ABSTRACT
During the COVID-19 pandemic, detained persons suffered an increasing number of human rights violations. A World Organisation Against Torture (OMCT) report highlighted the abusive practices and legal ways to fight them. People in detention are generally at high risk of infectious diseases. Jails are overcrowded everywhere, hygiene is generally poor, and quarantine is often impossible. Persons with pre-existing medical conditions or pregnancies are especially vulnerable. It thus was no surprise that COVID-19 spread fast in detention facilities. Because of rules meant to contain the disease, infected persons often struggled to get in touch with lawyers and insisted on judicial review. Nonetheless, lawyers did find ways to assist people in jails and improve protection against COVID-19. This article highlights the OMCT report that assessed pandemic-related human rights issues, which were prevalent in many countries, focusing on Asia, Africa, and Latin America. It also discusses the legal and advocacy strategies and promising practices to protect people from COVID-19 in detention effectively, challenge ongoing and pandemic-related human rights violations occurring in detention settings, and seek accountability for abusive law enforcement measures.
ABSTRACT
Introduction: Inflammatory Bowel Disease (IBD) is a chronic inflammatory disease of the gastrointestinal tract. Recently, physical activity has been suggested to improve quality of life and course of disease in adult IBD patients. Aims & Methods: The aim of this study was to examine physical functioning in paediatric and adolescent IBD patients and to investigate the effects of a tailored 12-week lifestyle intervention including a physical training program. This study is a randomized crossover trial, including a 12-week intervention and 12 week control period. All measurements were conducted at baseline, after the control period, and after the 12-week lifestyle intervention. The endpoints were (1) Disease activity: measured by PCDAI/ PUCAI and fecal calprotectin. Clinical remission was defined as PCDAI/ PUCAI scores <10. (2) Exercise capacity: PeakVO2 measured by maximal cardiopulmonary exercise test, (3) Physical activity levels: measured by actigraph, (4) Endurance: walked distance on 6-minute walking test, (5) Quality of life: measured by IMPACT-III questionnaire and the child health questionnaire, (6) Fatigue: measured by the PedsQol Multi Fatigue Scale. The tailored 12-week lifestyle intervention was designed based on the baseline measurements, and consisted of 3 supervised strenuous physical training sessions a week and healthy diet advice in accordance with measured total energy expenditure. Results: Sixteen paediatric IBD patients (median age 15 [9 - 17]) were included, 13 patients successfully completed the training program, 2 patients are still participating. At baseline 3 out of 13 patients were in clinical remission. Patients had reduced exercise capacity (76.8%±17.7% of predicted PeakVO2), and reduced physical activity levels as shown by 80.3%±7.4% of measured time being spent in sedentary activity. PCDAI/ PUCAI scores decreased significantly (13.8±11.7 vs. 3.65±4.5, P=0.002). Fecal calprotectin decreased significantly over the exercise period (400 [18-3089] vs. 128 [20-2704], P=0.041). All patients but one had no changes in medical regimens before or during the lifestyle intervention that could have influenced disease activity. After the 12-week lifestyle intervention period, 9 out of 13 patients were in clinical remission. Maximum walked distance increased significantly (503±69 vs. 540±77 meters, P=0.001), although PeakVO2 and percentage of time spent in moderate-to-vigorous activity did not. Patients improved on overall quality of life measured by the Impact-III (+2.4 points, p=0.017). The Child Health Questionnaire showed a significant improvement on the child-reported physical functioning scale and on 5 parent-reported scales of quality of life. Child-reported fatigue measured by the PedsQol MFS did not improve significantly, parents-reported fatigue did. No changes were found on mentioned outcomes during the control period. The control period was extended by 3 months due to the COVID-19 lockdown, which started right after baseline measurements and lasted the entire study. The lockdown possibly affected normal daytime activities of the patients during this study. Conclusion: This study is the first to investigate the effects of a tailored life-style intervention on disease activity, exercise capacity, physical activity, endurance, quality of life and fatigue in paediatric IBD patients. This study shows that a 12-week tailored physical training program including diet advice is safe and beneficial for paediatric IBD patients, and may even contribute to better control of inflammation.