Perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples of the Department of Presidente Hayes, Paraguay

Introduction: During the COVID-19 pandemic, factors such as border closures, late receipt of vaccines, limitation of population circulation, relocation of nurses from vaccination areas to areas of care for patients with COVID-19, added to the fear of contagion affected vaccination coverage in several countries. Objective: Describe the perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples in the department of Presidente Hayes, Paraguay 2022. Methods: Descriptive, retrospective, observational study with a qualitative-quantitative cross-sectional design. Results: The characteristics of the indigenous peoples reveals that 110 (26.44%) are between 28 and 37 years old, 276 (66.35%) are female, 133 (31.97%) are of the Angaité ethnic group, 290 (69.71%) have studies up to the primary level and 178 (42.79%) have single marital status. The perception towards the COVID-19 vaccination was favorable in 201 subjects (48%) and very unfavorable in 148 (36%). There are indigenous peoples with great influence of cultural and religious beliefs in relation to vaccines. Regular vaccination was affected. Discussion: It was observed that the COVID-19 pandemic and the appearance of the vaccine developed distrust not only in the COVID-19 vaccine but also in the rest of the vaccines in some of the towns studied. © 2023, Faculty of Medical Sciences, Santa Rosa del Aguaray Branch, National University of Asuncion. All rights reserved.

COVID-19: prevention, diagnosis and treatment. Recommendations of a multidisciplinary group.

BACKGROUND: SARS-CoV-2 infection, which causes COVID-19, has impacted the entire world due to its extensive and rapid spread. In the last two years, more than 412 million cases have been confirmed, with more than 5.8 million deaths, as of February 14, 2022. OBJECTIVE(S): Integrate a series of recommendations based on the best level of evidence in prevention, diagnosis and treatment of SARS-CoV-2 infection, including its new variants. METHODOLOGY: Review of different international guidelines and recent articles published in peer-reviewed journals. Issue recommendations based on the level of evidence and degree of confirmation established by the guidelines of the National Institute for Health and Care Excellence (NICE). The authors analyzed the selected articles and, based on their experience, summarized the most relevant to meet the objectives of these recommendations. RESULT(S): 200 articles were found, of which only 124 were selected that met the requirements to identify the level of evidence and degree of recommendation. CONCLUSION(S): Prevention through vaccination continues to be the best tool to establish protection mechanisms against the virus and substantially reduce hospitalizations and associated mortality. Although homologous vaccination is still the accepted reference pattern, the efficacy of heterologous schemes to avoid hospitalization and mortality must be considered. Monoclonal experiments, such as sotrovimab, have activity against the Omicron variant and the AZD7442 molecule that have shown high efficacy in preventing symptomatic COVID-19 in pre- and post-exposure conditions.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Analysis of the teaching perception on the educational management of the confinement by covid-19 in Spain

This research has analyzed the satisfaction on the part of the teaching staff regarding the management at the educational level by the national institutions in Spain, the Autonomous Communi-ties and the educational centers during the confinement stage by covid-19, through a design analysis. Quantitative pretest-posttest without a control group, with the collaboration of 295 teachers from private, public and concerted centers with ages between 24 and 64 years of all educational levels. Regarding the results, statistically significant differences have been found in the comparison of teacher satisfaction in terms of managing the pandemic, with no differences based on gender. The national insti-tutions and the Autonomous Communities showed lower levels of satisfaction compared to the teacher's perception of the educational centers, as well as in the comparison of these variables depending on the type of center of the teaching staff, having found differences between public-private centers and public-subsidized, and not having been so between private and concerted centers.

