Introduction to part VII: Students' reflections

This section gives space for learners to express their impressions and present their experiences during their learning process in health promotion. This section comprises two chapters: Chap. 45, A Student Perspective on Learning and Doing Settings-Based Health Promotion in the Era of TikTok by Catherine Jenkins, from London South Bank University, London, UK;and Chap. 46, The Impact that Learning About Health Promotion Had on Me. Embracing Health Promotion: A Puerto Rican Metamorphosis by Elisa Ramos-Vazquez and colleagues. Chapter 45 reflects the present time as it was written during the COVID-19 pandemic and describes the use of digital devices to develop its teaching-learning process. The other chapter, 46, has in its title an intriguing word-"metamorphosis, " which means transformation, change, transition, and movement. This chapter brings many examples to illustrate the voices of the students. These two chapters are an inspiration to always include students not as passive subjects in the teaching-learning process in health promotion but as fundamental partners in the construction of meaningful and transformative learning. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022. All rights reserved.

Differences in D-Dimer Levels in Covid-19 Patients with Versus without Venous Thromboembolisms (Vte)

INTRODUCTION: Coronavirus disease 2019 (COVID19) is known to cause coagulopathy as multiple systemic coagulation and inflammatory responses are activated during infectious complications. In COVID19 patients, hypercoagulopathy usually presents with an elevated D-dimer level. METHOD(S): All patients >= 18 years old who were admitted to NYU Langone Hospital-Long Island with a primary diagnosis of COVID-19 or with a flagged admission of COVID19 during April 1, 2020 to June 30, 2020 were included. IRB approval was acquired prior to data collection and upon permission, the clinical pharmacy IT department ran a report to identify patients. Most patients had a positive reverse-transcription polymerase chain reaction (RT-PCR) test during their admission, while a small number of patients were diagnosed before admission. Admissions included ICU patients or general ward patients. Series of D dimers were recorded. RESULT(S): There were 350 patients enrolled in the study, 331 had no VTE, 19 had VTE. Peak D dimer was 4876 (range 1509 to 15,872) in VTE group vs. 680 in non VTE group (range: 257 to 2723). 47.4% of VTE group had peak D dimer greater than 5000 vs. 16% of non VTE group. Surprisingly, there was no difference in mortality between the two groups: 26.3% for VTE group;19.9% in non VTE group, (p=0.556). However, VTE group had higher ICU admission rate 42.1% vs. 20.2% of non VTE group, p=0.039. Length of intubation was also significantly higher in VTE group (27 days) comparing to non VTE group (6 days), p=0.007. CONCLUSION(S): Covid 19 patients with VTE have much higher D dimer than non VTE Covid 19 patients. Although there is no difference in mortality in the two groups in our study, VTE group is associated with higher ICU admission as well as longer length of intubation days.

Variation in Lung Function in Pediatric and Adolescent Population Post SARS-COV-2 Infection: Pediatric Pulmonary Practice Experience

