New report reveals hopes and resilience of older adults through COVID

by Trinity College Dublin

Credit: Pixabay/CC0 Public Domain

Researchers at the Irish Longitudinal Study on Aging (TILDA) at Trinity have released a new report which offers fresh insight into how older adults grappled with the COVID crisis during the first wave of the public health emergency (July—October 2020). The report, In Their Own Words: The Voices of Older Irish People in the COVID-19 Pandemic, surveys 4,000 participants from TILDA's nationally representative group of people aged 60 and over in Ireland, recording first-hand accounts of their experiences. The contributions in the report reveal the impact of COVID-19 and diversity of experiences, showing the challenges faced by older people in Ireland but also recording their hopes, determination and resilience during the first wave of the pandemic.

26 aug 2021--Since the COVID-19 pandemic was declared a global health crisis by the World Health Organisation in 2019, older adults have carried the greatest risk and burden of serious infection and ill-health from the virus. Globally, over 95% of COVID-19 related deaths occurred among those over 70, in Ireland, 93% of COVID-19 deaths were comprised of adults over 70. As a consequence of public health restrictions including national lockdowns, many people struggled with the abrupt disruption to everyday routines, social outlets and activities. In a previous TILDA COVID-19 report of adults over 60, 29% reported high stress levels, while 21% reported depressive symptoms.

What does the report reveal?

In this new report, TILDA participants tell of the impact of COVID-19 "in their own words," so we hear the voices of those most affected by policy restrictions. One of the dominant themes of the report is social isolation. Many participants were deeply impacted by restrictions, reporting heightened feelings of loneliness, isolation, a lost sense of dignity and challenges ensuing from the enforced restrictions in social contact. However, many also shared coping strategies, demonstrating remarkable resilience throughout; they speak of maintaining a positive outlook, optimism and a sense of gratitude while adapting to public health measures. The research shows how these positive dispositions served as coping strategies to help maintain respondents' wellbeing in challenging circumstances. The study also reveals the adaptability of older adults, with many developing new skills and hobbies, using the events of lockdown to engage with new activities.

Key findings

• 20% indicated a capacity to cope or demonstrated resilience to the challenges of the pandemic.
• 20% referred to increased feelings of social isolation or loneliness. Participants regularly voiced that their greatest challenge was coping with the loneliness which was brought with the pandemic.
• Some participants commented on their frustration at feeling neglected and disregarded by the media or public health commentators; dislike of the word "cocooning" was frequently expressed.
• 55% referred to hope and optimism for the future when asked what they most looked forward to once the pandemic had ended.
• Most participants had strong desires and aspirations to meet up with children and grandchildren, as well as other family and friends.
• Many participants who were working at the time of the pandemic discussed the challenges of losing their jobs or experiencing an increase in working hours due to their role as essential workers.
• Many voiced a desire to re-engage with activities suspended due to COVID-19.
• A number of participants commented on their hope to see a more just society emerge once the pandemic had finally ended.

Dr. Mark Ward, senior research fellow at TILDA and lead author, said: "Sixteen months on from the emergence of COVID-19 in Ireland, the negative consequences of the crisis and subsequent impact on the health and wellbeing of older adults is clear. However, thanks to the successful rollout and uptake of the COVID-19 vaccination program, hope and optimism are now returning to the lives of older adults. TILDA's report not only reveals lessons to be learned for the future but offers important insights from the unique experiences and diverse perspectives of older adults impacted by the COVID-19 emergency."

Professor Rose Anne Kenny, principal investigator of TILDA, said: "Not only have older adults been disproportionately impacted by the fallout of the COVID-19 crisis, but the sacrifices they have had to make throughout have been enormous. Disruptions to daily routines, an increasing sense of loneliness, isolation and fear, as well as increased risk of severe illness from the virus are just some of the ways older adults have been deeply impacted. What is most striking in this report is their strong, resilient nature in response to the pandemic. Many have lost friends and loved ones due to COVID-19 and faced a loss of independence, separation from family, and even ageism in the media and in many of the policy initiatives, all of which takes its toll on overall health and wellbeing.

"Indeed, the case is strong for our society to review our attitudes to aging and be alert to covert ageism in how we address or represent older people. What, for example, are the implications of a 'cocooning' policy for those it affects? The covert message may be that the over 70s have less worth than others in society and therefore can be excluded from active participation, despite strong evidence to the contrary from TILDA and many other studies."

