Implementation Evaluation of HUGS/Abrazos During the COVID-19 Pandemic: A Program to Foster Resiliency in Pregnancy and Early Childhood.

Early life adversity can significantly impact child development and health outcomes throughout the life course. With the COVID-19 pandemic exacerbating preexisting and introducing new sources of toxic stress, social programs that foster resilience are more necessary now than ever. The Helping Us Grow Stronger (HUGS/Abrazos) program fills a crucial need for protective buffers during the COVID-19 pandemic, which has escalated toxic stressors affecting pregnant women and families with young children. HUGS/Abrazos combines patient navigation, behavioral health support, and innovative tools to ameliorate these heightened toxic stressors. We used a mixed-methods approach, guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, to evaluate the implementation of the HUGS/Abrazos program at Massachusetts General Hospital from 6/30/2020-8/31/2021. Results of the quality improvement evaluation revealed that the program was widely adopted across the hospital and 392 unique families were referred to the program. The referred patients were representative of the communities in Massachusetts disproportionately affected by the COVID-19 pandemic. Furthermore, 79% of referred patients followed up with the initial referral, with sustained high participation rates throughout the program course; and they were provided with an average of four community resource referrals. Adoption and implementation of the key components in HUGS/Abrazos were found to be appropriate and acceptable. Furthermore, the implemented program remained consistent to the original design. Overall, HUGS/Abrazos was well adopted as an emergency relief program with strong post-COVID-19 applicability to ameliorate continuing toxic stressors while decreasing burden on the health system.

Assessing the implementation of governance best practices by Latin American ports

In this paper, a semi-structured interview approach is used to assess governance and institutionalist practices promoted among successful port systems worldwide, in Latin American ports. The aim is to provide recommendations that would allow Latin American ports to reach high performance scores through governance practices, and face the challenges imposed by the COVID-19 pandemic, fostering a more resilient port ecosystem. A three-stage methodological framework, composed of six steps, is proposed. In the first stage, semi-structured interviews were carried out, with a total of 178 participants, to assess the state of implementation of governance practices in 24 Latin American ports. These practices were identified from a literature review and are promoted among successful port systems worldwide. In a second stage, the relationship between governance practices in ports and their performance was analyzed, aiming to identify those governance and institutionalist strategies that are most extensively used by the best performing ports. Finally, in a third stage, we provide recommendations that would allow Latin American ports to reach high performance scores through improved governance practices. The results indicate that digitalization and coordination among the stakeholders of the port logistics community are two of the most cited governance practices in the best performing Latin American ports. This paper contributes to the theory of port governance in Latin America, by empirically relating and identifying those governance practices which contribute to port performance. © 2022, The Author(s), under exclusive licence to Springer Nature Limited.

Online cognitive behavioural therapy as a psychological vaccine against stress during the COVID-19 pandemic in pregnant women: A randomised controlled trial.

The COVID-19 pandemic has affected the population's levels of stress and anxiety due to its contagious nature and the uncertainties generated by its novelty. One population that is especially vulnerable to these psychological consequences are pregnant women. This is why the objective of this study was to test the efficacy of an online stress management programme of a cognitive behavioural nature on pregnant women during the COVID-19 pandemic, in Spain. The trial was controlled and randomised, with a total of 207 pregnant women divided into three groups: the Online Cognitive Behavioural Therapy group (o-CBT) (N = 70); the Online Psychological Support group (o-PS) (N = 69); and the Usual Care group (UC) (N = 68). To test the therapy's efficacy, the women's resilience, perceived stress, pregnancy-specific stress and psychopathological symptoms were assessed before and after the intervention. The o-CBT and o-PS consisted of a programme of 8 group sessions (one per week). The results showed that pregnant women who participated in the o-CBT group presented lower rates of pregnancy-specific stress and perceived stress, as well as greater resilience and lower anxiety, depression and obsessions-compulsions symptoms. These data show the efficacy of the treatment programme and thus confirm the importance of implementing these types of interventions during a woman's pregnancy, especially over periods of major stress, such as during a pandemic.

