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The health conditions generated by the COVID-19 pandemic severely restricted in-person therapy, and as a result online therapy was put into practice. The objective of this study was to describe and analyse, from the perspective of the therapist, how the pandemic has influenced their experience and clinical practice. Qualitative interviews were conducted with 24 Latin American therapists who had performed online therapy during the pandemic. The information was analysed following the coding procedures of the Grounded Theory. Three core categories were constructed from the analysis: (a) impact on the therapist: spiral of uncertainty, oppression and adaptive astonishment;(b) incorporation of technologies into clinical practice: 'I never thought they could help';and (c) transformation of the practice of psychotherapy: 'water always finds its way'. The model incorporates and relates therapists' perceptions of their professional work, patients' attitudes towards this new psychotherapy method, perception of the therapeutic relationship and process, and the facilitators and obstacles experienced in online therapy.
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Introduction: The COVID-19 pandemic and associated preventive measures have an impact on the persons' mental health, including increasing risk of symptoms of anxiety and depression in particular. Individual experiencing mental health difficulties in the past could be especially vulnerable during lockdown, however, few studies have tested this empirically considering preexisting mental health difficulties using longitudinal data. Objective(s): The objective of this study is to examine the longitudinal association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown due to the COVID-19 pandemic in a community sample. Method(s): Seven waves of data collection were implemented from March-May 2020. Generalized estimation equations models were used to estimate the association between preexisting symptoms of anxiety/depression and symptoms of anxiety/depression during lockdown among 662 mid-aged individuals from the French TEMPO cohort. Result(s): We found an elevated odds ratio of symptoms of anxiety/ depression (OR=6.73 95% [CI=4.45-10.17]) among individuals experiencing such symptoms prior lockdown. Furthermore, the odds of symptoms of anxiety/depression during lockdown was elevated among women (OR=2.07 [95% CI=1.32-3.25]), subjects with low household income (OR=2.28 [1.29-4.01]) and persons who reported loneliness (OR=3.94 [2.47-6.28]). Conclusion(s): This study demonstrates a strong relationship between preexisting symptoms of anxiety/depression and anxiety/depression during the COVID-19 outbreak among mid-aged French adults. The findings underline the role of preexisting symptoms of anxiety/depression as a vulnerability factor of anxiety/depression during lockdown. Furthermore, the study shows that loneliness is independently associated with symptoms of anxious/depression, when controlling for prior anxiety/ depression symptoms.
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Background Since 2020, the COVID-19 pandemic has greatly affected people including a significant increase in mental health difficulties. Cigarette smoking is found to be strongly associated with mental health conditions, which is why the pandemic might have influenced the secular decline in smoking rates observed over recent years. Persons belonging to socioeconomically disadvantaged groups may be particularly affected, both because the pandemic is found to exacerbate existing social inequalities and because this group was more likely to smoke before the pandemic. We examined the prevalence of smoking in a French cohort study, focusing on differences between educational attainment. In addition, we examined the association between educational level and interpersonal changes in tobacco consumption from 2018 to 2021. Methods The TEMPO cohort study included 1785 French adults followed between 1991 and 2021. With four assessments of smoking status available before and two after the onset of COVID-19, we estimated the smoking prevalence over time stratified by highest obtained diploma. We studied interpersonal change in smoking status between 2018 and 2021 among 148 smokers, using multinomial logistic regression. Results The prevalence of smokers was higher among those with low educational attainment compared with those with higher diploma at all timepoints. The difference between the two groups increased from 2020 to 2021 (4.8% to 9.4%). Smokers with high educational level were more likely to decrease their tobacco consumption from 2018-2021 compared to low educated smokers (aOR=2.72 [1.26;5.89]). Conclusions Current findings showed a widening of the socioeconomic gap over time in smoking rates, which emphasizes the vulnerability of persons with low educational attainment to smoking, also during the pandemic. Key messages • The existing gap in smoking prevalence between lower and higher diploma groups has increased from 2020 to 2021, which may be a consequence of the COVID-19 pandemic. • From 2018 to 2021, people with high school as highest qualification were less likely to decrease their tobacco use compared to higher educated people.
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Crowd sourcing and human computation has slowly become a mainstay for many application areas that seek to leverage the crowd in the development of high quality datasets, annotations, and problem solving beyond the reach of current AI solutions. One of the major challenges to the domain is ensuring high-quality and diligent work. In response, the literature has seen a large number of quality control mechanisms each voicing (sometimes domain-specific) benefits and advantages when deployed in largescale human computation projects. This creates a complex design space for practitioners: it is not always clear which mechanism(s) to use for maximal quality control. In this article, we argue that this decision is perhaps overinflated and that provided there is "some kind" of quality control that this obviously known to crowd workers this is sufficient for "high-quality" solutions. To evidence this, and provide a basis for discussion, we undertake two experiments where we explore the relationship between task design, task complexity, quality control and solution quality. We do this with tasks from natural language processing, and image recognition of varying complexity. We illustrate that minimal quality control is enough to repel constantly underperforming contributors and that this is constant across tasks of varying complexity and formats. Our key takeaway: quality control is necessary, but seemingly not how it is implemented.
