Predicting Uptake of the COVID Coach App Among U.S. Military Veterans: A Funnel Analysis Using a Probability-Based Panel (Preprint)

BACKGROUND Although the pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of pre-existing mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated, but its uptake and usage among older veterans has not been explored. OBJECTIVE The purpose of the current study was to characterize smartphone ownership rates among U.S. veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. METHODS Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3,078 U.S. military veterans before and one year into the pandemic. The NHRVS sample was drawn from KnowledgePanel®, a research panel of more than 50,000 households maintained by Ipsos, Inc. Median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peri-pandemic follow-up assessment on a mobile device (n = 814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n = 34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020 and November 7, 2021. RESULTS We found that most U.S. veterans own smartphones and veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related PTSD symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach was relatively low (3.3% of eligible participants, n = 34), 50% of the participants returned to the app for more than one day of use. The interactive tools for managing stress were used most frequently. CONCLUSIONS Although the coronavirus pandemic has increased the need for and creation of digital mental health tools, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools, such as apps, to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan.

Anxiolytic Effect and Improved Sleep Quality in Individuals Taking Lippia citriodora Extract

The current fast-moving, hectic lifestyle has increased the number of individuals worldwide with difficulties in managing stress, which in turn is also affecting their sleep quality. Therefore, the objective of the current study was to assess a natural plant-based dietary supplement comprised of lemon verbena (Lippia citriodora) extract, purified in phenylpropanoids, in alleviating stress and improving quality of sleep. A double-blind, placebo-controlled study was conducted for 8 weeks, followed by a 4-week washout period. Both validated questionnaires and functional tests were performed during the study, whereas questionnaires were used after the washout. As a result, the group taking the lemon verbena extract significantly reduced their perception of stress after 8 weeks, which was corroborated by a significant decrease in cortisol levels. After the washout period, the subjects reported to present even lower stress levels, due to the lasting effect of the ingredient. As for sleep quality, the subjects taking the supplement reported feeling better rested, with a stronger effect observed in women. Sleep tracking using a wearable device revealed that the supplement users improved their times in the deeper stages of sleep, specifically their percentage of time in deep sleep and REM. In conclusion, lemon verbena extract purified in phenylpropanoids is revealed as a natural solution to help individuals to improve their stress and sleep quality.

Reflections of Technology Narratives

This narrative explores the changing role of technology during the pandemic while simultaneously offering strategies for managing stress caused by the overuse of technology. Technology brings people together who cannot see each other in person, such as families who live in different locations and students who attend online classes. Technology serves the dual role of keeping people connected, especially during events such as a pandemic, and making people feel disconnected due to distraction caused by devices.

The Ostrich Community Internet-Cognitive Behavioural Therapy Program for Distress Related to Carrying Debt

Many individuals struggling with debt will experience associated psychological stress that negatively impacts both their physical and psychological health. People in debt may be too ashamed to participate in support groups or to seek face-to-face therapy but may welcome the more anonymous help that can be made available through an internet-based therapeutic intervention. The Ostrich community internet-cognitive behavioural therapy program was specifically designed to assist individuals with distress related to carrying debt, facilitating them to move out of denial of their financial problems to managing stress symptoms and mobilizing them to be able to cope more effectively with the financial problems. Preliminary outcome studies have demonstrated the feasibility of this approach and its effectiveness.

Reflections of Anxiety Narratives

This narrative discusses a research study using both qualitative and quantitative methods to illustrate the connections between writing and healing. College students who answered survey questions about their health reported anxiety as a concern. Writing in journals became a method of coping with anxiety, which led the research to evolve into a social action project of managing stress and eliminating the stigma surrounding anxiety. Resources to help anxiety include exercise, nutrition, and belonging to a supportive community.

Intervention of Yoga in Stress, Anxiety and Depression

Yoga is not only an art but also an ancient science that evolved more than 5000 years ago. It is practised by people from all walks of life in almost every part of the world. In the past, the practice, which was seen to be spiritual and divine, used to be confined to smaller groups of individuals who were seeking moksha or liberation; however, the trend has transformed over the decades. Today, there are so many yoga studios worldwide, and this has made it easy for yoga enthusiasts. This chapter investigates the effectiveness of yoga not only as a complementary therapy but also as a viable option in the management of stress, anxiety and depression. Articles were retrieved using PubMed, MEDLINE and PsychInfo databases. The findings reveal that the practice of yoga as a complementary therapy and stand-alone therapy is effective in managing stress, anxiety and depression. However, further research is needed as all the studies reviewed were limited in terms of heterogeneity, sample size, intervention styles, frequency and duration of practice, and also teaching methods. The chapter concludes with suggestions for home practice.

