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Tuesday, February 1, 2022

Could Covid-19 still be affecting us in decades to come?

 Surviving a pandemic isn't always the end of the story – some viruses can have health effects that linger on for decades, eventually leading to a range of devastating diseases.

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In the 1960s, epidemiologists studying the long-term prognosis of survivors of the 1918 Spanish Influenza began to notice an unusual trend. Those who were born between 1888 and 1924 – meaning they were either infants or in young adulthood at the time of the pandemic – appeared to have been two or three times more likely to develop Parkinson’s disease at some point in their life than those born at different times.

It was a striking finding. For while the potential neurological consequences of flu infections have been documented by doctors for centuries – there are medical reports of this which date back to 1385 – the sheer scale of the Spanish Flu, which infected around 500 million people globally, meant scientists could link a heightened risk of disease to the pandemic.

In recent years, an elevated risk of Parkinson's has also been identified in the survivors of outbreaks of HIV, West Nile virus, Japanese encephalitis, Coxsackie, Western Equine virus and the Epstein-Barr virus. Neurologists attempting to understand why this happens believe that each of these viruses are capable of crossing into the brain, and in some cases damaging the fragile structures which control the co-ordination of movement, known as the basal ganglia, initiating a process of degeneration which can lead to Parkinson's.

Now scientists are keen to monitor whether the current pandemic will also trigger a higher rate of Parkinson's cases in decades to come.

"We don't know but we need to consider that this could become the case," says Patrik Brundin, a Parkinson's researcher at the Van Andel Institute, in Grand Rapids, Michigan. "There are several studies highlighting that people who have recovered from Covid often have long-term central nervous system deficits including loss of sense of smell and taste, brain fog, depression, and anxiety. The numbers are troubling."

While Sars-CoV-2 can invade brain tissue, the scientific jury remains open on whether it will contribute to neurodegenerative disease. Coronaviruses are generally known as "hit and run viruses", because they tend to cause fairly short disease, even if this proves deadly in some cases. In contrast, DNA viruses such as Epstein-Barr can linger permanently in the body and are more associated with long-term illness.

But there have been some indications in the past there might be more to coronaviruses than we perhaps suspect. In the 1990s, Canadian neurologist Stanley Fahn published a study which identified antibodies to the coronaviruses that cause the common cold in the cerebrospinal fluid of Parkinson's patients.

Over the past year, scientists like Brundin have been concerned by the emergence of a small handful of case studies describing patients who have developed what doctors term acute Parkinsonism – abnormalities such as tremors, muscle stiffness, and impaired speech – following Covid-19 infection. More research has found that some Covid-19 patients have disruptions in one of the body's most critical systems, known as the kynurenine pathway. This runs from the brain to the gut, and is used to produce a number of crucial amino acids required for brain health. But when it malfunctions, it can lead to the accumulation of toxins which are thought to play a role in Parkinson's disease.

Other neurologists, however, warn it is still far too early to draw any link between Covid-19 and Parkinson's.

The 1918 flu pandemic was still affecting the health of the global population over 40 years later (Credit: Getty Images)

The 1918 flu pandemic was still affecting the health of the global population over 40 years later (Credit: Getty Images)

Alfonso Fasano, a neurology professor at the University of Toronto, points out that the cases of acute parkinsonism which have been described could simply involve patients who were already in the early stages of the disease, and the stress of being infected with Covid-19 simply accelerated or "unmasked" the symptoms. "So far, we're talking of about a dozen cases, usually lacking detailed information," he says. "It's true that what we call a post-encephalitic parkinsonism can occur after a viral infection, but not every pandemic is the same. The Spanish Flu was caused by a completely different virus."

However many feel that there is a need for continued monitoring of any Parkinson’s-like symptoms which emerge in people who have previously been infected with Covid-19, in case the coming years reveal a gradual spike in cases.

But Parkinson's is not the only concern. Experts around the world are trying to figure out if Covid-19 will induce a hidden wave of other illnesses, related to the disruption Sars-CoV-2 causes to the human immune system. If this pans out it would have major public health implications, but it could also help us find new ways of detecting these diseases at an early stage, and even pave the way to new treatments and vaccines.