An Analysis of the Perception of Students and Teachers towards the Home-Based Online Learning Modality and the Students' Academic Achievement of a Private School in the National Capital Region (NCR) of the Philippines

The Covid-19 pandemic shut schools worldwide and as a result, new learning modalities such as Home-Based Online Learning (HBOL) were implemented to continuously provide quality education and make learning seamless as possible even without physical interaction among students and teachers. Utilizing a quantitative research design, this study aims to determine the perception of students and faculty regarding the first implementation of a full home-based online learning program of a private school in the Philippines. It also aims to provide an overview on how the students perform in a full online education based on assessment results and report card grades. A total of 169 faculty, 39 administrators and 1600 students from Grade 1 to Grade 12, or N=1808, participated in the study through an online survey. Results show that the overall design and objectives of the HBOL program are clear. The online class schedule is manageable and the combination of synchronous and asynchronous as learning modalities is beneficial. Also, the provided technical support is sufficient. However, the sudden shift from actual traditional face-to-face to full virtual classes caused stress and adjustment difficulties specifically with concerns that involve connectivity, amount of workload, class preparations, delivery and understanding the lessons, classroom management, student engagement and social interactions. Regarding academic achievement, the formative and summative assessment results of select Math, English, and Science classes are all above the passing grade and the final grade average of the students in the first trimester of SY 2020-2021, pilot implementation of HBOL, is highly satisfactory. Results obtained may be used as a basis to further improve the program as these are generally good and favorable to the school considering that the transition to a full online class was the institution's immediate response to the face-to-face restrictions brought about by the global health crisis. © 2022 ACM.

Predictors of left ventricular ejection fraction recovery after transcatheter aortic valve replacement (TAVR)

Introduction: Transcatheter aortic valve replacement (TAVR) has proven benefits in patients with reduced left ventricular ejection fraction (LVEF). A significant proportion of them shows recovery of systolic function Objective: To analyse the main baseline, electrocardiographic and echocardiographic characteristics that may predict LVEF recovery after TAVR. Methods: A cohort study was conducted. Consecutive patients undergoing TAVR in our center from January 2012 to December 2020 were included. Baseline clinical profile, electrocardiographic (EKG), echocardiographic (ECH) parameters were recorded, as well as MACE during followup (major adverse cardiovascular events including: all-cause mortality, myocardial infarction, cerebrovascular accident and heart failure hospitalization). Reduced systolic function was defined as LVEF <50%. We considered recovery of systolic function as LVEF ≥50% at follow-up. Results: A total of 292 patients were included. 48% were women and the median age was 81.07 years (77.63-86.22). 22.6% (66 patients) had reduced LVEF at baseline. Half of them showed recovered systolic function during follow-up. Patients who did not recovered LVEF had a higher prevalence of dyslipidemia and peripheral artery disease. History of cardiac surgery was more frequently found in this group, and they showed a higher surgical risk estimated by EuroScore II. They had lower LVEF and aortic valve mean gradient, and more frequently presented non-synus rhythm (NSR), left bundle branch block and right ventricular dysfunction (RVD). These characteristics are shown in figure 1. In univariate analysis lower Euroscore II, presence of synus rhythm, absence of LBBB and RVD, as well as higher aortic valve mean gradient were predictors of LVEF recovery. In multivariate analysis RVD and mean aortic gradient were independent predictors. Among all patients included in our study, those presenting with RV dysfunction were significantly associated with lower LVEF mean values (46,0% vs 57,2%;p<0,01) After a median follow-up of 21.3 (8.52-38.94) months, MACE were lower in recovered LVEF group (HR 0.25 95% CI: 0.05-1.21). There were no statistically significant differences in all-cause mortality, nevertheless there was a trend towards a higher non-cardiovascular mortality in this group, essentially at the expense of deaths from malignant neoplasms and SARS-COV- 2 infections. Survival curves for MACE are represented in figure 2. Conclusion: In our study, half of the patients with impaired ventricular function undergoing TAVR showed recovery of ejection fraction. Right ventricular function and aortic valve mean gradient at baseline were independent predictors of recovery. Identifying predictors of LVEF recovery is fundamental in the evaluation of potential candidates for TAVR, and can help clinicians assess risks and benefits, as well as long-term prognosis of these patients.

