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Introduction: The COVID-19 pandemic caused significant decreases in outpatient procedures, many of which are required before to antireflux operation (ARS). The purpose of this study was to add functional luminal imaging probe (FLIP) to esophagogastroduodenoscopy (EGD) and esophageal pH monitoring to assess its utility in decreasing the need for follow up studies in patients being evaluated for ARS. Method(s): Retrospective observational study was performed on 81 patients being evaluated for GERD who underwent EGD, pH monitoring, and FLIP. Data collected included average distensibility index (DI) at 60 mL, presence of repetitive anterograde or retrograde contractions, hiatal hernia dimensions, pathology results, pH data, and need for follow-up testing. Result(s): Based on FLIP results, HRM was recommended in 35 patients (43.2%). This included 14 patients with DI suggestive of significant esophagogastric junction outflow obstruction, eight of whom completed HRM with four confirmed as achalasia. FLIP results were suspicious for eosinophilic esophagitis (EoE) in four patients of which one was confirmed as EoE on biopsy. Gastric emptying study was felt to be necessary for 11 patients before to ARS. Conclusion(s): FLIP identified patients with possible alternative pathologies including achalasia and EoE that would otherwise be a contraindication to ARS. FLIP at the time of EGD and pH monitoring is useful as it guides the clinical decision on need for additional outpatient procedures, which may be difficult to obtain in pandemic conditions. FLIP was effective at reducing the requirements for further follow-up testing in the majority of patients being evaluated for potential ARS.
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People's health information-seeking behaviors differ by their health literacy levels. This study assessed the relationship between health literacy and college students' levels of trust in and use of a range of health information sources of COVID-19. We collected data from August to December 2020 among college students (n = 763) through an online survey. We used a health literacy measure containing three self-reported survey questions, developed by the CDC. We assessed the extent to which participants trusted and used any of the sixteen different sources of information about COVID-19. Respondents reported high levels of trusting and using COVID-19 information from the CDC, health care providers, the WHO, state/county/city health departments, and official government websites when compared to other sources. After controlling for demographic characteristics (i.e., gender, age, race, ethnicity, and income), those who reported having lower health literacy were significantly less likely to trust and use COVID-19 information from these health authorities when compared to participants who reported having higher health literacy. Students with lower self-reported health literacy indicated not trusting or using official health authority sources for COVID-19 information. Relying on low-quality information sources could create and reinforce people's misperceptions regarding the virus, leading to low compliance with COVID-19-related public health measures and poor health outcomes.
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Introduction: The COVID-19 pandemic and subsequent public health response resulted in unprecedented changes to society, including recommendations for social and physical distancing. Sexual dysfunction is best understood within a biopsychosocial framework, and it is reasonable to predict that biological, psychological, and social aspects of the COVID-19 pandemic may impact sexual function, particularly in a patient population actively planning pregnancy. Objective: The aim of this study was to understand the impact of the COVID19 pandemic - including COVID-19 infection, COVID-19 vaccination, and psychosocial conditions of the pandemic - on the sexual function of women receiving fertility care. Methods: Eligible patients aged 18 or older were identified using ICD codes related to female infertility and fertility testing and invited to complete an online survey regarding COVID-19 infection and vaccination status, fertility planning, and the impact of pandemic conditions on sexual function. Participants were recruited from a large academic-based fertility center and received care between April 2020 and April 2021. χ2 was used for between-group comparisons. Results: Of the 738 eligible patients, 197 participants completed the survey. Seventy-four (37.5%) participants had been pregnant within the past year and 168 (85.3%) participants had attempted to conceive in the past year. Forty-four (22.3%) participants reported prior COVID-19 infection, with 29 confirmed diagnoses and 15 suspected diagnoses. Further, 107 (54.2%) participants had been vaccinated against COVID-19, 35 (17.8%) were planning on being vaccinated, and 52 (26.4%) were not planning on being vaccinated. Participants declining vaccination cited concerns with health, fertility, pregnancy, breastfeeding, and a lack of vaccine safety data as common reasons for declining. Most (n = 180;91.4%) participants were sexually active at the time of survey, but only 25 (12.7%) reported their sex life was improved as a result of the pandemic;this did not differ in patients with or without a prior COVID-19 infection (15.9% vs. 11.8%, P=NS). These participants cited having more time with their partner, working from home, fewer outside stressors and social obligations, improved relationship dynamics and emotional bonding, and shared feelings about pandemic-related policies as reasons for improved sexual function. Of the 44 participants who had experienced COVID-19 infection, the majority (52.3%) expressed interest in returning to sexual activity within two weeks of infection. An additional 20.5% reported interest in sexual activity between two and four weeks after infection. Most (81.8%) stated that they were “not at all” or “not really” concerned about infecting their partner through intimacy or intercourse and 70.5% stated that their interest in sex was “not at all” or “not really” affected by their COVID-19 infection. Finally, 68.2% of participants reported that their ability to enjoy sex was “not at all” or “not really” affected by their COVID-19 infection. Conclusions: The majority of participants in this study did not experience improved sexual function during the pandemic, but those who did may offer insight into psychosocial and environmental factors that contribute to sexual function. The majority of participants who experienced COVID-19 infection did not report significant disruption to their sexual function as a result of their infection.
