People with metastatic breast cancer face barriers to finding information and support

People with metastatic breast cancer face barriers to finding information and support Background FORCE, a national nonprofit organization developed a health communication tool to help patients assess research relevance, key findings, and the quality of media reporting on cancer to support informed and shared health decision-making. People with metastatic breast cancer (mBC) are a priority population. Methods The organization conducted a survey about awareness of and access to breast cancer information and supportive services for people living with metastatic breast cancer. The organization promoted the survey through e-mail and social media, and a network of partner organizations that serve the metastatic breast cancer community. The survey invited respondents to volunteer to participate in focus groups and a follow-up survey in order to support efforts to serve this priority population. Results and Conclusions While interest in clinical trials was high, many users reported that thy do not know how to find an appropriate clinical trial. A majority of the 335 respondents were interested in information about clinical trials, treatment side effects, research findings, long-term health issues, diet/exercise, fatigue, and emotional health. Three quarters of the respondents indicated that they had never participated in a clinical trial, 67% indicated they would be interested in participating in the future, and about 40% indicated they did not know how to find a clinical trial recruiting people with metastatic breast cancer. Approximately one-third of participants were unable to obtain referrals to services they sought. Other barriers to services included lack of insurance coverage, lack of availability, and the COVID-19 public health emergency. Focus group responses indicate that women with mBC find the health communication tool to be useful, and appropriate in language, images, and tone. Results indicate that women with mBC are interested in finding information about clinical trials and other topics related to treatment side effects and quality of life. FORCE and partners are incorporating these results into tailored online resources to meet the needs of the mBC community.

Impact of telehealth on improving access to pregnancy care in an underserved population

Objective: Social determinants of health (SDOH) contribute to health inequities in pregnancy. The availability, convenience, and timeliness of access to care affects healthcare utilization. The COVID-19 pandemic exposed the need for efficient and widespread implementation of telehealth services. However, expanding telehealth services has changed adherence to maternal fetal medicine (MFM) at a large, urban, Federally Qualified Health Center (FQHC). We describe the utilization of these services and its effect on adherence to MFM visits. Study Design: This is a retrospective, quality improvement project comparing non-adherence to scheduled visits looking at two time frames: 1) Pre-COVID (8/1/2018-2/29/2020) in-person only 2) Post-COVID 1/1/2021-7/31/2022 in-person or virtual. All encounters in MFM at FQHC were included during these periods. In the Post-COVID period, patients had the option for either in-person or virtual visit at the time of scheduling, while in pre-COVID period, in-person visit was the only option. Chi-square was used to compare differences between groups, with p< 0.05 defined as significant. Result(s): A total of 1,607 encounters were included, n=609 in the pre-COVID and n=998 in the post-COVID group. Encounter completion rates differed between the pre-COVID and post-COVID groups (80% vs. 86%, p= 0.001), Table. In the post-COVID group, when telehealth was an alternative option, non-adherence rates were significantly lower in comparison to when telehealth was not an option in the pre-COVID group. However, in the post-COVID group, the non-adherence rate between virtual only or in-person only visits were not significantly different (p=0.178). Conclusion(s): The availability of either in-person or virtual visits improved compliance and access to MFM care in a FQHC. While the option of telehealth services can improve patient compliance with visits, this may exacerbate other disparities due to limited internet services, access to remote devices, or language barriers. Further research is needed to understand how telehealth can be an ongoing solution to overcome the SDOH that create inequity. [Formula presented] [Formula presented] Copyright © 2022

Reykjanes Mantle Convection and Climate: Crustal Objectives

The five primary sites proposed for International Ocean Discovery Program (IODP) Expedition 395, which was postponed because of the COVID-19 pandemic, were cored during IODP Expedition 395C. The Expedition 395C operations, shipboard measurements, and sampling were adjusted to account for the absence of a sailing science party. The Expedition 395/395C objectives are (1) to investigate temporal variations in ocean crust generation at the Reykjanes Ridge and test hypotheses for the influence of Iceland mantle plume fluctuations on these processes, (2) to analyze sedimentation rates at the Björn and Gardar contourite drifts, as proxies for Cenozoic variations of North Atlantic deepwater circulation, and for uplift and subsidence of the Greenland-Scotland Ridge gateway related to plume activity, and (3) to analyze the alteration of oceanic crust and its interaction with seawater and sediments. During Expedition 395C, basalt cores were collected at four sites: U1554, U1555, U1562, and U1563. Sediment cores were also collected from these sites as well as from Site U1564, and casing was installed to 602 m at Site U1554. The amount of recovered cores, their preliminary descriptions, and the analyses of shipboard samples show that the results of Expedition 395C will fulfill a significant part of the Expedition 395 objectives. Basalts were collected from two V-shaped ridge and trough pairs, which will allow the investigation of the variability in mantle source and temperature causing this ridge/trough pattern. Basalt cores span an expected age range of 2.8–13.9 Ma, which will allow us to investigate the hydrothermal weathering processes. Sediments from the Björn drift were cored to basement, along with the uppermost 600 m of sediments from the Gardar drift. The data provided by Expedition 395C are a major advancement in achieving the work of Expedition 395. © 2022 Authors. All rights reserved.