More information: Mark Ward et al, Altered lives in a time of crisis: The impact of the COVID-19 pandemic on the lives of older adults in Ireland. Findings from The Irish Longitudinal Study on Ageing, (2021). DOI: 10.38018/TildaRe.2021-01

Provided by Trinity College Dublin 

 

Telehealth helped physical therapists support patients virtually during pandemic, study finds

by University of Missouri

Credit: Pixabay/CC0 Public Domain

As a pediatric physical therapist in Clinton, Missouri, Jessica Luechtefeld was used to a hands-on coaching approach whenever meeting with her patients at their preschools, in their homes or at the Child's Play Therapy clinic. But the COVID-19 pandemic forced physical therapists like Luechtefeld to cancel in-person sessions and quickly transition to telehealth appointments to continue providing essential care.

26 aug 2021--While the switch to telehealth showcased new opportunities for how critical therapy services can still be delivered virtually, a new study at the University of Missouri found it also exposed some technical issues for patients in rural areas.

"When meeting with patients virtually, I would demonstrate to the parents or caregivers what I wanted them to do to coach their child through the exercises, and we would try to come up with fun games to keep the child engaged," Luechtefeld said. "For example, I might tell them to roll up some towels and line them up end to end to make a balance beam, placing a toy car on one end and a racetrack on the other end so the child had an incentive for practicing his balance while walking."

Curious about how other pediatric physical therapists were adjusting to providing virtual services during the pandemic, Luechtefeld collaborated with Jamie Hall, an assistant teaching professor in the MU School of Health Professions, to create and distribute a survey to pediatric physical therapists to better understand their successes and challenges using telehealth. While caregiver engagement was reported as the biggest facilitator to successful telehealth therapy sessions, access to reliable Wi-Fi was a common challenge, particularly for rural families.

"The switch happened so suddenly that many pediatric physical therapists had no training, experience or support with telehealth, but we all desperately wanted to continue providing these much-need services to our patients as they are developing so early on in their lives," Hall said. "We see a wide variety of patients. While some kids might be recovering from a sports injury, other children might be born with early onset conditions, such as cerebral palsy, Down syndrome or muscular dystrophy."

Luechtefeld saw firsthand the challenges that arise when physical therapists are so heavily reliant on technology, as broadband internet can be limited in rural areas and Wi-Fi can be spotty at times.

"Sometimes a parent or caregiver would ask me what step they should do next to help their child through an exercise, and the video would start buffering, so it was harder to track the child's progress," Luechtefeld said. "Another thing we noticed was using a laptop or tablet would work better since the screen is larger and you can set it down without holding it, but not every family can afford those devices, so access remains a big issue, particularly in rural areas."

Hall found that a silver lining that discovered during the pandemic was the convenience and flexibility telehealth may provide for families who often drive long distances to and from physical therapy clinics for their children to receive hands-on, in-person appointments.

"Going forward, we can consider a hybrid model where patients come into the clinic once a month and then they can do a telehealth visit from home twice a month as well," Hall said. "Telehealth can help cut down on travel time and improve efficiency while still delivering the essential services kids need to support their mobility, balance, posture and overall development."

As a pediatric physical therapist, Hall is passionate about the role telehealth will play for younger physical therapists like Luechtefeld moving forward.

"I have been able to impact families one at a time as a clinician," Hall said. "Now as a researcher and assistant teaching professor, I can help the next generation of physical therapists, so it feels great to help out as many families as possible."

"Pediatric physical therapy telehealth and COVID-19: Factors, facilitators, and barriers influencing effectiveness—a survey study" was recently published in Pediatric Physical Therapy.

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More information: Jamie B. Hall et al, Pediatric Physical Therapy Telehealth and COVID-19: Factors, Facilitators, and Barriers Influencing Effectiveness—a Survey Study, Pediatric Physical Therapy (2021). DOI: 10.1097/PEP.0000000000000800

Provided by University of Missouri 

 

Tailoring wearable technology and telehealth in treating Parkinson's disease

by University of British Columbia

Credit: Pixabay/CC0 Public Domain

Wearable health technologies are vastly popular with people wanting to improve their physical and mental health. Everything from exercise, sleep patterns, calories consumed and heart rhythms can be tracked by a wearable device.

26 aug 2021--But timely and accurate data is also especially valuable for doctors treating patients with complicated health conditions using virtual care.

A new study from the Southern Medical Program (SMP), based at UBC Okanagan, has examined the use of wearable health technology and telehealth to treat patients with Parkinson's disease.

Dr. Daryl Wile, a movement disorder specialist and SMP clinical assistant professor, routinely uses telehealth to connect with Parkinson's patients across the vast and rugged landscape of British Columbia's interior.

"Even prior to the pandemic, telehealth helped deliver specialized care to patients living in remote and rural settings," says Wile, a clinical investigator with the Centre for Chronic Disease Prevention and Management. "But with the complex nature of Parkinson's, we wanted to enhance these appointments to better understand how movements vary throughout a patient's entire day."

To add a new layer of health information, Wile and the research team added wearable technology to the equation.

