1
|
Maybin J, Watters M, Rowley B, Walker C, Sharp G, Alvergne A. COVID-19 and abnormal uterine bleeding: potential associations and mechanisms. Clin Sci (Lond) 2024; 138:153-171. [PMID: 38372528 PMCID: PMC10876417 DOI: 10.1042/cs20220280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
The impact of COVID-19 on menstruation has received a high level of public and media interest. Despite this, uncertainty exists about the advice that women and people who menstruate should receive in relation to the expected impact of SARS-CoV-2 infection, long COVID or COVID-19 vaccination on menstruation. Furthermore, the mechanisms leading to these reported menstrual changes are poorly understood. This review evaluates the published literature on COVID-19 and its impact on menstrual bleeding, discussing the strengths and limitations of these studies. We present evidence consistent with SARS-CoV-2 infection and long COVID having an association with changes in menstrual bleeding parameters and that the impact of COVID vaccination on menstruation appears less significant. An overview of menstrual physiology and known causes of abnormal uterine bleeding (AUB) is provided before discussing potential mechanisms which may underpin the menstrual disturbance reported with COVID-19, highlighting areas for future scientific study. Finally, consideration is given to the effect that menstruation may have on COVID-19, including the impact of the ovarian sex hormones on acute COVID-19 severity and susceptibility and reported variation in long COVID symptoms across the menstrual cycle. Understanding the current evidence and addressing gaps in our knowledge in this area are essential to inform public health policy, direct the treatment of menstrual disturbance and facilitate development of new therapies, which may reduce the severity of COVID-19 and improve quality of life for those experiencing long COVID.
Collapse
Affiliation(s)
- Jacqueline A. Maybin
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Marianne Watters
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Bethan Rowley
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | - Catherine A. Walker
- Centre for Reproductive Health, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, U.K
| | | | - Alexandra Alvergne
- ISEM, Univ Montpellier, CNRS, IRD, Montpellier, France
- School of Anthropology and Museum Ethnography, Oxford, U.K
| |
Collapse
|
2
|
Jacobs ET, Cordova-Marks FM, Farland LV, Ernst KC, Andrews JG, Vu S, Heslin KM, Catalfamo C, Chen Z, Pogreba-Brown K. Understanding low COVID-19 booster uptake among US adults. Vaccine 2023; 41:6221-6226. [PMID: 37666694 DOI: 10.1016/j.vaccine.2023.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort. METHODS A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. RESULTS The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11-0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03-0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08-4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69-3.43). CONCLUSIONS Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.
Collapse
Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Felina M Cordova-Marks
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leslie V Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jennifer G Andrews
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sage Vu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kelly M Heslin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Collin Catalfamo
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| |
Collapse
|
3
|
Farland LV, Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, Herbst-Kralovetz MM, Mahnert ND, Pogreba-Brown K, Ernst KC, Jacobs ET. COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertil Steril 2023; 119:392-400. [PMID: 36539055 PMCID: PMC9758067 DOI: 10.1016/j.fertnstert.2022.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination. DESIGN Longitudinal study. PATIENT(S) We recruited a volunteer sample with and without a history of SARS-CoV-2 infection who enrolled in the Arizona COVID-19 Cohort (CoVHORT) study and participated in a reproductive sub-cohort who were pre-menopausal, not pregnant, and had received a COVID-19 vaccine in 2021 (n = 545). EXPOSURE(S) Demographic and reproductive characteristics were collected via self-reports. MAIN OUTCOME MEASURE(S) Information on self-reported changes in the menstrual cycle after COVID-19 vaccination was collected from May 2021 to December 2021. We looked at demographic and reproductive characteristics as predictors of menstrual cycle change. RESULT(S) The majority of our vaccinated sample received the Pfizer-BioNTech vaccine (58%), and were 26-35 years old (51%), non-Hispanic (84%), and White (88%). Approximately 25% of vaccinated participants reported a change in their menstrual cycle after vaccination; the majority reported changes after their second dose (56%) as compared with their first (18%) and third (14%) doses. The most commonly reported changes were irregular menstruation (43%), increased premenstrual symptoms (34%), increased menstrual pain or cramps (30%), and abnormally heavy or prolonged bleeding (31%). High self-reported perceived stress levels compared with low perceived stress (OR, 2.22; 95% CI 1.12-4.37) and greater body mass index (OR, 1.04; 95% CI 1.00-1.07) were associated with greater odds of experiencing the menstrual cycle changes after the vaccination. Participants having a history of SARS-CoV-2 infection were less likely to report changes in their menstrual cycle after vaccination compared with the participants with no history of SARS-CoV-2 infection (OR, 0.58; 95% CI 0.32-1.04). CONCLUSION(S) Among vaccinated participants, approximately 25% of them reported predominantly temporary changes in the menstrual cycle, however, we are unable to determine whether these changes are due to normal cycle variability. The COVID-19 vaccines are safe and effective for everyone, including pregnant people and people trying to conceive; hence, these findings should not discourage vaccination.