The diabetes dilemma

In the spring of 2020, Francesco Rubino, a metabolic and bariatric surgeon at Kings College London, began to hear an increasing number of reports about Covid-19 patients coming into hospital with unusually high blood sugar levels, even though they had no previous history of diabetes.

At the same time, doctors were also noticing that patients who already had diabetes appeared to be particularly vulnerable to the disease. Rubino was curious to see whether this strange relationship was a sign that Covid-19 was directly impacting the pancreas, a complex organ which contains beta cells for producing insulin, the hormone that helps the body metabolise sugar molecules from the blood.

He set up a global database called the CovidDiab registry to follow these patients, and find out what happened to them. So far they have been tracking 700 cases over the past year, and the hope is that their data might help solve an enduring problem that has intrigued scientists for many years, namely whether viruses can directly trigger type 1 diabetes.

A number of viruses have been linked to the rare neurological condition Guillain-Barré syndrome. One is Zika, which may have led to a spike in cases in 2015 (Credit: Getty Images)

A number of viruses have been linked to the rare neurological condition Guillain-Barré syndrome. One is Zika, which may have led to a spike in cases in 2015 (Credit: Getty Images)

In the past, associations have been made between type 1 diabetes – a chronic condition which typically develops in childhood or adolescence as patients' pancreases become steadily unable to produce insulin – and various viruses such as Coxsackie B, rubella, cytomegalovirus, and mumps. Scientists suspect that these viruses may be capable of infecting the pancreas, either by escaping from the lungs or leaking out of the gut and into blood vessels. In 2015, researchers at the Oslo Diabetes Research Centre discovered a persistent, low grade viral infection in beta cells extracted from pancreas tissue biopsies of newly diagnosed type 1 diabetes patients, but there have been too few cases to establish concrete proof.

"There's been epidemics before which have been associated with new cases of diabetes," says Rubino. "But this link has been based on a handful of medical reports. So we're hoping that by looking at several hundred cases, we might see an association which is more informative."

Since the beginning of the Covid-19 pandemic, there have already been repeated indications of an abnormal spike in type 1 diabetes cases. By the summer of 2020, hospitals in North West London were already reporting double the number of cases they would typically see, while a paper in Nature earlier this year found Covid-19 survivors in the US were around 39% more likely to have a new diabetes diagnosis in the six months following infection compared to non-infected individuals.

Scientists are now trying to prove that Covid-19 is actually directly contributing to this rise in cases. Shuibing Chen, a stem cell biologist at Weill Cornell Medicine, feels there is evidence which suggests that the virus can attack beta cells, and also generate inflammation in the pancreas and other organs, causing damage to various systems which control blood sugar levels.

"We have detected viral antigens in human pancreatic beta cells in autopsy samples of Covid-19 patients, which supports the role of direct infection," Chen says.

But not everyone is so convinced. Others point out that patients appearing to develop diabetes as a result of Covid-19 could actually be incurring pancreas damage due to intensive steroid treatment while in hospital. Or they may have already been in the early stages of developing diabetes, and Covid-19 again may simply have unmasked the disease.

It's thought that certain viruses can trigger an immune response which later increases the risk of a person developing Parkinson's disease (Credit: Getty Images)

It's thought that certain viruses can trigger an immune response which later increases the risk of a person developing Parkinson's disease (Credit: Getty Images)

"There have been some reports arguing that Sars-CoV-2 can not only directly infect beta cells, but also might kill them," says Matthias Von Herrath, a professor of autoimmunity at the La Jolla Institute for Immunology. "A follow up report, however, argues against the notion that it commonly affects beta cells. So the jury as to how specific and dangerous it is in causing beta cell functional loss is still out."

Over the coming months, the hope is that the CovidDiab database will yield some more concrete answers. "We don't expect to be able to answer all the questions, but we hope to learn a lot from these 700 cases which probably represents the largest cohort of virus-related diabetes," Rubino says. "How plausible is it that Covid might have been behind these cases? Is there a direct mechanism and if so, what is it?"

But type 1 diabetes is not the only autoimmune disease being linked to Covid-19. Over the past year, a number of reports have associated Sars-CoV-2 infection with other autoimmune disorders such as Guillain–Barré Syndrome, a rare and serious condition in which the immune system attacks the nerves, causing numbness, issues with balance and coordination, weakness, and pain, and sometimes paralysis..