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OBJECTIVE: The purpose of this study was to examine the relationships between the psychosocial effects of the 2019 novel coronavirus (COVID-19) pandemic, and maternal mental health and maternal-fetal bonding in a sample of pregnant women. MATERIALS AND METHODS: This is an online, observational, surveybased study.Women were recruited from the outpatient Obstetrics and Gynecology and Psychiatry clinics of a hospital in the Midwest and via community online advertisements. Women aged 18 to 45 years old and currently pregnant in their second or third trimester were eligible to participate. Data was collected between June 2020 and April 2021.Women completed the surveys online at a location of their choosing using the institution's REDCap survey software. Descriptive and frequency statistics assessed characteristics of the study sample and Pearson's r correlation statistics were conducted to examine the associations between psychosocial stress due to the COVID-19 pandemic and maternal depression and anxiety and maternal-fetal bonding using validated instruments. Thematic assessment of qualitative, shortanswer responses assessing participants' perspectives of the positive and negative impacts of the pandemic on their maternal-fetal bonding was conducted. RESULTS: A total of 30 women completed the survey at the time of this analysis. The mean age was 32.07 (SD = 0.67) years and the majority of women (n = 26, 86%) were Caucasian. Three women (10%) reported receiving assisted reproductive technology for their current pregnancy. Greater psychosocial stress due to the pandemic conditions, assessed by the COVID-19 Family Stress Screener, was associated with higher depression scores assessed by the Edinburgh Postnatal Depression Scale (r = .50, p < .05) and higher anxiety scores assessed by the Generalized Anxiety Disorder- 7 Item Scale (r =.48, p < .05). There was a marginally significant association indicating greater psychosocial stress due to pandemic conditions was associated with more positive maternal-infant bonding assessed by the Maternal Antenatal Attachment Scale (r = .37, p = .05 ). Themes derived from qualitative items indicated that women identified more time spent at home due to furlough or working from home and fewer social obligations due to physical distancing allowed them to have more time and energy to focus on maternal-fetal bonding. Themes also indicated that fear of contracting COVID-19 and greater demands for caring for current children were negative effects of the pandemic that may contribute to higher anxiety and barriers to bonding. CONCLUSIONS: Greater psychosocial stress during COVID-19 pandemic conditions is related to higher levels of maternal depression and anxiety in pregnancy. However, some psychosocial effects (e.g., more time spent at home and with immediate family) may also contribute to greater opportunities for women to focus on maternal-fetal bonding. IMPACT STATEMENT: Assessment of levels of psychosocial stress due to pandemic conditions by reproductive medicine health care providers may allow for the identification of women at greater risk for maternal depression and anxiety.
