Social support and grief education can ameliorate mental and physical health risks in widow(er)s. However, barriers often prevent older individuals from attending support groups. This controlled ...pilot study examined the feasibility and acceptability of an online, real-time, interactive virtual reality (VR) support group for widow(er)s, and assessed the preliminary efficacy of the VR support group for improving psychosocial outcomes and sleep quality compared to an active control grief education website. Thirty widow(er)s (Mage = 67.0, SD = 11.0) participated in an 8-week VR support group or accessed a grief education website. Participants completed self-report measures of depression, grief intensity, grief cognitions, yearning, loneliness, perceived stress and sleep quality at three time points. Participant attrition and self-report indicated that both interventions were feasible and acceptable. Both groups showed significant improvements in grief severity, grief cognitions, yearning, loneliness, perceived stress, and global sleep quality across study time points. However, only widow(er)s in the VR support group showed a significant improvement in depression across time. This study demonstrates the feasibility, acceptability and preliminary efficacy of an accessible and low-cost online support format for widow(er)s.
•Significant improvements in depressive symptoms in Virtual Reality (VR) group.•High levels of social support experienced among VR support group participants.•Improved psychosocial outcomes and sleep quality in VR and active control group.•Feasibility and acceptability of a VR support group for older widow(er)s.
Objective: Following bereavement, yearning and grief rumination are repetitive cognitive processes that can lead to disordered grief. Mindfulness training (MT) has been shown to reduce maladaptive ...repetitive thought. The current quasi-randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of MT for bereavement-related grief. Method: Ninety-five widow(er)s (Mage = 67.5, 79% women, 98% White) between 6 months to 4 years post-loss were assigned to a 6-week MT intervention or a progressive muscle relaxation (PMR) intervention, or a wait-list condition. Outcome measures were grief severity (Revised Inventory of Complicated Grief), yearning (Yearning in Situations of Loss), rumination (Utrecht Grief Rumination Scale), and decentering (Experiences Questionnaire-Decentering) assessed at baseline, Weeks 2 and 4 of intervention, post-intervention, and 1-month post-intervention. Growth curve analysis examined group differences in rates of improvement in outcomes through follow-up and associations with improvement in grief severity. Results: The MT and PMR groups showed significant rates of decline in grief severity and yearning, though only the PMR group showed a greater rate of decline in grief severity than wait-list. All groups showed significant rates of decline in grief rumination. The PMR and wait-list groups showed significant rates of increase in decentering compared to the MT group. Conclusions: Results support the feasibility and acceptability of MT and PMR for widow(er)s as well as the preliminary efficacy of PMR for improving grief severity in widow(er)s compared to a wait-list control condition. With replication, PMR could be a standalone intervention for non-disordered grief or a component of treatment for disordered grief.
What is the public health significance of this article?
This study highlights the potential of a 6-week progressive muscle relaxation (PMR) intervention to improve grief outcomes following spousal bereavement. Compared to a wait-list control, PMR training was most effective for improving grief severity in widow(er)s, though effects of the PMR and mindfulness training (MT) interventions were similar across grief outcomes.
What is already known on this topic? In June 2022, COVID-19 vaccines were authorized for use in children aged 6 months–5 years. Intent to vaccinate and vaccination rates in children have been low. ...What is added by this report? During July 2021–May 2022, in a longitudinal cohort of 393 children aged <5 years in four states, parental intent to vaccinate children against COVID-19 and perception of COVID-19 vaccine safety and effectiveness declined over a 3-month period, but intent to vaccinate and perceptions of vaccine safety returned to baseline after 6 months. What are the implications for public health practice? Identifying and addressing barriers to COVID-19 vaccination in children aged <5 years and educating parents about COVID-19 vaccine effectiveness and safety in young children are critical to increasing pediatric COVID-19 vaccination coverage.
In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, ...and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.