Scientists believe that patients who have been admitted to hospital with Covid-19 are particularly prone to going on to develop such complications as they are more likely to have auto-antibodies in their blood – a form of protein produced by the immune system which is directed against the body's own tissues, leading to complications. A consortium of scientists at the University of Birmingham are now following a cohort of individuals who had been severely ill with Covid-19, to see how many develop longer term autoimmune problems and what makes certain people particularly vulnerable.

"We can't predict the future," says Russell Dale, who researches autoimmune illnesses at the University of Sydney. "But there are a number of precedents of infectious diseases leading to inflammatory and autoimmune problems."

Diagnostics and vaccines

The prospect of Covid-19 leading to a silent surge of chronic illnesses is a sobering one, but if conclusive links can be established between viral infection and different conditions, it could transform the way we look for and treat many of these diseases in future.

In the case of type 1 diabetes, scientists are particularly keen to study exactly what happens after beta cells become infected with Sars-CoV-2 to see if there is a way to prevent their destruction, and hence halt the onset of the disease before it fully develops. "Understanding the link between viral infection and type 1 diabetes might facilitate early diagnosis and prevention," says Chen.

Coxsackie B virus has been linked to the development of type 1 diabetes – and now scientists are wondering if Covid-19 could also make people more susceptible (Credit: Alamy)

Coxsackie B virus has been linked to the development of type 1 diabetes – and now scientists are wondering if Covid-19 could also make people more susceptible (Credit: Alamy)

Knut Dahl-Jørgensen, a consultant in pediatric endocrinology and diabetes at the Oslo Diabetes Research Centre, told the BBC his colleagues are initiating a clinical trial to see whether antiviral treatment can help protect the pancreas in children who have been newly diagnosed with type 1 diabetes.

Chen is also leading a project which involves sifting through a large library of different chemical compounds to see if any can make beta cells more resilient to viral attack. So far they have already identified one particular compound called trans-ISRIB, which appears to be capable of protecting the insulin-producing capacities of beta cells when infected with Sars-CoV-2 in a petri dish. While this is not yet approved by regulators nor tested in humans, and so cannot be used in Covid-19 patients experiencing blood sugar abnormalities at the moment, Chen hopes that in future it could be administered as a preventative drug for vulnerable individuals in the aftermath of infection.

A strong link between Covid-19 and different autoimmune conditions could also encourage the development of protective vaccines against other viruses which have been previously associated with these illnesses. Researchers at the Karolinska Institute, Tampere University, and the University of Jyväskylä have developed a potential vaccine candidate which protects against all six strains of Coxsackie B, and has been shown to prevent mice from developing virus-induced type 1 diabetes.

Gunnar Houen, an immunologist at the State Serum Institute in Copenhagen, believes it could also lead to further investment in vaccines against Epstein-Barr, a virus which has been associated with the development of rheumatoid arthritis and multiple sclerosis, as well as certain cancers.

"Vaccines are very likely to be effective against Epstein-Barr if given early enough, as most people are infected by this virus during the first one or two years of life," says Houen. "There will be a market for this, since the associated diseases cause as much or even more harm as Covid-19."

In the meantime, scientists hoping that the coming months and years will reveal more about the propensity of Covid-19 to trigger each of these illnesses.

"All these questions will not be answered tomorrow, or in the next couple of months, but over the next year we hope to be able to look into this data and begin to answer certain questions, start to see some patterns and maybe have some answers," says Rubino.

https://www.bbc.com/future/article/20220127-could-covid-19-still-be-affecting-us-in-decades-to-come

Many people say they’ve gotten false negatives on at-home, COVID-19 tests. Why?

 Jackie Kramer thought she had COVID-19 late last month.

Everyone in her family tested positive. And she had symptoms: congestion, a headache and fatigue.


Yet the Andersonville woman kept testing negative, over and over again. She took several PCR tests and rapid, at-home COVID-19 tests every day for a week.

“I don’t understand why I tested negative for a week when I had all the symptoms,” said Kramer, 56. “I’d stare at it, like, how can this be?” She spent the week isolating from her husband, 21-year-old daughter and 18-year-old son, to avoid catching COVID-19, just in case the tests were right.


Finally, after a week of testing negative, an at-home test came back positive, confirming what she had suspected — but wasn’t 100% sure of — all along. She called the experience “extremely frustrating.”


