Researchers in UofL’s surveyed more than 700 people on a broad spectrum of psychological well-being factors and at the same time, tested the participants’ cardiovascular disease risk factors, including cholesterol levels, blood pressure, triglyceride levels and arterial stiffness, which is associated with the progression of heart disease. They found that participants who scored higher on the well-being survey also had lower levels of cardiovascular disease risk factors.

One of the strongest findings in the study, which was published in the , was that well-being moderated the association between age and arterial stiffness. While study participants with the lowest well-being scores were more likely to have increased arterial stiffness with age, there was no association between age and arterial stiffness for those with high levels of well-being.

Previous studies have showed a correlation between optimism and happiness and lower risk of cardiovascular health events. The survey for this study took a broader approach to assess psychological well-being, said Alison McLeish, associate professor of clinical psychology at UofL and first author of this study.

“In addition to happiness and optimism, overall well-being includes something we call flourishing. It’s when you’re doing things in your work or in your personal life that use your personal strengths and in which you’re striving to reach a goal,” McLeish said. “It might not always bring you happiness in the moment, but there’s an outcome that is exciting and brings you joy and a sense of accomplishment.”

The study’s authors suggested that health care providers may want to incorporate psychological well-being evaluation when assessing cardiovascular risk and recommend well-being interventions to mitigate the effects of age-related decline in cardiovascular health.

Rachel Keith, UofL associate professor of medicine and co-author who coordinated cardiovascular health assessments for the study, said that having an additional option to reduce heart disease that does not involve medication is appealing.

“When clinicians address heart health without medications we typically think about diet, exercise and tobacco cessation. Given that cardiovascular disease is so prevalent in our society, incorporating new and novel approaches that address risk, such as assessing and educating on ways to improve psychological well-being, may provide exciting opportunities to increase health, especially in an aging population,” Keith said.

Individuals can take steps on their own to maximize psychological well-being. McLeish suggested practicing mindfulness activities, for one. This could be seated meditation or intentionally being present in the moment while doing daily tasks such as walking, washing the dishes or even eating. In addition, she suggested what she calls positive psychology interventions.

“Part of that is identifying your strengths and your values so you can start to craft your life and your activities to build on those strengths and utilize them in different ways. You can do activities that use those strengths as a way to feel a sense of accomplishment as well as joy and happiness,” McLeish said.

McLeish said that while more research is needed to determine the extent to which improving well-being will improve cardiovascular disease risk, this study supports the idea that improving mental health can have a positive impact on physical health.

“The absence of disease doesn’t necessarily indicate health or well-being. It just gets you to neutral,” McLeish said. “A lot of times, both clinical psychology as well as medicine are focused on the absence of disease. We are trying to say let’s go a little bit further than that.”

The UofL study is believed to be the first to connect biomarkers for chronic disease risk to factors such as stress, employee capacity for work assigned, workplace physical and social environment and whether we see our work as meaningful. The findings are published in the��.

These factors are part of a new concept the UofL researchers have coined which they hope will become a model for both employers and employees to better understand the health impacts of workplace culture.

“For a long time, we’ve assumed that workplace culture can impact our health,” said Brad Shuck, an author on the study and organizational culture researcher in UofL’s . “This study shows, in biological terms, that assumption is true and improving our understanding of these links could help both employees and employers make better, more informed decisions that keep everyone healthy and happy in their work����Ա������DzԳ���Գٲ�.”

In the study, Shuck and�� researchers Kandi Walker, Joy Hart and Rachel Keith asked participants to complete questionnaires on their well-being and work determinants of health factors, such as how engaged and positive or negative they felt about their work environment. Walker and Hart hold faculty appointments in the College of Arts & Sciences and Keith is a faculty member in the School of Medicine.

Between Aug. 25 and Sept. 1, investigators from the tested nearly 3,000 Jefferson County residents for the to detect the presence of the virus in participants’ nasal swabs by the polymerase chain reaction (PCR) method and for the presence of antibodies against the virus in their blood.

