'I feel like this will never end': mental health during the COVID-19 pandemic among older adults with chronic conditions

OBJECTIVES

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health.

METHODS

A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes.

RESULTS

We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use.

CONCLUSION

This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

Social Contact, Emotional Support, and Anxiety during the COVID-19 Pandemic among Older Adults with Chronic Conditions

OBJECTIVES

The COVID-19 pandemic may contribute to heightened anxiety among older adults with chronic conditions, which might be attenuated by social resources. This study examined how social contact and emotional support were linked to anxiety symptoms among adults aged 50 and older with chronic conditions, and whether these links varied by age.

METHODS

Participants included 705 adults (M = 64.61 years, SD = 8.85, range = 50- 94) from Michigan (82.4%) and 33 other U.S. states who reported at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020.

RESULTS

Multiple regression models revealed among younger people, those reporting more frequent social contact had significantly lower anxiety symptoms. Emotional support was not significantly associated with anxiety symptoms.

CONCLUSIONS

More frequent social contact was linked to lower anxiety symptoms for younger but not older individuals. Emotional support was not significantly associated with anxiety symptoms.

CLINICAL IMPLICATIONS

Interventions to manage anxiety during the pandemic among older adults with chronic conditions may benefit from strategies to safely increase social contact, especially for middle-aged adults.

Mental Health Consequences of the COVID-19 Pandemic Among Older Adults With Chronic Conditions

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. This cross-sectional qualitative study evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. Participants included a total of 492 adults (M = 64.95 years, SD = 8.91, range = 50 – 94) from Michigan (82.1%) and 33 other U.S. states who reported a diagnosis of at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. Participants provided open-ended responses to a question about the pandemic’s impact on how they were taking care of their mental health. The data were coded to ascertain relevant concepts and were reduced to develop major themes. We determined four main themes. The pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health care. Taken as a whole, this study indicates that older adults with chronic conditions encountered a variety of challenges to managing their mental health in the early months of the COVID-19 pandemic, but also demonstrated considerable resilience. These findings identify potential risk and protective factors to target as part of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder

BACKGROUND

Social relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone.

METHODS

Participants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use.

RESULTS

Roughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use.

CONCLUSIONS

Couples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women's perceptions of relationship quality might be a particularly important target for clinical care and interventions.

Variations in attack behaviours between Glossina palpalis gambiensis and G. tachinoides in a gallery forest suggest host specificity

Tsetse flies Glossina palpalis gambiensis and G. tachinoides are among the major vectors of sleeping sickness (Human African Trypanosomiasis-HAT) and nagana (African Animal Trypanosomiasis - AAT) in West Africa. Both riparian species occur sympatrically in gallery forests of south west Burkina Faso, but little is known of their interspecies relationships although different authors think there may be some competition between them. The aim of this study was to check if sympatric species have different strategies when approaching a host. A man placed in a sticky cube (1 m × 1 m × 1 m) and a sticky black-blue-black target (1 m × 1 m) were used to capture tsetse along the Comoe river banks in a Latin Square design. The number and the height at which tsetse were caught by each capture method were recorded according to species and sex. Glossina p. gambiensis was more attracted to human bait than to the target, but both species were captured at a significantly higher height on the target compared with the human bait (P < 0.05). No significant difference in heights was found between G. tachinoides and G. p. gambiensis captured on targets (33 and 35 cm, respectively, P > 0.05). However, catches on human bait showed a significant difference in height between G. tachinoides and G. p. gambiensis (22.5 and 30.6 cm, respectively, P < 0.001). This study showed that these sympatric species had different attack behaviours to humans, which is not the case with the target. The implications of these findings are discussed.

Tsetse diversity and abundance in Southern Burkina Faso in relation with the vegetation