Introduction: In our study, we are reporting pulmonary function testing (PFT) changes post recovery from SARS-CoV-2 infection in the pediatric and adolescents. This is a unique paper which may shed light on a matter of utter importance that has been poorly reported in the literature. Studies reviewing SARS-CoV-2 infection PFT, mostly from adult, had shown obstructive and restrictive impairment, small airway dysfunction, and decreased diffusion capacity for carbon monoxide (DLCO), which gives an overall assessment of the lung's ability of gas exchange likely due to SARS-CoV-2 triggered pulmonary vasculopathy. Restrictive pattern and decreased DLCO were the most frequently impaired PFT parameter. Method: This is a single-site retrospective charts review of children and adolescents, ages 6 to 22 years old, who presented to pediatric pulmonology outpatient after having a SARS-CoV-2 infection. They were either managed in the hospital and had at least one pulmonary symptom or they were managed as outpatient. Results: In our case series of 33 patients, mean age was 16.8 years, the majority were seen as an outpatient (78.7%, 26/33). PFT results were interpreted using ATS standard, 4 PFT were suboptimal, mean time from SARSCoV- 2 infection and PFT was 4.3 months. Among patients with optimal PFT, 72.4% (21/29) had abnormal PFT (table 1). Subjects with PFT changes, 9 previously healthy subjects had PFT changes post- SARS-CoV-2, compared to 12 patients who had history of asthma. All hospitalized patients had measured DLCO except one whom DLCO wasn't measured. Among all hospitalized patients, whose pulmonary imaging exhibited ground glass opacities, 2 patients had normal DLCO (42.8%, 2/6). The rate of low DLCO was higher inpatient than outpatient cases (42.9% vs. 4.5%, p<0.0369) with mean DLCO 71.2% predicted. All hospitalized patients with decreased DLCO had elevated lactate dehydrogenase (LDH) and D-dimer.The most common co-morbid conditions noted to have were asthma (55%, 16/29) and obesity/overweight (51.7%, 15/29). Subjects who were hospitalized, 71% (5/7) required supplemental oxygen;most common chest imaging findings were bilateral ground-glass opacity, or patchy infiltrates. LDH was elevated in 71% (5/7) whereas D-dimer was elevated in 85.7% (6/7). All received steroids, and 85.7% (6/7) received remdesivir. Conclusion: SARS-CoV-2 related pulmonary complications remains a topic of research and is poorly studied in pediatric population. Impaired DLCO could correlate imaging findings However;we didn't find that association in our report, which is limited by low sample size. PFT may be useful as an objective measure for post-COVID infection follow up. (Figure Presented).

Neoadjuvant endocrine therapy (NET) during COVID-19: Single institution survey of patients perspectives

Background: Coronavirus disease 2019 (COVID-19) resulted in a global pandemic, which led to deferral of surgeries for early stage breast cancer during March-June 2020. Institutional guidelines were developed to use neoadjuvant endocrine therapy (NET) as a bridge to surgery. As a follow up to initial data presented at SABCS 2020 demonstrating patient acceptance of NET, the present study provides results from a survey which explored psychosocial factors associated with medication compliance. Objective: Primary objective was to identify any barriers to compliance with NET. Method: This was a single institution, prospective study that surveyed patients diagnosed with DCIS and early stage breast cancer at Perlmutter Cancer Center at NYU Langone Hospital and NYU Langone Hospital-Long Island from March 15, 2020-June 1, 2020. Questions were based on the Beliefs about Medicines Questionnaire specific for endocrine therapy (BMQ-AET) and the Medication Adherence Report Scale. Responses were recorded on a Likert scale and included 7 questions regarding perceptions about breast cancer treatment, 10 questions addressing experience with NET, and 5 questions gauging at adherence to NET. Inclusion criteria were males and females older than 18 years old, with an initial diagnosis of DCIS or early stage HR+ Her2/neu-breast cancer, who were prescribed NET. Descriptive statistics were calculated and subgroups were compared using Fisher's exact tests. Analyses were performed using SAS version 9.4. Results: From March 15-June 1, 2020, 13 patients were diagnosed with DCIS and 29 patients with HR+ Her2/neu-breast cancer for whom NET was recommended. Demographics are shown in Table 1. All 42 patients were female with an average age of 60.9 years. Majority of patients were post-menopause (74%) and predominantly white (64%), with an income of less than $60, 000 (52.4%). Average NET duration was 6.7 weeks. Survey responses displayed in Table 2 indicate statistically significant p values in bold. Patients >50 years old, post-menopause and invasive breast cancer had a stronger belief that NET would be helpful, resulting in greater perception to breast cancer treatment and higher adherence to NET. Patients treated with NET for greater than 4 weeks also felt that NET would make them feel well compared to ≤4 weeks. Interestingly, no significant differences in responses based on education or income level were observed. Conclusion: COVID-19 pandemic presented a unique opportunity to use NET, which is often underutilized outside of clinical trials. In this single institution prospective study, we found that post-menopause patients greater than 50 years old with invasive breast cancer perceived hormonal therapy as beneficial to their health, resulting in increased medication compliance. These findings can be used when counseling patients currently treated with NET as well as those patients may be appropriate for NET in the post-COVID era.