Collapse
Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona; University of Arizona Cancer Center, University of Arizona
| | - Sana M Khan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alexandra Shilen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Providence Ishimwe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alicia M Allen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona
| | - Melissa M Herbst-Kralovetz
- University of Arizona Cancer Center, University of Arizona; Department of Basic Medical Sciences, College of Medicine-Phoenix, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Nichole D Mahnert
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; University of Arizona Cancer Center, University of Arizona.
| |
Collapse
|
4
|
Leybas Nuño V, Mantina NM, Dawodu O, Dykinga M, Carr DL, Pogreba-Brown K, Cordova-Marks F, Jehn M, Peace-Tuskey K, Barraza L, Garcia-Filion P. Consequences of COVID-19 on adolescents in Arizona: A longitudinal study protocol. Front Public Health 2022; 10:945089. [PMID: 36589965 PMCID: PMC9797691 DOI: 10.3389/fpubh.2022.945089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The long-term impact of COVID-19 is unknown. We developed a 5-year prospective cohort study designed to generate actionable community-informed research about the consequences of COVID-19 on adolescents ages 12-17 years in Arizona. Methods The study has two primary outcomes: 1) acute and long-term outcomes of COVID-19 illness and 2) symptoms of depression and anxiety. Data is collected using an online survey with plans to integrate qualitative data collection methods. The survey is administered at baseline, 4, and 8 months in year one, and annually in years two through five. This study is informed by Intersectionality Theory, which considers the diverse identities adolescents have that are self and socially defined and the influence they have collectively and simultaneously. To this end, a sample of variables collected is race/ethnicity, language usage, generational status, co-occurring health conditions, and gender. Additional measures capture experiences in social contexts such as home (parent employment, food, and housing security), school (remote learning, type of school), and society (racism). Results Findings are not presented because the manuscript is a protocol designed to describe the procedure instead of report results. Discussion The unique contributions of the study is its focus on COVID-19 the illness and COVID-19 the socially experienced pandemic and the impact of both on adolescents.
