Department of Biostatistics and Health Data Science

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https://hdl.handle.net/1805/7161
A dual department of the Richard M. Fairbanks School of Public Health and the IU School of Medicine.

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Browsing Department of Biostatistics and Health Data Science by Author "Abrahim, Heather L."

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    A distinct symptom pattern emerges for COVID-19 long-haul: a nationwide study
    (Springer Nature, 2022-09-23) Pinto, Melissa D.; Downs, Charles A.; Huang, Yong; El‑Azab, Sarah A.; Ramrakhiani, Nathan S.; Barisano, Anthony; Yu, Lu; Taylor, Kaitlyn; Esperanca, Alvaro; Abrahim, Heather L.; Hughes, Thomas; Giraldo Herrera, Maria; Rahamani, Amir M.; Dutt, Nikil; Chakraborty, Rana; Mendiola, Christian; Lambert, Natalie; Biostatistics, School of Public Health
    Long-haul COVID-19, also called post-acute sequelae of SARS-CoV-2 (PASC), is a new illness caused by SARS-CoV-2 infection and characterized by the persistence of symptoms. The purpose of this cross-sectional study was to identify a distinct and significant temporal pattern of PASC symptoms (symptom type and onset) among a nationwide sample of PASC survivors (n = 5652). The sample was randomly sorted into two independent samples for exploratory (EFA) and confirmatory factor analyses (CFA). Five factors emerged from the EFA: (1) cold and flu-like symptoms, (2) change in smell and/or taste, (3) dyspnea and chest pain, (4) cognitive and visual problems, and (5) cardiac symptoms. The CFA had excellent model fit (x2 = 513.721, df = 207, p < 0.01, TLI = 0.952, CFI = 0.964, RMSEA = 0.024). These findings demonstrate a novel symptom pattern for PASC. These findings can enable nurses in the identification of at-risk patients and facilitate early, systematic symptom management strategies for PASC.
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    A novel conceptual model of trauma-informed care for patients with post-acute sequelae of SARS-CoV-2 illness (PASC)
    (Wiley, 2022) Burton, Candace W.; Downs, Charles A.; Hughes, Thomas; Lambert, Natalie; Abrahim, Heather L.; Giraldo Herrera, Maria; Huang, Yong; Rahmani, Amir; Lee, Jung-Ah; Chakraborty, Rana; Pinto, Melissa D.; Biostatistics, School of Public Health
    Aim: This paper proposes a novel, trauma-informed, conceptual model of care for Post-Acute Sequelae of COVID-19 illness (PASC). Design: This paper describes essential elements, linkages and dimensions of the model that affect PASC patient experiences and the potential impact of trauma-informed care on outcomes. Data sources: PASC is a consequence of the global pandemic, and a new disease of which little is known. Our model was derived from the limited available studies, expert clinical experience specific to PASC survivors and publicly available social media narratives authored by PASC survivors. Implications for nursing: The model provides a critical and novel framework for the understanding and care of persons affected by PASC. This model is aimed at the provision of nursing care, with the intention of reducing the traumatic impacts of the uncertain course of this disease, a lack of defined treatment options and difficulties in seeking care. The use of a trauma-informed care approach to PASC patients can enhance nurses' ability to remediate and ameliorate both the traumatic burden of and the symptoms and experience of the illness. Conclusion: Applying a trauma-informed perspective to care of PASC patients can help to reduce the overall burden of this complex condition. Owing to the fundamentally holistic perspective of the nursing profession, nurses are best positioned to implement care that addresses multiple facets of the PASC experience. Impact: The proposed model specifically addresses the myriad ways in which PASC may affect physical as well as mental and psychosocial dimensions of health. The model particularly seeks to suggest means of supporting patients who have already experienced a life-threatening illness and are now coping with its long-term impact. Since the scope of this impact is not yet defined, trauma-informed care for PASC patients is likely to reduce the overall health and systems burdens of this complex condition.
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    COVID-19 Survivors’ Reports of the Timing, Duration, and Health Impacts of Post-Acute Sequelae of SARS-CoV-2 (PASC) Infection
    (Cold Spring Harbor Laboratory Press, 2021) Lambert, Natalie; Survivor Corps; El-Azab, Sarah A.; Ramrakhiani, Nathan S.; Barisano, Anthony; Yu, Lu; Taylor, Kaitlyn; Esperanca, Alvaro; Downs, Charles A.; Abrahim, Heather L.; Rahmani, Amir M.; Borelli, Jessica L.; Chakraborty, Rana; Pinto, Melissa D.; Biostatistics, School of Public Health