The increase of human population, combined with climatic changes, contributed to the modification of spatial distribution of tsetse flies, main vector of trypanosomiasis. In order to establish and compare tsetse presence and their relationship with vegetation, entomological survey was performed using biconical traps deployed in transects, simultaneously with phyto-sociological study, on the Comoe river at its source in the village of Moussodougou, and in the semi-protected area of Folonzo, both localities in Southern Burkina Faso. In Folonzo, the survey revealed a diversity of tsetse with 4 species occurring with apparent densities as follows: Glossina tachinoides (8.9 tsetse/trap/day); G. morsitans submorsitans (1.8 tsetse/trap/day); G. palpalis gambiensis (0.6/trap/day) and G. medicorum (0.15 tsetse/trap/day). In Moussodougou, a highly anthropized area, mainly G. p. gambiensis was caught (2.06 tsetse/trap/day), and rarely G. tachinoides. The phyto-sociological study allowed discrimination of 6 types of vegetation in both localities, with 3 concordances that are riparian forest, shrubby and woody savannah. In Moussodougou, all tsetse were caught in the riparian forest. That was also the case in Folonzo where a great proportion (95 to 99 % following the season) of G. p. gambiensis and G. tachinoides were caught in the gallery, while G. m. submorsitans was occurring as well in the gallery as in the savannah, and G. medicorum in the forest gallery. This study showed that although G. tachinoides and G.p. gambiensis are both riparian, they do not have the same preference in terms of biotope.

Retina layer segmentation using kernel graph cuts and continuous max-flow

Circular scan Spectral-Domain Optic Coherence Tomography imaging (SD-OCT) is one of the best tools for diagnosis of retinal diseases. This technique provides more comprehensive detail of the retinal morphology and layers around the optic disc nerve head (ONH). Since manual labelling of the retinal layers can be tedious and time consuming, accurate and robust automated segmentation methods are needed to provide the thickness evaluation of these layers in retinal disorder assessments such as glaucoma. The proposed method serves this purpose by performing the segmentation of retinal layers boundaries in circular SD-OCT scans acquired around the ONH. The layers are detected by adapting a graph cut segmentation technique that includes a kernel-induced space and a continuous multiplier based max-flow algorithm. Results from scan images acquired with Spectralis (Heidelberg Engineering, Germany) prove that the proposed method is robust and efficient in detecting the retinal layers boundaries in images. With a mean root-mean-square error (RMSE) of 0.0835 ± 0.0495 and an average Dice coefficient of 0.9468 ± 0.0705 pixels for the retinal nerve fibre layer thickness, the proposed method demonstrated effective agreement with manual annotations.

Outline-based morphometrics, an overlooked method in arthropod studies?

Modern methods allow a geometric representation of forms, separating size and shape. In entomology, as well as in many other fields involving arthropod studies, shape variation has proved useful for species identification and population characterization. In medical entomology, it has been applied to very specific questions such as population structure, reinfestation of insecticide-treated areas and cryptic species recognition. For shape comparisons, great importance is given to the quality of landmarks in terms of comparability. Two conceptually and statistically separate approaches are: (i) landmark-based morphometrics, based on the relative position of a few anatomical "true" or "traditional" landmarks, and (ii) outline-based morphometrics, which captures the contour of forms through a sequence of close "pseudo-landmarks". Most of the studies on insects of medical, veterinary or economic importance make use of the landmark approach. The present survey makes a case for the outline method, here based on elliptic Fourier analysis. The collection of pseudo-landmarks may require the manual digitization of many points and, for this reason, might appear less attractive. It, however, has the ability to compare homologous organs or structures having no landmarks at all. This strength offers the possibility to study a wider range of anatomical structures and thus, a larger range of arthropods. We present a few examples highlighting its interest for separating close or cryptic species, or characterizing conspecific geographic populations, in a series of different vector organisms. In this simple application, i.e. the recognition of close or cryptic forms, the outline approach provided similar scores as those obtained by the landmark-based approach.

[Human African trypanosomiasis in Côte d'Ivoire and Burkina Faso: optimization of epidemiologic surveillance strategies]