"We recruited Parkinson's patients with either tremors or involuntary movements," says Joshua Yoneda, SMP student and co-author of the study. "We then divided them into two groups—some using telehealth and device-based health tracking and others attending traditional face-to-face appointments."

The telehealth group wore wearable devices to track their movements, involuntary or not, throughout waking hours. The reported data was then reviewed during telehealth appointments to identify peak times patients experienced Parkinson's symptoms.

"With the integration of accurate and reliable data from wearable devices, we were able to tailor a patient's medication to better manage their symptoms throughout the day," adds Wile.

As part of the study, patients were asked a series of questions from the standardized Parkinson Disease Quality of Life Index. Both study groups were assessed at intervals of six weeks, three months and six months.

Overall, the patients using the wearable devices reported positive experiences and health outcomes in combination with telehealth appointments to access specialized care.

"There's definitely a strong case to leverage multiple technologies to improve a patient's quality of life and limit the added stress and cost associated with travel," says Yoneda.

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More information: Dakota Peacock et al, Tailoring the use of wearable systems and telehealth for Parkinson's disease, Parkinsonism & Related Disorders (2021). DOI: 10.1016/j.parkreldis.2021.07.004

Provided by University of British Columbia 

 

How older people are mastering technology to stay connected after lockdown

by Carolyn Wilson-Nash, Julie Tinson, The Conversation

Credit: Tomertu/Shutterstock

It's a well-worn stereotype: the image of an elderly person fiddling with technology that leaves them completely bamboozled. The media often depict older people struggling to use or manage digital technology. While this is often designed to be humorous, it can undermine them as users of technology. And that's a problem if it turns older people off from trying to engage with digital devices, as it can affect their wellbeing.

26 aug 2021--Older adults are already at a digital disadvantage: 18% of over-65s do not have internet access. Propelled by enforced isolation, older people increasingly turned to technology during the pandemic, but not all were able to connect or communicate with friends and family via the internet.

Of course some older people have less experience of digital technology than others, and unsurprisingly describe mixed emotions regarding the use of everyday devices such as smartphones, laptops, e-readers and tablets. They also report not having much confidence when it comes to using them. Lack of control, a sense of being overwhelmed, and poor product design can lead to feelings of being incompetent, alone and even trapped.

Yet for those who persevere, the rewards can be plentiful: completing tasks more easily, communicating more effectively, increased independence and a sense of achievement. These things are important if this growing part of the population is to experience aging in a more positive and empowering way.

Through our research we wanted to examine these mixed emotions that older people have about using technology, and how they develop ways to combat the challenges they face. While digital technology has been shown to alleviate pressure on health and social care, until now there's been a limited understanding of how using technology influences the way older adults live.

Attitudes towards technology

While many see digital technology as a challenge to be conquered, there are different ways of overcoming or confronting the obstacles. Some may view the challenge as a personal goal, using instruction manuals or simply trial and error to prevail over software updates, unwanted viruses or junk mail.

Others view digital technology as a collective endeavor, asking friends and family for help. Not only is this the most successful strategy, it also fosters important interaction with others. For example, during the pandemic many younger people acted as IT support for older friends and relatives.

Not all elderly people have this kind of network, but arguably they can benefit most from greater use of the internet to feel connected and keep loneliness at bay. In these situations, there are useful schemes run by charities such as Age UK, where digital champions can help older adults master technology.

Adopting strategies

Understandably frustrations emerge when learning a new skill, but some older people have shown how they overcome their exasperation by developing a relationship with their devices. Naming their tablet or humanizing their phone helps to bond older people to technology.

In our study different devices were often referred to as having a personality, gender, or even a mind of their own. This strategy brings a little levity to a situation that could otherwise be stressful.

Once these people become more used to digital technology, familiarity can encourage continued use. With a new device, software and apps they know and understand can be downloaded so that it feels less alien. Similarly, if a touchscreen is problematic, some older people might decide to use a keyboard and mouse instead.

Breeding confidence

Using technology at any age can have its pros and its cons, but our research reveals that older adults can offer a unique perspective. Using lifelong wisdom, they can take a step back and acknowledge that technology has its faults. If things go wrong, their judgment and experience is useful in helping to understand that the key to using technology is persistence. One participant, Christopher, 83, said: "There's one sure thing: life will come to an end, and technology will always go wrong. My son's partner sends me texts from their holiday in Tunis. When I try to reply I keep getting 'no service' and my message is refused … [but] I know they will be worried if they don't get a reply. When I was a kid, Tunis was a distant desert war zone, with cinema newsreels a week later … and here's me now, whingeing about lack of instant contact."

These findings are significant for technology development, marketing and customer services. Designing technology for older people should be based on their experiences and offer continuity. Digital devices need to include familiar commands, buttons, screens, and add-ons to previous models. This will enhance the ability to get to grips with updates and developments. And in turn this will help foster social connections as well as boost independence and confidence.

