[General Practitioners' Experiences with COVID-19: a Survey After the First Wave of the Pandemic in March/April 2020]. / Erfahrungen von HausärztInnen mit COVID-19 und der Pandemie ­ ein Survey nach der ersten Pandemiewelle im März/April 2020.

BACKGROUND AND OBJECTIVES: The first wave of the COVID-19 pandemic (Mar-Apr 2020) posed significant challenges for primary care. The goal of this study was to analyse the burden of the crisis situation as experienced by the general practitioners (GPs) at its beginning and over the course of the pandemic and to identify factors predictive of the sense of being overburdened. METHODS: In this cross-sectional study, a total of 6300 randomly selected GPs in four federal states of Germany were contacted per post in order to survey changes in health care they provided and their psychological burden in the context of the pandemic between August and October 2020. RESULTS: The response rate was 23%; 46% of the participants were female. At the beginning of the pandemic, 40% of the participants experienced a high or a very high level of being overburdened; later on, it was only 10%. With increasing numbers of COVID patients, the sense of being overburdened increased, as also their perceived capability to care for COVID patients. Predictors of a sense of being overburdened were, among others, a high level of psychological stress, excessive organising efforts, poor capability to care for COVID patients, and scarce supply of protective equipment. CONCLUSION: Despite a sense of being overburdened initially, GPs felt increasingly capable of caring for COVID patients. To help GPs in future crisis situations like this pandemic, organization of care should be simplified to the extent possible so that they can focus on patient care.

Understanding Mobile Health and Youth Mental Health: Scoping Review.

BACKGROUND: A total of 75% of people with mental health disorders have an onset of illness between the ages of 12 and 24 years. Many in this age group report substantial obstacles to receiving quality youth-centered mental health care services. With the rapid development of technology and the recent COVID-19 pandemic, mobile health (mHealth) has presented new opportunities for youth mental health research, practice, and policy. OBJECTIVE: The research objectives were to (1) synthesize the current evidence supporting mHealth interventions for youths who experience mental health challenges and (2) identify current gaps in the mHealth field related to youth's access to mental health services and health outcomes. METHODS: Guided by the methods of Arksey and O'Malley, we conducted a scoping review of peer-reviewed studies that used mHealth tools to improve youth mental health (January 2016-February 2022). We searched MEDLINE, PubMed, PsycINFO, and Embase databases using the following key terms: (1) mHealth; (2) youth and young adults; and (3) mental health. The current gaps were analyzed using content analysis. RESULTS: The search produced 4270 records, of which 151 met inclusion criteria. Included articles highlight the comprehensive aspects of youth mHealth intervention resource allocation for targeted conditions, mHealth delivery methods, measurement tools, evaluation of mHealth intervention, and youth engagement. The median age for participants in all studies is 17 (IQR 14-21) years. Only 3 (2%) studies involved participants who reported their sex or gender outside of the binary option. Many studies (68/151, 45%) were published after the onset of the COVID-19 outbreak. Study types and designs varied, with 60 (40%) identified as randomized controlled trials. Notably, 143 out of 151 (95%) studies came from developed countries, suggesting an evidence shortfall on the feasibility of implementing mHealth services in lower-resourced settings. Additionally, the results highlight concerns related to inadequate resources devoted to self-harm and substance uses, weak study design, expert engagement, and the variety of outcome measures selected to capture impact or changes over time. There is also a lack of standardized regulations and guidelines for researching mHealth technologies for youths and the use of non-youth-centered approaches to implementing results. CONCLUSIONS: This study may be used to inform future work as well as the development of youth-centered mHealth tools that can be implemented and sustained over time for diverse types of youths. Implementation science research that prioritizes youths' engagement is needed to advance the current understanding of mHealth implementation. Moreover, core outcome sets may support a youth-centered measurement strategy to capture outcomes in a systematic way that prioritizes equity, diversity, inclusion, and robust measurement science. Finally, this study suggests that future practice and policy research are needed to ensure the risk of mHealth is minimized and that this innovative health care service is meeting the emerging needs of youths over time.

Quality of Physical Activity Participation Among Adults with Disabilities Through Pandemic Restriction.