The BNT162b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine was recommended by CDC's Advisory Committee on Immunization Practices for persons aged 12-15 years (referred to as adolescents in this report) on ...May 12, 2021, and for children aged 5-11 years on November 2, 2021 (1-4). Real-world data on vaccine effectiveness (VE) in these age groups are needed, especially because when the B.1.1.529 (Omicron) variant became predominant in the United States in December 2021, early investigations of VE demonstrated a decline in protection against symptomatic infection for adolescents aged 12-15 years and adults* (5). The PROTECT
prospective cohort of 1,364 children and adolescents aged 5-15 years was tested weekly for SARS-CoV-2, irrespective of symptoms, and upon COVID-19-associated illness during July 25, 2021-February 12, 2022. Among unvaccinated participants (i.e., those who had received no COVID-19 vaccine doses) with any laboratory-confirmed SARS-CoV-2 infection, those with B.1.617.2 (Delta) variant infections were more likely to report COVID-19 symptoms (66%) than were those with Omicron infections (49%). Among fully vaccinated children aged 5-11 years, VE against any symptomatic and asymptomatic Omicron infection 14-82 days (the longest interval after dose 2 in this age group) after receipt of dose 2 of the Pfizer-BioNTech vaccine was 31% (95% CI = 9%-48%), adjusted for sociodemographic characteristics, health information, frequency of social contact, mask use, location, and local virus circulation. Among adolescents aged 12-15 years, adjusted VE 14-149 days after dose 2 was 87% (95% CI = 49%-97%) against symptomatic and asymptomatic Delta infection and 59% (95% CI = 22%-79%) against Omicron infection. Fully vaccinated participants with Omicron infection spent an average of one half day less sick in bed than did unvaccinated participants with Omicron infection. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children is essential to inform policy and guide healthcare ...professionals advising parents and caregivers of children who test positive for SARS-CoV-2.
This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents.
The PROTECT multisite network was initiated in July 2021 and aims to enroll approximately 2,305 children across four U.S. locations and collect data over a two-year surveillance period; the enrollment target was based on prospective power calculations and account for expected attrition and nonresponse. Study sites recruit parents and legal guardians (PLGs) of age-eligible children participating in the existing HEROES-RECOVER network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and PLGs' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self- or PLG-collected weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like-illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with their PLG's permission, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical records (EMR) linkages where available and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries.
Data collection began in July 2021 and is expected to continue through Spring 2023. As of 05/13/2022, 2,371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites.
As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health.
Demands on health systems due to COVID-19 are substantial, but drivers of healthcare utilization are not well defined in non-severe SARS-CoV-2 infections. Among a prospective cohort of frontline ...workers from July 2020 to February 2023, we assessed predictors of healthcare utilization during SARS-CoV-2 infection.
Weekly specimens tested via real-time reverse transcriptase polymerase chain reaction analysis. Participants reported sociodemographic, health status information, and illness experience information. Primary outcome was healthcare utilization during SARS-CoV-2 infection. Predictors included sociodemographic characteristics, baseline health status, and measures of illness severity. Multivariable logistic regression was utilized to generate odds ratios for predictors of healthcare utilization.
1,923 SARS-CoV-2 infections (1,276 first infections and 647 reinfections from 4,208 participants): 1221 (63.5%) individuals were between 40 and 65 years old; 1115 (58.0%) were female; 449 (23.3%) were Hispanic and 1305 (67.9%) non-Hispanic White. 294 (15.3%) individuals sought medical care during first infection, 106 (5.5%) during reinfection. Sociodemographic and baseline health characteristics were not associated with healthcare utilization during infections from any variant for first infections, while age (OR 1.04, 95%CI 1.01-1.07) was during Omicron reinfection. In first infection, number of symptoms (OR 1.16, 95%CI 1.00-1.36 in Origin/Alpha, OR 1.12, 95%CI 1.00-1.49 in Delta, OR 1.09, 95%CI 1.01-1.16 in Omicron), number of days spent in bed (OR 1.13, 95%CI 1.02-1.33 in Origin/Alpha, OR 1.23, 95%CI 1.00-1.59 in Delta, OR 1.12, 95%CI 1.03-1.22 in Omicron), and illness duration (OR 1.01, 95%CI 1.00-1.04 in Origin/Alpha, OR 1.01, 95%CI 1.00-1.03 in Delta, OR 1.01, 95%CI 1.00-1.02 in Omicron) were related to healthcare utilization for all variants. Number of days in bed (OR 1.12, 95%CI 1.01-1.27), illness duration (OR 1.01, 95%CI 1.00-1.02), and hours of work missed (OR 2.24, 95%CI 1.11-4.74) were positively associated with healthcare utilization during Omicron reinfection.