Stereotyping of older people also needs to stop. Experience and perspective should be acknowledged, respected and reflected in marketing campaigns. Messaging should underscore the potential benefits of mastering technology, emphasizing the importance of being connected and socially involved to a person's independence.

Finally, customer service should be easily accessible and well versed in issues older people face to provide the necessary support, building on schemes offered by Age UK's digital champions. Clearly there is a crucial role for friends, family, and communities to ensure that older people remain socially active, engaged and connected through technology. Their wellbeing may depend on it.

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Provided by The Conversation 

 

Digital health is a vital tool: How to make it more sustainable

by Maddy Thompson, The Conversation

Nine recommendations from the Riyadh Declaration on Digital Health. Credit: RGDHS 2020

The pandemic has shown us the extraordinary potential of digital health to fight global health inequalities by providing expanded access to healthcare: as well as by better informing our responses to health crises.

26 aug 2021--Tools such as wearable monitoring devices, video consultations, and even chat-bots driven by AI can provide care from a distance and often cost less than a face-to-face meeting with a doctor or nurse. This, in turn, can improve global access to high-quality treatment.

Throughout the pandemic, being able to collect real-time data from cases across the world has been vital to local and global responses to combat the virus and track its progress. Machine learning analysis of viral gene sequences, track-and-trace mobile apps and telehealth services have also played their part. But as this monumental shift towards digital health accelerates, the environmental issues it raises are often overlooked.

Climate change disproportionately affects developing countries. Places that already face poor health outcomes are further subjected to the health effects of environmental change. Plus, considering that emissions from computing devices, data centers and communications networks already account for up to 4% of global carbon emissions, leaving environmental factors out of digital health debates is a significant omission.

As we continue to roll out this indispensable infrastructure, we also need to assess how we can minimize its environmental impact. My research shows three main ways that digital health technologies can contribute to environmental change and what can be done.

Green mining

First, raw materials needed to produce digital health technologies including robotic tools, smartphones and cameras are taken from mines, which are mostly located in developing countries.

The toxic waste spillages that can occur when mining these materials create serious environmental degradation, potentially exposing workers to dangerous toxins. Meanwhile, at the other end of the process, the mishandling of discarded electrical devices can also release toxic chemicals into the environment, creating severe health risks for local populations—including organ damage.

On top of this, the carbon required to produce electronic devices makes up around 8% of all carbon produced globally. Increased demand for devices driven by digital health's expansion will only push emissions higher.

Steps including developing "green mining"—mining practices that minimize environmental damage and emissions while maximizing recycling and supply-chain efficiency—are vital to protect our planet alongside our health.

Green cloud computing

Second, from electronic health records to biometric data collected by wearable technologies, the digital health industry produces vast amounts of information. Health data accounts for around 30% of the world's data.

This data and the insights it provides on population health are key to improving people's health. But due to the electricity needed to run the huge servers that host cloud services, safely storing data in the cloud can take up to one million times more energy than saving data directly to devices.

To reduce the environmental impacts of data centers, initiatives like green cloud computing (which aims for carbon-neutral data processing, for example, by investing in carbon offsets) and virtualisation (which reduces the physical numbers of servers needed to store data by shifting that data to virtual servers) should become key priorities.

The carbon costs of running artificial intelligence and blockchain health technologies to better support patients are also significant. As such, the use of environmentally conscious technologies such as tiny machine learning and compact AI, that reduce software size and power, need to be implemented.

Green IT

Third, we need to consider whether the promise that digital health will lower carbon emissions due to reducing travel to physical health centers is likely to materialize.

Although the increase in telehealth tech means that more patients are accessing healthcare from their homes or workplaces, these reductions in local travel are shown to have minimal effects on emissions and only become cost-effective when telehealth replaces local trips of at least 7.2km (or just over four miles).

A more pressing—and overlooked—concern, however, is the cost associated with housing large telehealth operations in call centers. As with cloud servers, telecommunications centers need vast amounts of energy to power and cool equipment.

The NHS has recently pledged to achieve a net zero carbon footprint by 2040. However, as the recent IPCC report assessing the state of the world's climate indicates, change must be more rapid.

In the Philippines—home to a large hub of international telehealth operators—green information technologies such as recyclable office equipment and remote working are used to reduce the environmental costs associated with communication. Such practices must become commonplace.

Green initiatives should be adopted across the healthcare sector as far as possible. The problem is that many digital health technologies result from design decisions beyond the field of healthcare: so big tech must also do its part in creating more sustainable systems.

Without taking such steps, we run the risk that digital health will only lead to additional global health burdens, particularly among the world's most vulnerable populations.