BEREAVEMENT IN THE COVID-19 PANDEMIC: THE GRIEF EXPERIENCE OF AFRICAN AMERICAN & LATINO COMMUNITIES

Background: The COVID-19 pandemic death rate for African American and Latinx communities is twice as high as White Americans, leaving more loved ones to cope with the difficulties of bereavement. With already existing challenges, the COVID-19 pandemic has emphasized the need to understand the disproportionate struggles of people of color. Methods: To study the impact, we conducted the Survey of Bereavement After Covid-Related Death. In the current study, 267 participants answered online surveys, measuring loss characteristics, demographics, depression, grief, and an option for open-ended comments. Results: Grief and depression scores were predicted by kinship relationship, participant age, and time since loss, but were not predicted by gender, race, or ethnicity in regression analyses (grief: F = 6.38, p < .001;depression: F = 5.30, p < .001). However, the sample was not representative of the current population, with fewer African Americans and Hispanic/Latinx individuals than in the community. Conclusion: Pandemic grief severity and depression following bereavement is predicted by factors seen in pre-pandemic grief research. However, the study revealed that there are still significant challenges among recruiting underrepresented populations in academic research, indicating that further research is necessary.

GRIEF AND LOSS DURING THE COVID-19 PANDEMIC: EXPLORING PERCEIVED PHYSICAL HEALTH AS A PREDICTOR FOR RUMINATION

Background: Ruminative thought predicts complicated grief and hinders the adjustment to loss by acting as a cognitive avoidance strategy. Not only is the process linked to psychological issues, rumination is also associated with negative health consequences, such as poor sleep quality, impaired immune functioning, and cardiovascular disease. Understanding how bereaved people adjust to the death of a loved one, and the associated physical and psychological health outcomes, can offer meaningful direction for interventions. Self-reported physical health has been shown to be indicative of documented physical health. Very few studies have investigated the potential relationship between self-reported physical health and rumination, especially in the bereaved population. Methods: Arizonans who experienced the death of a partner, child, sibling, parent, grandparent, other family member, non-biological family, or close friend in the past year were recruited for a semi- structured phone interview, during which they reported their grief severity, depressive symptoms, grief-specific rumination, and perceived physical health. Results: In the present study (N = 51), we tested whether perceived physical health acts as a predictor for grief-specific rumination in bereaved individuals who experienced the death of a loved one during the COVID-19 pandemic. Participants (74.5% White, 80.4% non-Hispanic) had an average age of 51 (SD = 15.9) and were mostly female (76.5%). Linear regression analyses showed that self-reported physical health predicted grief rumination outcomes (F = 4.0, p = 0.005). Notably, self-reported physical health also predicted grief severity (F = 4.0, p < 0.005) and depression (F = 5.2, p < 0.001). Conclusion: These results are consistent with previous findings that engagement in ruminative thought is associated with poorer health. Using self-report measures to assess physical health may offer accessible insights related to psychological health outcomes-especially in a time of social distancing.

PANDEMIC GRIEF STUDY (PANGS): ACUTE GRIEF OF BEREAVED RELATIVES FOLLOWING DEATHS DURING COVID-19

Background: The COVID-19 pandemic has led to the death of over 700,000 Americans, with each death leaving 9 surviving Americans (i.e., over 6 million bereaved). One harsh reality of the pandemic has been that survivors have often not been able to care for their dying loved ones, and grieve for them in traditional ways (e.g., wakes, funerals), due to social distancing. The present study used semi-structured clinical interviews to investigate acute grief during the pandemic. Methods: Participants were interviewed by phone, including the Center for Epidemiological Studies-Depression scale, a 20-item measure of depression;the Prolonged Grief Disorder scale, a 13-item measure of prolonged grief disorder;the Work and Social Adjustment Scale (WSAS), a 5-item measure assessing for adjustment after major life events;the Post-Traumatic Growth (PTG) scale, a 10-item measure of growth following a traumatic event such as the death of a loved one;the Utrecht Grief Rumination Scale (UGRS), a 15-item scale measuring various aspects of grief-related rumination;the Interpersonal Support Evaluation List (ISEL), a 12-item measure assessing for social support following a major life event. Results: Participants (N = 51, 74.5% White, 80.4% non-Hispanic) had an average age of 51 (SD = 15.9) and were mostly female (76.5%). 53.0% said they were unable to provide support for their dying loved one, 45.1% said they were not able to say good-bye, 47.1% said they were not prepared, 45.1% said they should have been present for the death. The sample experienced sub-clinical depressive symptoms (M = 10.04, SD = 7.03), and moderate prolonged grief symptoms (M = 23.0, SD = 9.15). Participants had a mean of 7.61 (SD = 10.02) on the WSAS, 23.24 (SD = 13.50) on the PTG, 17.31 (SD = 14.50) on the UGRS, and 30.25 (SD = 4.63) on the ISEL. Conclusion: Despite feeling unprepared for the death of their loved ones during the pandemic, depression and grief scores suggest that many individuals are resilient, given their moderate prolonged grief and sub-clinical depression scores on average. The scores for the WSAS suggest that people are adjusting to work and social life following the death of their loved ones. Clinical intervention should focus on the small proportion who are not adjusting during pandemic bereavement.