Adaptasi Kebijakan, Dampak Perkuliahan Daring, dan Strategi Mahasiswa Menjaga Imunitas Tubuh di Masa Pandemi Covid-19

The world was shocked by a disaster in the form of a very dangerous virus, namely the corona virus or called Covid-19 which requires humans to be able to adapt to this Covid-19 pandemic situation, including in the field of education. At the higher educational level, the learning system changes from face-to-face learning to online learning. This article discusses how students adapt in relation to various policies, the impact of online learning, and students’ strategies in maintaining body immunity during the Covid-19 pandemic. Using a qualitative approach, this research was conducted in the city of Makassar, South Sulawesi Province. Data was collected using in-depth interview and observation. Those who participated in this study were 20 students, consisting of 15 males and five females, whose age ranging between 19 and 22 years. They come from various public and private campuses in the city of Makassar. The results of the study show that during the Covid-19 pandemic, students experienced many changes. Students themselves adapted to various emerging policies related to Covid-19, which include not only government and lecturing policies, but also internal student organization policies. For students, online lectures have impacted not only on the learning process, but also on student health. Various strategies were carried out by students in an effort to maintain body immunity in the midst of the Covid-19 pandemic policy, namely complying with health protocols; implementing a healthy lifestyle; managing stress; and taking supplements. It is argued in this articles that in order to prevent the spread of Covid-19, students adapt to the conditions that occur during the Covid-19 pendemic and apply related strategie. Lecturers also need to create a friendly environment and creative method of teaching, so that students can enjoy online learning on that limited screen.

Preliminary Efficacy of an mHealth Mindfulness Intervention With Caregivers of Older Adults With MCI or Dementia

Decades of research have documented the negative effects of caregiving on unpaid caregivers. Caregivers are more likely to suffer from high levels of stress and anxiety, and caregivers of older adults with dementia are at especially high risk. Mindfulness Therapy (MT) is a promising, non-pharmacological technique with proven efficacy and effectiveness in managing stress and anxiety in diverse populations. Mindfulness Coach is an m-health delivered mindfulness therapy intervention developed by the Veterans Affairs National Center for PTSD. The objective of this paper is to report the preliminary efficacy of an 8-week pilot trial of mHealth-delivered mindfulness therapy to alleviate anxiety and caregiver stress in caregivers of persons with dementia. Sixty caregivers of patients with mild cognitive impairment or dementia were recruited to participate in this single group pre-post design study. After receiving an orientation to using the app, participants were instructed to use the app daily to learn about and practice mindfulness skills. At the end of the 8 weeks, there was a significant reduction between baseline anxiety on the Hospital Anxiety and Depression Scale Anxiety subscale (mean = 14.45, SD = 3.36) 15.42, SD = 3.12) and 8 weeks (mean = (t(55)=2.6, p=.012) and perceived stress measured by the perceived stress scale at baseline (mean = 23.59, SD = 3.99) and 8 weeks (mean = 21.12, SD = 3.09), (t(56)=5.94, p<.001). This study offers preliminary evidence that mHealth Mindfulness Therapy strategies may help caregivers manage the stress and anxiety associated with caregiving.