Background. Physical activity (PA) is essential for maintaining well-being in adults with disabilities. This population experienced reduced PA during the COVID-19 pandemic; yet, the impact on quality of PA participation remains unclear. Purpose. This secondary analysis explored how pandemic restrictions impacted six experiential dimensions of quality of PA participation among adults with disabilities. Methods. An exploratory sequential mixed-methods design, including semi-structured interviews (n = 10) and self-reported surveys (n = 61), was conducted in May-2020 and February-2021. Quality of PA participation was measured using the Measure of Experiential Aspects of Participation (MeEAP). Participants included community-dwelling adults over 19 years of age (mean 59.2 ± 14.0 years) living with stroke, spinal cord injury, or other physical disabilities. Findings. Directed content analysis identified three themes related to adjusting PA participation for restrictions, motivation barriers, and valuing social support. These themes highlighted five factors, such as resilience, as potential quantitative predictors of quality of PA participation. While paired correlations with MeEAP scores were observed, these factors were not statistically predictive in multiple regression analysis (adjusted R2 = -0.14, F(10,50) = 0.92, p = .53). Implications. The interplay between Meaning, Autonomy, Engagement, and Belongingness dimensions of quality of PA participation was complex, with an emphasized role for mental health, in adults with disabilities.

Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients.

Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.

Preliminary investigation of the student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH).

BACKGROUND: COVID-19 public health restrictions (i.e. physical distancing) compromise individuals' ability to self-manage their health behaviours and may increase the risks of adverse health events. OBJECTIVES: To evaluate the student-delivered Community Outreach teleheAlth program for Covid education and Health promotion (COACH) on health-directed behaviour (self-management) among older adults (≥65 years of age, n = 75). Secondary objectives estimated the influence of COACH on perceived depression, anxiety, and stress; social support; health-related quality of life; health promotion self-efficacy; and other self-management domains. METHODS: COACH was developed to provide chronic disease management and prevention support among older adults via telephone or videoconferencing platforms (i.e. Zoom). In this single-group, pre-post study, our primary outcome was measured using the health-directed behaviour subscale of the Health Education Impact Questionnaire. Secondary measures included the Depression, Anxiety and Stress Scale, Medical Outcomes Study: Social Support Survey, MOS Short Form-36, and Self-Rated Abilities for Health Practices Scale. Paired sample t-tests were used to analyse outcome changes. RESULTS: Mean age of participants was 72.4 years (58.7% female; 80% ≥2 chronic conditions). Health-directed behaviour significantly improved after COACH (P < 0.001, d = 0.45). Improved health promotion self-efficacy (P < 0.001, d = 0.44) and decreased mental health were also observed (P < 0.001, d = -1.69). DISCUSSION: COACH likely contributed to improved health-directed behaviour and health promotion self-efficacy despite the diminished mental health-related quality of life during COVID-19. Our findings also highlight the benefits of using health professional students for the delivery of virtual health promotion programs. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov ID: NCT04492527.

Application of real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance.

BACKGROUND: Evaluation of the application of CSF real-time quaking-induced conversion in Creutzfeldt-Jakob disease surveillance to investigate test accuracy, influencing factors, and associations with disease incidence. METHODS: In a prospective surveillance study, CSF real-time quaking-induced conversion was performed in patients with clinical suspicion of prion disease (2014-2022). Clinically or histochemically characterized patients with sporadic Creutzfeldt-Jakob disease (n = 888) and patients with final diagnosis of non-prion disease (n = 371) were included for accuracy and association studies. RESULTS: The overall test sensitivity for sporadic Creutzfeldt-Jakob disease was 90% and the specificity 99%. Lower sensitivity was associated with early disease stage (p = 0.029) and longer survival (p < 0.001). The frequency of false positives was significantly higher in patients with inflammatory CNS diseases (3.7%) than in other diagnoses (0.4%, p = 0.027). The incidence increased from 1.7 per million person-years (2006-2017) to 2.0 after the test was added to diagnostic the criteria (2018-2021). CONCLUSION: We validated high diagnostic accuracy of CSF real-time quaking-induced conversion but identified inflammatory brain disease as a potential source of (rare) false-positive results, indicating thorough consideration of this condition in the differential diagnosis of Creutzfeldt-Jakob disease. The surveillance improved after amendment of the diagnostic criteria, whereas the incidence showed no suggestive alterations during the COVID-19 pandemic.

