ABSTRACT
Objectives: Obesity is an epidemic in gynecologic oncology, leading to an increased risk of surgical complications and poor cancer outcomes. Cognitive-behavioral therapy (CBT) is an effective weight loss strategy. We aimed to determine whether group CBT is an effective weight loss tool when offered in an outpatient gynecologic oncology setting. Methods: We established a CBT-based weight management intervention for gynecologic oncology patients at an NCI-designated cancer center. The intervention was a 12-week group-based weight loss program offered to patients from the gynecologic oncology clinic with body mass indices (BMI) between 25-50 kg/m2. Sessions were free of charge, led by a psychologist and dietitian, and transitioned from in-person to tele-visits due to the COVID-19 pandemic. The program combined nutritional education, lifestyle changes, and CBT approaches, with 12 weekly group visits followed by three monthly individual follow-up visits. Each participant was given a goal weight loss of 7% total body weight (TBW). Retrospective data were collected from patients enrolled in the intervention from September 2019 through March 2021. Paired t-tests were performed to compare the pre-program and ending weights for all participants. Weight loss data were tested for normality using the Shapiro-Wilk test. Results: A total of 29 patients were enrolled in four cohorts during the study timeframe. Fifty-nine percent of participants were White, 38% were Black. The mean age among participants was 56 years, and the mean BMI was 41 kg/m2. Most participants had a history of endometrial hyperplasia or malignancy (58%) and had stage I disease (59%). Among the participants, 22 (76%) completed the program. The average weight loss among all participants during the 12-week program was 5.6 pounds (CI: -8.9- -2.1, p = 0.002), equivalent to an average 2% change in TBW. Among the 22 participants who completed the program, the average weight loss was 7.4 pounds (CI: -11.1- -3.8, p <0.001), equivalent to an average 3% change in TBW. Weight loss was sustained at the 6-month mark, with an average change in TBW of 2-3% when comparing weight at 6 months to pre-program weight. Conclusions: This CBT-based weight loss intervention was feasible and acceptable to gynecologic oncology patients. While the average weight loss fell short of the goal of 7% TBW, the 2-3% change in TBW achieved on average with this intervention was stable over six months. Additionally, retention within the intervention was high and maintained during COVID-19 with tele-visits. Given that weight loss plateaued when transitioning from weekly to monthly sessions, our findings suggest that longer, more intensive treatment may be needed to promote sustainable weight loss among gynecologic oncology patients. Collaboration between psychologists, oncology dietitians, and gynecologic oncologists, with continued support for psychologists and dieticians at cancer centers, is critical to the success of such programs. CBT is a feasible behavioral intervention to add further multidisciplinary efforts to tackle the complexity of obesity in cancer survivors. [Formula presented]
ABSTRACT
The already high rates of anxiety and depression among healthy children have increased further since the COVID-19 pandemic began in early 2020. Pre-pandemic data suggest children with chronic disease were already experiencing increased rates of anxiety and depression as compared to their healthy peers. There is currently a paucity of literature on the prevalence of anxiety and depression in patients with pediatric pulmonary hypertension. In addition, there are no practice recommendations regarding mental health screening in this population. We evaluated provider perception of mental health screening at fourteen pediatric pulmonary hypertension care centers across the United States and Canada utilizing a cross-sectional survey. Thirty-seven providers from fourteen pediatric pulmonary hypertension centers in North America completed the survey. Health care providers caring for pediatric pulmonary hypertension patients perceive their patient cohort to frequently experience anxiety and depression. In addition, these providers believe that their patients would benefit from formalized, and routine, assessment of anxiety and depression with referral to mental health services as appropriate. Barriers to current mental health services were identified. This highlights the need to better understand the prevalence of anxiety and depression in pediatric pulmonary hypertension patients and to establish formal mental health screening practices within pediatric pulmonary hypertension care centers.
ABSTRACT
Artistic work in Aotearoa has long been underpaid and undervalued. In this paper, we examine policy statements made by the New Zealand government from September 2017 until November 2020 about the nature and value of artistic work. Early statements appear to challenge the economization of the arts, and to suggest alternative ways the arts might be valued, including for their inherent connection to well-being and social justice. However, rather than moving the arts away from commercial imperatives, we argue that government initiatives have been implicitly equipping artists and arts organizations to deliver their own economization.
ABSTRACT
Introduction: Outcomes and characteristics of patients with severe aortic stenosis (AS) treated during the COVID-19 pandemic is unknown. Methods: This was a single-centre observational study of patients undergoing AS treatment with transcatheter (TAVI) or surgical (SAVR) therapy during the first-wave of the UK COVID-19 pandemic compared to a control cohort undergoing treatment in 2019. Demographics, baseline echocardiogram, CT, procedural characteristics and outcome data were collated. The primary outcome was 30-day allcause mortality. The secondary endpoint was duration of post-procedural hospitalisation. Results: 319 patients were recruited - 122 underwent intervention during the pandemic [73 TAVI;49 SAVR] and 197 in 2019 [127 TAVI;70 SAVR]. In 2020, TAVI patients had a higher Euroscore II (p<0.001) but there were no differences in procedural complications or mortality [p=0.16] compared to TAVI 2019 cases. Duration from TAVI to discharge was shorter in 2020 (p<0.001). SAVR 2020 patients had similar baseline profile [p=0.48], surgical characteristics, mortality (p=0.68) and duration from SAVR to discharge compared to those in 2019. During the pandemic, TAVI patients were older (p<0.001) and had a higher Euroscore II (p<0.001) than SAVR counterparts. TAVI patients had reduced 30-day mortality [0 (0%) vs 3 (6%);p=0.06] and were discharged more rapidly post-intervention than SAVR patients [median 1 [1] vs 7 [4] days;p<0.001) translating into shorter hospitalization (p<0.001). Conclusions: TAVI and SAVR can be safely delivered with predictable resource utilisation during a pandemic. Despite the TAVI cohort incorporating higher risk, older patients, outcomes were at least as good as SAVR with a shorter length of post-procedural hospitalisation.