Course of COVID-19 infection in patients with congenital adrenal hyperplasia.

Context: Patients with primary adrenal insufficiency due to congenital adrenal hyperplasia (CAH) are at risk for adrenal crisis during infectious illnesses. Increased risk of infection including COVID-19 has been variably reported. Objective: To evaluate COVID-19 illness outcomes and stress dose practices in a large cohort of patients with CAH during the first two years of the pandemic and compare observations of COVID-19 infection in patients with CAH to the general USA population. Methods: Between March 2020 and November 2022, patients with CAH followed at the National Institutes of Health Clinical Center were queried about COVID-19 infection during their routine visits. Cases of COVID-19 were compared to controls. COVID-19 infection rates and symptoms were compared to general USA population data from the Centers for Disease Control and Prevention. Results: Of 168 patient visits, there were 54 (32%) cases of COVID-19 infection, and 15 (28%) were pediatric. Overall an association was found between acquiring COVID-19 and obesity (p=0.018), and adults acquiring COVID-19 were on lower doses of fludrocortisone (p=0.008). Fewer cases of COVID-19 infection were reported in those receiving hydrocortisone or modified-release hydrocortisone compared to longer acting glucocorticoids (p=0.0018). In our CAH population, the pattern of COVID-19 infection rates and COVID-related symptomatology were similar to those observed in the general USA population. Most patients with the presumed alpha variant reported anosmia and ageusia, while gastrointestinal symptoms were commonly reported during the delta and omicron waves. Stress dosing occurred in 30/54 cases, and 7 received parenteral hydrocortisone. Two hospitalizations occurred; one pediatric and one adult, both with co-morbidities. There were 5 emergency room visits and no reported deaths. Conclusion: Patients with CAH with close follow-up do not appear to be at increased risk of acquiring COVID-19 or to have a more severe course of COVID-19 compared to the general USA population. Obesity may increase risk of acquiring COVID-19 in patients with CAH, and overall infection risk may be lower in those receiving short-acting and circadian glucocorticoid replacement therapy. Established age-appropriate guidelines for stress dosing during infectious illnesses should be used for patients with CAH and COVID-19. COVID-19 specific guidelines are not indicated. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT00250159.

Comparing first and second generation digital natives' Internet use, Internet anxiety, and Internet identification.

The aim of the study was to compare first and second generation Digital Natives' attitudes toward and use of the Internet. The sample of first generation Digital Natives consisted of 558 students who we surveyed in 2002 and who were born after 1980. The sample of second generation Digital Natives consisted of a sample of 458 students who we surveyed in 2012 and were born after 1993. They completed a questionnaire in the first semester of their first academic year, which consisted of a measure of Internet experience, an Internet anxiety scale, and an Internet identification scale. Second generation Digital Natives had more positive attitudes toward the Internet than first generation Digital Natives. They had higher scores on the Internet identification scale and lower scores on the Internet anxiety scale compared with first generation Digital Natives. Furthermore, we found that second generation Digital Natives used the Internet more than first generation Digital Natives. E-mail was the most popular activity for both generations, although second generation Digital Natives used it significantly more than first generation Digital Natives. Social networking sites emerged as very popular for second generation Digital Natives. Both generations reported low use of Web 2.0 technologies.

Gender, internet experience, Internet identification, and internet anxiety: a ten-year followup.

In 2002, we found gender differences in the use of the Internet. Since then, however, the Internet has changed considerably. We therefore conducted a follow-up study in 2012. The study involved 501 students (389 females and 100 males, 12 participants unspecified gender) and we measured Internet use, Internet anxiety, and Internet identification. We found that males had a greater breadth of Internet use; they used the Internet more for games and entertainment than females. The differentiation between males and females in terms of Internet use is evident, and in some ways is even more distinct than 10 years ago. In our previous research we had found no gender differences in the use of the Internet for communication, whereas in the current study we have found that females use the Internet for communication than males and were using social network sites more than males. We also found, consistent with our previous study, that Internet identification and Internet anxiety were related to Internet use.