The results showed that approximately 1.1% of all the participants tested positive for active coronavirus infections. Among vaccinated participants only 0.7% had an active infection, while nearly 5% of unvaccinated participants were actively infected. This number would roughly correspond to 7,260 active infections in the county, a nearly tenfold increase in infection rates over the rates measured in April, despite a sharp increase in vaccinated residents, as shown in Figure 1.

As in previous testing rounds, the team also tested for antibodies in participants. They found that independent of their vaccination status, in both the sampled and volunteer groups, nearly 16% of the participants had natural infection antibodies against the virus suggesting that they must have been infected by the virus in the recent past. These data indicate that in the last few months, at least 100,000 adults in Jefferson County have had COVID-19.

“These results highlight the steep rise in coronavirus infections in our community and provide a startling snapshot of the current state of the pandemic,” said Aruni Bhatnagar, director of the Envirome Institute. “Our estimates suggest that the number of infected individuals may be twice as high as that indicated in public records.

“Our work shows the vaccine is working as intended. Our population was almost 90% vaccinated, much higher than the 64% of fully vaccinated county residents. In the entire cohort, vaccinated people were over 12 times less likely to be infected compared with unvaccinated people. Though in our volunteer group, 65% of the active infections were in fully vaccinated individuals who had received the vaccine earlier this year. Most reported no or mild allergy-like symptoms and did not recognize that it may be a COVID infection thus did not think they needed to get tested.”

The study also provided estimates of where in Jefferson County the infections are most prevalent. To identify infection rates in different areas, the researchers classified the participants into neighborhood zones, as shown in Figure 2.

The highest rate of active infection was found in Zone 3A, or far southwestern Jefferson County. The highest rate of those recently having had an infection was found in Zone 3B, central southern Jefferson County, as shown in Figure 3.

Participants from Zone 3B also reported lower rates of vaccination, although vaccination rates were lowest in Zone 1B in western Jefferson County, as shown in Figure 4.

“Even though nearly 90% of the participants in the entire study population were vaccinated, we had areas that reported as low as 60% vaccination, and the persistence of infection in some geographical areas seems to be related to lower rates of reported vaccination,” said Rachel Keith, associate professor of environmental medicine at UofL who conducted the study. “Our results show that much work remains to be done and that knowing that rates of infection are high in their community may be an added incentive for some individuals to get vaccinated.

“Additionally, knowing that fully vaccinated individuals may still get an active infection allows those individuals to take additional precautions such as masking or testing which helps keep the community safe, including any young or immunocompromised friends and families who may need extra protection.”

“The vaccine is very effective. Nearly 96% of vaccinated individuals had detectable levels of antibodies against the virus in their blood. However, in a small number of people (less than 0.6%) the levels of antibodies were undetectable in our assay, even though these individuals were fully vaccinated,” Keith said. “The lack of a measurable response in some individuals even after vaccination may be due to their health and immune status. We are analyzing our results to find out more about why some rare individuals do not develop high antibody levels in response to vaccination.”

Using the data from more than 7,000 individuals tested over the past year, the team is trying to identify personal and environmental characteristics that increase the risk for coronavirus infection and how vaccination reduces this risk.

For this round of testing, the team collected samples at 13 locations across Jefferson County. Active coronavirus infections were analyzed by Bluewater Labs and antibodies against the virus were assayed at at the .

To randomly sample people from all parts of the city and to include proportional number of individuals of different age and race/ethnicity, researchers at UofL partnered with Westat to mail approximately 30,000 letters asking people to participate in the study. Nearly 1,000 people who responded to this invitation were tested and an additional 1,886 booked their own appointments after hearing about the study in the news or on social media.

This study was supported in part by a contract with the Centers for Disease Control and Prevention.

Between Nov. 9 and 16, researchers at the tested samples from 2,800 individuals representing all parts of Jefferson County for both active infection and antibodies, indicating previous infection. From those test results, project researchers estimate that during these dates, 1 in 50 Louisville residents were infected and that the rates of infection were nearly five times higher than the publicly reported number of cases, estimated at 0.4% of the population.