L’objectif de cet article est de décrire les récentes données de surveillance médicale de la Trypanosomose Humaine Africaine (THA) au Burkina Faso et en Côte d’Ivoire afin (i) de dresser un bilan de la situation actuelle de la maladie dans ces deux pays qui entretiennent depuis plus d’un siècle des liens migratoires, économiques et épidémiologiques intimes et (ii) de définir les stratégies à mettre en place dans l’objectif d’une élimination durable. Les résultats de la surveillance active et passive ont montré que les trypanosomés dépistés au Burkina-Faso ces dernières années sont tous des cas importés provenant de Côte d’Ivoire. Cependant, la réintroduction du parasite est effective et le risque d’une reprise de la transmission existe. En Côte d’Ivoire, plusieurs foyers “historiques” toujours endémiques font craindre des phénomènes de réémergence et de propagation. Dans l’objectif d’une élimination durable de la THA dans ces deux pays, les acteurs de la lutte doivent adapter leur système de surveillance en fonction des différents contextes épidémiologiques. Les prévalences actuelles ne justifient plus, excepté des cas particuliers, l’usage systématique et très onéreux du dépistage actif par prospections médicales exhaustives. Elles tendent plutôt à privilégier des systèmes intégrés aux systèmes de santé nationaux et utiliser des méthodes permettant de cibler les zones prioritaires d’intervention à partir notamment d’un échange d’informations épidémiologiques entre les deux pays. Pour accompagner le processus d’élimination durable, les acteurs de la recherche doivent étudier le rôle respectif des réservoirs humain et animal dans le maintien de la transmission, participer au suivi sur le long terme des cas traités et des suspects sérologiques, et évaluer en termes de coût/efficacité les stratégies mises en place par les Programmes Nationaux afin de les optimiser.

[Entomological survey in the historical focus of human African trypanosomiasis of Bendje (Gabon)]

La situation de la maladie du sommeil est très peu connue au Gabon. De nombreux foyers historiques n’ont pas été prospectés depuis plus de 15 ans. Le foyer historique de Bendjé fournit régulièrement quelques cas, dépistés passivement, qui concernent le plus souvent des pêcheurs dont il est a priori difficile de déterminer le lieu probable de contamination du fait de leur grande mobilité au cours de leurs activités. La présence des hommes infectés dans ce foyer historique pourrait favoriser son réveil s’il existe un contact étroit entre les différents éléments potentiellement présents du cycle épidémiologique (homme, vecteur, trypanosome). Afin de vérifier l’existence éventuelle d’un risque trypanosomien dans ce foyer, nous y avons mené une enquête entomologique. Des pièges ont été posés dans des biotopes fréquentés par l’homme et laissés en place pendant quatre jours. Trois espèces de glossines (Glossina palpalis palpalis, G. pallicera newsteadi et G. caliginea) ont été capturées et deux espèces de trypanosomes (Trypanosoma vivax et T. brucei s.l.) identifiées par PCR. Ces résultats suggèrent l’existence d’un cycle de transmission animal. Le contact entre les hommes et les glossines est particulièrement étroit dans tous les types de site prospectés, à l’exception de la mangrove.

Epidemiological study of canine trypanosomosis in an urban area of Ivory Coast

Following confirmed cases of trypanosomosis in military working dogs, a cross-sectional study was undertaken to evaluate the source of infection and determine the prevalence of canine infection with Trypanosoma congolense in the urban focus of Abidjan, Ivory Coast. Blood from 123 dogs were collected and subjected to PCR using specific primers for Trypanosoma congolense "forest type". In addition, an entomological study was conducted in an urban area near the forest surronding the military camp. The observed prevalence was 30.1% and PCR positivity to Trypanosoma congolense was not significantly associated with sex or age of animals. This study demonstrates the high contamination rate of dogs in enzootic zones, the potential risk of introduction of the disease in free animal populations and the ability of Glossina palpalis to adapt to urban areas and to transmit trypanosomosis in such areas. The factors leading to a possible emergence of canine trypanosomiasis in enzootic zones need further investigations.

[Eco-distribution and Trypanosoma infection of Glossina palpalis palpalis in the Banco forest of and its relics, Abidjan (Côte d'Ivoire)]

In order to implement an anti-vector programme in the suburb of Abidjan (Côte d'Ivoire), investigations were conducted to assess the tsetse fly densities as well as infection with trypanosomes. Catches were carried out during the rainy season and dry season with Vavoua traps laid during four consecutive days in different sites (Banco forest, Abidjan zoological park, area of the University of Abobo-Adjamé). One species of tsetse fly (Glossina polpalis palpalis) and two species of trypanosomes (Trypanosoma congolense, T. vivax) have been revealed. The apparent density per trap per day (DAP) is very high in the zoological park, 54.8 tsetse fly/trap/day during the dry season and 28.1 during the rainy season. At the University of Abobo-Adjamé, the DAP is respectively 13.5 and 8.1 tsetse fly/trap/day during the rainy season, and in the dry season it is only 0.9 and 0.8 in the Banco Forest. The physiological age on all sites is as follows: 57.5 % of old parous, 39% of young parous and 3.6 % of nulliparous in the rainy season. These proportions vary to 51.9% of young porous, 47.1% of old parous and 1% of nulliparous in the dry season. The overall infection rate is estimated at 20.7% in the rainy season and 20% in the dry season. Statistical analysis have showed a significant difference in the distribution of infection rates.