Anxiety and Social Support Are Associated with Loneliness among Adults with Disabilities and Older Adults with No Self-Reported Disabilities 10 Months Post COVID-19 Restrictions

With increased physical restrictions during the coronavirus disease 2019 (COVID-19) pandemic, many individuals, especially older adults and individuals with disabilities, experienced increased feelings of loneliness. This study aimed to identify factors associated with loneliness among older adults and people with disabilities residing in British Columbia (BC), Canada 10 months following COVID-19 physical restrictions. Participants included a total of 70 adults consisting of older adults (>65 years of age) without any self-reported disabilities and adults (aged 19 or above) with disabilities (e.g., stroke, spinal cord injury, etc.). Participants completed standardized self-report measures of their levels of anxiety, depression, social support, mobility, and loneliness. We used hierarchical linear regression to determine the association of age, sex, disability status, anxiety, depression, social support, and mobility with loneliness. Participants reported general low levels of loneliness, anxiety, and depression and an overall high level of perceived social support. Most participants reported living with others. Our analysis showed a positive association between anxiety and loneliness (beta = 0.340, p = 0.011) and a negative association between social support and loneliness (beta = -0.315, p = 0.006). There was no association between depression and loneliness (beta = 0.210, p = 0.116) as well as between mobility and loneliness (beta = -0.005, p = 0.968). These findings suggest that anxiety and social support have been significantly associated with loneliness in older adults and people with disabilities during the COVID-19 pandemic. Increased efforts to reduce anxiety and improve social support in clinical and community settings may be helpful in reducing loneliness in older adults and people with disabilities during the COVID-19 pandemic.

One Step at a Time, One Day at a Time': Life Profiles of Individuals with Disabilities across the First Year of the COVID-19 Pandemic

Individuals with disabilities underwent substantial changes in life due to the COVID-19 pandemic. However, little is known about the experiences of this population during the first year of the pandemic. Hence, drawing on data from a longitudinal mixed-methods study, this study aimed to identify different COVID-19 life profiles among people with disabilities. Sixty-one participants were interviewed at four timepoints, which paralleled restriction changes in British Columbia, Canada. These data were analyzed to identify different life profiles over the course of the first year of the pandemic. The analysis identified three interlinked profiles: (1) 'being in a straitjacket' examines the increasing restriction-related frustrations experienced by participants;(2) 'seizing the reins' explores the positive routines that participants established by filling the gaps with meaningful activities;and (3) 'staying content during COVID' describes a 'keep calm, carry on' attitude, where minimal impact of the pandemic was observed by participants. The three COVID-19 life profiles provide insight to the challenges encountered, resources used, and the varying experiences of individuals with disabilities as they adjusted to a different way of living. These findings can facilitate future research that could develop interventions and services for individuals with disabilities in subsequent pandemics or disasters.

Exploring Loneliness in The Older Adults And The Disability Populations 12-Months Post COVID-19 Restrictions

Research Objectives To identify factors associated with loneliness among the older adults and the disability populations 12-months following COVID-19 physical restrictions. As well as to identify strategies to alleviate the loneliness experienced by these populations. Design The data in this study were taken from a larger study with a longitudinal concurrent mixed-methods design with four data collection points. Data from time point four (12-months post COVID-19 restrictions) were used for our study purposes. Setting This study was completed within the general community of adults living in Canada, British Columbia. The study and data collection were completed through online survey tools. Participants A Survey of a total of 70 British Columbian adults who self-identified as being comfortable writing and speaking in English and belonging within the older adults (>64 years) or the disability populations (self-described and including stroke, spinal cord injury and other disabilities) were included. Interventions N/A. Main Outcome Measures The main outcome measures included scores on the Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS), as well as the UCLA Three-Item Loneliness Scale. These scales measure for anxiety and depression, social support, and loneliness respectively. Data collected through these measures were analyzed using multiple linear regression to investigate the association between the independent variables, anxiety, depression, social support, and the dependent variable, loneliness. Results Our analysis showed a statistically significant positive association between anxiety and loneliness (β = 0.363, p < 0.05), and a statistically significant negative association between social support and loneliness (β = -0.360, p < 0.05). There was no statistically significant association between depression and loneliness (β = 0.142, p > 0.05). Conclusions Anxiety and social support were significant predictors for loneliness in the older adults and disability populations during the COVID-19 pandemic. Facilitating engagement in occupation to reduce anxiety and improve social support may be helpful in reducing loneliness in these populations. Author(s) Disclosures No conflicts of interest.