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OBJECTIVE: To determine the impact of the COVID-19 pandemic on the attitudes and perceptions towards conception planning and fertility treatment among health care workers with infertility MATERIALS AND METHODS: Eligible female subjects age 18 years or older were identified with ICD codes related to female infertility and fertility testing. Recruited subjects received care from a single provider in an academic- based fertility center between April 2020 and April 2021. Respondents completed an online survey regarding attitudes and perceived impact of the pandemic towards fertility treatment, vaccination, and conception planning. Subjects were compared based on their healthcare worker (HCW) status. RESULTS: Of the 738 eligible subjects, 190 participants completed the survey, 72 (37.9%) of which had conceived in the last year, and 58 (30.7%) were HCWs. In the last year, 82.6% had fertility treatment and 20% underwent IVF. Additionally, 23.2% had confirmed or presumed COVID-19 and 22.7% were pregnant at the time of diagnosis. A total of 34.1% of patients had postponed treatment, most of whom (75%) were due to hospital or clinic delays. Only 25% made the personal decision to delay treatment. 34.1% of HCWs compared to 32.2% of non-HCWs delayed treatment during the pandemic (NS). The power analysis for this comparison provided 98.5% power with an alpha 0.05 to detect a difference of 30% given our sample size. HCWs were more likely to delay treatment due to concerns of becoming ill from COVID-19 while pregnant than non-HCW (p<0.0001). However, HCWs had a tendency to delay care due to distress surrounding prenatal care, labor, and delivery (2.7 ± 1.5 vs 2.4 ± 1.4 on a Likert scale). HCWs who had COVID had a more negative pregnancy and birth experience (2.0 ±2.3 vs 1.3 ± 0.8). Overall, 54.2% of patients have been vaccinated, 62.1% of whom were HCWs. Of those unvaccinated, 40.5% plan on getting vaccinated. Reasons not to get vaccinated was due to fertility concerns (45.9%), health concerns (25.7%) (i.e. allergies to vaccines), or breastfeeding status (28.4%). A small number of patients stated that they would like to not be breastfeeding (6.3%) or pregnant (14.7%) when vaccinated. Among non-vaccinated individuals, fewer HCWs (23.8%) planned on becoming vaccinated compared to non- HCW (46.0%). Non-HCWs trended towards not being vaccinated due to fertility concerns (20.5% vs 12.1%), while HCW trended towards other reasons (i.e. breastfeeding) (13.8% vs 9.9%). CONCLUSIONS: In the infertility population, the pandemic affected HCW and non-HCW discordantly. Although HCW workers were less worried about having COVID-19 while pregnant and more non-HCWs did not get vaccinated due to fertility concerns. HCWs also had a tendency towards more stress and negative experiences with prenatal care and L&D. IMPACT STATEMENT: HCWs with infertility are discordantly affected by the pandemic and by understanding these differences providers can provider better support and care for these patients.
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Background: Short-term effectiveness of COVID-19 vaccination is widely demonstrated, but the emerging real-world data suggest that immunity may wane over-time (Levin et al. NEJM 2021). Herein we aimed to explore the long-term efficacy of the COVID-19 vaccination among pts with genitourinary cancer. Methods: In this study, pts with genitourinary malignancies (prostate, kidney, and bladder cancers) who had not received COVID-19 vaccination were included. Blood samples were collected prior to and after one dose of either an adenovirus- or mRNA-based COVID-19 vaccine at the 2- and 6-month timepoints. Additional blood samples from pts receiving systemic treatment were collected at 3 consecutive therapy cycles following vaccination. Antibody titers were assessed using the SCoV-2 Detect IgG ELISA assay and results were reported as immune status ratios (ISR). T-cell receptor (TCR) repertoire sequencing was performed using the MiXCR software (MiLabs) and custom strips were used to assess TCR abundance and homology clustering. Results: A total of 183 pts were enrolled, and 136 pts provided baseline blood samples. Among these, 59 (8:51 F:M) provided samples for both the 2-and 6-month timepoints by the 10/6/2021 data cut-off. In this subset of pts, median age was 66 (range 48-85) and 33 (55.9%), 25 (42.4%), and 1 (1.7%) pts had prostate, kidney, and bladder cancer, respectively. A majority of the pts (93.2%) were on systemic treatment with 23.7% on immune checkpoint inhibitors, 18.6% on targeted agents, and 1.7% on chemotherapy. The most commonly administered vaccines were BNT162b2 (61.0%) followed by mRNA-1273 (37.3%) and Ad26.COV2.S (1.7%). The mean (±standard deviation) ISR values at baseline and 2 months were 0.68±1.59 and 6.62±1.75, respectively. At the 6-month timepoint, mean ISR was 5.46±1.61;this was significantly lower than the 2-month antibody titers (p < 0.0001), and reflects a reduction of 17.6%. Further data on TCR sequencing will be presented at the meeting. Conclusions: To our knowledge, this is the first data assessing the long-term serologic outcomes of COVID-19 vaccination in pts with cancer. Our data suggest waning immunity over time in cancer pts. Strategies to prolong host immunity against SARS COV-2 (e.g., booster vaccination) are likely warranted.