Tsetse elimination: its interest and feasibility in the historical sleeping sickness focus of Loos islands, Guinea

Guinea is the West African country which is currently the most prevalent for sleeping sickness. The littoral area is the region where most of the recent sleeping sickness cases have been described, especially the mangrove sleeping sickness foci of Dubreka and Boffa where Glossina palpalis gambiensis is the vector. Loos islands constitute a small archipelago 5 km apart from the capital, Conakry. Medical, animal, and entomological surveys were implemented in these islands in Oct-Nov 2006. No pathogenic trypanosomes were found in these surveys. The locally very high tsetse densities (up to more than 100 tsetse/trap/day) linked to pig rearing, constitute a high potential risk for humans (taking into account populations movements with neighboring active sleeping sickness foci of the Guinea littoral, and the history of sleeping sickness on these islands), and for the economically important pig rearing, as well as a danger for tourism. This situation, associated to the possibility of elimination of these tsetse populations due to low possibility of reinvasion, led the National Control Program to launch a tsetse elimination project following an "area wide" strategy for the first time in West Africa, which participates in the global objective of the PATTEC (Pan African Tsetse and Trypanosomosis Eradication Campaign).

[One century of "sleeping sickness" in West Africa]

This paper summarizes the geography of sleeping sickness disease (or Human African Trypanosomiasis, HAT) over the last 100 years in West Africa, with the objective of identifying today's priority areas for the sleeping sickness surveillance. The history and geography of the disease are based on a bibliographic review of old reports and recent publications on recent results obtained from medical surveys conducted in West Africa up to 2007. This allowed us to situate the historical geography of HAT from the beginning of the 20th century to nowadays. For instance, active HAT foci seem to have moved from the North (savannah area) to the South (forest area) in the last century. Taking into account the limited nature of the information available, endemic HAT presently appears to be limited to areas where annual rainfall is higher than 1,200 mm, although the reasons for this remain unknown. During this period of time there has also been a shift towards the south of the isohyets and of the northern distribution limit of tsetse. Currently the most severely affected countries are Guinea and Ivory Coast, whereas the northern countries seem less affected, but many parts of West Africa still lack information on HAT and remain to be investigated. These observations, put back in the current context of demographic growth and climatic global change, responsible for landscape evolution, political instability and population movements, raise the question of HAT becoming.

L'impact de la guerre sur l'evolution de la THA dans le centre-ouest de la cote d'ivoire

OBJECTIVE

To evaluate the situation of sleeping sickness in west-central Côte d'Ivoire from 2000 to 2003, in view of the war which broke out in September 2002.

METHODS

Active surveys by medical teams and passive case detection.

RESULTS

Between 2000 and 2003, 250 patients were diagnosed with sleeping sickness. At first it appeared that sleeping sickness prevalence had fallen since the beginning of political troubles. But this apparent drop was due to poor population coverage. Participation in medical surveys differed according to ethnic group, reflecting land use conflicts between ethnic communities. Such conflicts are common in this area, but have been exacerbated by the war.

CONCLUSION

In war, assessing the importance of sleeping sickness by medical surveys only is very difficult. But detection of sleeping sickness cases by passive surveillance increased.

Mixed infections of trypanosomes in tsetse and pigs and their epidemiological significance in a sleeping sickness focus of Côte d'Ivoire

