The influence of social norms varies with “others” groups: Evidence from COVID-19 vaccination intentions

The theory that health behaviors spread through social groups implies that efforts to control the pandemic through vaccination will succeed if people believe that others in their groups are getting vaccinated. But “others” can refer to many (often overlapping) groups, such as one’s family, neighborhood, city, state, or political party. These distinctions and their relationship to behavior are understudied in the social norms and public health literature. One challenge to studying them is that many factors may confound making inferences from observed relationships between perceived social norms (what people believe others do) and intended behaviors (what people themselves will do) because there are often plausible common causes for both. For example, vaccination intentions and perceptions of one’s social group’s intentions could both increase with age, since age is a known COVID-19 risk factor and people may know more people in their own age groups. We address these issues by applying a matched design that approximates pair-randomized experiments to survey data collected in the US during late fall 2020 (N = 890) and spring 2021 (N = 996). We find that a strong relationship between perceived vaccination social norms and vaccination intentions remains when controlling for a host of real risk factors as well as dimensions known to predict COVID-19 preventive behaviors even though they are not associated with risk. The strength of the relationship declines as the queried social group grows larger and more heterogeneous. The relationship for co-partisans is second in magnitude to that of family and friends among Republicans but undetectable for Democrats. Sensitivity analysis shows that these relationships could be explained away only by an unmeasured variable with large effects on both social norms perceptions and vaccination intentions (odds ratios between two and nineteen times), and a prediction from the false consensus interpretation that intentions cause perceived social norms is not supported. We discuss the implications for public health policy and understanding social norms.

A-96 Stability of ImPACT’s Latent Structure from Baseline to Post Concussion Assessment

Objective ImPACT is commonly used for sport-concussion management. Baseline and post-concussion tests serve as within-athlete comparisons for return-to-play decision-making. Previous literature has questioned whether ImPACT’s five composites accurately represent the internal structure of its cognitive scores. A recent alternative four-factor structure has strong confirmatory evidence for baseline scores (Maietta et al., doi:10.1037/pas0001014). The present study examined the stability of these constructs post-concussion. Method The current study utilized a case-matched design (age, sex, sport category) to select a sample of 3560 high school athletes’ baseline (n = 1780) and post-concussion (n = 1780) assessments. Multi-group CFA of first-order, hierarchical, and bifactor models was conducted to assess measurement invariance (configural, metric, scalar, and residual invariance) between baseline and post-concussion samples. Change in comparative fit indices was interpreted as the primary indicator of model invariance. Results ImPACT’s five composite structure, as well as the hierarchical and bifactor models, exhibited inadequate fit to the baseline and post-concussion data. The four-factor model demonstrated superior fit in the baseline sample and good fit in the post-concussion sample. The four-factor structure demonstrated invariance across injury status (baseline to post-concussion). Conclusion Given that ImPACT’s scores are used for return-to-play decision-making, it is important that they are psychometrically sound. Recent literature suggests that ImPACT’s five composites are not an adequate representation of the cognitive constructs. Findings support validity of the four-factor structure despite injury status, suggesting these cognitive constructs are assessable at both pre- and post-concussion. Additional research is needed to determine implications of these findings for tracking cognitive change following sport-related concussion and making return-to-play decisions.

Spatial variation in the joint effect of extreme heat events and ozone on respiratory hospitalizations in California

Extreme heat and ozone are co-occurring exposures that independently and synergistically increase the risk of respiratory disease. To our knowledge, no joint warning systems consider both risks; understanding their interactive effect can warrant use of comprehensive warning systems to reduce their burden. We examined heterogeneity in joint effects (on the additive scale) between heat and ozone at small geographical scales. A within-community matched design with a Bayesian hierarchical model was applied to study this association at the zip code level. Spatially varying relative risks due to interaction (RERI) were quantified to consider joint effects. Determinants of the spatial variability of effects were assessed using a random effects metaregression to consider the role of demographic/neighborhood characteristics that are known effect modifiers. A total of 817,354 unscheduled respiratory hospitalizations occurred in California from 2004 to 2013 in the May to September period. RERIs revealed no additive interaction when considering overall joint effects. However, when considering the zip code level, certain areas observed strong joint effects. A lower median income, higher percentage of unemployed residents, and exposure to other air pollutants within a zip code drove stronger joint effects; a higher percentage of commuters who walk/bicycle, a marker for neighborhood wealth, showed decreased effects. Results indicate the importance of going beyond average measures to consider spatial variation in the health burden of these exposures and predictors of joint effects. This information can be used to inform early warning systems that consider both heat and ozone to protect populations from these deleterious effects in identified areas.