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Provided by The Conversation 

New cell phone and smart watch models can interfere with pacemakers and defibrillators

by Elsevier

New research findings verify FDA recommendation for patients with implanted medical devices to keep their smart phones and watches at least six inches away to avoid interference with implanted medical devices. Credit: US Food and Drug Administration

After reports of smart phone and watch interference with implanted medical devices, investigators affiliated with the Center for Devices and Radiological Health (CDRH) at the US Food and Drug Administration conducted a study that supports the FDA recommendation that patients keep any consumer electronic devices that may create magnetic interference, including cell phones and smart watches, at least six inches away from implanted medical devices, in particular pacemakers and cardiac defibrillators. Their findings appear in Heart Rhythm, the official journal of the Heart Rhythm Society, the Cardiac Electrophysiology Society, and the Pediatric & Congenital Electrophysiology Society.

26 aug 2021--"Ensuring the safety of our nation's medical devices is a cornerstone of our consumer protection mission, especially as technology continues to advance," explained lead investigator Seth J. Seidman, MS, Research Electrical Engineer and EMC Program Advisor with the CDRH. "As part of this work, the agency reviewed recently published articles describing the possibility that certain newer cell phones, smart watches, and other consumer electronics with high field strength magnets may temporarily affect the normal operation of implanted electronic medical devices, such as pacemakers and implantable defibrillators. Based on our review, we decided to conduct our own testing to confirm and help inform appropriate recommendations for patients and consumers."

Cardiac implanted electronic devices are intended to support heart rhythm disorders, such as slow or fast heart rates. Implantable pacemakers and cardioverter defibrillators (ICDs) include a "magnet mode" designed to be used when a patient is undergoing a procedure where electromagnetic interference is possible, or when suspension of the device is necessary for medical treatment. However, this feature can also be triggered accidentally from strong magnetic fields greater than 10G, which can change how the device works and could result in serious harm to the patient.

Historically, magnets strong enough to trigger this magnet mode were very large and identifiable, such as stereo speakers or electronic motors in cordless tools. With the advent of small rare-earth magnets, however, strong magnetic fields can be found in headphones, door locks, or small phone speakers.

The investigators tested the magnetic field output of all iPhone 12 and Apple Watch 6 models at varying distances from the devices. They found that all the devices have static magnetic fields significantly greater than 10G in close proximity, high enough to place implanted cardiac devices into magnet mode. However, when a separation distance of six inches or more is maintained, the phones and watches will not trigger magnet mode.

"Because of these results, we are taking steps to provide information for patients and healthcare providers to ensure they are aware of potential risks and can take simple proactive and preventive measures like keeping consumer electronics, such as certain cell phones and smart watches, six inches away from implanted medical devices and not carrying consumer electronics in a pocket over the medical device," advised Mr. Seidman.

"We believe the risk to patients is low and the agency is not aware of any adverse events associated with this issue at this time. However, the number of consumer electronics with strong magnets is expected to increase over time. Therefore, we recommend people with implanted medical devices talk with their healthcare providers to ensure they understand this potential risk and the proper techniques for safe use. The FDA will continue to monitor the effects of consumer electronics on the safe operation of medical devices," noted Mr. Seidman.

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More information: Seth J. Seidman et al, Static magnetic field measurements of smart phones and watches and applicability to triggering magnet modes in implantable pacemakers and implantable cardioverter-defibrillators, Heart Rhythm (2021). DOI: 10.1016/j.hrthm.2021.06.1203

Provided by Elsevier 

 

Telepsychiatry found to be a resounding success in 5-year trial

by University of Washington

Credit: Unsplash/CC0 Public Domain

John Nolan served in the U.S. Army and Marines and later worked in law enforcement and as a correctional officer. A career spent dealing with traumatic events led to post-traumatic stress disorder and insomnia. He felt like his life was spinning out of control.

26 aug 2021--Nolan was greatly helped by telepsychiatry services in his town, 125 miles from Little Rock, Ark. He was invited to chair the community advisory board for the largest trial of telepsychiatry to date.

The five-year study, published Aug. 25 in JAMA Psychiatry, found that telepsychiatry in rural, federally qualified health centers was a resounding success for patients who had screened positive for bipolar disorder and/or PTSD.

The trial was called The Study to Promote Innovation in Rural Integrated Telepsychiatry (SPIRIT). It was designed to identify the best approach to delivering tele-mental health services to rural primary-care clinics.

"The results of our trial showed that if you give access to high-quality care for patients who are underserved, they improve their quality of life," said lead researcher Dr. John Fortney, a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine.

The 1,004 participants were enrolled from 24 federally qualified health centers in Washington, Arkansas and Michigan.

Without telepsychiatry, most of these patients would likely not receive help from a mental health specialist for these complex psychiatric disorders, the researchers said.

In fact, only one-third of individuals with bipolar disorder and PTSD receive specialty mental health care in a year, the researchers wrote. They said in primary care settings, only 10% of patients with these disorders receive adequate care.