Qualitative Experiences of Trained Medical Student Coaches Delivering a Community-Outreach Telehealth Coaching Program...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To describe medical student coaches' experiences leading the Community Outreach teleheAlth program for Covid education and Health promotion (COACH). Qualitative, descriptive study. Online via Zoom video conferencing. Trained medical student coaches (n = 19) were recruited from the University of British Columbia via convenience sampling. Seventy-four percent of participants were female and had an average age of 25.6. Most participants (57.9%) were from visible minority populations, and 42.1% administered COACH in suburban/rural areas. COACH included six 30-45-minute one-on-one sessions where student coaches promote positive health behaviours to adults ages 65 or older. Participants engaged in a 45-to-60-minute semi-structured interview conducted via one-on-one Zoom video-conferencing calls. Interview questions focused on students' experiences delivering COACH, their understanding of various health-related topics (e.g., chronic care, virtual health, and health promotion), and possible impacts on their beliefs and future practice. Interviews were transcribed verbatim and analyzed thematically. Three main themes emerged from our thematic analysis, including: (1) exploring opportunities for knowledge and skill acquisition (i.e., learning virtual care, health promotion strategies for chronic care, and client-centered care), (2) developing clinical perspective and acumen (i.e., developing a chronic care perspective, overcoming challenges to health coaching, and developing interest in chronic care practice), and (3) learning to appreciate patient care (i.e., becoming a health motivator and appreciating the opportunity to build rapport). Findings suggest that COACH supported development of knowledge, skill, and confidence in medical school students in areas of health promotion, virtual care, and chronic disease management. These findings also demonstrate promise for the use of health professional students and telehealth in advancing chronic care health services. We report no real or perceived conflicts of interest.

Qualitative Experiences of Trained Medical Student Coaches Delivering a Community-Outreach Telehealth Coaching Program

Research Objectives To describe medical student coaches’ experiences leading the Community Outreach teleheAlth program for Covid education and Health promotion (COACH). Design Qualitative, descriptive study. Setting Online via Zoom video conferencing. Participants Trained medical student coaches (n = 19) were recruited from the University of British Columbia via convenience sampling. Seventy-four percent of participants were female and had an average age of 25.6. Most participants (57.9%) were from visible minority populations, and 42.1% administered COACH in suburban/rural areas. Interventions COACH included six 30-45-minute one-on-one sessions where student coaches promote positive health behaviours to adults ages 65 or older. Main Outcome Measures Participants engaged in a 45-to-60-minute semi-structured interview conducted via one-on-one Zoom video-conferencing calls. Interview questions focused on students’ experiences delivering COACH, their understanding of various health-related topics (e.g., chronic care, virtual health, and health promotion), and possible impacts on their beliefs and future practice. Interviews were transcribed verbatim and analyzed thematically. Results Three main themes emerged from our thematic analysis, including: (1) exploring opportunities for knowledge and skill acquisition (i.e., learning virtual care, health promotion strategies for chronic care, and client-centered care), (2) developing clinical perspective and acumen (i.e., developing a chronic care perspective, overcoming challenges to health coaching, and developing interest in chronic care practice), and (3) learning to appreciate patient care (i.e., becoming a health motivator and appreciating the opportunity to build rapport). Conclusions Findings suggest that COACH supported development of knowledge, skill, and confidence in medical school students in areas of health promotion, virtual care, and chronic disease management. These findings also demonstrate promise for the use of health professional students and telehealth in advancing chronic care health services. Author(s) Disclosures We report no real or perceived conflicts of interest.

Challenges in Delivering Vital Services During The COVID-19 Pandemic: Perspectives From Brain Injury Associations...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To describe community brain injury (BI) associations' experiences during the COVID-19 pandemic. Anonymous online survey study. In January 2022 the project team, including community BI association co-investigators, collected responses from key stakeholders in the 70 eligible BI associations across Canada. Respondents were from 45 associations, including associations in Pacific/Western (n=18;40%), Central (n=25;56%), and Atlantic Canada (n=2;4%). Respondents were primarily paid executive directors (n=35;78%) representing primarily associations employing 10 or less people (n=33;77%) but serving 100 or more different clients (n=31;69%) before the COVID-19 pandemic. None. The online 26-item survey had quantitative and narrative questions about three main topics: association sustainability, meeting the needs of clients, and addressing public health. Thirty-four (76%) associations reported reductions in funding or financial resources during the pandemic which affected provision of programs or services, and only 14 (31%) received sufficient funds to a large or very large extent to cover additional pandemic-related expenses. Yet, twenty-eight (62%) associations reported increased demand for their programs or services, and 42 (93%) innovated their programs or services to meet varied and widespread client needs during the pandemic. Forty-two (93%) associations provided services or information to clients to explain public health guidelines, and forty-one (91%) associations reported clients experienced challenges in understanding and following public health guidelines. Narrative data provided further depth to the quantitative data. Community BI associations have a vital role in the long-term rehabilitation and management of BI. However, the COVID-19 pandemic challenged BI associations to remain sustainable and meet the needs of their clients. Researchers and policy makers need to acknowledge and adequately support the indispensable work of associations in the BI rehabilitation continuum, as the loss of community BI associations could have vast ramifications. This survey study was funded in part by Canadian Institutes of Health Research (CIHR);the funder did not have a role in design, data collection, analysis, or reporting.