Can Government Intervention Increase Volunteers and Donations? Analyzing the Influence of VISTA With a Matched Design

The United States has long relied on private organizations to provide public services to poor communities. However, while the federal government’s support of the civic sector through grants and contracts is well studied, little research investigates how it subsidizes voluntary organizations through national service programs, such Volunteers in Service to America (VISTA). In this article, we assess whether nonprofits that receive VISTA members show higher levels of donations and volunteers than matched nonprofits that did not receive VISTA members in the years following the Great Recession. We find that nonprofits that participated in the VISTA program had higher numbers of volunteers 2 years after participation, suggesting that national service was effective at supporting local organizations and building local civic infrastructure during an economic recovery. We also follow VISTA receiving organizations from 2010 to 2016 in a longitudinal design, finding a robust relationship of VISTA service and volunteering. These findings suggest VISTA is a resource for organizations and invite further research on the relationship between national service and anti-poverty work.

MO206MALE SEX IS ASSOCIATED WITH IN-HOSPITAL DEATH IN NON-DIALYSIS CKD PATIENTS WITH COVID-19

Background and Aims Coronavirus disease (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) can lead to significant organ injury. CKD has been associated with increased mortality in previous epidemics, and male sex has been correlated with worse outcomes during COVID-19 in the general population. Our aim was to describe the differential effect of sex as a risk factor for in-hospital mortality among non-dialysis CKD subjects. Method Multicenter, observational cohort study including 136 adult patients with CKD and 136 age- and sex-matched controls who required admission for COVID-19 in three academic hospitals in Spain. Viral infection was confirmed by real-time RT-qPCR and/or serologic testing in all cases. Disease severity on admission was classified according to the WHO—China Joint Mission Report on COVID-19. The presence of CKD was defined as sustained eGFR <60 and >15 ml/min/1.73m2 within the 6 months prior to COVID-19 hospitalization. Demographic and clinical data were gathered from medical records. Outcomes were recorded during the following 28 days after admission. We applied Cox proportional hazards models, adjusted for age, sex, hypertension, diabetes and severe or critical disease at presentation. Results Due to the matched design, no differences were found regarding age and sex between cohorts. CKD patients suffered more frequently from hypertension and diabetes and presented higher 28-day mortality after hospital admission due to COVID-19 compared with age- and sex-matched controls (40.4 vs. 24.3%; P=0.004). In adjusted Cox regression analysis among CKD patients, only age (HR: 1.087, 95% CI: 1.047-1.128) and male sex (HR: 1.883, 95% CI: 1.045-3.391) were independent predictors of 28-day mortality. Comparatively, among patients without CKD, only age acted as an independent predictor for 28-day mortality (HR: 1.082, 95% CI: 1.033-1.133). None of the variables included in adjusted regression was able to predict ICU admission in any of the cohorts. Conclusion Male sex is associated with increased mortality, but not with ICU admission, after hospitalization due to COVID-19 among non-dialysis CKD patients. That effect was not observed among hospitalized controls without CKD.

A Case-Control Study of Accidental Falls During Surgical Hospitalizations

Background Postoperative falls are preventable complications. The study aims were to describe the rate and circumstances surrounding postoperative falls and explore potential associations with patient and procedural characteristics with emphasis on the use of sedative medications. Methods Medical records of hospitalized patients undergoing non-lower extremity surgery under general anesthesia from January 1, 2010, through April 30, 2018 were reviewed for falls within 72 postoperative hours. Perioperative use of sedatives, sleep aids, gabapentinoids, and opioids were abstracted. Each fall case was matched with two controls on age, sex, and procedure type. Descriptive statistics and multivariable analysis accounting for the matched design were performed. Results There were 343 falls among 200 186 hospitalized surgical patients (incidence of 17.1 [95% CI: 15.4, 19.0] falls per 10 000 procedures) with largest proportion of falls occurring on postoperative day 2 (n = 134, 39.1%). Most falls occurred in the general hospital wards (n = 304, 88.6%) and were unwitnessed (n = 186, 55.9%). The incidence of major injuries was 1.0 (95% CI: .1 – 3.6) per 100 000 procedures. Home use of non-benzodiazepine hypnotics (odds ratio 2.68, 95% CI: 1.47, 4.88, P=.001) and blood transfusions were associated with increased fall risk. Hospital stay was longer in patients who fall (7 [4, 15] vs. 5 [3, 9] days, P < .001). Conclusions The rate of postoperative falls in our institution was low and frequently unwitnessed. The use of non-benzodiazepine hypnotics is a modifiable risk factor associated with postoperative falls. Serious complications after falls were rare.

Effects of Acupuncture on Lowering Blood Pressure in Postmenopausal Women with Prehypertension or Stage 1 Hypertension: A Propensity Score-Matched Analysis

Postmenopausal women have a higher prevalence of hypertension compared to premenopausal women. Hypertension is a risk factor for cardiovascular diseases, the prevalence of which is ever increasing. This study investigated the effects of long-term acupuncture on lowering the blood pressure of postmenopausal women with prehypertension and stage 1 hypertension. Participants were 122 postmenopausal women aged less than 65 years, diagnosed with prehypertension or stage 1 hypertension (systolic blood pressure 120–159 mmHg or diastolic blood pressure 80–99 mmHg). We used a propensity score-matched design. The experimental group (n = 61) received acupuncture for four weeks every six months over a period of two years. The control group (n = 61) received no intervention. An Analysis of covariance (ANCOVA) was performed for the primary efficacy analysis. Relative risk ratios were used to compare group differences in treatment effects. Acupuncture significantly reduced the participants’ diastolic blood pressure (−9.92 mmHg; p < 0.001) and systolic blood pressure (−10.34 mmHg; p < 0.001) from baseline to follow-up. The results indicate that acupuncture alleviates hypertension in postmenopausal women, reducing their risk of developing cardiovascular diseases and improving their health and quality of life.