Nolan had originally enrolled in the study that led to this trial called Telemedicine for Outreach for PTSD at the Department of Veterans Affairs in Little Rock, also overseen by Fortney.

"It made a huge difference in my life," he said.

As the SPIRIT trial wound down, Nolan said he could hear the hope and relief in the voices of participants who shared their stories in a video documentary.

SPIRIT trial

The trial compared two interactive video approaches to integrate remote specialty mental health services in participating clinics. Tele-referral services involved one-on-one visits with a psychiatrist or licensed clinical psychologist. Tele-collaborative services involved a telepsychiatrist and care manager supporting visits with a primary care provider. This collaborative model, pioneered at the UW School of Medicine, allows a psychiatrist to manage more patients than the traditional referral model.

After patients completed the baseline survey, they were randomized to either get tele-referral care or tele-collaborative care.

The clinics partnered with the state medical schools to provide the telepsychiatry and telepsychology services. While many federally qualified health centers provide mental health care, only about 10% of staff are psychiatrists or licensed clinical psychologists, Fortney said.

By providing care from the states' medical schools, they minimized patients' travel burdens. And the potential stigma of a mental health care visit was averted by having the medical school providers credentialed to practice at the health center, giving the appearance of a regular healthcare visit.

Results of trial

Patients in both groups reported substantially and statistically significant improvements in perceived access to care, decreases in their mental health symptoms and medication side effects, and improvements in their quality of life. There was no difference between the groups, and there were no differences in outcomes regarding age, gender, race or ethnicity.

"One of the major contributions of this study is what we knew to be effective for depression and anxiety we now know also achieves good outcomes for patients with PTSD and bipolar disorder," said Dr. Paul Pfeiffer, associate professor of psychiatry at the University of Michigan Medical School. Pfeiffer led the Michigan-based study activities.

The trial results come as the COVID-19 pandemic has enabled providers and patients alike to experience virtual care and to see the benefits for themselves, paving the way for wider adoption of telepsychiatry.

Dr. Jürgen Unützer, chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine, said both the timing and impact of this trial are really important.

"We're at a time now where almost everybody has sort of come to realize what a huge burden untreated mental illness and addiction problems have been," he said.

While there is still a critical workforce shortage of psychiatrists, psychologists, clinical social workers and counselors, Unützer said, this trial shows how to distribute the available workforce a little bit more effectively.

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More information: John C. Fortney et al, Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care, JAMA Psychiatry (2021). DOI: 10.1001/jamapsychiatry.2021.2318

Provided by University of Washington 

 

For many, long COVID looks a lot like chronic fatigue

by Johns Hopkins University

Two cells (darker color) in a cluster being attacked by free radicals (red molecules) and undergoing oxidative stress. Johns Hopkins Medicine researchers suggest that oxidative stress may cause the similar-type symptoms seen in both long COVID and ME/CFS (formerly known as chronic fatigue syndrome). Credit: M.E. Newman, Johns Hopkins Medicine, National Cancer Institute, National Institutes of Health

A team of researchers, including two from Johns Hopkins Medicine, have published a review article highlighting similarities between certain lingering symptoms following COVID-19 illness—a condition called "long COVID"—and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a debilitating, complex disorder previously known as chronic fatigue syndrome.

26 aug 2021--The researchers say the symptoms shared by the two conditions may involve a biological response that goes haywire when the body encounters certain infections or other environmental hazards.

"The body's response to infection and injury is complex and covers all body systems," says lead author Bindu Paul, Ph.D., assistant professor of pharmacology and molecular sciences at the Johns Hopkins University School of Medicine. "When that response is in disarray—even just one aspect of it—it can cause feelings of being tired, brain fog, pain and other symptoms."

In their review, published Aug. 16, 2021, in the Proceedings of the National Academy of Sciences, Paul and her co-authors highlight the evidence seen in both acute COVID and ME/CFS of various underlying biological disorders. In particular, the researchers suggest a central role for the way cells behave when too many oxygen molecules pile up in a cell—a process called oxidative stress or redox imbalance. The team describes how redox imbalance may be connected to the inflammation and disorders of metabolism that are found in the two diseases.

Paul has previously studied the role of oxidative stress in conditions such as Huntington's disease, Alzheimer's disease and Parkinson's disease.

As of August 2021, approximately 36 million Americans have been diagnosed with COVID-19. "We do not yet know how many of these patients will experience long COVID, but it's estimated that at least 7% experience extended symptoms," says co-author Anthony Komaroff, M.D., the Steven P. Simcox, Patrick A. Clifford and James H. Higby Distinguished Professor of Medicine at Harvard Medical School.

The expert team urges that some of the recent National Institutes of Health funding assigned to study the long-term health effects of COVID-19 be used to investigate both long COVID and ME/CFS. Those studies, they believe, could shed light on other diseases characterized by oxidative stress, inflammation and metabolic disorders.