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Purpose or Objective Clinical trials are essential to improve cancer treatment. Trials rely on wide-ranging patient (pt) participation to gain adequate sample sizes and externally applicable results. The Danish Breast Cancer Group (DBCG) develops national guidelines for breast cancer therapy, and this is preferably through clinical trials. During 2015-2021 moderately hypofractionated adjuvant loco-regional breast cancer (BC) radiation therapy (RT) was tested in an international trial, the DBCG SKAGEN Trial 1, testing 50Gy/25 fr (standard) versus 40Gy/15fr (experimental). The trial inclusion criteria were broad, thus any pt with indication for loco-regional RT (LR-RT) for unilateral early high-risk BC with no prior cancer and willing/able to participate in the 10-year follow up was a candidate.Recently, the inclusion of pts in trials may have been particularly challenged due to difficulties imposed by the COVID 19 pandemic. Hitherto, the DBCG has had no evidencebased knowledge about trial participation rates (TPR). These are important for evaluating the applicability of the trial results and planning of future RT trials. We present annual trial participation rates during the inclusion period. Materials and Methods The international DBCG SKAGEN Trial 1 randomized patients from 2015 to July 1st 2021, and the 17 participating institutions from 7 countries accrued 2,963 patients. Eight of these institutions accruing 2,184 pts in all delivered data on the total number of pts treated with LR-RT during the inclusion period. We calculated annual TPRs per institution and overall as TPR (number pts enrolled per year/ number pts treated with LR-RT per year). Results From 6,929 pts receiving LR-RT, 2,184 pts were enrolled, corresponding to an overall TPR of 31.5% (figure 1). In all eight institutions, accrual was running from 2016 (figure 2). From 2016, the average single institution TPR per year ranged from 14.4% to 50.4%. Annual TPRs varied with time: most institutions experienced a modest decline in TPR during 2019-2020, while in 2021 TPR seemed to stabilize. In one institution, accrual was terminated during 2020 due to COVID 19 related restrictions.(Figure Presented)(Figure Presented)Conclusion TPRs displayed considerable variation across institutions and time and were vulnerable to COVID 19 related restrictions. Even with a straight-forward trial design and the prospect of a shortened LR-RT course, only one institution succeeded in accruing more than half of the patients likely to be trial candidates. The results indicate, that a TPR around 50% was feasible for the best performing department, thus implying a large potential for better trial accrual in most centres. In future trials, systematic monitoring of TPRs and reasons for not participating should be undertaken to optimize trial designs and accrual procedures
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Background and aim: The Coronavirus 2019 (COVID-19) pandemic has affected the delivery of healthcare around the world. We assessed the impact of the COVID-19 pandemic on hospital presentations, reperfusion treatment and outcomes in a comprehensive stroke centre. Methods: In this observational study seven months of retrospective data from February 2020 at the beginning of the pandemic were compared to data collected for the same time frame in 2019. Results: There was a transient reduction in stroke presentation only at the beginning of the wave of COVID-19 community transmissions in Sydney. There were significantly more haemorrhagic strokes in the COVID- 19 period (n = 66, 15.4 % vs n = 95, 21.5 %, p = 0.02) and baseline stroke severity was higher (NIHSS median 3 vs 4, p = 0.049). Similar proportions of ischaemic stroke patients received reperfusion therapy in the two time periods (IV thrombolysis [n = 51, 17.3% vs n = 52, 17.9%, p = 0.838];and ECR [n = 38, 12.9% vs n = 46, 15.9%, p = 0.30]). The time from presentation to stroke bed admission was significantly shorter during the COVID-19 period (p = 0.031). Three-month follow-up Modified Rankin Score was 2 (median) in both periods (P = 0.92). Conclusion: There was no change in stroke presentations overall during the 2020 COVID 19 pandemic time period with the exception of the first phase of the pandemic. Baseline stroke severity scores were higher. There was no difference in the degree of disability at three-month follow-up.
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Introduction: We analyze the relation between work and health drawing on the labor experiences of adult men who reside in a working-class neighborhood located in the periphery of Buenos Aires City. More specifically, we analyze how precarious jobs impact on their psychophysical health through work conditions that expose them to diverse risks and deprivations for quality of life and health care. Methodology: Data come from qualitative, in-depth, interviews that we conducted with adult men as part of a larger study on health care with residents of the neighborhood. Results: Precarious jobs affect health in various ways. Some of the interviewees have been exposed to physical and psychosocial risks due to the work conditions and environment in the workplace. The negative consequences that precarious jobs have for quality of life are also salient, by limiting their capability to plan ahead, organize everyday life and develop self-care practices. Conclusions: We highlight the importance of considering precarious work as a social determinant of health, since it is a multidimensional trait that helps to analyze its negative consequences on working-class men. We also point to the adverse consequences for health of precarious jobs throughout the life-course, in part, due to age-based chronic conditions but also due to the cumulative disadvantages produced by precarious and vulnerable work trajectories.