In a sleeping sickness focus of Côte d'Ivoire, trypanosomes were characterized in humans, pigs and tsetse using various techniques. Out of 74 patients, all the 43 stocks isolated by KIVI (Kit for In Vitro Isolation) appeared to belong to only one zymodeme of Trypanosoma brucei gambiense group 1 (the major zymodeme Z3). The only stock isolated on rodents belonged to a different, new, zymodeme (Z50), of T. b. gambiense group 1. From 18 pigs sampled in the same locations as the patients, PCR showed a high proportion of mixed infections of T. brucei s. l. and T. congolense riverine-forest. Zymodemes of T. brucei s. l. from these pigs were different from those found in humans. From a total of 16 260 captured tsetse (Glossina palpalis palpalis), 1701 were dissected and 28% were found to be infected by trypanosomes. The most prevalent trypanosome was T. congolense riverine-forest type, followed by T. vivax, T. bruceis. l. and T. congolense savannah type, this latter being associated to the forest type of T. congolense in most cases. Mixed infections by 2 or 3 of these trypanosomes were also found. Use of a microsatellite marker allowed us to distinguish T. b. gambiense group 1 in some of the mature infections in tsetse. Differences in infection rates and in trypanosome genotypes according to the host might indicate that the pig may not be an active animal reservoir for humans in this focus.

[Human African trypanosomiasis in the mangrove forest in Guinea: epidemiological and clinical features in two adjacent outbreak areas]

The purpose of this study carried out in two adjacent areas of the coastal mangrove forest of Guinea (Dubreka and Boffa) was to screen the population for disease, provide information on human African trypanosomiasis (HAT, a.k.a. sleeping sickness) and compare the epidemiologic and clinical features with those of outbreak areas in the Ivory Coast where more data is currently available. Cases of HAT were confirmed by parasitological testing after active medical work-up (91 of 9637 patients examined). Five cases were confirmed in patients in treatment centers. Of the first 57 cases admitted for treatment in the Dubreka and Boffa centers, 29 were responded to a clinical and epidemiological questionnaire and underwent thorough clinical examination. Disease stage was determined by cytochemical testing of cerebrospinal fluid. As in outbreak areas of the Ivory Coast, sleeping sickness in Dubreka and Boffa is a rural disease mainly affecting the working population. Most cases identified in Guinea involved men and women working in farming, fishing, or salt extraction. However unlike Ivory Coast outbreak areas where ethnic diversity related to share cropping is considered to play a major role in maintaining endemicity, almost all patients in our study (98%) were from the native Soussou population that is self employed and lives in villages with no immigrant population. While clinical symptoms observed in these patients were not different from those reported elsewhere, there was a high frequency of cervical adenopathy (93%). This finding could provide a useful diagnostic sign for screening populations living in these mangrove forest regions and as a source for parasitological diagnosis as shown by the fact that 88.5% of patients were screened on the basis of lymph node fluid specimens. Most patients including among those identified by active work-up (5%) were in the meningo-encephalitis phase of the disease (98%). The findings of this study underline the need not only to continue surveillance in these regions but also to extend surveillance throughout the country as a means of avoiding recrudescence and extension of the disease.

[Role of patient travel in transmission of human African trypanosomiasis in a highly endemic area of the Ivory Coast]

Human African trypanosomosis (HAT) remains a major public health problem in Subsaharan Africa. The region around the town of Bonon in middle western Côte d'Ivoire is a highly endemic HAT zone. The purpose of this study was to assess the role of travelling of infected patients in transmission of HAT. The study population included a total of 96 patients in whom HAT had been diagnosed actively or passively between 1999 and 2000. Information on each patient's residence and workplaces, i.e. water site, and farm field, was used to calculate the mean distance traveled and mean number of places visited daily by each patient. Findings indicated that both parameters, i.e., distance traveled and number of places visited, were significantly higher for patients living in Bonon than those living in hamlets or homesteads. Based on analysis of patient movements the endemic zone could be divided into three subdivisions with different modes of disease transmission. This study was performed as a preliminary step for a larger investigation designed to allow specific targeting of HAT hot spots based mainly on a geographic information system.

Host age and time of exposure in Trypanosoma brucei gambiense Human African Trypanosomiasis

Human African Trypanosomiasis is related to behavioural risk factors but complex interactions exist between (i) environmental and behavioural risk factors, (ii) vector and (iii) human host. Our aim was to investigate the interrelationships between previously analysed risk factors and the roles of age and time of exposure according to ethnic group and migration status. However, this descriptive and retrospective study is based on cases only (no controls) and our results must therefore be regarded as hypothesis-generating. Individuals originating from areas where sleeping sickness is absent and who settle in an endemic area seem to develop the disease after a shorter time of exposure than native subjects from endemic areas. Our results emphasise the complexity of vector-transmitted disease epidemiology, involving behavioural and/or environmental risk factors on the one hand, and more individual ones such as ageing, immunity and genetic background on the other hand.