ME/CFS is a complex condition affecting 1 million to 2.5 million people in the United States. It is characterized by a cluster of symptoms, including severe and debilitating fatigue, disrupted and unrefreshing sleep, difficulty thinking (commonly called "brain fog"), abnormalities of the autonomic nervous system and post-exertional malaise—a flare-up of multiple symptoms following physical or cognitive exertion.

The team hopes that this scientific review will spur and help focus research on the molecular basis of both long COVID and ME/CFS.

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More information: Bindu D. Paul et al, Redox imbalance links COVID-19 and myalgic encephalomyelitis/chronic fatigue syndrome, Proceedings of the National Academy of Sciences (2021). DOI: 10.1073/pnas.2024358118

Provided by Johns Hopkins University 

 

The risk of developing a disease linked to genetics tends to decrease with age

by Public Library of Science

Credit: CC0 Public Domain

People often get sicker as they grow older, but new research from Gil McVean of the University of Oxford and colleagues finds that the impact of a person's genes on their risk of getting sick actually wanes with age. The researchers published their new findings August 26th in the journal PLOS Genetics.

26 aug 2021--The genes we inherit from our parents influence our risk for almost all diseases, from cancer to heart disease to autoimmune disorders. With new genomic technologies, scientists can now use a person's genome to predict their future disease risk. However, recent work has shown that the predictive power of a person's genetics can depend on their age, sex and ethnicity.

In the new study, McVean's team investigated whether the risk of developing a disease posed by carrying certain genes changes as a person gets older. In other words, they wanted to know if there are windows when people are more or less likely to develop diseases linked to genetics. They used genomic data from 500,000 people in the UK Biobank to look at how their genetics impact their risk of developing 24 common diseases. While different diseases had different risk patterns, the researchers showed that a person's genetic risk is highest early in life and then drops off for many diseases, including high blood pressure, skin cancer and underactive thyroids.

Currently, the reasons why the risk posed by a person's genes decreases with age are not clear. The researchers suspect that there may be unknown processes at work, such interactions between a person's genes and their environment that lead to disease. A better understanding of how age impacts a person's risk of developing a disease linked to their genes may help researchers make more accurate predictions about whether an individual will ultimately become sick with that condition.

McVean adds, "Our work shows that the way in which genetics affects your risk of getting a disease change throughout life. For many diseases, genetic factors are most important in determining whether you will get a disease early in life, while—as you age—other factors come to dominate risk."

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More information: Jiang X, Holmes C, McVean G (2021) The impact of age on genetic risk for common diseases. PLoS Genet 17(8): e1009723. doi.org/10.1371/journal.pgen.1009723

Provided by Public Library of Science 

 

Environmental pollution may contribute to racial/ethnic disparities In Alzheimer's disease risk, says new study

by Keck School of Medicine of USC

Credit: CC0 Public Domain

Fine particle pollution may be one reason why Black women have double the risk of developing Alzheimer's than white women, suggests new research from the Keck School of Medicine of USC.

26 aug 2021--For decades, research has shown the risk for developing Alzheimer's disease in the United States is dramatically higher among African American populations than in non-Hispanic white populations. Scientists have suspected a variety of contributing factors, but the underlying reasons have remained unclear.

Now, a new study in The Journals of Gerontology, conducted in collaboration with researchers across the country, points to environmental neurotoxins—specifically, ambient fine particles in the air known as PM2.5—as possible culprits in the disproportionate number of African American, particularly Black women, affected by dementia.

Zeroing in on fine particle pollution as a factor in racial/ethnic disparities

"Data increasingly show that older people are more likely to develop dementia if they live in locations with high PM2.5, and African American populations are more likely to live in neighborhoods near polluting facilities—like power-generating and petrochemical plants—that emit the particulate matter," said corresponding author Jiu-Chiuan Chen, MD, associate professor of population and public health sciences at the Keck School of Medicine of USC. "Our study demonstrates that older Black women live in locations with higher levels of PM2.5, and we ask whether their elevated exposure could account for the higher numbers of Alzheimer's cases. The evidence does reveal a positive association."

After adjusting for risk factors such as smoking, education, income, diabetes, hypertension and BMI, Black women still had roughly two times greater a risk of developing Alzheimer's disease than white women, the researchers found.

Chen and his colleagues report two major novel findings in their study, both with important implications. The first is that the increased risk of Alzheimer's disease in older Black women may be partly explained by their elevated exposure to PM2.5; the second is that older Black women are more susceptible to its adverse effects.

"Our work offers the scientific community an important perspective on the study of dementia; namely, that we must have a greater awareness of environmental racism that can impact brain aging and disproportionately affect people of color," Chen says. "There is also a key regulatory takeaway, which is that we have to continue enforcing the Clean Air Act, with its mandate to provide a safe margin for air quality that will protect the health of susceptible populations."

