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Background: We sought to assess the anxiety and depression scores of pregnant women in Hong Kong during the COVID-19 pandemic and to evaluate the impact of demographic, economic and social factors on these scores. Method(s): This was part of an ongoing worldwide cross-sectional study conducted from 22 May 2020 to 28 February 2021. Data were collected through an anonymous web-based survey. The severity of depression and anxiety was assessed using the Patient Health Questionnaire-9 (PHQ-9) score and the General Anxiety Disorder-7 (GAD-7) score, respectively. Result(s): A total of 361 participants completed both the GAD-7 and PHQ-9 questionnaires. Participants with psychiatric illness reported a significant higher median GAD-7 score (6.00, interquartile range [IQR] 3.00-7.75 vs. 2.00, IQR 0.00-6.00, p = 0.001), while the median PHQ-9 score was also higher but was not statistically significant (6.50, IQR 3.00-11.00 vs. 5.00, IQR 3.00-8.00, p = 0.066). A higher proportion of participants with psychiatric illness reported moderate-severe depression and anxiety (35.7% vs. 16.5%, p = 0.002, 17.8% vs. 3.6%, p < 0.001 respectively). Multivariate regression analysis demonstrated that financial difficulty, in education and pregnancy by in-vitro fertilization were associated with a higher PHQ-9 score in pregnant women during the COVID-19 pandemic, while underlying psychiatric illness was associated with a higher GAD-7 score. Support from a partner was demonstrated to be associated with a reduced level of depression and anxiety in pregnancy. Conclusion(s): Pregnant women with underlying psychiatric illness were more vulnerable during the COVID-19 pandemics than the non-psychiatric counterparts. Partner support is important for alleviating depression and anxiety in pregnancy during the COVID-19 pandemic. Clinical Trial Registration: The study was registered at http://www.clinicaltrials.gov, registration number NCT04377412.Copyright © 2023 The Author(s).
ABSTRACT
Background: Patients with systemic lupus erythematosus (SLE) are at increased risk of severe COVID-19 due to the underlying disease, comorbidities and use of immuno-suppressants (IS). An alternative option would be to adopt telemedicine (TM) to maintain medical care while minimizing exposure. Despite being widely adopted during the pandemic, the evidence supporting the use of TM in rheumatology has been limited. Objectives: We primarily aimed to evaluate the effectiveness to maintain disease activity control using TM delivered care compared to conventional in-person follow-up in patients with lupus nephritis (LN). The secondary objectives were to compare the patient reported outcomes, safety and cost-of-illness from the patient's perspective between the 2 modes of health care delivery. Methods: This was a 1-year, single-center, RCT conducted at a regional hospital in Hong Kong. From May 2020, consecutive adult patients with a SLE according to the 2019 EULAR/ACR classifcation criteria followed up at the LN clinic were invited to participate in the study. Participants were randomized 1:1 to either TM (TM group) or standard FU (SF group). Patients randomized to receive TM FU were scheduled for a video consultation via a commerical software ZOOM. Patients in the SF group received standard in-person outpatient care. SLE disease activity at each consultation was assessed by SLEDAI-2k and physician global assessment (PGA). Results: A total of 144 patients with LN were randomized and 3 patients self-withdrew from the study. The mean age was 44.5±11.4 years and the median time from diagnosis to randomization was 168 months (range: 1-528). Most of the patients had class III, IV or V LN (87.2%) and were on prednisolone (89.4%, median dose 5mg daily). Many of them (68.1%) were on IS. While 66.0% of the patients were in lupus low disease activity state (LLDAS), none had disease remission. There were no baseline differences, including demographics, SLEDAI-2k (TM: 3.8±2.3, SF: 3.2±2.2, p=0.13, PGA (TM: 6.2±6.5, SF: 4.6±5.9, p=0.13) and SLE damage index (TM: 1.1±1.3, SF: 0.8±1.1, p=0.10), between the 2 groups. At one year, 80.0% and 80.2% of the patients in the TM group and SF group were in LLDAS or remission respectively. SLE disease activity indices including SLEDAI-2k, PGA, proteinuria amount and serum anti-ds-DNA level remained similar between the 2 groups. Within the study period, 28 (40%) patients in the TM group and 21 (29.6%) patients in the SF group had disease fare (p=0.20). There were no differences in the SF-36, lupusQoL and HADS scores between the 2 groups at the end of the study. The overall patient satisfaction score was higher in the TM group with a signifcantly shorter waiting time before seeing doctors. At the end of the study, 67.9% of the overall participants agreed to (versus 15.0% who did not agree to) use TM as a mode of future FU. The mean indirect costs of illness (HKD26,681 vs HKD12,016, p=0.20) and the out-of-pocket costs for health care services were similar between the 2 groups (TM: HKD13,547 vs SF: HKD12,297, p=0.83) in one year. The total number of FU was similar (TM: 6.0±2.0, SF: 5.7±1.7, p=0.40). However, signifcantly more patients in the TM group (29/70, 41.4% vs 4/71, 5.6%;p<0.01) requested change mode of FU. The proportion of patients requiring hospitalization during the study period was also higher in the TM group (TM: 23/70, 32.9% vs 11/71, 15.5%;p=0.02). After adjusting for age and pred-nisolone dosage, not being in LLDAS at baseline was the predictor of hospitalization (OR 3.4, 95%CI 1.20-9.65). None of the participants was tested positive for COVID-19. Conclusion: TM FU resulted in similar 1-year disease activity control and better satisfaction in patients with LN compared to standard care. However, a signifcant proportion of patients cared by TM required in-person visits or were hospitalized. The results of the study suggest that TM delivered care could help minimizing exposure to COVID-19, but it needs to be complemented by physical visits, particularly in those with unstable d sease.