Like Kramer, many people during this surge have gotten negative results on at-home tests only to later learn that they actually had COVID-19 — a fact that comes as the federal government pushes to get more free at-home tests into people’s hands. Experts, however, say the at-home tests remain as accurate as they’ve ever been, even with the omicron variant. Rather, experts attribute the false negatives to other possible factors: no test is 100% accurate, people may not be administering them correctly, or people are testing too early to detect their COVID-19 infections.

“You should never do just one test,” said Dr. Emily Landon, hospital epidemiologist at University of Chicago Medical Center. “There’s a reason there’s two tests in the box.”

It can take time for the amount of the virus in a person’s body to reach a high enough level that an at-home test would detect it, she said. A vaccinated person might get symptoms of COVID-19 before an at-home test would turn out a positive result, because the person’s body has already been primed to fight the infection and starts doing so with only a small amount of the virus in the body, Landon said.

Like Kramer, people who feel ill and get a negative result on an at-home test should take the tests repeatedly, as often as daily, depending on the specific test’s instructions and if they have enough tests on-hand, Landon said. If there is only one at-home test available, wait until the second or third day of symptoms to test, and if the test is negative, get a PCR test, she said.

PCR tests can detect COVID-19 for a longer window of time than at-home tests.

In recent weeks, it wasn’t always possible for people who felt ill to use at-home tests every day, given that they were tough to find on store shelves and could cost $20 to $30 a package. The federal government is now sending four free tests to each household, and health insurance companies are now covering up to eight tests per month per person, though that doesn’t apply to people on Medicare.

People should take advantage of those programs, and get plenty of tests, Landon said. If people are treating at-home tests like precious resources, they’re not using them correctly, she said.

“They’re best used regularly and in an ongoing way as we battle the pandemic,” Landon said. “If you have them on-hand like toilet paper ... and stockpile them, you’re going to have enough.”

Lisa Guo knows she was fortunate to have several COVID-19 tests on-hand last month, after she was exposed to a co-worker with COVID-19.

Guo took an at-home test about two days after the exposure, and that test came back negative. The next morning Guo, 33, of Lakeview, woke with a headache, dry cough and low fever. She took another at-home test that, again, came back negative.

She began to feel frustrated, not knowing exactly what she had or how long she’d have to stay home from work.

Still feeling sick the next day, she again swabbed her nose at home. Finally, the test was positive — and she felt relieved to finally know what she had and how to proceed.

“I knew I had something and I was pretty sure it was COVID, and that’s why I kept testing,” said Guo, who was sick for about two weeks but has since recovered. She also tested repeatedly because of guidance from her father, who is an emergency room doctor, she said.

It’s possible, experts say, that not everyone understands they’re supposed to take multiple at-home tests if they feel sick and get negative results. The instructions that come with at-home tests tell people to take a second test, and explain that more frequent testing may help detect COVID-19 more quickly, but not everyone may read through all the instructions.

For Abbott Laboratory’s popular BinaxNOW test, for example, some of those directions and warnings are spelled out over four pages of fine print on the back of the instructions for administering the test.

The tests could also be producing some false positives because that’s the nature of tests, experts say. No test is perfect. COVID-19 at-home tests generally have 70% to 90% accuracy, depending on the brand, in detecting COVID-19 compared with PCR tests, which take longer to return results.

At-home tests also, generally, aren’t as effective when used by asymptomatic people, such as after an exposure, Landon said. Those people should likely get PCR tests instead, or, if they’re going to use at-home tests, take them every other day starting three days after the exposure until nine days after.

“There’s a reason we don’t routinely have medical tests available at the pharmacy — because they’re really hard to interpret,” Landon said. She noted that pregnancy tests are one of the few tests widely available, and those are simpler to perform and easier to interpret. “You have to understand the benefits and risks of the tests, follow complex instructions and understand what to do for follow-up based on results of the test.”

Still, despite the limitations of at-home COVID-19 tests — and negative test results in people who actually have COVID-19 — experts say they’re still valuable.

“What these tests are good for is picking up the highly contagious people,” said Dr. Robert Murphy, executive director of the Havey Institute for Global Health at Northwestern University Feinberg School of Medicine.

People who test positive on at-home tests likely have so much virus in their bodies that they’re more likely to be contagious than those who test negative, even if they have COVID-19, he said.