The main factors associated with healthcare utilization for SARS-CoV-2 infection were symptom severity and duration. Practices and therapeutics aimed at decreasing these factors would be most helpful in easing the burden on health systems.
•In a multi-site cohort, we examine how parents' KAPs related to COVID-19 vaccination translate to vaccine uptake in children.•COVID-19 vaccination rates remain low in kids. More research is needed ...on COVID-19 vaccine hesitancy among parents.•Parents' KAPs changed throughout the pandemic. Policies to increase vaccine uptake should focus on safety and effectiveness.
Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months–17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months.
The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar’s test for paired samples was used to evaluate KAP change over time.
A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5–11 years (aOR 13.1, 95 % CI 8.5–20.4 and aOR 6.4, 95 % CI 4.3–9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8–13.0 and aOR 8.9, 95 % CI 4.4–18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up.
The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.
Social vigilance refers to the process of monitoring one’s social environment for potential threats or monitoring a threat to determine a change in status that may require coping. Vigilance itself ...may be an outcome of attentional bias for ambiguous and negative social cues. Recent work has examined the effects of vigilant behavior on cardiovascular reactivity as a potential health-moderating pathway; however, a connection between attention bias and vigilance has yet to be established. The aim of this study was to examine the relationships between individual differences in social vigilance, attention bias for negative social cues, and cardiovascular reactivity. A diverse sample of 96 young adults (55 women) completed an observational laboratory study involving a baseline followed by an attention bias dot-probe task and later a 5-min video observation period. Participants were selected based on outer tertile scores on the social vigilance questionnaire to represent high and low individual differences in social vigilance. An incentive condition was created by informing half the participants that their $5 payment is contingent on their performance in the attention bias task (high incentive) while half are told they will receive payment regardless of performance (low incentive). Thus, the study is a 2 (high, low vigilance) X 2 (Female, male gender) X 2 (high, low incentive) experimental design. The attention bias task is a 15-minute program wherein reaction times to a standardized set of emotional faces is performed. A Tobii eye tracker is used to quantify gaze time, with impedance cardiography and a GE Carescape BP monitor used to assess cardiovascular reactivity throughout the study. Separately, the NH H-Probe(S) type was found to have a decrease in reaction time by 2.3/ms of those in the high incentive condition, t(935) = -2.01, p<0.05. Individuals in the high-incentive group, told they were to receive $5 dollars had a decrease in reaction time when presented with a happy stimulus. Incentive type and SVQ did not interact to predict reaction time to any stimulus valence-types. There was no interaction between incentive, SVQ, or stimulus valence. Social Vigilance did however predict a lowering of reaction time, quicker responses, for vigilance towards threat equations by 4.408/ms, t(1066)=-2.072, p<.04. A significant interaction between incentive type, vigilance, and gender was discovered F(1,65) = 7.99, p< 0.01 for systolic blood pressure during the task. During rest, a significant main effect of vigilance on systolic blood pressure arose at F(1,61)=5.221, p<0.05. Contributions to the understanding of vigilance as a consequent behavior from attention bias and as a moderating factor of stress effects on cardiovascular reactivity are discussed.