Impact of Covid-19 pandemic on gynecological cancer management: national survey. GineonCoVIDsurg Study

Introduction/Background*The current COVID 19 pandemic is having a major impact on healthcare systems around the world. Modifications in health resources have been necessary to face this new situation, which have had a direct impact on clinical practice, also affecting the field of gynecology oncology. To date, the evidence of the changes that COVID-19 has implied in the management of patients with gynecological cancer is scarce.The objective of this study is to evaluate the impact of the COVID-19 pandemic on the management of patients with gynecological cancer by a nationwide survey to oncogynecologists.MethodologyObservational study that collects data from a national survey sent via email to Spanish oncogynecological surgeons on June 2021. The survey included a total of 35 questions which were divided into 6 sections including assessment of the personal characteristics of responders, questions related to the triage procedures and protective measures adopted in the hospital against COVID-19 and questions related to changes in the management of ovarian, endometrial and cervical cancer after COVID-19 outbreak.Result(s)*Overall, 75 participants completed the questionnaire. The results showed that 85% of gynecologic surgeons were not concerned about COVID-19 outbreak and 79.7% of the participants stated that COVID-19 has not significantly modified their everyday practice. All surgeons declared triage method adopted in order to minimise COVID 19 diffusion. 87.5% did not modify surgical approach, although 6.9% decreased laparoscopic use in favor of laparotomic surgery. Only 45.1% of the surgeons adopted specific protection against COVID-19 in robotic or laparoscopic surgery, however 55.6% of the participants adopted it in open surgery. The use of neoadjuvant chemotherapy increased in 31.9% in favor of primary cytoreduction in ovarian cancer. 11.3% and 15.5% of patient with cervical and endometrial cancer respectively suffered a delay in cancer treatment during the pandemic.Conclusion*The conclusions of the study showed how the COVID-19 pandemic has influenced the surgical management of patients with gynecological cancer in different Spanish hospitals.

Impact of COVID-19 pandemic on gynecological cancer healthcare: patient´s perspective

Introduction/Background*COVID -19 pandemic has shown a huge impact in health-care systems. In the field of gynecology oncology, we had to postpone routinary tests and check-ups, as well as attend patients that had undergone an oncological process via telephone. Due to their vulnerability, the psychological impact on this patient has been even worse than on other users of the health system. The aim in this study is to evaluate the concerns, global health status and quality of life of patients with gynecological cancer during the pandemic.MethodologyThe GineonCoVID study is a multicenter Spanish study that collect data from a national survey. The anonymous survey consists of 23 questions regarding the personal experience of the patient and modifications in health care during follow up of patient with gynecological malignancies from April to May 2021. The survey has been divided into 3 sections. In this sub-analysis the results of the questions related to anxiety, concerns, quality of life and state of mind of the interviewed patients will be evaluated.Result(s)*376 patients responded to the survey. The median age was 58 years. 43% of the patients were diagnosed with endometrial cancer, 27.3% with ovarian cancer and 24.1% with cervical cancer. 39.6% and 33.6% of patients suffered anxiety and depression respectively during the pandemic. 81% of the patients report having a good quality of life during the last year. Results showed that 54.2% of the respondents are not concerns about viral infection and 67.9% consider that the risk of being infected during follow-up is low. 94% do not perceive changes in follow up, but if they do, 44% believe that clinical health care has experienced a change. 71.4% of the patients are concern about not being able to attend clinical visits.Conclusion*The pandemic could increase anxiety and depression, although it does not appear to worsen the quality of life in patients with gynecological cancer. More than half of the patients consider that they have a low risk of being infected during follow-up but are concerned about not being able to attend clinical visits due to the pandemic.

Changes in surveillance of patients with gynecological cancer during COVID-19 pandemic