Acalculous Cholecystitis: A Novel and Lethal Unrecognized Complication in Severe CoVID 19

Background. SARS-COV-2 infection is known to cause tissue damage in several organs outside of the respiratory tract. The pathogenesis of tissue damage is hypothesized to be caused by direct viral damage, endothelial injury, and ischemic or thrombotic events. Gastrointestinal symptoms were first characterized mainly as diarrhea and diffuse abdominal pain and discomfort, which can be hard to interpret in the setting of a generalized inflammatory response;gallbladder injury and inflammation causing acute acalculous cholecystitis has been scarcely reported Methods. Here we discuss five cases of patients presenting with symptoms of cholecystitis. All five patients underwent multiple imaging studies, and all of them were compatible with acute cholecystitis;some of them had an imaging report of lithiasic cholecystitis, while the rest were reported with microlithiasis or biliary sludge. Four out of the five patients underwent laparoscopic cholecystectomy;biopsies were taken, consistently those reported with acalculous cholecystitis. The remaining patient died of CoVID 19 complications prior to surgery, but after a percutaneous cholecystostomy tube was placed. Results. All these patients have in common the prolonged fasting, because they all required invasive mechanical ventilation, consequently, they all developed multiple focal pneumonia and respiratory distress syndrome. This fast is related to the development of gangrenous ischemia in the gallbladder, which manifests as a late complication due to SARS-CoV-2 infection, in addition to being related to angiotensin-2 converting receptors and virus replication proteins, as well as the pro-inflammatory and hypoxia state that in itself causes the infection (9). All showed a cholestatic pattern, highlighting that this complication developed in an average time of 3 weeks after the onset of SARS-CoV2 symptoms, in addition to the fact that in most cases a negative test was already shown at the time of the complication. Conclusion. Acalculous cholecystitis is one of the extrapulmonary complications that has been seen in patients with this infection, not being the most common, but one of those that has generated a higher mortality rate in patients due to its late diagnosis and non-specific clinical picture in certain occasions (9).

Management of time resources in students and teachers according to the perception of educators during the COVID19 pandemic

The current investigation analyzed the perception of timing resources management not only in the students, but also in teachers. Thereby it also investigates its relationship with the gender in a pre- pandemic and lockdown context, such as COVID19 through an analysis from a quantitative design (pre-test, post-test) without a control group, in which 295 teachers from states, semi-privates and private schools have collaborated and whose age range between 24 and 64 years old in different educational levels in Spain. According to the results, the perception of time management was modified because of the precipitous implementation of online teaching against face-to-face teaching, showing a saving time perception due to new technologies in students and teachers by way of illustration the increase in class organization, materials correction and families meeting without differentiation between genders. The perception of the students' time dedicated to study has increased and has been found to have significant statistically differences in women.

Biocatalyst developed with recovered iron-rich minerals enhances the biotransformation of SARS-CoV-2 antiviral drugs in anaerobic bioreactors.

The biotransformation of the SARS-CoV-2 antiviral drugs, ribavirin and tenofovir, was studied in methanogenic bioreactors. The role of iron-rich minerals, recovered from a metallurgic effluent, on the biotransformation process was also assessed. Enrichment of anaerobic sludge with recovered minerals promoted superior removal efficiency for both antivirals (97.4 % and 94.7 % for ribavirin and tenofovir, respectively) as compared to the control bioreactor lacking minerals, which achieved 58.5 % and 37.9 % removal for the same drugs, respectively. Further analysis conducted by liquid chromatography coupled to mass spectroscopy revealed several metabolites derived from the biotransformation of both antivirals. Interestingly, tracer analysis with 13CH4 revealed that anaerobic methane oxidation coupled to Fe(III) reduction occurred in the enriched bioreactor, which was reflected in a lower content of methane in the biogas produced from this system, as compared to the control bioreactor. This treatment proposal is suitable within the circular economy concept, in which recovered metals from an industrial wastewater are applied in bioreactors to create a biocatalyst for promoting the biotransformation of emerging pollutants. This strategy may be appropriate for the anaerobic treatment of wastewaters originated from hospitals, as well as from the pharmaceutical and chemical sectors.