Collapse
Affiliation(s)
- Velia Leybas Nuño
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health (MEZCOPH), University of Arizona, Tucson, AZ, United States,*Correspondence: Velia Leybas Nuño
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Oriyomi Dawodu
- Department of Health Promotion Sciences, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Maureen Dykinga
- Department of Health Promotion Sciences, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Dametreea L. Carr
- Department of Epidemiology and Biostatistics, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Felina Cordova-Marks
- Department of Health Promotion Sciences, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona States University, Tempe, AZ, United States
| | - Kimberly Peace-Tuskey
- Department of Health Promotion Sciences, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | - Leila Barraza
- Department of Community, Environment and Policy, MEZCOPH, University of Arizona, Tucson, AZ, United States
| | | |
Collapse
|
5
|
Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection: results from the Arizona CoVHORT. Epidemiol Infect 2022; 150:e136. [PMID: 35801302 PMCID: PMC9343359 DOI: 10.1017/s0950268822001200] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
6
|
Lebar V, Laganà AS, Chiantera V, Kunič T, Lukanović D. The Effect of COVID-19 on the Menstrual Cycle: A Systematic Review. J Clin Med 2022; 11:jcm11133800. [PMID: 35807090 PMCID: PMC9267255 DOI: 10.3390/jcm11133800] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/19/2022] [Accepted: 06/28/2022] [Indexed: 01/17/2023] Open
Abstract
Researchers have been studying COVID-19 from day one, but not much is known about the impact of COVID-19 on the reproductive system, specifically the female reproductive system. There has been substantial anecdotal and media coverage on the effect of COVID-19 on the female reproductive system and changes in the menstrual cycle, but so far available data are not robust enough to draw firm conclusions about the topic. This article was carried out to present already published studies on the correlation between SARS-CoV-2 infection and menstrual cycle changes. A systematic literature search was conducted on the Medline, Scopus, and Cochrane Library databases in accordance with the PRISMA guidelines. Three studies were finally included in the review. The findings of the studies indicate changes in menstrual volume and changes in menstrual cycle length as consequences of SARS-CoV-2 infection; the latter was also the most common menstrual irregularity reported by the included studies. Women have mainly reported decreased menstrual volume and a prolonged cycle. The findings also indicate that the severity of COVID-19 does not play a role in menstrual cycle changes. However, the research on this topic is still too scarce to draw definitive conclusions, and there is a need for further research. The relevant conclusions, which could be drawn only from a well-constructed study, would have a major effect on defining the impact of SARS-CoV-2 infection on the menstrual cycle.
Collapse
Affiliation(s)
- Vojka Lebar
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.S.L.); (V.C.)
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico—Di Cristina—Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (A.S.L.); (V.C.)
| | - Tina Kunič
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia;
| | - David Lukanović
- Department of Gynecology, Division of Gynecology and Obstetrics, Ljubljana Medical Center, Zaloška 2, 1000 Ljubljana, Slovenia;
- Correspondence: ; Tel.: +38-615-226-005
| |
Collapse
|
7
|
Habila MA, Valencia DY, Khan SM, Heslin KM, Hoskinson J, Ernst KC, Pogreba-Brown K, Jacobs ET, Cordova-Marks FM, Warholak T. A Rasch analysis assessing the reliability and validity of the Arizona CoVHORT COVID-19 vaccine questionnaire. SSM Popul Health 2022; 17:101040. [PMID: 35155727 PMCID: PMC8824717 DOI: 10.1016/j.ssmph.2022.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the widespread availability of COVID-19 vaccines in the United States, many that have chosen not to be vaccinated have done so because of vaccine hesitancy. This highlights the need for tools that accurately capture the knowledge, attitudes, and beliefs towards COVID-19 vaccines, and provide steps toward improving vaccine acceptance. Methods Participants of the Arizona CoVHORT (COVID-19 Cohort) received a one-time, electronic based cross-sectional questionnaire intended to capture underlying motivations regarding vaccination, as well as hesitations that may prevent people from getting vaccinated. Rasch analysis was conducted among 4703 CoVHORT participants who had completed the vaccine questionnaire to assess questionnaire reliability and validity. Response categories were grouped to optimize scale functioning and to ensure independent probabilities of participant endorsement. Results A total of 4703 CoVHORT participants completed the questionnaire, of whom 68% were female, and who had a mean age of 48 years. Participants were primarily White (90%), highly educated (63% with a college degree or above, with most respondents (45%) having an income of more than $75,000 per annum. The results indicated the questionnaire has good reliability and construct validity for assessing attitudes and beliefs about the COVID-19 vaccines. In-fit mean-squares for included items ranged from 0.61 to 1.72 and outfit mean-squares ranged from 0.56 to 1.75, and correlation coefficients ranged from 0.25 to 0.75. The person-item map indicated normal distribution of logit scores measuring perceptions about COVID-19 vaccinations. Conclusions The CoVHORT vaccine questionnaire demonstrated satisfactory reliability and construct validity in assessing attitudes and beliefs about COVID-19 vaccines. Overall results provide a starting point for a reliable and valid tool to assess knowledge and perceptions about COVID-19 vaccination, ultimately providing public health professionals with an instrument to assess the factors that are associated with vaccine acceptance or hesitancy.
