza. "This link warrants an emphasis on 'air hygiene' through improved indoor ventilation as aerosols are capable to persist suspended for longer times," says Rodó, and highlights the need to include meteorological parameters in the evaluation and planning of control measures.

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More information: Xavier Rodó, Climatic signatures in the different COVID-19 pandemic waves across both hemispheres, Nature Computational Science (2021). DOI: 10.1038/s43588-021-00136-6. www.nature.com/articles/s43588-021-00136-6

Provided by Barcelona Institute for Global Health 

 

How many people get 'long COVID?' More than half, researchers find

by Pennsylvania State University

Credit: Pixabay/CC0 Public Domain

More than half of the 236 million people who have been diagnosed with COVID-19 worldwide since December 2019 will experience post-COVID symptoms—more commonly known as "long COVID"—up to six months after recovering, according to Penn State College of Medicine researchers. The research team said that governments, health care organizations and public health professionals should prepare for the large number of COVID-19 survivors who will need care for a variety of psychological and physical symptoms.

30 oct 2021--During their illnesses, many patients with COVID-19 experience symptoms, such as tiredness, difficulty breathing, chest pain, sore joints and loss of taste or smell.

Until recently, few studies have evaluated patients' health after recovering from the coronavirus. To better understand the short- and long-term health effects of the virus, the researchers examined worldwide studies involving unvaccinated patients who recovered from COVID-19. According to the findings, adults, as well as children, can experience several adverse health issues for six months or longer after recovering from COVID-19.

The researchers conducted a systematic review of 57 reports that included data from 250,351 unvaccinated adults and children who were diagnosed with COVID-19 from December 2019 through March 2021. Among those studied, 79% were hospitalized, and most patients (79%) lived in high-income countries. Patients' median age was 54, and the majority of individuals (56%) were male.

The researchers analyzed patients' health post-COVID during three intervals at one month (short-term), two to five months (intermediate-term) and six or more months (long-term).

According to the findings, survivors experienced an array of residual health issues associated with COVID-19. Generally, these complications affected a patient's general well-being, their mobility or organ systems. Overall, one in two survivors experienced long-term COVID manifestations. The rates remained largely constant from one month through six or more months after their initial illness. 

The investigators noted several trends among survivors, such as:

• General well-being: More than half of all patients reported weight loss, fatigue, fever or pain.
• Mobility: Roughly one in five survivors experienced a decrease in mobility.
• Neurologic concerns: Nearly one in four survivors experienced difficulty concentrating.
• Mental health disorders: Nearly one in three patients were diagnosed with generalized anxiety disorders.
• Lung abnormalities: Six in ten survivors had chest imaging abnormality and more than a quarter of patients had difficulty breathing.
• Cardiovascular issues: Chest pain and palpitations were among the commonly reported conditions.
• Skin conditions: Nearly one in five patients experienced hair loss or rashes.
• Digestive issues: Stomach pain, lack of appetite, diarrhea and vomiting were among the commonly reported conditions.

"These findings confirm what many health care workers and COVID-19 survivors have been claiming, namely, that adverse health effects from COVID-19 can linger," said co-lead investigator Vernon Chinchilli, chair of the Department of Public Health Sciences. "Although previous studies have examined the prevalence of long COVID symptoms among patients, this study examined a larger population, including people in high-, middle- and low-income countries, and examined many more symptoms. Therefore, we believe our findings are quite robust given the available data."

"The burden of poor health in COVID-19 survivors is overwhelming," said co-lead investigator Dr. Paddy Ssentongo, assistant professor at the Penn State Center for Neural Engineering. "Among these are the mental health disorders. One's battle with COVID doesn't end with recovery from the acute infection. Vaccination is our best ally to prevent getting sick from COVID-19 and to reduce the chance of long-COVID even in the presence of a breakthrough infection."

The mechanisms by which COVID-19 causes lingering symptoms in survivors are not fully understood. These symptoms could result from immune-system overdrive triggered by the virus, lingering infection, reinfection or an increased production of autoantibodies (antibodies directed at their own tissues). The SARS-CoV-2 virus, the agent that causes COVID-19, can access, enter and live in the nervous system. As a result, nervous system symptoms such as taste or smell disorders, memory impairment and decreased attention and concentration commonly occur in survivors. 