Technology as Treatment: Use of Virtual Complementary and Integrative Therapies by Patients in Neurology

Objective: Given the reductions in in-person visits and the increases in teleneurology visits, we sought to determine whether patients increased their use of virtual complementary and integrative therapies. Background: Patients with neurological disorders may seek treatment options in addition to those recommended by their providers. Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). Design/Methods: By examining two separate datasets that included cohorts of patients with neurological disorders, we assessed patients' use of virtual (and non-virtual) CITs and determined whether there were clinical characteristics that predicted their use. The two studies that comprised this report included one that examined patient and provider experiences with teleneurology visits, and another that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. Results: Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Conclusions: Data from our investigations demonstrated that, in addition to its other roles in teleneurology, CIT-related technologies may be utilized in the treatment of neurologic conditions.

COVID-19 mortality in New York City across neighborhoods by race, ethnicity, and nativity status. (Special Issue: Examining the COVID crisis.)

New York City has lost more lives from COVID-19 than any other American city. This study examines variation in covid-19 deaths across neighborhoods as it relates to variation in the racial, ethnic, and nativity-status composition of neighborhoods. This topic has received little scholarly attention and is imperative to explore, given the absence of racial and ethnic specific COVID-19 mortality rates by neighborhood. New York City is a racially and ethnically segregated city, and a longstanding destination of immigrants, making some neighborhoods more susceptible to greater levels of COVID-19 mortality than others. Using ZCTA-level data on COVID-19 deaths and demographic data from the American Community Survey, our descriptive and bivariate choropleth mapping analyses reveal that a racial, ethnic, and nativity-status hierarchy exists in the geographic distribution of COVID-19 mortality. Implications of these findings are discussed as they relate to residential segregation and persistent spatial inequalities faced by neighborhoods of color.

Editorial: Diagnostic Testing for SARS-Coronavirus-2 in the Nursing Facility: Recommendations of a Delphi Panel of Long-Term Care Clinicians.

With the COVID-19 pandemic progressing, guidance on strategies to mitigate its devastating effects in nursing facilities (NFs) is critical to preventing additional tragic outcomes. Asymptomatic spread of COVID-19 from nursing facility staff and residents is a major accelerator of infection. Facility-wide point-prevalence testing is an emerging strategy in disease mitigation. Because time is not available to await the results of randomized controlled trials before implementing strategies in this high-risk setting, an expert Delphi panel composed of experienced long-term care medicine professionals has now met to provide testing guidance for SARS-Coronavirus-2 to NFs. After many email and telephone discussions, the panel responded to a questionnaire that included six different scenarios, based on varying availability of Polymerase Chain Reaction (RT-PCR) testing and personal protective equipment (PPE). The panel endorsed facility-wide testing of staff and residents without dissent when diagnostic RT-PCR was available. While the panel recognized the limitations of RT-PCR testing, it strongly recommended this testing for both staff and residents in NFs that were either COVID-19 naive or had limited outbreaks. There was also consensus on testing residents with atypical symptoms in a scenario of limited testing capability. The panel favored testing every 1 to 2 weeks if testing was readily available, reducing the frequency to every month as community prevalence declined or as the collection of additional data further informed clinical critical thinking and decision-making. The panel recognized that frequent testing would have consequences in terms of potential staff shortages due to quarantine after positive tests and increased PPE use. However, the panel felt that not testing would allow new clusters of infection to form. The resulting high mortality rate would outweigh the potential negative consequences of testing. The panel also recognized the pandemic as a rapidly evolving crisis, and that new science and increasing experience might require an updating of its recommendations. The panel hopes that its recommendations will be of value to the long-term care industry and to policy makers as we work together to manage through this challenging and stressful time.