Collapse
Affiliation(s)
- Magdiel A Habila
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA.,University of Arizona, College of Pharmacy, Department of Health and Pharmaceutical Outcomes, Tucson, AZ, USA
| | - Dora Y Valencia
- University of Arizona, College of Medicine, Department of Clinical and Translational Sciences, Tucson, AZ, USA
| | - Sana M Khan
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Kelly M Heslin
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | | | - Kacey C Ernst
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Kristen Pogreba-Brown
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Elizabeth T Jacobs
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Felina M Cordova-Marks
- University of Arizona, Department of Health Behavior and Health Promotion, Tucson, AZ, USA
| | - Terri Warholak
- University of Arizona, College of Pharmacy, Department of Health and Pharmaceutical Outcomes, Tucson, AZ, USA
| |
Collapse
|
8
|
Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, Jacobs ET, Farland LV. SARS-CoV-2 infection and subsequent changes in the menstrual cycle among participants in the Arizona CoVHORT study. Am J Obstet Gynecol 2022; 226:270-273. [PMID: 34555320 PMCID: PMC8452349 DOI: 10.1016/j.ajog.2021.09.016] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022]
|
9
|
Donzella SM, Kohler LN, Crane TE, Jacobs ET, Ernst KC, Bell ML, Catalfamo CJ, Begay R, Pogreba-Brown K, Farland LV. COVID-19 Infection, the COVID-19 Pandemic, and Changes in Sleep. Front Public Health 2022; 9:795320. [PMID: 35174134 PMCID: PMC8841649 DOI: 10.3389/fpubh.2021.795320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 01/07/2023] Open
Abstract
The objective of this study was to investigate the differences in sleep patterns among individuals with and without laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 test results and self-reported measures recalling sleep habits prior to and during the pandemic were collected from May 2020 to March 2021 among 1,848 individuals in The Arizona CoVHORT Study. We used linear and logistic regression to model the association between test status, presentation of symptoms, and time since test result with sleep duration and trouble sleeping, respectively. Mixed models were used to investigate change in sleep duration prior to the pandemic compared to during the pandemic. Overall, 16.2% of the sample were SARS-CoV-2 positive, 64.3% were SARS-CoV-2 negative, and 19.5% were untested for SARS-CoV-2. Independent of SARS-CoV-2 infection status, all participants slept longer during the pandemic compared to pre-pandemic (Δ SARS-CoV-2 positive: 77.7 min, 95% CI 67.9, 87.5; Δ SARS-CoV-2 negative: 13.4 min, 95% CI 8.4, 18.3). However, SARS-CoV-2 positive participants slept 60.9 min longer (95% CI 49.1, 72.8) than SARS-CoV-2 negative participants in multivariable-adjusted models and had greater odds of trouble sleeping three or more times per week since the start of the pandemic (OR: 1.34 95% CI 1.02, 1.77) This greater odds of trouble sleeping persisted for participants who reported sleep habits > 30 days after their positive SARS-CoV-2 (OR: 2.11 95% CI 1.47, 3.03). Sleep patterns among non-hospitalized individuals with COVID-19 were altered following infection, regardless of the presentation of symptoms and time since infection.
