COVID-19

Posted on Mental health

1 in 8 older adults experienced depression for the first time during the COVID-19 pandemic


A new, large-scale study of more than 20,000 older adults in Canada found that approximately 1 in 8 older adults developed depression for the first time during the pandemic.

For those who had experienced depression in the past, the numbers were even worse. By the autumn of 2020 almost half (45%) of this group reported being depressed.

Published in the International Journal of Environmental Research and Public Health, the research analysed responses from the Canadian Longitudinal Study on Aging, which collected data from participants for an average of seven years.

“The high rate of first-onset depression in 2020 highlights the substantial mental health toll that the pandemic caused in a formerly mentally healthy group of older adults.” says first author, Andie MacNeil, a recent Master of Social Work graduate from the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging, University of Toronto.

While the surge in prevalence of depression among older adults during the pandemic is well known, few studies prior to this have identified the percentage of people who experienced it for the first time or the percentage of people with a history of the disorder who experienced a relapse.

“The devastation of the pandemic which upended so many aspects of daily life hit those with a history of depression particularly hard,” says co-author Sapriya Birk, a researcher formerly based in the Department of Neuroscience, Carleton University, Ottawa who is currently a medical student at McMaster University, Hamilton, Canada. “Health professionals need to be vigilant in screening their patients who had mental health problems at an earlier time in their life.”

The researchers identified several factors that were associated with depression among older adults during the pandemic, including inadequate income and savings, loneliness, chronic pain, trouble accessing healthcare, a history of adverse childhood experiences, and family conflict.

Older adults who, prior to the pandemic perceived their income to be inadequate for satisfying their basic needs, and those who had fewer savings were more likely to develop depression during the pandemic.

“These findings highlight the disproportionate mental health burden borne by individuals with low socioeconomic status during the pandemic. Many of these socioeconomic risk factors may have been exacerbated by the economic precarity of the pandemic, particularly for individuals with fewer resources,” says co-author Margaret de Groh, Scientific Manager at the Public Health Agency of Canada.

Individuals who experienced various dimensions of loneliness, such as feeling left out, feeling isolated, and lacking companionship had approximately 4 to 5 times higher risk of both incident and recurrent depression.

“It is not surprising that the lock-down was particularly difficult for older adults who were isolated and lonely during the pandemic.  Social connections and social support are essential for well-being and mental health. Better support and outreach are needed for those who are isolated,” says co-author Ying Jiang, Senior Epidemiologist at the Public Health Agency of Canada.

Older adults in chronic pain and those who had trouble accessing their usual healthcare, medication or treatments were more likely to be depressed during the autumn of 2020.

“This finding underlines the importance of streamlining service provision to ensure less disruption of medical services when future pandemics arise,” says co-author Professor Paul J. Villeneuve, Department of Neuroscience, Carleton University, Canada.

Individuals with a childhood history of adversity were more likely to be depressed during the Autumn of 2020.  Older adults who experienced family conflict during the pandemic had more than triple the risk of depression compared to their peers who did not.

“Family conflict is a major stressor that can impacts mental health even in the best of times. With the enforced close quarters of lockdown and the stress of the pandemic, there was considerable strain on many family relationships. The ensuing conflict was a major risk for depression,” says senior author, Professor Esme Fuller-Thomson at University of Toronto’s FIFSW and director of the Institute for Life Course & Aging.

The study was published in the International Journal of Environmental Research and Public Health.  The study included 22,622 participants of the Canadian Longitudinal Study on Aging (CLSA) who provided data at the baseline wave (2011–2015), follow-up 1 wave (2015–2018), and during the pandemic (September–December 2020).  The impact of the pandemic on depression among older Canadians may even be greater than observed because vulnerable populations were under-represented in the CLSA.

“We hope our findings can help health and social work professionals improve targeted screening and outreach to identify and serve older adults most at risk for depression,” said Andie MacNeil.

Posted on Diabetes

Can a COVID-19 infection have long-term health effects on people with diabetes, including their risk for heart disease?


College of Medicine researcher Dr. Dinender Singla believes that the genetic makeup of patients with diabetes or those predisposed to the disease makes them more prone to post-COVID inflammatory conditions that impact the heart and brain.

“We believe that COVID-19 can alter a person’s genetic makeup which can enhance the proliferation of disease and cause further deterioration in diabetes and associated heart disease,” explained Dr. Singla, who is the AdventHealth Chair of Cardiovascular Science at the College of Medicine.