“At this rate, as many as 13,000 Louisville residents likely are infected today, many of them asymptomatic and who unwittingly may be spreading the virus,” said Aruni Bhatnagar, director of the institute. “These rates are startling and should make every person living in Louisville re-evaluate their personal precautions to avoid coronavirus, especially as we approach the holidays.”

Other key findings from the project’s latest round of testing:

• Antibody testing indicates a 150% increase in antibody presence compared to documented cases.
• Nearly 13,000 Louisville residents likely were infected between September and November.
• About 45,000 people in Louisville likely have had a coronavirus infection at some point since the beginning of the pandemic based on antibody testing.
• Shively and Northeastern Jefferson County currently show the highest rates of infection in the city.

Benefits of representative sampling

The is a series of studies to estimate the true prevalence of SARS-CoV-2, the virus causing COVID-19, in Jefferson County. This phase of the project involves testing a representative sample of individuals from different areas in the city in proportion to the age and race of the population of the area. Researchers say this approach provides a more reliable estimate of the breadth and spread of coronavirus infection in different parts of the city than testing only those who have reason to believe they may have the virus. The team tested its first community sample in June, a second in September and the most recent in November.

In addition to the 2% infection rate among randomized participants, individuals who participated without an invitation showed a 3.3% rate of infection. This is higher than the random sampling because individuals self-selecting for testing are more likely to have been exposed to the virus.

“Most of the individuals we identified as having coronavirus infection did not have overt symptoms, which indicates that a large number of cases are likely to remain undetected,” said Rachel Keith, assistant professor of environmental medicine at UofL, who conducted the study. “We do not know for sure, but it seems likely that the recent increase in infections may be in part due to asymptomatic individuals.”

The project also tested for antibodies against the virus and found a one-and-a-half-fold increase in the number of individuals who previously had been exposed to the virus. Study researchers estimate that by Nov. 20, more than 45,000 individuals had been infected by the virus, rather than the 20,500 known cases documented so far. These data also suggest that approximately 15,000 individuals became infected between September and November.

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“One reason for the recent increase in coronavirus infection may be the recent drop in temperature,” Bhatnagar said. “ shows that low temperatures promote the spread of the virus. Hence, we were expecting the rates of infection to rise in winter, but this increase is much more than we thought.

“Unfortunately, things are likely to get much worse in the coming months as temperatures dip even further. Therefore, we urgently need collective action, maybe just for a few months more. An effective vaccine is on the horizon so it seems that there is clear hope ahead that might hearten us to make the necessary sacrifices for a little longer.”

In an effort to obtain a uniform sample of city residents, investigators at the institute mailed 30,000 letters to households across Louisville for the November round of testing. The invitations were sent to individuals selected using addresses derived from��U.S. Census Bureau tract boundaries in proportion to the total population in each geographic area.

In addition, any adult resident of Jefferson County was invited to participate through news and social media messages.

A total of 2,800 individuals were tested, 1,091 in response to the invitations and an additional 1,709 who booked their own appointments. The testing took place at 10 community drive-up or walk-up locations. Participants were tested both for the presence of the virus in participants’ nasal swabs and for antibodies against the virus in their blood, indicating a previous infection. Samples were analyzed at UofL’s Regional Biocontainment Laboratory (RBL) by assistant professor Krystal Hamorsky, and Amanda Lasnik, at the Center for Predictive Medicine for Biodefense and Emerging Infectious Diseases.

The random sampling of different neighborhoods also allowed the team to identify areas with higher prevalence of infection. Although infections were spread throughout the county, the highest rates were in the Shively area as well as northeastern Jefferson County.

The researchers are planning to conduct a fourth round of randomized coronavirus testing in Jefferson County Dec. 9-14.

This study was supported in part by the City of Louisville, the James Graham Brown Foundation, the Owsley Brown Family Foundation, Foundation for a Healthy Kentucky and others.