Murphy still recommends people use at-home tests before gatherings with people outside their households.

“I test everybody, knowing it’s not such a sensitive test, but it gives me some extra reassurance that you’re going to pick out the superspreaders, the people who are highly contagious,” he said.

It can also be a good type of test for people who feel ill, if they take it repeatedly, he said. And at-home tests are preferable to sending everyone who starts coughing to get a PCR test, given that PCR tests often require appointments and can take days to get results.

At-home tests aren’t a perfect test, but they’re the best option out there at the moment for testing large numbers of people frequently, in hopes of limiting the spread of COVID-19, experts said.

“They are useful, but everything has its limitations, and this is just one tool we have,” Murphy said.


https://www.chicagotribune.com/coronavirus/ct-coronavirus-covid-at-home-tests-false-negatives-20220201-szrpf43ewrav7bukaivvrt7qi4-story.html

Calls for restrictions to lift as cases decrease across US

 Authorities across the country are under growing pressure to lift COVID-related restrictions.


Only five states are reporting a significant increase in COVID cases, with overall cases around the country down 30%.

Infections in children have also dropped for the first time since Thanksgiving, down by nearly one-third.

What Docs Don't Know About the Disabilities Act Can Hurt Them and Patients

 Lisa Iezzoni, MD, a professor of medicine at Harvard Medical School and a disability researcher at Massachusetts General Hospital, has used a wheelchair for more than 30 years because of multiple sclerosis. When she visits her primary care doctor, she doesn't get weighed because the scales are not wheelchair accessible.

This failure to weigh her and other patients in wheelchairs could lead to serious medical problems. Weight is used to monitor a person's overall health and prenatal health and to determine accurate doses for medications such as some chemotherapies, says Iezzoni.

In another situation, a man who used a wheelchair said that his primary care doctor never got him out of it for a complete physical exam. The patient later developed lymphoma, which first appeared in his groin. The doctor should have accommodated his disability and used a height-adjustable exam table or a portable lift to transfer him onto the table.

When physicians don't provide access to medical care that patients with disabilities need, they put themselves at greater risk of lawsuits, fines, and settlements.

Yet, a new study in Health Affairs suggests that a large percentage of doctors are not fully aware of what they are legally required to do.

Under federal nondiscrimination laws (Americans With Disabilities Act [ADA], American Rehabilitation Act, and ADA Amendments Act), medical practices must provide equal access to people with disabilities, accommodate their disability-related needs, and not refuse them medical services because of their disabilities, say disability experts.

Where Doctors Go Wrong With Disability Laws

What doctors don't know about providing reasonable accommodations makes them vulnerable to lawsuits, which worries more than two thirds of the 714 outpatient doctors surveyed.

Not only are they required to provide reasonable accommodations, but they also have to pay for them, say the researchers. One fifth of the surveyed doctors said they didn't know that practice owners have to pay.

More than one practice has made patients pay for services needed for their disability, such as sign language interpreters — the patients later complained this violated the ADA to enforcement agencies.

Doctors also don't know that they have to collaborate with patients to determine what reasonable accommodations they need — over two thirds of those surveyed said they didn't know it was a joint responsibility, the study found.

Elizabeth Pendo, JD

When doctors fail to accommodate patients' disability needs, they engage in discrimination and violate the ADA, says Elizabeth Pendo, JD, a co-author of the study and the Joseph J. Simeone Professor of Law at St. Louis University School of Law in Missouri.

The US Department of Justice (DOJ) has investigated several patient complaints of alleged disability discrimination recently and resolved the disputes with agreements and small fines in some cases. "The goal is not to get large financial settlements but to work with practices to get the correct procedures in place to be compliant," says Pendo.

Physicians would be wise to check out whether their practices are as accessible as they think. Even if there's a ramp to the office building, the parking lot may not have a van-accessible space or enough handicapped parking signs, or the exam room may be too narrow for a wheelchair to navigate.

These practices violated the ADA and agreed to make changes:

  • Family & Internal Medicine, in Hamden, Connecticut, has two buildings that patients with physical disabilities couldn't easily enter. The physician owners agreed to change the buildings' entrances and access routes and add features to make it easier to use examination rooms and restrooms and the check-in and check-out areas.