"Our study was not designed to confirm COVID-19 as the sole cause of these symptoms. It is plausible that symptoms reported by patients in some of the studies examined were due to some other causes," said Ssentongo.

According to the researchers, early intervention will be critical for improving the quality of life for many COVID-19 survivors. They said that in the years ahead, health care providers will likely see an influx of patients with psychiatric and cognitive problems, such as depression, anxiety or post-traumatic stress disorder, who were otherwise healthy before their COVID-19 infection. Based on these findings, health care providers should plan and allocate resources accordingly in order to effectively monitor and treat these conditions.

The research team noted that these long-term health conditions may cause increased demand for medical care and could overwhelm health care systems, particularly in low- and middle-income countries. They said the findings from this study could help shape treatment plans to improve care for COVID-19 patients and establish integrated evidence-based clinical management for those affected.

"Since survivors may not have the energy or resources to go back and forth to their health care providers, one-stop clinics will be critical to effectively and efficiently manage patients with long COVID," Ssentongo said. "Such clinics could reduce medical costs and optimize access to care, especially in populations with historically larger health care disparities."

Th research was published in JAMA Network Open.

More information: Destin Groff et al, Short-term and Long-term Rates of Postacute Sequelae of SARS-CoV-2 Infection: A Systematic Review,
JAMA Netw Open (2021). DOI: 10.1001/jamanetworkopen.2021.28568

Provided by Pennsylvania State University 

 

Alzheimer's and COVID-19 share a genetic risk factor

by University College London

Credit: Pixabay/CC0 Public Domain

An anti-viral gene that impacts the risk of both Alzheimer's disease and severe COVID-19 has been identified by a UCL-led research team.

30 oct 2021--The researchers estimate that one genetic variant of the OAS1 gene increases the risk of Alzheimer's disease by about 3-6% in the population as a whole, while related variants on the same gene increase the likelihood of severe COVID-19 outcomes.

The findings, published in Brain, could open the door for new targets for drug development or tracking disease progression in either disease, and suggest that treatments developed could be used for both conditions. The findings also have potential benefits for other related infectious conditions and dementias.

Lead author Dr. Dervis Salih (UCL Queen Square Institute of Neurology and UK Dementia Research Institute at UCL) said: "While Alzheimer's is primarily characterized by harmful build-up of amyloid protein and tangles in the brain, there is also extensive inflammation in the brain that highlights the importance of the immune system in Alzheimer's. We have found that some of the same immune system changes can occur in both Alzheimer's disease and COVID-19.

"In patients with severe COVID-19 infection there can also be inflammatory changes in the brain. Here we have identified a gene that can contribute to an exaggerated immune response to increase risks of both Alzheimer's and COVID-19."

For the study the research team sought to build on their previous work, which found evidence from a large dataset of human genomes, to suggest a link between the OAS1 gene and Alzheimer's disease.

The OAS1 gene is expressed in microglia, a type of immune cell that constitutes around 10% of all cells found within the brain. Investigating the gene's link to Alzheimer's further, they sequenced genetic data from 2,547 people, half of whom had Alzheimer's disease. They found that people with a particular variation, called rs1131454, of the OAS1 gene were more likely to have Alzheimer's disease, increasing carriers' baseline risk of Alzheimer's by an estimated 11-22%. The new variant identified is common, as just over half of Europeans are believed to carry it, and it has a bigger impact on Alzheimer's risk than several known risk genes.

Their findings add OAS1, an anti-viral gene, to a list of dozens of genes now known to affect a person's risk of developing Alzheimer's disease.

The researchers investigated four variants on the OAS1 gene, all of which dampen its expression (activity). They found that the variants increasing the risk of Alzheimer's disease are linked (inherited together) with OAS1 variants recently found to increase the baseline risk of needing intensive care for COVID-19 by as much as 20%.

As part of the same research, in immune cells treated to mimic the effects of COVID-19, the researchers found that the gene controls how much the body's immune cells release pro-inflammatory proteins. They found that microglia cells where the gene was expressed more weakly had an exaggerated response to tissue damage, unleashing what they call a 'cytokine storm,' which leads to an autoimmune state where the body attacks itself.

OAS1 activity changes with age, so further research into the genetic network could help to understand why older people are more vulnerable to Alzheimer's, COVID-19, and other related diseases.