Eating habits and academic stress among university students during the COVID-19 pandemic, Paraguay 2021

The objective of the study was to identify the eating habits related to the level of stress among students of the National University of Caaguazu during the COVID-19 pandemic. A descriptive, observational, cross-sectional study was carried out with 353 students selected from different faculties. Demographic variables, eating habits and academic stress were studied. A total of 353 university students were included in the study, 64.9% female, and 59.5% under 23 years of age. 36.5% belonged to the Faculty of Production Sciences while 30% were from the third year. In total, 64.8% (229 students) had a high level of stress. High stress level was related to high consumption of sweets (AOR= 2.94, 1.57-5.51), high consumption of fast food (AOR= 2.23, 1.14-4.32), low consumption of fruits (AOR= 1.66, 0.99-2.79), skipping lunch (AOR= 2.94, 1.55-5.60), and increased daily snacks (AOR= 3.36, 1.74-6.47). The results of our study made visible the problem that academic stress during the Covid-19 pandemic influenced the acquisition of bad eating habits. Copyright © 2022, Sociedad Chilena de Nutricion Bromatologia y Toxilogica. All rights reserved.

Active Monitoring of Adverse Events in a Closed Population: Contributions from Colombia to COVID-19 Vaccines Safety

Introduction: Information on the effectiveness and safety of vaccines for COVID-19 is limited as clinical trials did not provide enough evidence about long-term effects and all possible adverse events [1]. Moreover, marketing authorization for these vaccines was conditioned on providing more information about adverse events and effects on populations not included in clinical trials, like pregnant and pediatric population [2,3]. Objective(s): To evaluate the clinical performance and Adverse Events Following Immunization (AEFIs) of the vaccines against COVID-19 in a closed cohort from a Colombian university. Method(s): This is an observational study of a prospective cohort, with members of the Universidad Nacional de Colombia (UNAL, by its Spanish acronym) followed from June 2021 to April 2022. Data was collected via a telephonic survey and additional clinical information was provided by the health institution Unisalud. Description of the AEFIs in the population and the characteristics of the people with adverse events was analyzed. Result(s): A total of 3,764 persons were included, 35.73% reported AEFIs from which around 8.55% (115/1,345) experienced them 5 days after immunization. AEFIs tended to have low or medium intensity (70% on a 5 Likert scale, from very low to very high) and a duration between 1 and 3 days (65.1%). The vaccine with fewer AEFIs was Sinovac and was statistically different from Pfizer and AstraZeneca (using Tukey HSD and 95% confidence). Conclusion(s): The percentage of AEFIs is consistent with findings in active monitoring programs. Risk factors coincide with other studies. This study demonstrates high rates of AEFIs in the population differing by brand. Serious events were rare. This study contributes to the knowledge of AEFIs for vaccines only used in middle and lowincome countries. The active monitoring program of UNAL gives very relevant and reliable information. Models to study risk factors for AEFIs are needed and are currently in development by the authors.

Active Monitoring of Adverse Events in a Closed Population: Contributions from Colombia to COVID-19 Vaccines Safety: An International Journal of Medical Toxicology and Drug Experience

Introduction: Information on the effectiveness and safety of vaccines for COVID-19 is limited as clinical trials did not provide enough evidence about long-term effects and all possible adverse events [1]. Moreover, marketing authorization for these vaccines was conditioned on providing more information about adverse events and effects on populations not included in clinical trials, like pregnant and pediatric population [2,3]. Objective: To evaluate the clinical performance and Adverse Events Following Immunization (AEFIs) of the vaccines against COVID-19 in a closed cohort from a Colombian university. Methods: This is an observational study of a prospective cohort, with members of the Universidad Nacional de Colombia (UNAL, by its Spanish acronym) followed from June 2021 to April 2022. Data was collected via a telephonic survey and additional clinical information was provided by the health institution Unisalud. Description of the AEFIs in the population and the characteristics of the people with adverse events was analyzed. Results: A total of 3,764 persons were included, 35.73% reported AEFIs from which around 8.55% (115/1,345) experienced them 5 days after immunization. AEFIs tended to have low or medium intensity (70% on a 5 Likert scale, from very low to very high) and a duration between 1 and 3 days (65.1%). The vaccine with fewer AEFIs was Sinovac and was statistically different from Pfizer and AstraZeneca (using Tukey HSD and 95% confidence). Conclusion: The percentage of AEFIs is consistent with findings in active monitoring programs. Risk factors coincide with other studies. This study demonstrates high rates of AEFIs in the population differing by brand. Serious events were rare. This study contributes to the knowledge of AEFIs for vaccines only used in middle and lowincome countries. The active monitoring program of UNAL gives very relevant and reliable information. Models to study risk factors for AEFIs are needed and are currently in development by the authors.

Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

MULTISCREEN CONSUMPTION FROM A MARKETING PERSPECTIVE IN TIMES OF COVID-19

The research is of a mixed type, that is to say, an exploratory and conclusive research was carried out. It is exploratory, qualitative and observational. Since the study phenomenon was studied from its qualities. And it is conclusive, descriptive, transversal and non-experimental. The conclusive research was carried out through a survey, and for the exploratory stage, in-depth interviews were conducted. The research question was: What are the differences in multiscreen consumption among generations X, Y and Z in the face of the Covid-19 pandemic in Puebla? And as Hypothesis H1: The multiscreen consumption is significantly different in generations X, Y and Z during the pandemic due to the permanence in the homes. Likewise, the objective is to analyze the differences in multiscreen consumption behavior in generations X, Y and Z during the Covid-19 pandemic in Puebla. The research was conducted at 95% confidence level with a sample of 409 subjects. In the case of the exploratory research, it was decided to select only 15 subjects who met the profile of opinion leaders for the qualitative research. The study subjects (poblanos of generation X, Y and Z) consider that their time in front of a screen has increased considerably since the 2020 pandemic, since it generated a new lifestyle where people of different generations have had to adapt. Currently it is essential to have and know how to use audiovisual devices, likewise people belonging to generation Y and X were forced to improve their skills or learn to handle the devices in order to stay in touch with their environment. This is due to the fact that since the confinement by Covid19 during 2021 everything has been channeled to virtually, such as communication, shopping, sales, education, culture, etc.

Emotional Impact of COVID-19 on Palliative Care Healthcare Professionals

Background/aims: Palliative care professionals (PCP) work in an environment of great emotional impact where patients and caregivers present high levels of emotional distress and suffering. Working in these units frequently involves high levels of emotional distress. The emergence of the COVID-19 pandemic has intensified this emotional distress. The aim of this work was to analyze the levels of emotional distress of palliative care health professionals during the second wave of the pandemic in Spain. Methods: A descriptive cross-sectional study of palliative care health professionals who responded to an online survey during the second COVID-19 pandemic in Spain (July 2020). 95 palliative care professionals (58 women and 37 men) with a mean age of 45.72 ± 11.71 years responded to an online survey voluntarily, after giving informed consent. In addition to sociodemographic variables, anxiety, depression, emotional distress, post-traumatic stress, and questions related to the COVID-19 situation and the institution were analyzed. The study was approved by the Ethics Committee of the Autonomous University of Barcelona. Results: 53.7% of the health professionals reported anxiety, 46.7% depression, 54.5% emotional distress, and 28% post-traumatic stress disorder (PTSD). A 26.5% of the professionals think that they require psychological help. 32.8% believe that they feel recognized by their institution, and 28.7% feel cared for by their institution. We observe that the professionals who feel recognized by their institutions experience less emotional distress (p<0.01) and believe they need less psychological support (p<0.05) than those who do not perceive it. Conclusions: A high emotional impact generated by the COVID-19 pandemic is observed in PC professionals. It would be necessary to provide psychological resources related to emotional regulation and coping strategies to deal with this situation of high emotional impact generated by the pandemic and promote their well-being and facilitate coping of future pandemics.