Introduction/Background*The impact of the COVID-19 pandemic on Spanish hospitals over the past year has forced healthcare institutions to make drastic changes in the management of oncology patients. The main objective of this study is to describe the changes in ambulatory attendance of patients with gynecological cancer and the ease of contact with the gynaecological oncology section reported by users.MethodologyThe GineonCoVID study is a multicenter Spanish study that collect data from a national survey. The anonymous survey consists of 23 questions regarding the personal experience of the patient and modifications in health care during follow up of patient with gynecological malignancies from April to May 2021. The survey has been divided into 3 sections. In this sub-analysis, questions regarding follow-up modifications and the perspective of the patients with gynecological cancer about changes were analyzed.Result(s)*376 patients responded to the survey. The median age was 58 years. 43% of the patients were diagnosed with endometrial cancer, 27.3% with ovarian cancer and 24.1% with cervical cancer. 85% of the patients had an appointment that was delayed by the pandemic. 67.7% considered that the situation justified the delay of the appointment. 93.3% who contacted the gynecological oncology unit were able to solve the problem by telephone. Upon entering the consultation, 41.3% were questioned about COVID symptoms or contacts. 97.6% considered that adequate measures were taken to avoid contagion during the medical visit. Regarding how they would value the care received (scale of 1–10), 2.2% scored it with a 7;6.7% with 8;23.2% with 9 and 67.7% with 10.Conclusion*The COVID-19 pandemic and the redistribution of health system resources have forced the development of variations in the assistance and follow-up patients with gynecological cancer in order to decrease the number of hospital visits and minimize the risk of infection. Telephone consultations and delay in routinary tests were very useful tools during this period without compromising the quality of care.

Fostering Resilience in Pregnancy and Early Childhood During the COVID-19 Pandemic: The HUGS/Abrazos Program Design and Implementation.

Pregnancy and early childhood pose unique sensitivity to stressors such as economic instability, poor mental health, and social inequities all of which have been magnified by the COVID-19 pandemic. In absence of protective buffers, prolonged exposure to excessive, early adversity can lead to poor health outcomes with significant impact lasting beyond the childhood years. Helping Us Grow Stronger (HUGS/Abrazos) is a community-based program, designed and launched at the time of the COVID-19 surge in the Spring of 2020, that combines emergency relief, patient navigation, and direct behavioral health support to foster family resilience and mitigate the negative impacts of COVID-related toxic stress on pregnant women and families with children under age 6. Through a targeted referral process, community health workers provide resource navigation for social needs, and a social worker provides behavioral health support. The use of innovative tools such as a centralized resource repository, community health workers with specialized knowledge in this age range, and a direct referral system seeks to assist in streamlining communication and ensuring delivery of quality care. We aim to serve over 300 families within the 1st year. The HUGS/Abrazos program aims to fill an important void by providing the necessary tools and interventions to support pregnant women and young families impacted by adversity exacerbated by the COVID-19 pandemic.

Impact of early detection and vaccination strategy in COVID-19 eradication program in Jakarta, Indonesia.

OBJECTIVE: Several essential factors have played a crucial role in the spreading mechanism of COVID-19 (Coronavirus disease 2019) in the human population. These factors include undetected cases, asymptomatic cases, and several non-pharmaceutical interventions. Because of the rapid spread of COVID-19 worldwide, understanding the significance of these factors is crucial in determining whether COVID-19 will be eradicated or persist in the population. Hence, in this study, we establish a new mathematical model to predict the spread of COVID-19 considering mentioned factors. RESULTS: Infection detection and vaccination have the potential to eradicate COVID-19 from Jakarta. From the sensitivity analysis, we find that rapid testing is crucial in reducing the basic reproduction number when COVID-19 is endemic in the population rather than contact trace. Furthermore, our results indicate that a vaccination strategy has the potential to relax social distancing rules, while maintaining the basic reproduction number at the minimum possible, and also eradicate COVID-19 from the population with a higher vaccination rate. In conclusion, our model proposed a mathematical model that can be used by Jakarta's government to relax social distancing policy by relying on future COVID-19 vaccine potential.

[Laparoscopic surgery in the COVID-19 era]. / Cirugía laparoscópica en tiempos de COVID-19.

Coexistence with COVID-19 infection (coronavirus disease 2019) in all hospital and health care settings is a current challenge of adaptation, as well as the creation of new protocols and care models. At present, there are still many unknowns about this infection, and much more unknown is the impact into the surgical field. Although evidence regarding the effect of SARS-CoV-2 and laparoscopic surgery is scarce, laparoscopy has been considered the method of choice by different scientific societies for most indications in gynaecology during the COVID-19 pandemic. This is due to the advantages over the open route. There is less morbidity and hospital stay, and in addition, as it involves autonomous and contained surgical procedures with respect to smoke release. Moreover, the instruments and the setting in the operating room mean that there can be safe distance from the surgeon and other staff to the patient. Overall, the main recommendations in laparoscopic surgery during the COVID era include: the use of Personal Protective Equipment for operating room personnel, and the adoption of safety measures to reduce CO2 exposure and surgical smoke release.