Neoadjuvant endocrine therapy (NET) as bridge therapy for early stage breast cancer during COVID-19: A single institution experience

Background: Neoadjuvant endocrine therapy (NET) has long been limited to patients who were deemed medically unfit for immediate surgery or on clinical trials. Coronavirus disease 2019 (COVID-19) resulted in a global pandemic, which led to deferral of elective surgeries including breast surgeries for early stage breast cancer patients during March-June 2020. Institutional guidelines were developed based on societal recommendations, including NCCN, to use NET as a bridge to surgery. Objective: Primary objective was to establish a database of early stage HR+ Her2/neu-breast cancer patients diagnosed during COVID-19 who were treated with NET as a bridge to surgery. Secondary endpoints include correlation between duration of NET and changes in pathological variables. Method: This was a single institution, retrospective observational study from Perlmutter Cancer Center at NYU Langone Hospital and NYU Langone Hospital-Long Island of DCIS and early stage breast cancer patients diagnosed from March 15, 2020-June 1, 2020 during COVID-19 pandemic. Inclusion criteria were males and females older than 18 years of age and initial diagnosis of DCIS or early stage HR+ Her2/neu-breast cancer who did not require neoadjuvant chemotherapy by established guidelines. Descriptive statistics were calculated separately by DCIS and invasive breast cancer using SAS version 9.4. Results: From March 15-S June 1, 2020, 13 patients who were diagnosed with DCIS and 41 patients with early stage HR+ Her2/neu-invasive breast cancer received NET (Table 1). Of the 41 patients with invasive breast cancer, 19 (46%) had Oncotype DX assay on biopsy specimens;12/19 (63%) had scores 10-14 and 7/19 (37%) had scores 15-25. 38/41 (92.7%) had post-surgery Ki-67% and 16/38 (42.1%) demonstrated maturation arrest (Ki-67 <2.7%). 26/41 (63%) invasive breast cancer patients had pre and post Ki-67% checked while on aromatase inhibitors (AI);21/26 (81%) had a decrease in Ki-67%, 2/26 (7.7%) patients had no change, and 3/26 (11.5%) had an increase. Of those 21 patients, the percent change of Ki-67% from baseline was mean 69.15% ± 22.58 and median 71.83%. No significant associations with changes (pre to post) in Ki-67%, T stage, ER% and PR% in NET for ≤4 weeks and >4 weeks (Table 2). Median duration of NET in invasive breast cancer was 6.85 weeks. 1 patient had a complete pathological response after NET and 2 patients were upstaged from DCIS to invasive carcinoma at the time of surgery. Conclusion: While the sample sizes are small, this is a unique cohort of early stage surgically resectable breast cancer patients who were treated with NET during the COVID-19 pandemic. This real-world data confirms pathological changes, especially decrease in Ki-67% even with short duration use of NET that has been reported in trials of neoadjuvant AI. Long term follow-up for survival outcome is planned.

Politicas publicas adoptadas en la pandemia de la COVID-19 en tres paises de America Latina: contribuciones de la Promocion de la Salud para no volver al mundo que existia

El mundo, despues de la pandemia de la COVID-19, no sera el mismo que existia y ni tan siquiera eso es deseable. La reanudacion de la "normalidad" (que solo es "normal" para unos pocos) seria el regreso a la produccion y el consumo insostenibles, la perdida de derechos, la exacerbacion de las iniquidades y una brutalidad diaria para muchos que luchan por sobrevivir. En America Latina (AL), el fin del mundo ya se anuncio incluso antes de la pandemia. Si, desde Bogota - 1992, la Declaracion de Promocion de la Salud denuncia la pobreza como el mayor determinante social de enfermedades en la region, los gobiernos parecen ignorarla, debilitando los sistemas de salud, educacion, ciencia y tecnologia, transferencia de ingresos y asistencia social bajo los auspicios de la austeridad fiscal, favoreciendo el aumento de la desigualdad. Usando datos de tres paises, Argentina, Brasil y Chile: 1) se senalan sus bajas inmunidades sociales anteriores a la pandemia;2) se analizan sus politicas publicas en respuesta a la pandemia, considerando los diferentes enfoques de intervencion en salud: grupos de riesgo, poblacion, vulnerabilidad y proporcionalismo universal;y, 3) se indica como la Promocion de la Salud (PS) podria influir sobre las politicas publicas para no volver al mundo que existia, usando como ancla dos documentos lanzados durante la pandemia y que explicitan la lente epistemica de la comunidad global de la PS en cinco puntos: intersectorialidad, sostenibilidad, empoderamiento, compromiso con la salud publica y equidad, y perspectiva de curso de vida. Evidencias producidas en el transcurso de la pandemia en los tres paises indican que los enfoques adoptados en las politicas publicas pueden, o no, favorecer el alcance de la agenda inconclusa de la PS y del desarrollo sostenible.