Dr. Singla has spent much of his research career studying heart failure, diabetes and inflammation. In a recent article published in the American Journal of Physiology–Heart and Circulatory Physiology, he examined the mechanisms and possible effects of COVID-19 on patients with high-risk diabetes and the virus’ potential to advance the disease, leading to inflammation and heart failure.

“Our thinking is COVID-19 could have three major long-term effects on patients,
Dr. Singla noted. “One is cognitive dysfunction, which can lead to Alzheimer’s disease. Second, it can enhance diabetes in pre-diabetic patients or pre-diabetic conditions. Third, it can exacerbate complications of diabetes such as cardiomyopathy or muscle dysfunction.”

Dr. Singla theorizes that some diabetic patients who were infected with COVID-19 may have developed a different cellular composition in their blood compared to diabetic patients who never had COVID.  The next step in his research is to analyze specific cellular differences in diabetics with and without a COVID infection.

“Our goal is to look into whether there is a difference in blood composition or variations in cytokines – proteins that affect communications between cells – compared to the non-COVID diabetic patients,” Dr. Singla said. “If any differences are noted, then we would need to examine what kind of diseases they could potentially cause or enhance in those patients.”

COVID-19 has affected more than 600 million people worldwide, and because vaccines have made the virus not as alarming today as it was two years ago, Dr. Singla said there are still many unanswered questions about COVID’s long-term impact on health.

“For example, if someone was genetically predisposed to developing heart disease or Alzheimer’s disease, if that person is affected by COVID-19, will that person develop heart disease or Alzheimer’s earlier than they were predisposed to?” Dr. Singla said. “Also how severe will their disease be and will it be different in people who contracted or did not have COVID-19?”

Dr. Singla said he is currently working on securing funding to explore the unanswered questions left in the wake of the virus.

 “We want to know will diabetes be present in patients infected with COVID-19 10 or 20 years from now?” Dr. Singla said. “Will they develop a special type of cardiomyopathy or diabetic muscle pain and will those diseases be much more in enhanced? Having this information will allow us to be one step ahead in developing therapeutics and treatments to manage any variations of diseases that may occur.”

Posted on Diabetes, Infectious Diseases

COVID-19 infection may increase risk of type 1 diabetes, suggests nationwide study of 1.2 million children

Nationwide study spanning first 2 years of the pandemic finds 0.13% of children and adolescents who contracted COVID-19 were diagnosed with type 1 diabetes a month or more after infection compared to 0.08% in children without a registered infection

Testing positive for SARS-CoV-2, the virus that causes COVID-19, is associated with an increased risk of new-onset type 1 diabetes in children and adolescents, according to a new research at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Stockholm, Sweden (19-23 Sept).   The study is by Hanne Løvdal Gulseth and Dr  German Tapia, Norwegian Institute of Public Health, Oslo, Norway, and colleagues.

The study used national health registers to examine new onset type 1 diabetes diagnoses made in all youngsters aged under 18 in Norway (over 1.2 million individuals) over the course of 2 years, starting on March 1, 2020, comparing those who contracted COVID-19 with those who did not.

“Our nationwide study suggests a possible association between COVID-19 and new-onset type 1 diabetes”, says Dr Hanne Løvdal Gulseth, lead author and Research Director at the Norwegian Institute of Public Health. “However, the absolute risk of developing type 1 diabetes increased from 0.08% to 0.13%, and is still low. The vast majority of young people who get COVID-19 will not go on to develop type 1 diabetes but it is important that clinicians and parents are aware of the signs and symptoms of type 1 diabetes. Constant thirst, frequent urination, extreme fatigue and unexpected weight loss are tell-tale symptoms.”

It has long been suspected that type 1 diabetes, which is usually diagnosed in younger people and is associated with the failure of the pancreas to produce insulin, is a result of an over-responsive immune reaction, possible due to a viral infection, including respiratory viruses.

Several recent case reports have suggested a link between new onset type 1 diabetes and SARS-CoV-2 infection in adults. But evidence is more limited in children. A recent CDC report found that US children were 2.5 times more likely to be diagnosed with diabetes following a SARS-CoV-2 infection, but it pooled all types of diabetes together and did not account for other health conditions, medications that can increase blood sugar levels, race or ethnicity, obesity, and other social determinants of health that might influence a child’s risk of acquiring COVID-19 or diabetes [1].