Perubahan IMT pada Penderita Hipertensi Sebelum dan Selama Masa Pandemi Covid-19

Changes in Body Mass Index (BMI) are the main predictors in controlling blood pressure, especially during the COVID-19 pandemic. This article aims to measure changes in BMI before and during COVID-19 for controlling obesity in hypertensive. This is a further analysis data from the Bogor Cohort Study on NCD Risk Factor and the study of the Impact of the COVID-19 Pandemic Period on Health and Mental Health Service Efforts in 2020 conducted 750 hypertension cases during 2011-2018. The dependent variable is the change in BMI which is categorized stable, decreasing, increasing based on the cut off of the mean difference in BMI. The independent variables include demographic characteristics, ownership of Health Insurance, behavior, disease status, monitoring of blood pressure, height and body weight and therapy. Data were analyzed by multinomial logistic regression. The proportion of hypertensive who experienced changes in BMI was stable, decreased and increased, respectively by 24.5 percent, 49 percent and 26.5 percent. Factors associated with changes in BMI decreased in hypertensive patients were obesity with a risk of 1.7 times (95% CI 1.1–2.6) and stress 4.8 times (95% CI 1.4–16). The factor of increased BMI changes were obesity with a protective risk of 0.6 times (95% CI 0.4 -0.9), sitting more than 5.5 hours had a risk of 1.6 (95 % CI 1.1 – 2.6), and smoking ≥200 cigarettes/day has a 4.2 times risk (95% CI 1.4 – 13.0). Suggestions need efforts to maintain a stable BMI by doing physical activity, managing stress and not smoking. Key words: changes in BMI, hypertension, COVID-19 pandemic Abstrak Perubahan Indeks Massa Tubuh (IMT) merupakan prediktor utama dalam pengendalian tekanan darah khususnya di masa pendemi COVID-19. Artikel bertujuan mengukur perubahan IMT sebelum dan pada masa COVID-19 untuk pengendalian obesitas pada penderita hipertensi. Artikel ini merupakan hasil analisis lanjut dari sumber data Studi Kohor Faktor Risiko PTM Bogor dan studi Dampak Masa Pandemi COVID-19 pada Upaya Pelayanan Kesehatan dan Kesehatan Mental tahun 2020 pada 750 kasus hipertensi periode 2011-2018. Variabel dependen adalah perubahan IMT yang dikategorikan menjadi 3 yaitu stabil, turun, naik berdasarkan cut off rerata perbedaan IMT. Variabel independen meliputi karakteristik demografi (umur, jenis kelamin, pekerjaan), kepemilikan Jaminan Kesehatan Nasional (JKN), perilaku (merokok, olahraga, lama duduk), status penyakit (gangguan mental emosional, komorbid), pemantauan (tekanan darah, tinggi badan, berat badan) dan perilaku pengobatan. Data dianalisis dengan regresi logistik multinomial. Proporsi penderita hipertensi yang mengalami perubahan IMT stabil, turun dan naik, masing-masing sebesar 24,5 persen, 49 persen dan 26,5 persen. Faktor-faktor yang berhubungan bermakna dengan perubahan IMT turun pada penderita hipertensi adalah obesitas dengan risiko 1,7 kali (95% CI 1,1– 2,6) dibanding normal dan stress 4,8 kali (95% CI 1,4 – 16,0), sedangkan faktor perubahan IMT naik yang berhubungan bermakna adalah obesitas risiko protektif 0,6 kali (95% CI 0,4 -0,9) dibandingkan tidak obese, lama duduk lebih dari 5,5 jam berisiko 1,6 (95% CI 1,1 – 2,6), serta merokok ≥200 batang/hari berisiko 4,2 kali (95% CI 1,4 – 13,0) dibandingkan bukan perokok. Saran perlu upaya menjaga IMT tetap stabil dengan cara melakukan aktifitas fisik, mengelola stres dan tidak merokok. Kata kunci : perubahan IMT, hipertensi, pandemic COVID-19

Environmental Stress in Chickens and the Potential Effectiveness of Dietary Vitamin Supplementation

Environmental stressors can promote the vulnerability of animals to infections; it is therefore, essential to understand how stressors affect the immune system, the adaptive capacity of animals to respond, and effective techniques in managing stress. This review highlights scientific evidence regarding environmental stress challenge models and the potential effectiveness of vitamin supplementation. The major environmental stressors discussed are heat and cold stress, feed restriction, stocking density, and pollutants. Much work has been done to identify the effects of environmental stress in broilers and layers, while few involved other types of poultry. Studies indicated that chickens' performance, health, and welfare are compromised when challenged with environmental stress. These stressors result in physiological alterations, behavioral changes, decreased egg and meat quality, tissue and intestinal damage, and high mortalities. The application of vitamins with other nutritional approaches can help in combating these environmental stressors in chickens. Poultry birds do not synthesize sufficient vitamins during stressful periods. It is therefore suggested that chicken diets are supplemented with vitamins when subjected to environmental stress. Combination of vitamins are considered more efficient than the use of individual vitamins in alleviating environmental stress in chickens.