Public policies adopted in the COVID-19 pandemic in three Latin American countries: contributions from Health Promotion not to return to the world that existed

El mundo, despues de la pandemia de la COVID-19, no sera el mismo que existia y ni tan siquiera eso es deseable. La reanudacion de la "normalidad" (que solo es "normal" para unos pocos) seria el regreso a la produccion y el consumo insostenibles, la perdida de derechos, la exacerbacion de las iniquidades y una brutalidad diaria para muchos que luchan por sobrevivir. En America Latina (AL), el fin del mundo ya se anuncio incluso antes de la pandemia. Si, desde Bogota - 1992, la Declaracion de Promocion de la Salud denuncia la pobreza como el mayor determinante social de enfermedades en la region, los gobiernos parecen ignorarla, debilitando los sistemas de salud, educacion, ciencia y tecnologia, transferencia de ingresos y asistencia social bajo los auspicios de la austeridad fiscal, favoreciendo el aumento de la desigualdad. Usando datos de tres paises, Argentina, Brasil y Chile: 1) se senalan sus bajas inmunidades sociales anteriores a la pandemia;2) se analizan sus politicas publicas en respuesta a la pandemia, considerando los diferentes enfoques de intervencion en salud: grupos de riesgo, poblacion, vulnerabilidad y proporcionalismo universal;y, 3) se indica como la Promocion de la Salud (PS) podria influir sobre las politicas publicas para no volver al mundo que existia, usando como ancla dos documentos lanzados durante la pandemia y que explicitan la lente epistemica de la comunidad global de la PS en cinco puntos: intersectorialidad, sostenibilidad, empoderamiento, compromiso con la salud publica y equidad, y perspectiva de curso de vida. Evidencias producidas en el transcurso de la pandemia en los tres paises indican que los enfoques adoptados en las politicas publicas pueden, o no, favorecer el alcance de la agenda inconclusa de la PS y del desarrollo sostenible.

Políticas públicas adoptadas en la pandemia de la COVID-19 en tres países de América Latina: contribuciones de la Promoción de la Salud para no volver al mundo que existía

El mundo, después de la pandemia de la COVID-19, no será el mismo que existía y ni tan siquiera eso es deseable. La reanudación de la "normalidad" (que solo es "normal" para unos pocos) sería el regreso a la producción y el consumo insostenibles, la pérdida de derechos, la exacerbación de las iniquidades y una brutalidad diaria para muchos que luchan por sobrevivir. En América Latina (AL), el fin del mundo ya se anunció incluso antes de la pandemia. Si, desde Bogotá - 1992, la Declaración de Promoción de la Salud denuncia la pobreza como el mayor determinante social de enfermedades en la región, los gobiernos parecen ignorarla, debilitando los sistemas de salud, educación, ciencia y tecnología, transferencia de ingresos y asistencia social bajo los auspicios de la austeridad fiscal, favoreciendo el aumento de la desigualdad. Usando datos de tres países, Argentina, Brasil y Chile: 1) se señalan sus bajas inmunidades sociales anteriores a la pandemia;2) se analizan sus políticas públicas en respuesta a la pandemia, considerando los diferentes enfoques de intervención en salud: grupos de riesgo, población, vulnerabilidad y proporcionalismo universal;y, 3) se indica cómo la Promoción de la Salud (PS) podría influir sobre las políticas públicas para no volver al mundo que existía, usando como ancla dos documentos lanzados durante la pandemia y que explicitan la lente epistémica de la comunidad global de la PS en cinco puntos: intersectorialidad, sostenibilidad, empoderamiento, compromiso con la salud pública y equidad, y perspectiva de curso de vida. Evidencias producidas en el transcurso de la pandemia en los tres países indican que los enfoques adoptados en las políticas públicas pueden, o no, favorecer el alcance de la agenda inconclusa de la PS y del desarrollo sostenible.