Air pollution and brain health

The study grew out of a long-standing partnership between USC faculty and researchers with the Women's Health Initiative Memory Study based at Wake Forest University. This research focused on studying Black women compared to non-Hispanic white women, because Black women carry the greatest burden of Alzheimer's disease and related dementias in the US. As it begins to unravel the complexities of racial disparities in Alzheimer's disease, the study also elucidates the need for future research.

"Our study suggests that PM2.5 may contribute to the difference in Alzheimer's disease risk based on race, and we also demonstrated that older African American women may be more susceptible to the particulate matter, but we still don't know why," Chen says. "Why are these particles more neurotoxic to Black women than to non-Hispanic whites? Going forward, we plan to look for answers by studying the effects of things like nutrition and brain structure."

When he was first recruited to USC in 2009, Chen set out to develop a new research program to study the health effects of air pollution exposure beyond its well-known impact on airways and lungs. "At the time, I was one of the first faculty members studying environmental influences on brain health," Chen recalls. "Today, the university has several leading programs, funded by the National Institutes of Health, examining how air pollution exposures affect neurodevelopment and brain aging. An increasing number of USC faculty are trying to better understand whether and why air pollution can cause more damage to the human brains in minority populations or communities with social disadvantages. Our study is just the beginning of vital scientific work that needs to be done."

More information: Diana Younan et al, Racial/Ethnic Disparities in Alzheimer's Disease Risk: Role of Exposure to Ambient Fine Particles, The Journals of Gerontology: Series A (2021). DOI: 10.1093/gerona/glab231

Provided by Keck School of Medicine of USC 

 

Report: What does the future hold for telehealth?

by University of Michigan

Credit: Unsplash/CC0 Public Domain

Thanks to the pandemic, we have gotten used to having appointments with their doctors and other health providers through video chats, phone calls and text-based e-visits.

14 aug 2021--But what does the future hold for telehealth, and how can providers, insurers and policymakers use the experience of the past year and a half to decide what kind of virtual care they will support once the pandemic ends?

A new report from the University of Michigan provides new data that could inform them all. The "snapshot" report spotlights a number of disparities in adoption, access and attitudes when it comes to telehealth, through previously unreleased data as well as finding from published research.

It's the product of work by dozens of U-M faculty members and research staff who collaborate with the Institute for Healthcare Policy and Innovation's Telehealth Research Incubator.

The rapid pivot to virtual visits in March and April 2020, when limiting in-person care to the most essential interactions, was one of the most rapid and revolutionary shifts modern medicine has ever witnessed," said Chad Ellimoottil, M.D., M.S., who leads IHPI's telehealth efforts and who was working to encourage and study virtual visits through his faculty role in the U-M Department of Urology for several years before the pandemic began. "Rapid access to data such as these can help decisionmakers at all levels make choices to make the best use of this option, but only if they listen to the voice of the patient and the frontline provider."

Key findings shared for the first time in the report come from an analysis of data from Michigan Medicine, U-M's academic medical center, as well as statewide records from Blue Cross Blue Shield of Michigan. The report also summarizes telehealth polling and research already published by teams led by IHPI members.

Among the newly released findings:

• 1 in 5 patient visits covered by BCBSM as of March 2021 are by telehealth, showing the lasting interest in virtual visits even as the pandemic ebbed.
• 91% of larger primary care practices in Michigan used telehealth, compared with 63% of solo practices. Larger practices also had a higher percentage of visits via telehealth.

• Striking disparities in use of video visits emerged from the analysis of Michigan Medicine data, with much lower use by patients who are older, are African-American, need an interpreter, have Medicaid as a primary insurance, or live in a zip code where less than half of households have broadband Internet access.

• Telephone-based audio-only visits have been covered by most insurers during the pandemic, but there are signs this may change once the emergency status is lifted. However, more than 60% of Michigan Medicine patients over age 65 used this option in May through June of 2020, with the percentage going up with age. Patients of any age who live in rural areas are also more likely to use audio-only visits.

• When all costs are taken into account, video visits and in-person visits cost approximately the same, and patients were no more likely to cancel or fail to show up for a video visit than they were for in-person visits.

• Half of all Michigan Medicine clinicians surveyed say that after the pandemic they intend to offer the same volume of video visits as now. About 40% said their productivity is the same now that telehealth is an option, and 27% say it's higher. A majority said they were able to provide the same quality of care over telehealth and establish the same level of rapport with patients.

In addition to the new data, the report summarizes key findings from studies published by IHPI members in medical and telehealth journals, and from the National Poll on Healthy Aging which released its second report on telehealth used by adults age 50 to 80 last year.

Provided by University of Michigan