Assessing the Unmet Needs of Spanish Speaking Family Caregivers of Persons Living with Dementia in the Greater Boston Area

Background: Spanish-speaking family caregivers of persons living with dementia (PLD) have limited resources in Spanish to aid in psychological coping with caregiver burden. They often have difficulty attending in-person training due to barriers such as transportation costs, identifying substitute care, and ongoing COVID-19 pandemic containment measures. There are few studies identifying Spanish language caregiver unique needs and preferences regarding desired caregiving skills and stress-reduction interventions. In this study, we sought to identify the unmet needs of Spanish-speaking family caregivers of PLD in the greater Boston area, as well as their preferences for virtual intervention frequency and duration. Method(s): We conducted two virtual focus groups with twelve Spanish language family caregivers of PLD (ages 37 to 87 years) recruited from the greater Boston area. Participants were asked semi-structured questions regarding their unmet needs for caregiver skills training and stress reduction. We employed an inductive and deductive driven mixed method analytic approach. A taxonomy was created to organize results based on participant responses. Result(s): Three major thematic clusters emerged. First, caregivers noted a desire to develop skills for managing stress, emotional reactivity, frustration, and grief. Second, there was an expressed need for education regarding disease-specific knowledge such as stages of dementia, common manifestations, management of challenging symptoms and communication strategies with the PLD;how to navigate the health care system;and finding additional resources for care in the community. Third, there was an interest in learning about interventions for the PLD, such as specific activities to help keep them engaged and active. A particular interest was expressed in any interventions that might slow disease progression. Regarding frequency and duration for virtual intervention, caregivers most commonly preferred weekly sessions for 6-10 weeks. Conclusion(s): Unmet needs of Spanish language family caregivers of PLD in the greater Boston area include education regarding disease-specific symptoms and their management, and resources to enhance well-being both in the caregiver and the PLD. Based on these results, we will develop a comprehensive virtual therapeutic intervention incorporating stress reduction techniques to facilitate emotion regulation, caregiver skills training, psychoeducation regarding dementia and caregiver resources, and healthful activities for the PLD. Copyright © 2022 the Alzheimer's Association.

Cultural tourism in cities post-COVID-19: A perspective and proposals for an alternative model

Tourism was a constantly growing industry until the halt brought about by the COVID-19 pandemic. In cities, its negative impact was increasing, with significant cases of overcrowding. COVID-19 has emerged as an exceptional disruptive stage, yet it is also an opportunity to abandon the rush towards unsustainability. This study is a critical analysis of tourism, looking at the most appropriate post-pandemic perspective for urban cultural tourism, based on sustainability and leaving aside the search for profit as the ultimate goal. The main objective is to make proposals for an alternative paradigm. This is a theoretical paper that draws on a literature review of 180 works of scientific reference. Complementarily, information published by the media is accessed and direct observation is carried out as fieldwork. Proposals are made on limiting the number of visitors, improving guided visits, tourist routes, experiential tourism, and virtual tours. We also propose a new centralised tourism governance and regulation of private agents. Therefore, the present text is of interest for public representatives working in the field of urban tourism. © 2021 Asociacion de Geografos Espanoles. All rights reserved.

Thyroid as a target of adjuvant autoimmunity/inflammatory syndrome due to mRNA-based SARS-CoV2 vaccination: from Graves' disease to silent thyroiditis.

BACKGROUND: As COVID-19 became a pandemic, the urgent need to find an effective treatment vaccine has been a major objective. Vaccines contain adjuvants which are not exempt from adverse effects and can trigger the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). There is very little information about autoimmune endocrine disease and the ASIA after the use of mRNA-based SARS-CoV2 vaccination. CASE SERIES: We report three cases and also review the literature showing that the thyroid gland can be involved in the ASIA induced by the mRNA-based SARS-CoV2 vaccination. We present the first case to date of silent thyroiditis described in the context of SARS-CoV2 vaccination with Pfizer/BioNTech. Also, we discuss the first subacute thyroiditis in the context of SARS-CoV2 vaccination with the Moderna's vaccine. Finally, we provide another case to be added to existing evidence on Graves' disease occurring post-vaccination with the Pfizer/BioNTech vaccine. DISCUSSION: Adjuvants play an important role in vaccines. Their ability to increase the immunogenicity of the active ingredient is necessary to achieve the desired immune response. Both the Moderna and the Pfizer/BioNTech vaccines use mRNA coding for the SARS-CoV2 S protein enhanced by adjuvants. In addition, the cross-reactivity between SARS-CoV2 and thyroid antigens has been reported. This would explain, at least, some of the autoimmune/inflammatory reactions produced during and after SARS-CoV2 infection and vaccination. CONCLUSION: The autoimmune/inflammatory syndrome induced by adjuvants involving the thyroid could be an adverse effect of SARS-CoV2 vaccination and could be underdiagnosed.

Time of stroke onset in coronavirus disease 2019 patients around the globe: A systematic review and analysis

Introduction: Coronavirus disease 2019 (COVID-19) has been associated with stroke, particular characteristics of these patients are not fully understood. The adequate management of these patients depends on the comprehension of factors such as temporality, clinical presentation and etiology. We hypothesize there is a differential temporal relationship between COVID-19 severity and stroke onset. Methods: Considering PRISMA guidelines, a systematic review of the literature as of July 2020 was conducted and registered on PROSPERO. Pubmed and Scopus studies reporting patients with COVID-19 and stroke were included. Clinical, sociodemographic and laboratory characteristics of patients were extracted and analyzed. Results: Forty-seven studies and 176 patients were included, with a mean age of 63.1 years (SD= 16 n=122), most of them were males (63.2% n=171). The most frequent etiology was cryptogenic (40.9% n=66), and a mean National Institute of Health Stroke Scale of 14.4 points was found (SD= 8.6 n=73). Large vessel occlusion (LVO) was reported in 65.9% patients (n=91) and these patients were younger with greater stroke severity. D-dimer, C-reactive protein, fibrinogen, ferritin and lactate dehydrogenase were elevated in most patients with reported findings. Most patients had severe COVID-19. The mean time from onset of respiratory symptoms to stroke was 9 days (SD=9.9), a shorter time was noted in those with mild and moderate disease compared with the longest time in severe disease, this difference was statistically significant (p< 0.001). Conclusions: There is a trend between the severity of COVID-19 and time to stroke onset, in which mild disease is associated with earlier stroke than severe disease. Age and stroke severity are related to the development of LVO. Inflammation and hypercoagulability markers are elevated in this disease, we propose to consider hypercoagulability secondary to COVID-19 as an underlying cause of stroke in these patients.