    IMPORTANCE Post-Acute Sequelae of SARS-CoV-2 Infection (PASC) is a major public health concern. Studies suggest that 1 in 3 infected with SARS-CoV-2 may develop PASC, including those without initial symptoms or with mild COVID-19 disease.1, 2 OBJECTIVE To evaluate the timing, duration, and health impacts of PASC reported by a large group of primarily non-hospitalized COVID-19 survivors. DESIGN, SETTING, AND PARTICIPANTS A survey of 5,163 COVID-19 survivors reporting symptoms for more than 21 days following SARS-CoV-2 infection. Participants were recruited from Survivor Corps and other online COVID-19 survivor support groups. MAIN OUTCOMES AND MEASURES Participants reported demographic information, as well as the timing, duration, health impacts, and other attributes of PASC. The temporal distribution of symptoms, including average time of onset and duration of symptoms were determined, as well as the perceived distress and impact on ability to work. RESULTS On average, participants reported 21.4 symptoms and the number of symptoms ranged from 1 to 93. The most common symptoms were fatigue (79.0%), headache (55.3%), shortness of breath (55.3%), difficulty concentrating (53.6%), cough (49.0%), changed sense of taste (44.9%), diarrhea (43.9%), and muscle or body aches (43.5%). The timing of symptom onset varied and was best described as happening in waves. The longest lasting symptoms on average for all participants (in days) were “frequently changing” symptoms (112.0), inability to exercise (106.5), fatigue (101.7), difficulty concentrating (101.1), memory problems (100.8), sadness (99.2), hormone imbalance (99.1), and shortness of breath (96.9). The symptoms that affected ability to work included the relapsing/remitting nature of illness (described by survivors as “changing symptoms”), inability to concentrate, fatigue, and memory problems, among others. Symptoms causing the greatest level of distress (on scale of 1 “none” to 5 “a great deal”) were extreme pressure at the base of the head (4.4), syncope (4.3), sharp or sudden chest pain (4.2), brain pressure (4.2), headache (4.2), persistent chest pain or pressure (4.1), and bone pain in extremities (4.1). CONCLUSIONS AND RELEVANCE PASC is an emerging public health priority characterized by a wide range of changing symptoms, which hinder survivors’ ability to work. PASC has not been fully characterized and the trajectory of symptoms and long-term outcomes are unknown. There is no treatment for PASC, and survivors report distress in addition to a host of ongoing symptoms. Capturing patient reports of symptoms through open-ended inquiry is a critical first step in accurately and comprehensively characterizing PASC to ensure that medical treatments and management strategies best meet the needs of individual patients and help mitigate health impacts of this new disease.
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    The other COVID-19 survivors: Timing, duration, and health impact of post-acute sequelae of SARS-CoV-2 infection
    (Wiley, 2022) Lambert, Natalie; Survivor Corps; El-Azab, Sarah A.; Ramrakhiani, Nathan S.; Barisano, Anthony; Yu, Lu; Taylor, Kaitlyn; Esperança, Álvaro; Mendiola, Christian; Downs, Charles A.; Abrahim, Heather L.; Hughes, Thomas; Rahmani, Amir M.; Borelli, Jessica L.; Rana; Chakraborty, Rana; Pinto, Melissa D.; Biostatistics, School of Public Health
    Aims and objectives: To determine the frequency, timing, and duration of post-acute sequelae of SARS-CoV-2 infection (PASC) and their impact on health and function. Background: Post-acute sequelae of SARS-CoV-2 infection is an emerging major public health problem that is poorly understood and has no current treatment or cure. PASC is a new syndrome that has yet to be fully clinically characterised. Design: Descriptive cross-sectional survey (n = 5163) was conducted from online COVID-19 survivor support groups who reported symptoms for more than 21 days following SARS-CoV-2 infection. Methods: Participants reported background demographics and the date and method of their covid diagnosis, as well as all symptoms experienced since onset of covid in terms of the symptom start date, duration, and Likert scales measuring three symptom-specific health impacts: pain and discomfort, work impairment, and social impairment. Descriptive statistics and measures of central tendencies were computed for participant demographics and symptom data. Results: Participants reported experiencing a mean of 21 symptoms (range 1-93); fatigue (79.0%), headache (55.3%), shortness of breath (55.3%) and difficulty concentrating (53.6%) were the most common. Symptoms often remitted and relapsed for extended periods of time (duration M = 112 days), longest lasting symptoms included the inability to exercise (M = 106.5 days), fatigue (M = 101.7 days) and difficulty concentrating, associated with memory impairment (M = 101.1 days). Participants reported extreme pressure at the base of the head, syncope, sharp or sudden chest pain, and "brain pressure" among the most distressing and impacting daily life. Conclusions: Post-acute sequelae of SARS-CoV-2 infection can be characterised by a wide range of symptoms, many of which cause moderate-to-severe distress and can hinder survivors' overall well-being. Relevance to clinical practice: This study advances our understanding of the symptoms of PASC and their health impacts.