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This cross-sectional analysis estimated differences, based on disability status, in college students' (n = 777) experiences during the COVID-19 pandemic. Data were modeled using t-tests and logistic regression. Most participants were white (86.2%), and women (66.4%). The mode age was 23. A third (35.6%) had at least one disability. Students reported high rates of psychosocial distress, like fear of contracting (59.7%) and spreading (74.3%) COVID-19, worry about friends and family (83.7%), and increased anxiety (72.5%), depression (59.9%), and substance use (24.7%). Forty-two percent (42.2%) were scared they would miss out on their education through virtual classes. About a third feared forgetting assignments (34.1%) and making mistakes (33.9%). Fewer students expressed apprehension about (27.9%) and intimidation by (26.3%) virtual learning. Only 17.2% would continue taking virtual classes after the pandemic. Students with disabilities (M = 12.4, SD = 4.1) experienced more psychosocial stressors compared to students without disabilities (M = 9.9, SD = 4.2), [t(775) = 7.86, p < 0.001]. In adjusted models, disabled students were more than twice as likely to experience worry about medical bills (OR = 2.29), loneliness (OR = 2.09), and increased anxiety (OR = 2.31). They were also more than three times as likely to report increased depression (OR = 3.51) and changes in sexual activity (OR = 3.12). However, students with disabilities (M = 1.5, SD = 1.1) also reported receiving more support compared to their non-disabled classmates (M = 1.1, SD = 1.1), [t(775) = 6.06, p < 0.001]. Disabled students were more likely to feel a sense of contributing to society by following precautions (OR = 1.80) and receive support from family and others (emotional support: OR = 2.01, financial support: OR = 2.04). Interestingly, no significant differences were found in students' feelings associated with online or virtual learning [t(526.08) = 0.42, p = 0.68]. Students with disabilities, though, trended toward reporting negative experiences with virtual learning. In conclusion, students with disabilities were disproportionately affected by COVID-19 stressors, but also expressed more support and a sense of contributing to the common good.
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COVID-19 , Disabled Persons , Education, Distance , Cross-Sectional Studies , Female , Humans , Pandemics , SARS-CoV-2 , StudentsABSTRACT
Background: Preliminary studies have characterized potential adverse effects associated with COVID-19 vaccination in pts with cancer. However, biological characterization of vaccine response has yet to be performed. Methods: Eligible pts with advanced GU cancers (metastatic/unresectable prostate, bladder and renal cell carcinoma [RCC]) and had not yet received COVID-19 vaccination. Pts were consented to receive sequential blood draws prior to vaccination and at landmarks of 2, 6, and 12 mos following vaccination. Pts on systemic treatment had additional blood draws coinciding with their first 3 cycles of therapy following vaccination. Ab titers to SARS-CoV-2 were quantified via ELISA and reported as an immune status ratio (ISR). RNA was extracted from PBMC aliquots, converted into cDNA and TCR α/β sequences were selectively amplified. TCR abundance and homology clustering was performed using custom scripts. Results: As of May 14, 2021, 130 pts had consented to the study of whom 126 pts submitted baseline (BL) specimens. The current analysis focuses on 56 pts who submitted cycle 1 (C1) specimens. Among these, 29, 26, and 1 pts had RCC, prostate and bladder cancer, respectively;19 were on checkpoint inhibitor (CPI)-based regimens while 37 were on non-CPI regimens. BNT162b2 (Pfizer) was the most commonly administered vaccine in the cohort (n=29), followed by mRNA-1273 (Moderna;n=26). COVID-19 Ab titers increased significantly from BL to C1 across the cohort from 0.19 (interquartile range [IQR] 0.12-0.18) to 4.37 (IQR 0.2-6.60;P<0.0001). However, 8/56 pts (14.3%) receiving CPI-based regimens and 8/56 pts (14.3%) receiving non-CPI-based regimens were noted to have negative Ab titers after a median of 18 and 35 days following initial vaccination, respectively. No significant difference was observed in the increase from BL to C1 in pts receiving CPI vs non-CPI-based regimens. Specimen collection is ongoing;updated Ab titer data and TCR sequencing data will be presented. Conclusions: Our data prompt concern for delayed or insufficient COVID-19 Ab response in a subset of pts with advanced GU cancers. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: R. Salgia: Non-Financial Interests, Personal, Advisory Board: Janssen;Non-Financial Interests, Personal, Advisory Board: AstraZeneca;Non-Financial Interests, Personal, Advisory Board: Merck;Non-Financial Interests, Personal, Advisory Board: Novartis. S.K. Pal: Financial Interests, Personal, Invited Speaker: Novartis;Financial Interests, Personal, Invited Speaker: Medivation;Financial Interests, Personal, Invited Speaker: Astellas Pharma;Financial Interests, Personal, Advisory Board: Pfizer;Financial Interests, Personal, Advisory Board: Novartis;Financial Interests, Personal, Advisory Board: Aveo;Financial Interests, Personal, Advisory Board: Myriad;Non-Financial Interests, Personal, Other: Genentech;Non-Financial Interests, Personal, Other: Exelixis;Non-Financial Interests, Personal, Other: BMS;Non-Financial Interests, Personal, Other: Astellas Pharma;Financial Interests, Institutional, Funding: Medivation. All other authors have declared no conflicts of interest.
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The role and efficacy of the laboratory in chemical education have recently been a subject of renewed discussion as researchers are called upon to address the question of whether laboratory education lives up to expectations. The COVID-19 pandemic, which forced most of the global student population to temporarily adopt remote learning, offers an unparalleled case study to investigate types of outcomes resulting from a variety of adjustments made to laboratory education. This scoping review article focuses on the reports of laboratory learning in chemistry and closely related disciplines during COVID-19 to analyze the types of adjustments made to laboratory curricula and the immediate effect of these adjustments on students. The aggregated findings suggest that a lack of hands-on laboratory experience was detrimental to certain types of learning and engagement but that other types of learning were successfully achieved remotely. For researchers, departments, and university administrators, the differentiation in these findings could help inform the ongoing discussion about the future of laboratory education. For instructors and student support staff, the findings indicate potential areas of deficiency and strength for the COVID-19 student cohort going forward. Finally, a laboratory learning theory and pedagogy are proposed to guide the use of the laboratory in chemical education and potentially in other laboratory-based sciences as well. © 2021 American Chemical Society and Division of Chemical Education, Inc.
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Rationale: As a result of the COVID-19 pandemic, social distancing guidelines have led to the limitation of hospital and clinic visits, with immunocompromised and high-risk patients advised to stay out of high-risk environments such as hospitals during non-emergent circumstances. Recruitment of study subjects is a Herculean task, and the limited number of patients seen face-to-face has required recruitment via telephone or virtual means. This presents difficulties in communication as well as missed opportunities. In this study, we evaluate precisely how challenging recruitment is during this time and compared these values to the relative 'ease' with which patients were recruited in the past. Method: Patients were identified and screened using EHRs (electronic health records), and health care providers were contacted regarding study involvement for potential subjects. Subjects were contacted via telephone, and a standardized script was followed by research coordinators conducting the calls to ensure uniformity. Unanswered calls were contacted a second time. Contacted patients were divided into four categories - those who did not pick up their telephones, those whose phone numbers were no longer in service, those who declined to participate, and those who agreed to participate. The number of willing subjects versus unwilling subjects was then compared to a previous study in which patients were recruited in a face-to-face environment. Furthermore, we evaluated the level of willingness patients expressed to participate during inperson introductions versus over the phone on a scale of willing, skeptical, and unwilling. Results: Conclusion: The COVID-19 pandemic has contributed to the development of many obstacles in patient recruitment. In our study, we found that although we are living in an era of advanced technology, patients still prefer face-to-face communication over virtual communication. When presented research studies face-to-face, patients showed more trust in the research coordinators as well as a greater sense of willingness to participate.