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The COVID-19 pandemic has dislocated work routines within health facilities due to new public health priorities. In circumstances characterized by uncertainty and risk in the face of an unknown disease and the constantly changing care protocols, questions arise about how members of healthcare teams have experienced these changes. We analyze the experience of health workers in a primary care center in the periphery of Buenos Aires during 2020, and describe the coordination strategies they developed to achieve greater anticipation and safety in the workplace. © 2021 Grupo Editor Yocavil. All rights reserved.
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Background : Currently available COVID-19 vaccines were developed for intramuscular injection and efficacy may not be ensured when given subcutaneously. In Germany most traditional vaccines were recommended to inject subcutaneously in patients with hemophilia to avoid intramuscular bleeds. Aims : To develop practical guidance for COVID-19 vaccination in people with hemophilia. Methods : The Delphi methodology was used to develop consensus recommendations. An initial, structured list of recommendations was prepared by a steering committee and evaluated by 34 hemophilia experts. Consensus was defined as ≥75% agreement (score 7 or higher on a scale of 1 to 9);strong consensus was defined ≥95% agreement. After 3 rounds of refinement, a final list of statements was compiled. Results : Consensus was achieved that COVID-19 vaccines licensed only for intramuscular injection should also be administered through this route in people with hemophilia. Prophylactic factor replacement should be given before vaccination in patients with moderate or severe hemophilia, preferentially given on the day of vaccination, and with a maximum interval between prophylaxis and vaccination of 24 h (factor VIII and conventional factor IX concentrates) or 48 h (half-life extended factor IX). Strong consensus was also achieved that patients with mild hemophilia and residual activity >10% and patients on prophylaxis with emicizumab do not need factor replacement before vaccination. Swelling, erythema and hyperthermia after vaccination are not always signs of bleeding but should prompt consultation of the hemophilia care center. In case of injection site hematoma, patients should receive replacement therapy until symptoms disappear. Adjunctive therapies of injection site hematoma include rest, cooling and antiphlogistic/analgetic therapy as needed. Conclusions : Using the Delphi methodology, strong consensus was achieved on recommendations for intramuscular COVID-19 vaccination after replacement therapy for people with hemophilia depending on disease severity.
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Purpose : Telehealth has a variety of proposed uses in ophthalmology and has become a valuable asset to health care in the COVID-19 pandemic. This retrospective, observational study characterizes the use of virtual visits and compares the outcomes of these visits to in-person visits during the pandemic period at a large academic institution. Methods : 2,943 virtual and 56,174 in-person visits occurring at Cole Eye Institute, Cleveland Clinic, were identified. A random sample of 3,000 in-person visits was selected for comparison. Canceled, incomplete and duplicated visits, as well as visits for patients aged less than 18 years old were excluded. Pearson's chi-square test of independence and test of proportions were used to assess relationships between categorical variables. Results : 2,266 virtual visits and 2,590 in-person visits were included. The visits distribution across ophthalmology specialties is summarized in table 1. 72.3% of the virtual visits resulted in a planned follow-up compared to 70.3% following an in-person visit (p=0.121). 15.9% of virtual patients were discharged compared to 10.8% of in-person patients (p<0.001). 5.6% of virtual patients were referred to a primary care doctor or different ophthalmology subspecialty compared to 6.9% in-person patients (p=0.081). 6.0% of the patients had an outpatient surgery scheduled after a virtual visit compared to 4.8% inperson patients (p=0.08). 0.2% of the virtual patients had a clinic procedure scheduled compared to 7.2% in-person patients (p<0.001). Loss to follow-up occurred due to cancelations (4.6% and 3.5% in the virtual and in-person visits, respectively, p=0.11), no shows (2.8% and 2.1%, p=0.2) and no schedule (10.4% and 2.3%, p<0.001). 84.6% of the completed follow-up visits after virtual visits were in-person and 15.4% were virtual, in comparison to 97.4% and 2.6% after an in-person encounter (p<0.001). Conclusions : The similar number of follow-up, referral and outpatient surgery outcomes across virtual and in-person visits suggests that teleophthalmology is a viable alternative for patient care. Virtual follow-ups occurred more often after a virtual visit. Discharges and unscheduled follow-up visits were also more prevalent in the virtual setting, implying a higher risk of care discontinuation in this group. Further research into the applications of telehealth for ophthalmology may be beneficial.
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Dancing has been recommended as a suitable home-based physical activity during the quarantine period associated with the COVID-19 pandemic. Dancing can reduce sedentary behavior and thereby maintain physical and emotional health. The aim of this article was to provide support to dance, fitness, and/or other health professionals in guiding individuals wishing to practice dancing activities at home. By considering dancing as a strategy to increase levels of physical activity at home, this article is divided into three sections: i) the structure of a dance session, ii) elements of aerobic fitness, and iii) safety considerations. A home setting dance session lasts ~40-50 minutes, including the warm-up, the specific dancing activities, and the cool-down. © 2021 SHAPE America.