Corporate social innovation during the COVID-19 pandemic: Some practices from Colombian companies

Given that the COVID-19 pandemic resulted in an unprecedented scenario, there were no previous lessons learned about the organizational responses to social problems. As a result of the above, this chapter describes the practices used by seven Colombian organizations to face the first months of the pandemic based on corporate social innovation framework. A qualitative approach was used to carry out the study and a qualitative content analysis as a research method. The results obtained indicate that the companies participating in the research developed actions in the four pillars, with actions associated with social issues being more prevalent, especially concerning workers and vulnerable populations. © 2021, IGI Global.

Innovative Educational Approach in Healthcare-Associated Infection Prevention and Control. Results of a European Study

Prevent and control healthcare-associated infections (HAIs) is a priority in healthcare assistance, not only due to present COVID-19 pandemic. Annually, around 3.2 million patients are affected by one of these infections and it is estimated that without controlling them, by 2050, 10 million more people could die every year, with especial relevance among elderly with infectious situations representing a third of mortality in people over 65 years old. Higher Education Institutions (HEI) in healthcare area have an important role in this panorama, by preparing students to be future professionals, stimulating them to have an innovative and entrepreneurial approach to today’s real-life challenges. A mixed-methods research was conducted, at European level (in Portugal, Finland, Poland and Spain), to facilitate learning of good practices on HAIs prevention and control while developing innovative solutions. 1475 participants were enrolled, from all partner HEI: 79 professors and mentors were interviewed (individual or focus group), 1326 final year nursing students made a self-report inventory (application of InovSafeCare Scale) and 70 students participated on focus group (agile piloting of the Model). The result of this research is a pedagogical model that mixes dimensions and methods that take nursing students closer to the demands of HAIs prevention and control and capacitates them to transfer knowledge to work settings with an innovative and entrepreneurial perspective – the InovSafeCare Model. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Outpatient Antimicrobial Stewardship Utilizing a Decentralized Model

Background. The majority of human antimicrobial utilization occurs in the outpatient setting. Despite being mainly viral in etiology, upper respiratory tract infections (URIs) were the most common indication for outpatient antimicrobial prescriptions at our institution. Methods. Through our electronic health record (EHR), we were able to determine our rate of antibiotic prescriptions for inappropriate URI diagnosis at our primary care practice sites. We selected staff volunteers from each our primary care practice sites to serve as stewardship champions. They were given training in stewardship best practices, and an URI stewardship toolkit which included viral URI prescription pad, EHR order panel, and patient education signage. They were tasked with providing education and feedback to their practice sites. We meet with them on a monthly basis to disseminate prescribing data and education. They also provided feedback from practice sites to the stewardship committee. Results. Our decentralized model was put in place in November 2020. In the 6 months prior to the intervention, the average prescribing rate was 29.1%. In the 6 months after the intervention, the average prescribing rate decreased by 15% to 24.8%. During the intervention phase, there was an increase in number of non-COVID URIs diagnosed at our primary care sites. Temporal Trend in Inappropriate Antibiotics Prescribing Rates for Viral URIs Preand Post- Intervention Inappropriate antibiotic prescribing rate for viral upper respiratory tract infections from May 2020 until May 2021. Intervention started in December 2021 (arrow). Preintervention average was 29.1%. Post-intervention age was 24.8% which is a 15% decline in prescribing rate. Viral Upper Respiratory Infections Visits The total number of visits for presumed viral upper respiratory infections to primary care sites from May 2020 until May 2021. The majority of COVID-19 precautions in the area expired at the end of March 2021. Conclusion. We have been able to lower our inappropriate prescriptions for URIs utilizing a decentralized model of stewardship champions. This result was especially notable as the intervention phase corresponded with the end of COVID-19 precautions and an increase in non-COVID URIs diagnosed. The advantage of this approach includes an advocate embedded at each practice site who is familiar with the opportunities and challenges of the site, and a two-way flow of information from practice sites to the stewardship committee. This model provided additional benefit during the COVID-19 pandemic as the ability of centralized staff to travel to off campus clinic sites was curtailed.

