Stressful experiences impact clinical symptoms in people with endometriosis

Endometriosis is a chronic condition that affects ~10% of women globally. Its symptoms include chronic pelvic pain, heavy periods and tiredness/fatigue, which have been associated with poorer quality of life and mental health. We aim to explore the impact of the COVID-19 pandemic on pain and fatigue symptoms and their interactions with the impact on mental health in people with endometriosis. This global cross-sectional online survey study collected data from 4717 adults with self-reported surgical/radiological diagnosis of endometriosis between May and June 2020. The survey included questions on the current status and changes of endometriosis symptoms (pelvic pain, tiredness/fatigue, and bleeding patterns), mental health, pain catastrophising, and the impact of the COVID-19 pandemic on the respondents’ lives. Compared to 6 months earlier, Respondents reported a marked worsening of their endometriosis symptoms (endometriosis-associated pain (39.3%;95% CI: 37.7, 40.5), tiredness/fatigue (49.9%;95% CI: 48.4, 51.2) and bleeding patterns (39.6%;95% CI: 38.2, 41)) and mental health (38.6%;95% CI: 37.2, 39.9). Those with a pre-existing mental health diagnosis (38.8%) were more likely to report their symptoms worsening. Worsening of pain and tiredness/fatigue was significantly correlated with worsening of mental health (P < 0.001). The relationship between changes in mental health and (a) change in pain and (b) change in fatigue was found to be weakly mediated by pain catastrophising scores (pain: B = 0.071, lower limit of confidence interval (LLCI) = 0.060, upper limit of confidence interval (ULCI) = 0.082, tiredness/fatigue: B = 0.050, LLCI = 0.040, ULCI = 0.060). This study demonstrates that stressful experiences impact the physical and mental health of people with endometriosis. The findings highlight the need to consider psychological approaches in the holistic management of people with endometriosis.Lay summary: Endometriosis is a chronic condition in which tissue similar to that of the lining of the womb grows outside it. It affects around 10% of women globally, and the symptoms often include persistent pelvic pain, heavy periods and tiredness/fatigue. These symptoms are associated with impaired mental health and life quality. This study used an online questionnaire to assess the experiences of people with endometriosis during the first months of the pandemic. Results from 4717 adults revealed that pelvic pain, tiredness/fatigue and bleeding worsened in more than 39% of the participants. Poor mental health was also exacerbated and associated with worsening in tiredness/fatigue. Further analysis revealed that this relationship could be partially explained by ‘pain catastrophising’, which measures how participants think about their pain. Our results suggest that stressful experiences like the pandemic negatively impact the already burdened mental health of people with endometriosis, who could benefit from psychological interventions.

Rural governance in Mexico in times of the pandemic. Analysis from the network of political participation mechanisms

Rural governance is a notion of relatively recent use at a global level in the academic field. In Mexico, rural governance has only recently come into use and refers to new, more collaborative forms of social and political coordination of rural public affairs. The text sustains that this, in part, is expressed in political participation mechanisms (PPM), arrangements or spaces in which governmental and non-governmental actors come together for this purpose. The main objective of this collaboration is to analyze the existing network or constellation of PPM in Mexico, in the context of the pandemic originated by Covid-19, and to discuss the way in which this emergency has affected the operation of these devices observed, as a whole, as a general unit of research and analysis. It is believed that this network has been of little use in dealing with the exceptional situation defined by social confinement, and that it is necessary to deepen its scope and capabilities so that in the future it may be constituted as a more effective way of amplifying the deliberative and participatory options available to citizens and rural civil society and, more generally, for democracy.

Working at home during Covid-19: Are extent and/or flexibility important for job satisfaction, social support, commitment and work interruptions?

The debate on the advantages and disadvantages of teleworking (i.e., working from home) has gained momentum during the Covid-19 pandemic: Even public authorities have given their employees the opportunity to switch to teleworking. Many studies on teleworking have been carried out with employees who have been teleworking for years. However, it is unclear which consequences a sudden shift to teleworking has. This article examines to what extent the use of teleworking and the possibility of its flexible usage are associated with work-related variables such as job satisfaction, social support, affective commitment and work interruptions. A total of 477 employees of a medium sized public agency took part in the online survey. Our analyses show that more teleworking is associated with fewer work interruptions. We did not find any significant association between the extent of teleworking and job satisfaction, affective commitment and social support. However, there were positive relationships between the perceived flexibility of the place of work with all outcomes with the exception of work interruptions. The findings provide evidence of the importance of the flexible use of teleworking and thus the perceived opportunity to decide for oneself whether to work from home. This implies that organizations-including public agencies-need employee-oriented flexibility, that is, they should give employees the greatest possible decision latitude on the individual use of flexible work options.

Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study

AIMS OF THE STUDY: There is increasing interest in better understanding of long COVID, a condition characterised by long-term sequelae-appearing or persistingafter the typical convalescence period-of coronavirus disease 2019 (COVID-19). Herein, we describe long-term outcomes regarding residual symptoms and psychological distress in hospitalised patients 1 year after COVID-19. METHODS: This prospective cohort study included consecutive adult patients hospitalised for confirmed COVID-19 in two Swiss tertiary-care hospitals between March and June 2020. The primary endpoint was evidence of long COVID 1 year after discharge, defined as =1 persisting or new symptom related to COVID-19, from a predefined list of symptoms. Secondary endpoints included psychological distress and symptoms of post-traumatic stress disorder (PTSD). RESULTS: Among 90 patients included in the study, 63 (70%) had symptoms of long COVID 1 year after hospitalisation, particularly fatigue (46%), concentration difficulties (31%), shortness of breath (21%) and post-exertion malaise (20%). Three predictors, namely duration of hospitalisation (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.00-1.22;p = 0.041), severity of illness (OR 1.19, 95% CI 1.04-1.37;p = 0.013), and self-perceived overall health status 30 days after hospitalisation (OR 0.97, 95% CI 0.94-1.00;p = 0.027) were associated with long COVID. Regarding secondary endpoints, 16 (18%) experienced psychological distress and 3 (3.3%) patients had symptoms of PTSD. CONCLUSION: A high proportion of COVID-19 patients report symptoms of long COVID 1 year after hospitalisation, which negatively affects their quality of life. The most important risk factors were severe initial presentation of COVID-19 with long hospital stays.

[COVID-19 in old age-The geriatric perspective]. / COVID-19 im Alter ­ Die geriatrische Perspektive.

Predominantly the older population is affected by a severe course of COVID-19. The mortality of hospitalized patients with COVID-19 above the age of 80 years is up to 54% in international studies. These observations indicate the necessity to highlight the geriatric perspective on this disease. The diagnostics and treatment of COVID-19 do not differ between younger and older patients but atypical symptoms should be expected more frequently in old age. Older subjects show an increased need for rehabilitation after COVID-19. Paradoxically, increasing rehabilitation demands go along with a reduced availability of geriatric rehabilitation options, the latter being a consequence of closure or downsizing of rehabilitation departments during the pandemic. In general, measures of isolation and quarantine should be diligently balanced as the health and emotional consequences of such measures may be severe in older persons. In light of the poor prognosis of older COVID-19 patients, advanced care planning becomes even more relevant. Caregivers and physicians should be encouraged to compose advanced care directives that also reflect the specific circumstances of COVID-19. Fortunately, current data suggest that the effectiveness of the vaccination with the mRNA-vaccines approved in Germany may be equally high in older compared to younger persons.

["Online from tomorrow on please": comparison of digital framework conditions of curricular teaching at national university ENT clinics in times of COVID-19 : Digital teaching at national university ENT clinics]. / "Ab morgen bitte online": Vergleich digitaler Rahmenbedingungen der curricularen Lehre an nationalen Universitäts-HNO-Kliniken in Zeiten von COVID-19 : Digitale Lehre an nationalen Universitäts-HNO-Kliniken.

BACKGROUND: The corona crisis not only affects professional activities but also teaching and learning at universities. Buzzwords, such as e­learning and digitalization suggest the possibility of innovative teaching approaches that are readily available to solve the problems of teaching in the current COVID-19 pandemic. The current conversion to digital teaching is not primarily driven by didactic rationale or institutional strategy but by external circumstances. OBJECTIVE: The aim of the study was to determine the teaching situation at national university ENT clinics and academic teaching hospitals at the start of the virtual corona summer semester in 2020. MATERIAL AND METHODS: A specifically self-designed questionnaire regarding the local situation and conditions as well as nationwide scenarios was sent to all 39 national university ENT clinics and 20 ENT departments at academic teaching hospitals. RESULTS: A total of 31 university hospitals and 10 academic teaching hospitals took part in the survey. There were obvious discrepancies between available resources and effectively available digital teaching and learning contents. Further criticism was expressed regarding the communication with the medical faculty, the digital infrastructure and particularly the frequent lack of collaboration with central support facilities, such as media, didactics and datacenters. CONCLUSION: There are positive examples of successful transformation of classroom teaching to an exclusively virtual summer semester 2020 within the university ENT clinics; however, critical ratings of assistant professors and medical directors regarding the current teaching situation predominated. A time-critical strategic advancement is urgently needed.