ABSTRACT
Background:Patients with lupus nephritis (LN) might be more susceptible to COVID-19 due to the underlying disease, co-morbidities and use of immunosuppressants. We hypothesized that telemedicine (TM) could be a well-accepted mode of health-care delivery minimizing the risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), while maintaining disease control in these patients.Objectives:To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of TM compared with standard in-person follow-up (FU) for patients with LN during COVID-19.Methods:This was a single-center randomized-controlled study. Consecutive patients followed at the LN clinic were randomized to either TM (TM group) or standard FU (SF group) in a 1:1 ratio. Patients in the TM group received scheduled follow-ups via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared.Results:From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had attended at least 2 FU visits. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group (mean 0.67±0.69 vs 0.45±0.60, p=0.003) (Table 1). The mean FU duration was 19.8±4.5 weeks. When comparing the most recent visit, the mean waiting time between entering the clinic waiting room (virtual or real) and seeing a rheumatologist (virtual or in-person) was significantly shorter in the TM group (22.5±28.6 vs 68.9±40.7 minutes, p< 0.001) (Figure 1A). The mean overall patient satisfaction score was higher in the TM group (mean 2.19±0.61 vs 1.89±0.78, p=0.042). The results of the post-consultation satisfaction questionnaire are shown in Figure 1B. The number of visits was similar in the two groups (TM: 3.1±1.3 vs SF: 3.0±1.2, p=0.981). However, there was a trend suggesting that alternative mode of FU was requested more frequently in the TM group than the SF group (TM: 12/60, 20.0% and SF: 5/62, 8.1%;p=0.057). More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%;p=0.049) within the FU period, which was no longer statistically significant after adjusting for the baseline PGA. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p=0.919). None of the patients had COVID-19.Conclusion:TM resulted in better patient satisfaction and could achieve similar disease control in patients with LN in the short-term when compared to standard care.Table 1.Baseline clinical data of the recruited patients and comparison between the telemedicine/standard follow-up groupsOverall (n=122)Telemedicine group (n=60)Standard follow-up group (n=62)P-valueAge in years44.4±11.544.1±11.744.7±11.50.779Gender: Female111 (91.0)55 (91.7)56 (90.3)0.796Disease duration in years15.1±9.016.2±8.714.0±9.10.115Nephritis class III, IV or V108 (88.5)54 (90.0)54 (87.1)0.42724 hour urine proteinuria in gram0.51±0.630.53±0.600.50±0.650.712Current use of prednisolone112 (91.8)57 (95.0)55 (88.7)0.323Daily prednisolone dose in mg5.51±4.215.69±4.175.34±4.290.570Use of immunosuppressant90 (73.8)46 (76.7)44 (71.0)0.474SLEDAI-2K3.65±2.334.00±2.343.30±2.290.097PGA0.56±0.650.67±0.690.45±0.600.003LLDAS78 (63.9)36 (60.0)42(67.7)0.251Remission0 (0)0 (0)0 (0)n/aPresence of comorbidity87 (71.3)40 (66.7)47 (75.8)0.264SDI0.93±1.151.08±1.280.78±0.980.243HAQ-DI0.23±0.460.25±0.470.21±0.440.571HADS: Anxiety scale Depression scale6.07±4.12 5.72±4.316.20±4.19 5.73±3.935.93±4.09 5.70±4.680.720 0.724Data are reported as mean ± SD or number (%). LLDAS: lupus low disease activity state;SDI: Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index;HAQ-DI: Health Assessment Questionnaire Disability Index;and HADS: Hospital Anxiety and Depression Scale.Disclosure of Interests:Ho SO: None declared, Evelyn Chow: None declared, Tena K. Li: None declared, Sze-Lok Lau: None declared, Isaac T. Cheng: None declared, Cheuk-Chun Szeto: None declared, Lai-Shan Tam Grant/research support from: Grants from Novartis and Pfizer.
ABSTRACT
Background: It is important to weigh the potential risk of exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during a doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with the patients' choice of TM use in lupus nephritis. Objectives: In this study, we aimed to examine the clinical variables associated with a higher preference for TM follow-up in patients with lupus nephritis. Methods: Consecutive patients followed at the lupus nephritis clinic were contacted for their preferred mode of follow-up. The demographic, socioeconomic and clinical data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher PGA and family monthly income (≥ USD3,800) preferred TM, while fulltime employees preferred in-person follow-up (Table 1). These predictors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income ≥USD3,800 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak. Conclusion: When choosing the mode of care delivery between TM and clinic visit, the patient's disease activity as well as employment and economic status appeared to be important.
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The year 2020 has started with the COVID-19 pandemic. This has caused education institutions worldwide to resort to online teaching and learning delivery to ensure safety while not to stop learning progress. It will be interesting to learn whether students are ready and willing to adopt this change, especially when the decision and the change were made within a very short period of time. This paper presents a study carried out across two semesters in a private university in Malaysia to investigate students learning experiences and factors that may influence it. Both quantitative and qualitative questions were given to over 400 students each semester to obtain their feedback. Statistical and sentiment analysis has been carried out to analyze and observe the produced results. © 2020 IEEE.