Collapse
Affiliation(s)
- Sidney M. Donzella
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Lindsay N. Kohler
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Health Promotion Science, University of Arizona, Tucson, AZ, United States
| | - Tracy E. Crane
- Department of Medical Oncology, University of Miami, Miami, FL, United States
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Collin J. Catalfamo
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Rachelle Begay
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| |
Collapse
|
10
|
Khan SM, Farland LV, Catalfamo CJ, Austhof E, Bell ML, Chen Z, Cordova-Marks F, Ernst KC, Garcia-Filion P, Heslin KM, Hoskinson J, Jehn ML, Joseph ECS, Kelley CP, Klimentidis Y, Russo Carroll S, Kohler LN, Pogreba-Brown K, Jacobs ET. Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ Open 2022; 12:e053403. [PMID: 35039294 PMCID: PMC8764711 DOI: 10.1136/bmjopen-2021-053403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study. SETTING AND DESIGN This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. PARTICIPANTS Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. RESULTS Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. CONCLUSION When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.
Collapse
Affiliation(s)
- Sana M Khan
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Collin J Catalfamo
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Erika Austhof
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Felina Cordova-Marks
- The University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Pamela Garcia-Filion
- Department of Biomedical Informatics, The University of Arizona, Tucson, Arizona, USA
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | | | - Megan L Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | | | - Connor P Kelley
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Yann Klimentidis
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Stephanie Russo Carroll
- Department of Community, Environment, and Policy, The University of Arizona, Tucson, Arizona, USA
- Native Nations Institute at the Udall Center for Studies in Public Policy, The University of Arizona, Tucson, Arizona, USA
| | - Lindsay N Kohler
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
| |
Collapse
|
11
|
Long-term health sequelae and quality of life at least 6 months after infection with SARS-CoV-2: design and rationale of the COVIDOM-study as part of the NAPKON population-based cohort platform (POP). Infection 2021; 49:1277-1287. [PMID: 34642875 PMCID: PMC8508400 DOI: 10.1007/s15010-021-01707-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022]
Abstract
Purpose Over the course of COVID-19 pandemic, evidence has accumulated that SARS-CoV-2 infections may affect multiple organs and have serious clinical sequelae, but on-site clinical examinations with non-hospitalized samples are rare. We, therefore, aimed to systematically assess the long-term health status of samples of hospitalized and non-hospitalized SARS-CoV-2 infected individuals from three regions in Germany. Methods The present paper describes the COVIDOM-study within the population-based cohort platform (POP) which has been established under the auspices of the NAPKON infrastructure (German National Pandemic Cohort Network) of the national Network University Medicine (NUM). Comprehensive health assessments among SARS-CoV-2 infected individuals are conducted at least 6 months after the acute infection at the study sites Kiel, Würzburg and Berlin. Potential participants were identified and contacted via the local public health authorities, irrespective of the severity of the initial infection. A harmonized examination protocol has been implemented, consisting of detailed assessments of medical history, physical examinations, and the collection of multiple biosamples (e.g., serum, plasma, saliva, urine) for future analyses. In addition, patient-reported perception of the impact of local pandemic-related measures and infection on quality-of-life are obtained. Results As of July 2021, in total 6813 individuals infected in 2020 have been invited into the COVIDOM-study. Of these, about 36% wished to participate and 1295 have already been examined at least once. Conclusion NAPKON-POP COVIDOM-study complements other Long COVID studies assessing the long-term consequences of an infection with SARS-CoV-2 by providing detailed health data of population-based samples, including individuals with various degrees of disease severity. Trial registration Registered at the German registry for clinical studies (DRKS00023742).
Collapse
|
12
|
Bell ML, Catalfamo CJ, Farland LV, Ernst KC, Jacobs ET, Klimentidis YC, Jehn M, Pogreba-Brown K. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PLoS One 2021; 16:e0254347. [PMID: 34347785 PMCID: PMC8336814 DOI: 10.1371/journal.pone.0254347] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.
Collapse
Affiliation(s)
- Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Collin J. Catalfamo
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Yann C. Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| |
Collapse
|