  • Riverside Medical Clinic, with seven medical offices in Riverside, California, failed to communicate effectively with deaf and hard-of-hearing patients. They should have had a qualified sign language interpreter, an assistive listening device, or another appropriate aid or service available to a deaf patient and her family. Instead, the office relied on a video remote interpretation system that often failed to work.

    The agreement requires the clinic to provide those aids and services to patients and their companions who are deaf or hard of hearing; advertise their availability; assess each patient who is deaf or hard of hearing to determine the best aids and services for their needs; and pay $5000 in compensation to the complainant and a $1000 civil penalty to the United States.

  • New England Orthopedic Surgeons, in Springfield, Massachusetts, refused to provide full joint replacements to two patients being treated with buprenorphine, a medication used to treat opioid use disorder. Rather than accommodate the patients, the surgeons referred them elsewhere because they were uncomfortable with the postoperative pain management protocol for patients prescribed buprenorphine.

    "The Americans With Disabilities Act protects healthcare access for people under medical treatment for Opioid Use Disorder," said Acting US Attorney Nathaniel R. Mendell. "Healthcare providers must comply with the ADA, even when doing so is inconvenient or makes them uncomfortable."

    The agreement requires the practice to adopt a nondiscrimination policy, provide training on the ADA and opioid use disorder, and pay two complainants $15,000 each for pain and suffering.

    The DOJ has filed civil lawsuits against medical practices when they failed to resolve the allegations. Recent cases include an ophthalmology practice with 24 facilities in Arizona that refused to help transfer patients in wheelchairs to surgery tables for eye surgery and required them to pay for transfer support services and two obstetricians-gynecologists in Bakersfield, California, who refused to provide routine medical care to a patient because of her HIV status.
     

What Doctors Should Know

Many people tend to think of a person with a disability as being in a wheelchair. But the ADA has a very broad definition of disability, which includes any physical or mental impairment that substantially limits any major life activity, says Pendo.

"It was amended in 2008 to clarify that the definition includes people with chronic diseases such as diabetes and cancer, cognitive and neurological disorders, substance abuse disorders, vision and hearing loss, and learning and other disabilities," she says.

That means that doctors have to accommodate many types of disabilities, which can be challenging. The ADA only specifies that fixed structures need to be accessible, such as parking lots, driveways, and buildings, says Iezzoni.

When it comes to "reasonable accommodations," doctors should decide that on a case-by-case basis, she says.

"We can say based on our study that 71% of doctors don't know the right way to think about the accommodations ― they don't know they need to talk to patients so they can explain to them exactly what they need to accommodate their disability," says Iezzoni.

Doctors are also required to provide effective communication for patients with sensory or cognitive disabilities, which can depend on the severity, says Pendo. Is the person deaf or hard of hearing, blind or partially sighted — is the dementia mild or severe?

"The requirement is there, but what that looks like will vary by patient. That's what's challenging," says Pendo.

Iezzoni recommends that doctor's offices ask patients whether they need special help or individual assistance when they make appointments and enter their responses in their records. She also suggests that patients be asked at follow-up appointments whether they still need the same help or not.

"Disabilities can change over time — a person with bad arthritis may need help getting onto an exam table, but later get a knee or hip replacement that is effective and no longer need that help," says Iezonni.

Benefits Outweigh Costs

Physicians have made progress in meeting the ADA's physical accessibility requirements, says Iezzoni. "The literature suggests that doctors have done a good job at fixing the structural barriers people with mobility issues face, such as ramps and bathrooms."

However, there are exceptions in rural older buildings which can be harder to retrofit for wheelchair accessibility, she says. "I recall interviewing a rural doctor several years ago who said that he knew his patients well and when a patient visits with mobility problems, he goes down and carries the patient up the steps to his office. My response was that is not respectful of the patient or safe for the patient or you. That doctor has since changed the location of his practice," says Iezzoni.

Some doctors may resist paying for accessible medical equipment due to cost, but she says the benefits are worth it. These include preventing staff injuries when they transfer patients and being used by patients with temporary disabilities and aging people with bad knees, backs, hearing and sight. In addition, businesses may be eligible for federal and state tax credits.

Iezzoni recently visited her doctor where they finally got height-adjustable exam tables. "I asked the assistant, who really likes these tables? She said it's the elderly ladies of short stature — the table is lowered and they sit down and get on it."