Silicone pulmonary embolism: A case report

INTRODUCTION: SPE is a rare entity reported in medical literature. Clandestine silicone application has been increasing in Mexico, leading to increased rates of SPE and death. Symptoms include dyspnea, chest pain, fever, cough, diffuse alveolar hemorrhage (DAH), and acute respiratory distress syndrome. In Mexico, from 2005-2014, 21.8% SPE deaths have been reported related to cosmetic procedures. DESCRIPTION: A 21-year-old, previously healthy transgender patient, with a history of multiple cosmetic surgeries, underwent to a gluteal augmentation procedure through injection of 1000 cc of liquid silicone in an outpatient clinic. The procedure was canceled after administration of 500 cc of silicone due to dyspnea and cough, and the patient was discharged. Two days later, the symptoms worsened, and she was admitted to the emergency department, with a blood pressure of 90/64 mmHg, SpO2 60%, respiratory rate of 40 bpm, and heart rate of 125 bpm. She was intubated and admitted to ICU. On clinical examination, we identified basal crackles, petechial hemorrhage, and erythematous puncture sites. CT pulmonary angiogram showed bilateral basal ground-glass opacities, ruling out thrombus in pulmonary circulation;and lung ultrasound with B pattern. Blood test showed thrombocytopenia, hypoxia (Pa02:FiO2 97 mmHg), elevated alveolar-arterial gradient, negative PCR SARS-CoV-2, and no renal failure. She was diagnosed with SPE;supportive management with lung protective ventilation, prone positioning (PP) and systemic steroids (SS) was initiated. She also had hemoptysis, new pulmonary infiltrates, and abnormal liver enzymes at ICU, which resolved spontaneously. After 8 sessions of PP, oxygenation improved, tracheostomy was performed due to ICU acquired weakness and was discharged home after 20 days of hospital stay. DISCUSSION: There is a paucity of reports of this complication. Our patient showed a significant improvement after administration of SS, which consists with an immunomediated mechanism. Studies have reported mortality from 24 to 33%, but can reach up to 100% if neurological symptoms are present. It is important to recognize that silicone injections are not safe and can lead to serious complications. Recognizing rare manifestations can help to distinguish this entity from other etiologies.

MITIGATION OF THE EDUCATIONAL IMPACT OF COVID-19 FROM TRANSFORMING NARRATIVES 4.0. IN ANALOG AND DIGITAL TECHNOLOGIES

This article poses the challenge of generating interactive practices mediated by pedagogical narratives, energized by the academy through challenge-based learning and classroom projects, to strengthen training in family-school interaction, in coherence with the methodology of work, a network of creative media in the ecology of screens that provide didactic sequences and adaptive learning is built for the first time, in and for the region. This research is committed to linking the actors of the educational community (parents, guardians and students) who at times have remained away from the new pedagogical trends in the global context. Specifically, the training of students was encouraged to get involved, from the intellectual, creative, emotional, social and physical aspects, in new pedagogical narratives, offering different opportunities to test solutions to various problems, as well as integrating learning, experience, cognition and educational behavior with tangible results of educational projection. As a result, there is the creation of a significant project for the production and co-creation of academic content from experiences that involve students and their families in new learning scenarios, in order to reach 108 municipalities and 275 educational institutions, in a synchronous work with 11 thousand teachers from all over the Department of Cundinamarca-Colombia.

"Listen to the Feedback of Students": First-Generation College Students Voice Inequalities in Schooling Brought on by the COVID-19 Pandemic

In March 2020, the higher-education community faced one of its largest disruptions to date with the COVID-19 pandemic forcing campuses to close their doors to thousands of students. The university-wide closures prompted a collaboration between researchers and college administrators to assess the impact of COVID-19 on First-Generation College Students (FGCS). The team surveyed 659 FGCS across five U.S. universities to assess the ways in which the pandemic exacerbated already existing inequalities students faced in their persistence to graduate from college. The team used the social cognitive career theory as a conceptual framework for analysis. Our findings revealed that when respondents compared their life before COVID-19 with their present state, FGCS were less likely to perceive they had enough money to return to college, felt overwhelmed and lonely by added stress, and were more likely to see an increase in family responsibilities.