Seasonal distribution of relapses in MOG antibody associated disease (MOGAD)

Introduction: The influence of environmental factors on central nervous system demyelinating conditions have been recently studied. In MOG antibody associated disease (MOGAD), a seasonal distribution of relapses is not yet well-defined. Objective(s):: To investigate the presence of seasonal distribution of MOGAD relapses. Method(s): Prospective data from consented MOGAD patients within the Oxford National NMO Highly Specialised Service were analysed until April 2022. Demographic and clinical characteristics, including relapse date and phenotype, were recorded. All relapses with month-defined dates were used to calculate observed monthly frequencies. Expected frequencies were calculated assuming an uniform distribution throughout the year, adjusting for month's length and patient numbers under follow up. Any deviation from a uniform distribution was analysed, and seasonal peaks were assessed using Friedman's, Edward's, Ratchet circular scan and Hewitt's rank-sum tests. Result(s): Three-hundred-four MOGAD patients were included, 190 (62.5%) females, mean age at onset 31 years (SD 16.9), median disease duration 3.0 (IQR 5.0) years, 77 (25.3%) with paediatric age onset. No significant seasonal pattern was identified when analysing all relapses (n=691), or onset relapses (n=286). Regarding age of disease onset, no seasonal pattern was found in onset under 18 (n=483) or over 18 years old (n=208). Regarding phenotype, no seasonal pattern was found in optic neuritis (n=483), transverse myelitis (n=180) or brain and brainstem relapses (n=125). Analysing all the relapses from the start of the COVID-19 pandemic (March 2020 - February 2022, n=112), a seasonal peak was identified from March to May (V(N)=0.132, p<0.05). Conclusion(s): No seasonal pattern of relapses in MOGAD was noted until the COVID-19 pandemic started in the UK. Seasonal infection peaks during winter and subsequent lockdowns could have influenced MOGAD relapse rates in the past two years.

THE PSYCHOLOGICAL IMPACT OF LIVING WITH ASTHMA DURING THE COVID-19 PANDEMIC

Background Underlying chronic conditions could make individuals particularly vulnerable to environmental stress during the coronavirus-19 disease (COVID-19) pandemic. Comorbid psychopathology frequent in asthma could increase the vulnerability of this population. As psychological symptoms are intimately linked with asthma control, research is needed to uncover potential mental health considerations for the clinical management of asthma in a pandemic setting. Objective We investigated whether differences exist between asthmatics relative to non-asthmatics in various dimensions of psychological health during a pandemic. We then investigated how perceived COVID-19 vulnerability, asthma and COVID-19 symptom experience, and symptom-related worry may mediate group differences in psychological distress. Methods Survey data on the physical, psychological, and pandemicrelated health of 234 adults was collected from July-November 2020. Controlling for demographic and health-related confounds, multiple regression analyses examined differences in psychological distress between asthmatics (n=111) and nonasthmatic controls (n=123) during a pandemic. Mediation analyses investigated roles of perceived COVID-19 vulnerability, symptom experience, and symptom-related worry in this model. Results Compared to non-asthmatics, scores on anxiety, stress, and symptoms of burnout were significantly higher for individuals with asthma (P<.05). Emotional exhaustion, represented by a subscale of the Maslach Burnout Inventory, remained elevated beyond general anxiety and depression. Experience of symptoms typical in both asthma and COVID-19 (i.e., chest tightness) mediated 42% of this effect (95%CI=[0.72, 2.51]). Conclusion The mental health of individuals with asthma is differentially impacted in a pandemic environment compared to individuals without asthma. Characteristics of burnout, partially mediated by physical symptoms related to asthma and COVID-19, may constitute a new ?symptom burnout? phenomenon related to viral pandemics. This phenomenon emerged over and above comorbid anxiety and depression, which are commonly observed in asthma. Our findings can contribute to an optimization of asthma management, and more research is needed to understand whether ?symptom burnout? exists beyond the limited access to care and heightened environmental stress of a viral pandemic.

ASTHMA AND CHRONIC STRESS DURING THE COVID-19 PANDEMIC: THE MEDIATING ROLE OF SLEEP

Background: Prior research indicates that asthma is associated with greater stress. Individuals with asthma are also more likely to experience sleep problems, and poorer sleep health has been linked to higher stress levels. However, the role of sleep in the relation between asthma and stress remains understudied. We sought to explore the relationship between asthma and chronic stress, and the potential mediating role of sleep quality components in this association, during July 2020-November 2020 of the COVID-19 pandemic, a period of sustained naturalistic stress. Method: Participants (adults, mean age 55.53 years, N=241, n=115 adults with asthma) completed self-report measures assessing sleep efficiency, sleep duration, nocturnal asthma symptoms, and chronic stress. Hierarchical multiple linear regression models controlling for age and sex examined asthma and sleep quality components as predictors of chronic stress during the COVID-19 pandemic. Using the distribution of products method, sleep efficiency and sleep duration were examined as mediators of the association between asthma and chronic stress. Within the sample of adults with asthma, nocturnal asthma symptoms were examined as an additional predictor of chronic stress during COVID-19. Results: Asthma independently predicted greater chronic stress during the COVID-19 pandemic. Asthma was not associated with lower sleep efficiency, nor was there a significant relation between sleep efficiency and chronic stress. However, asthma was significantly associated with shorter sleep duration, and shorter sleep duration predicted greater chronic stress during the COVID-19 pandemic. Sleep duration, but not sleep efficiency, mediated the relation between asthma and chronic stress. Within the sample of adults with asthma, shorter sleep duration, but not sleep efficiency nor nocturnal asthma symptoms, predicted chronic stress during the COVID-19 pandemic. These findings suggest that sleep plays a role in health in asthma, above the influence of nocturnal asthma symptoms. Overall, findings highlight the importance of maintaining adequate sleep duration during stressful periods for individuals with asthma.

Medical ethics for the military profession

This paper summarizes medical ethics in the military profession to raise military leaders' awareness of Military Medical Ethics (MME) and the ethical issues that may impact their medical services and personnel. First, it summarizes core concepts, including the four principles of medical ethics (autonomy, beneficence, non-maleficence, and justice), the two legal frameworks for the use of military force in war, jus ad bellum and jus in bello, and the concept of dual loyalty. It then examines MME issues during conflict, in garrison healthcare, and during the COVID-19 epidemic. Finally, it concludes by arguing that MME is an important domain of military ethics that should be taught to military leaders to complement the detailed education of MME military medical professionals. © 2021 Escuela Militar de Cadetes. All rights reserved.