But, Iezonni's main message to doctors is that patients with disabilities deserve equal quality of care.

"Just because we have a disability doesn't mean we should get worse care than other people. It's a matter of professionalism that doctors should want to give the same quality care to all their patients."

https://www.medscape.com/viewarticle/967663

White House 'confident' in health chief Becerra

 White House press secretary Jen Psaki fielded questions from reporters on Tuesday for about 50 minutes and addressed President Biden’s confidence in Health and Human Services Secretary Xavier Becerra, the role of Spotify using misinformation disclaimers, and N95 masks for Americans.

Here’s the White House briefing — in brief. 

Biden is confident in Becerra

Psaki said that Biden remains confident in Becerra amid reports of frustration from White House officials with the job the secretary has done during the COVID-19 pandemic.

“I would just reiterate that the president remains confident in the role of Secretary Becerra, he is somebody who is an important partner, he has been leading a range of efforts from the …Department of Health and Human Services,” Psaki said when asked if the president still has confidence in Becerra.

The Washington Post on Monday night reported that officials have openly discussed who might be better suited for Becerra’s role and that they have a poor relationship with Becerra.

Psaki called such reporting “palace intrigue.”

“We’re less focused on — not at all focused I should say — on palace intrigue as much as we are on vaccinating Americans, fighting the omicron surge, expanding testing capacity and getting more therapeutics out to the American people. And, that’s how we believe we, and the leaders of the cabinet, will be judged,” she said. 

Becerra has been under fire for what critics say is a lack of leadership in the COVID-19 response and outside health experts and former officials have accused him of taking a back seat during the crisis.

https://thehill.com/homenews/administration/592337-briefing-in-brief-white-house-confident-in-health-chief-becerra

Novel Virtual Reality Assessment of Functional Cognition

 Lilla Alexandra Porffy 1 Author Orcid Image ;  Mitul A Mehta 1 Author Orcid Image ;  Joel Patchitt 1, 2 Author Orcid Image ;  Celia Boussebaa 1 Author Orcid Image ;  Jack Brett 3 Author Orcid Image ;  Teresa D’Oliveira 1 Author Orcid Image ;  Elias Mouchlianitis 4 Author Orcid Image ;  Sukhi S Shergill 1, 5, 6 Author Orcid Image

doi: 10.2196/27641

PDF: https://www.jmir.org/2022/1/e27641/PDF

Background:Cognitive deficits are present in several neuropsychiatric disorders, including Alzheimer disease, schizophrenia, and depression. Assessments used to measure cognition in these disorders are time-consuming, burdensome, and have low ecological validity. To address these limitations, we developed a novel virtual reality shopping task—VStore.

Objective:This study aims to establish the construct validity of VStore in relation to the established computerized cognitive battery, Cogstate, and explore its sensitivity to age-related cognitive decline.

Methods:A total of 142 healthy volunteers aged 20-79 years participated in the study. The main VStore outcomes included verbal recall of 12 grocery items, time to collect items, time to select items on a self-checkout machine, time to make the payment, time to order coffee, and total completion time. Construct validity was examined through a series of backward elimination regression models to establish which Cogstate tasks, measuring attention, processing speed, verbal and visual learning, working memory, executive function, and paired associate learning, in addition to age and technological familiarity, best predicted VStore performance. In addition, 2 ridge regression and 2 logistic regression models supplemented with receiver operating characteristic curves were built, with VStore outcomes in the first model and Cogstate outcomes in the second model entered as predictors of age and age cohorts, respectively.

Results:Overall VStore performance, as indexed by the total time spent completing the task, was best explained by Cogstate tasks measuring attention, working memory, paired associate learning, and age and technological familiarity, accounting for 47% of the variance. In addition, with λ=5.16, the ridge regression model selected 5 parameters for VStore when predicting age (mean squared error 185.80, SE 19.34), and with λ=9.49 for Cogstate, the model selected all 8 tasks (mean squared error 226.80, SE 23.48). Finally, VStore was found to be highly sensitive (87%) and specific (91.7%) to age cohorts, with 94.6% of the area under the receiver operating characteristic curve.

Conclusions:Our findings suggest that VStore is a promising assessment that engages standard cognitive domains and is sensitive to age-related cognitive decline.

https://www.jmir.org/2022/1/e27641