Ph.D. student Naciye Magusali (UK Dementia Research Institute at UCL) said: "Our findings suggest that some people may have increased susceptibility to both Alzheimer's disease and severe COVID-19, irrespective of their age, as some of our immune cells appear to engage a common molecular mechanism in both diseases."

Following the outbreak of the COVID-19 pandemic, researchers from the UK Dementia Research Institute at UCL have pivoted their attention to investigating the long-term neurological consequences of the virus. Using biomarkers found in the blood and fluid surrounding the central nervous system, they are aiming to track neuroinflammation and injury to the neurons.

Dr. Salih said: "If we could develop a simple way of testing for these genetic variants when someone tests positive for COVID-19, then it might be possible to identify who is at greater risk of needing critical care, but there is plenty more work to be done to get us there. Similarly, we hope that our research could feed into the development of a blood test to identify whether someone is at risk of developing Alzheimer's before they show memory problems.

"We are also continuing to research what happens once this immune network has been activated in response to an infection like COVID-19, to see whether it leads to any lasting effects or vulnerabilities, or if understanding the brain's immune response to COVID-19, involving the OAS1 gene, may help to explain some of the neurological effects of COVID-19."

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More information: A genetic link between risk for Alzheimer's disease and severe COVID-19 outcomes via the OAS1 gene, Brain (2021). DOI: 10.1093/brain/awab337

Provided by University College London 

 Hippocampus is the brain's storyteller

by UC Davis

People love stories. We find it easier to remember events when they are part of an overarching narrative. But in real life, the chapters of a story don't follow smoothly one from another. Other things happen in between. A new brain imaging study from the Center for Neuroscience at the University of California, Davis, shows that the hippocampus is the brain's storyteller, connecting separate, distant events into a single narrative. The work is published Sept. 29 in Current Biology.

30 Oct 2012--Cohn-Sheehy and colleagues at Professor Charan Ranganath's Dynamic Memory Laboratory at the Center for Neuroscience used functional MRI to image the hippocampus of volunteers as they learned and recalled a series of short stories."Things that happen in real life don't always connect directly, but we can remember the details of each event better if they form a coherent narrative," said Brendan Cohn-Sheehy, a M.D./Ph.D. student at UC Davis and first author on the paper.

The stories, created specifically for the study, featured main and side characters and an event. The stories were constructed so that some formed connected, two-part narratives and others did not.

The researchers played recordings of the stories to the volunteers in the fMRI scanner. The next day, they scanned them again as the volunteers recalled the stories. The researchers compared the patterns of activity in the hippocampus between learning and recalling the different stories.

As expected, they saw more similarity for learning pieces of a coherent story than for stories that did not connect. The results show the coherent memories being woven together, Cohn-Sheehy said.

"When you get to the second event, you're reaching back to the first event and embedding part of it in the new memory," he said.

Hippocampus weaves memories

Next, they compared hippocampal patterns during learning and retrieval. They found that when recalling stories that formed a coherent narrative, the hippocampus activates more information about the second event than when recalling non-connected stories.

"The second event is where the hippocampus is forming a connected memory," Cohn-Sheehy said.

When the researchers tested the volunteers' memory of stories, they found that the ability to bring back hippocampal activity of the second event was linked to the amount of detail the volunteers could recall.

While other parts of the brain are involved in the process of memory, the hippocampus appears to bring pieces together across time and form them into connected, narrative memories, Cohn-Sheehy said.

The work is part of a new era in memory research. Traditionally, in neuroscience, researchers have studied the basic processes of memory involving disconnected pieces of information, whereas psychology has a tradition of studying how memory works to capture and connect events in the "real world." These two camps are starting to merge, Cohn-Sheehy said.

"We're using brain imaging to get at realistic memory processes," he said.

Research on memory processes could ultimately lead to better clinical tests for early stages of memory decline in aging or dementia, or for assessing damage to memory from brain injuries.

Additional authors on the study are: Jordan Crivelli-Decker, Kamin Kim and Alexander Barnett at UC Davis; and Angelique Delarazan, Zachariah Reagh and Jeffrey Zacks at Washington University St. Louis. The work was partly funded by the U.S. Office of Naval Research and the National Institute of Aging.

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More information: The hippocampus constructs narrative memories across distant events, Current Biology (2021). DOI: 10.1016/j.cub.2021.09.013

Journal information: Current Biology