In this nationwide study, Gulseth and colleagues linked individual-level data from national health registries for all children and adolescences in Norway (1,202,174 individuals). Data were obtained from the Norwegian preparedness register that is updated daily with individual-level data on PCR-confirmed SARS-CoV-2 infections, COVID-19 vaccinations and disease diagnoses from the primary and secondary health care service.

Children were followed from March 1st 2020 (the start of the pandemic) until diagnosis of type 1 diabetes, they turned 18 years old, death, or the end of the study (March 1st 2022), whichever occurred first.

The researchers examined the risk of young people developing new-onset type 1 diabetes within or after 30 days after PCR-confirmed SARS-CoV2 infection. They compared this group with children and adolescents in the general population who did not have a registered infection, as well as to a group of children who were tested but found to negative for the virus.

Over the 2 year study period, a total of 424,354 children tested positive for SARS-CoV-2 infection and 990 new-onset cases of type 1 diabetes were diagnosed among the 1.2 million  children and adolescents included in the study.

After adjusting for age, sex, country of origin, geographical area and socio-economic factors, the analyses found that young people who contracted COVID-19 were around 60% more likely to develop type 1 diabetes 30 days or more after infection compared to those without a registered infection or who tested negative for the virus (see figure in full abstract).

“The exact reason for the increased risk of type 1 diabetes in young people after COVID-19 is not yet fully understood and requires longer-term follow-up and further research into whether the risk could be different in children who are infected with different variants”, says Gulseth.

She adds, “It’s possible that delays in seeking care because of the pandemic might explain some of the increases in new cases. However, several studies have shown that SARS-CoV-2 can attack the beta cells in the pancreas that produce insulin, which could lead to development of type 1 diabetes. It’s also possible that inflammation caused by the virus may lead to exacerbation of already existing autoimmunity.”

The authors acknowledge that the study was observational and does not prove cause and effect, and they cannot rule out the possibility that other unmeasured factors (e.g., underlying conditions) or missing data may have affected the results. They also note that they only included children who took a PCR test, not a lateral flow test or asymptomatic infections, in the analyses which may limit the conclusions that may be drawn.

Posted on Infectious Diseases

Helping patients manage long covid

A home test to help patients manage long covid at home has been developed and is available to download.

The adapted Autonomic Profile (aAP) test can be done by anyone with symptoms of autonomic dysfunction in conditions such as long covid, chronic fatigue syndrome, fibromyalgia, and diabetes 1 and 2 where people get feelings such as dizziness or blackouts.

The team behind the test was led by Dr Manoj Sivan, Associate Professor in the University of Leeds’ School of Medicine, and Research Lead for the Leeds Long Covid service. Dr Sivan is Europe’s leading advisor on the treatment of the condition and led the development of the first long COVID measure, called C19-YRS (Yorkshire Rehabilitation Scale), which has been advocated for use by NHS England and NICE.

Autonomic testing is usually done on a single occasion in hospital. Patients lie on a tilt table, and their heart rate and blood pressure are measured as the table is manoeuvered from the horizontal position to vertical.

The new aAP test can be done at home, meaning patients can better understand and self-manage their condition over time, as well as monitor the effectiveness of treatment prescribed by clinicians. It also reduces demand on NHS resources. By recording their blood pressure and heart rate at key times and in response to key activities, patients can work out if foods, exercise or other activities trigger their symptoms, and make lifestyle changes accordingly.

The results can also be shared with clinicians to help them understand how patients’ bodies react to common triggers and stimuli in everyday life.

Joanna Corrado, Clinical Research Fellow in Leeds’ School of Medicine, and part of the research team, said: “Fluctuations in the condition, referred to as crashes, are one of biggest problems long covid patients face. The aAP test allows patients to capture these fluctuations more reliably, in addition to having a one-off test in the hospital. The test enables capturing symptoms in relation to physical activities, mental work, emotional stress and food intake. This allows them to make adjustments to their daily activities and avoid the fluctuations as much as possible. This can be very empowering for patients.”

Autonomic system

The autonomic system regulates involuntary physiologic processes including heart rate, blood pressure, breathing and digestion. Dysfunctions develop when the nerves of this system are damaged, such as after a disease like COVID-19. Symptoms include dizziness and fainting on standing up; an inability to alter heart rate with exercise, or exercise intolerance, and digestive difficulties like loss of appetite, bloating, diarrhoea; palpitations, dizziness, brain fog and sleep problems.