Comparison of Outcomes Between Transperitoneal and Retroperitoneal Robotic Partial Nephrectomy: A Meta-Analysis Based on Comparative Studies

BackgroundTo compare perioperative, functional and oncological outcomes between transperitoneal robotic partial nephrectomy (TRPN) and retroperitoneal robotic partial nephrectomy (RRPN).MethodsA literature searching of Pubmed, Embase, Cochrane Library and Web of Science was performed in August, 2020. Pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were estimated using fixed-effect or random-effect model. Publication bias was evaluated with funnel plots. Only comparative studies with matched design or similar baseline characteristics were included.ResultsEleven studies embracing 2,984 patients were included. There was no significant difference between the two groups regarding conversion to open (P = 0.44) or radical (P = 0.31) surgery, all complications (P = 0.06), major complications (P = 0.07), warm ischemia time (P = 0.73), positive surgical margin (P = 0.87), decline in eGFR (P = 0.42), CKD upstaging (P = 0.72), and total recurrence (P = 0.66). Patients undergoing TRPN had a significant higher minor complications (P = 0.04; OR: 1.39; 95% CI, 1.01–1.91), longer operative time (P &lt; 0.001; WMD: 21.68; 95% CI, 11.61 to 31.76), more estimated blood loss (EBL, P = 0.002; WMD: 40.94; 95% CI, 14.87 to 67.01), longer length of hospital stay (LOS, P &lt; 0.001; WMD: 0.86; 95% CI, 0.35 to 1.37). No obvious publication bias was identified.ConclusionRRPN is more favorable than TRPN in terms of less minor complications, shorter operative time, less EBL, and shorter LOS. Methodological limitations of the included studies should be considered while interpreting these results.

Matched Cohort Study of Convalescent COVID-19 Plasma (CCP) Treatment in Severely or Life Threateningly Ill COVID-19 Patients

Background The utility of convalescent COVID-19 plasma (CCP) in the current pandemic is not well defined. We sought to evaluate safety and efficacy of CCP in severely or life threateningly ill COVID-19 patients when matched with a contemporaneous cohort. Methods Patients with severe or life threatening COVID-19 were treated with CCP according to FDA criteria, prioritization by an interdisciplinary team and based on CCP availability. Individual-level matched controls (1:1) were identified from patients admitted during the prior month when no CCP was available. Safety outcome was freedom from adverse transfusion reaction and efficacy outcome a composite of death or worsening O2 support. Demographic, clinical and laboratory data were analyzed by univariate and multivariable regression analyses accounting for matched design. Results Study patients (N=94, 47 matched pairs) were 62% male with mean age of 58 and 98% (90/94) were minority (53% Hispanic, 45% Black, non-Hispanic) in our inner-city population. Seven-day composite and mortality outcomes suggested a non-significant benefit in CCP treated patients (adjusted hazard ratio (aHR), 0.70; 95% confidence interval (CI), 0.23 to 2.12; P=0.52; aHR, 0.23; 95% CI, 0.04 to 1.51; P=0.13, respectively). Stratification by pre-transfusion mechanical ventilation status showed no differences between groups. No serious transfusion reactions occurred. Conclusion In this short-term matched cohort study, transfusion with CCP was safe and showed a non-significant association with study outcomes. Randomized and larger trials to identify appropriate timing and dosing of CCP in COVID-19 is warranted. Trial Registration: ClinicalTrials.gov Identifier: NCT04420988

Heteromultivalent topology-matched nanostructures as potent and broad-spectrum influenza A virus inhibitors

Here, we report the topology-matched design of heteromultivalent nanostructures as potent and broad-spectrum virus entry inhibitors based on the host cell membrane. Initially, we investigate the virus binding dynamics to validate the better binding performance of the heteromultivalent moieties as compared to homomultivalent ones. The heteromultivalent binding moieties are transferred to nanostructures with a bowl-like shape matching the viral spherical surface. Unlike the conventional homomultivalent inhibitors, the heteromultivalent ones exhibit a half maximal inhibitory concentration of 32.4 ± 13.7 μg/ml due to the synergistic multivalent effects and the topology-matched shape. At a dose without causing cellular toxicity, >99.99% reduction of virus propagation has been achieved. Since multiple binding sites have also been identified on the S protein of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), we envision that the use of heteromultivalent nanostructures may also be applied to develop a potent inhibitor to prevent coronavirus infection.