Current tests to evaluate dysfunctions of the autonomic system are based on cardiovascular reflexes triggered by performing activities that stimulate the system. Blood pressure and heart rate can be affected by standing up or lying on a tilt table; breathing techniques; muscle contracting or relaxing, and mental arithmetic.

Development of the aAP began during the COVID-19 pandemic to enable patients to undergo testing and monitoring at home, rather than attend hospital.

It involves patients using a blood pressure monitor and heart rate monitor at home to observe physiological responses to key activities in daily life. Readings are taken on waking, after meals, after exertion and before sleep. The patients record changes in blood pressure and heart rate, and also record their symptoms, such as dizziness, on an aAP diary sheet.

Unlike other standardised tests, there is no need to abstain from caffeine, nicotine, alcohol or medications for the aAP, as the purpose is for patients to test in their daily life the reaction to common  stimuli, and record normal or abnormal autonomic responses.

Dr Sivan said: “There are 2 million individuals with long covid in the UK and it is estimated more than a third of them might have altered functioning of the autonomic nervous system. This can present not only as feeling dizzy or racing of the heart but also as fatigue, exercise intolerance, brain fog, pain, bowel and bladder symptoms. This test gives people with long covid easy access to diagnosis and monitor their own symptoms at home, and gives them reliable evidence of the situations that trigger their symptoms.”

Posted on A to Z of Medical Conditions, Infectious Diseases

Vagus nerve stimulation – an electric pill for inflammation?

aVNS


Individualised auricular vagus nerve stimulation at the right time and with the right strength. CREDIT TU Wien

A system out of balance

When a virus – such as SARS-CoV-2 – triggers an inflammatory response in the body, this information is transmitted to the brain via the sensory nervous system. The Vagus nerve, which extends from the brain to most organs in the human body, responds in a regulatory way with an anti-inflammatory reflex. However, if the anti-inflammatory response is too weak, an excessive inflammation may negatively affect the body’s own regeneration. To restore the balance between the initially protective inflammatory response and the regenerative processes, aVNS systems can be used.

To test their hypothesis that aVNS also supports the healing process in severe Covid-19 cases, TU researchers worked closely with the Hospital Favoriten, the Medical University of Vienna, the Health Service Centre of the Vienna Private Clinic, the Sigmund Freud Private University Vienna and the Immunological Day Clinic Vienna.

aVNS in severe Corona courses

In its most recent study, the research team was able to show that the positive effect that Vagus nerve stimulation has on the course of severe Corona diseases, which was already predicted in 2020 – at the beginning of the pandemic – actually exists. For this purpose, the team investigated the use of aVNS on patients who were acutely ill with Corona and were about to receive artificial respiration.

When the virus attacks the body, the inflammatory response and healing process can become unbalanced. The inflammatory response of the body then causes more damage than the virus itself. This balance must be restored – for example, by using an aVNS system. “The electrostimulation of the auricular vagus nerve was not only able to stop the inflammatory reaction in Covid-19 patients, it was even able to counteract it,” Eugenijus Kaniusas, professor at the Institute for Biomedical Electronics at TU Wien, emphasises the result.

Stimulating at the exact right time

The therapeutic success of aVNS also increases by adapting the system. If an aVNS system constantly sends electrical impulses, this can lead to side effects such as pain. The power consumption is also significantly higher compared to when the system reacts individually to the patient and sends targeted stimuli. To realise this, the researchers around PhD student Babak Dabiri have integrated a closed-loop control. Eugenijus Kaniusas explains: “This allows us to stimulate the Vagus nerve exactly when the brain is listening. This is the case when the heart is contracting and blood is flowing into the vessels or when the person is exhaling.” In this way, over- and under-stimulation can be prevented, which often results from persistent aVNS.

While simple measurements refer exclusively to the past, Kaniusas and his team worked with predictions: “In the study, we were able to show that predictive stimulation works and leads to the desired result. This was possible due to a feedback function of the system, via which the aVNS system can constructively interfere with the parasympathetic system,” the electrical engineer Kaniusas says. “The aVNS system listens to the measured biosignals and sends its stimulus at exactly the right time, like an intelligent electric pill,” he finally draws a comparison. This is an important step in the direction of personalisation, through which the research team also expects better therapeutic success and more acceptance by users.