Challenges in Delivering Vital Services During The COVID-19 Pandemic: Perspectives From Brain Injury Associations

Research Objectives To describe community brain injury (BI) associations’ experiences during the COVID-19 pandemic. Design Anonymous online survey study. Setting In January 2022 the project team, including community BI association co-investigators, collected responses from key stakeholders in the 70 eligible BI associations across Canada. Participants Respondents were from 45 associations, including associations in Pacific/Western (n=18;40%), Central (n=25;56%), and Atlantic Canada (n=2;4%). Respondents were primarily paid executive directors (n=35;78%) representing primarily associations employing 10 or less people (n=33;77%) but serving 100 or more different clients (n=31;69%) before the COVID-19 pandemic. Interventions None. Main Outcome Measures The online 26-item survey had quantitative and narrative questions about three main topics: association sustainability, meeting the needs of clients, and addressing public health. Results Thirty-four (76%) associations reported reductions in funding or financial resources during the pandemic which affected provision of programs or services, and only 14 (31%) received sufficient funds to a large or very large extent to cover additional pandemic-related expenses. Yet, twenty-eight (62%) associations reported increased demand for their programs or services, and 42 (93%) innovated their programs or services to meet varied and widespread client needs during the pandemic. Forty-two (93%) associations provided services or information to clients to explain public health guidelines, and forty-one (91%) associations reported clients experienced challenges in understanding and following public health guidelines. Narrative data provided further depth to the quantitative data. Conclusions Community BI associations have a vital role in the long-term rehabilitation and management of BI. However, the COVID-19 pandemic challenged BI associations to remain sustainable and meet the needs of their clients. Researchers and policy makers need to acknowledge and adequately support the indispensable work of associations in the BI rehabilitation continuum, as the loss of community BI associations could have vast ramifications. Author(s) Disclosures This survey study was funded in part by Canadian Institutes of Health Research (CIHR);the funder did not have a role in design, data collection, analysis, or reporting.

Social Cognitive Predictors of Health Promotion Self-Efficacy among Older Adults during the COVID-19 Pandemic...American Congress of Rehabilitation Medicine (ACRM) Annual Conference, November 8-11, 2022, Chicago, Illinois

To examine the relative importance of social cognitive predictors on health promotion self-efficacy among community-living adults, aged >65 years during COVID-19. This cross-sectional study was a secondary analysis of baseline data from a larger chronic disease self-management support intervention. This study was conducted in the general community setting. The mean age of participants (n=75) was 72.4 years old (SD=5.8;44 female). Seventy participants (93%) reported living with long term disability resulting from arthritis (n=33), degenerative disk disease (n=18), stroke (n=6), and other conditions (n=18). Not applicable. Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale [3]. Independent predictors of performance including performance accomplishment, vicarious learning, verbal persuasion, and affective states [4] were assessed using the health directed behavior subscale of the Health Education Impact Questionnaire [5], positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS) [6], informational support subscale of MOS-SSS, and the Depression Anxiety Stress Scale [7], respectively. After controlling for age and sex, linear regression analyses revealed statistically significant associations between health promotion self-efficacy and: (i) performance accomplishment (health-directed behavior;β=2.98, p=0.04);(ii) verbal persuasion (informational support;β=5.30, p=0.01);and (iii) affective state (depressive symptoms;β=-0.84;p< 0.001). Vicarious learning (positive social interaction;β=-1.23;p=0.55) did not significantly predict health promotion self-efficacy. Overall, this model was statistically significant (p< 0.001) and explained 48% of the health promotion self-efficacy variance. Verbal communication supports and strategies to address depressive symptoms and facilitate health-directed behaviors may improve health promotion self-efficacy in the context of physical and social distancing (i.e., COVID prevention strategies). A lack of relationship between self-efficacy and vicarious learning highlights the overall impact COVID had on in-person engagement. We report no real or perceived conflicts of interest.

Social Cognitive Predictors of Health Promotion Self-Efficacy among Older Adults during the COVID-19 Pandemic

Research Objectives To examine the relative importance of social cognitive predictors on health promotion self-efficacy among community-living adults, aged >65 years during COVID-19. Design This cross-sectional study was a secondary analysis of baseline data from a larger chronic disease self-management support intervention. Setting This study was conducted in the general community setting. Participants The mean age of participants (n=75) was 72.4 years old (SD=5.8;44 female). Seventy participants (93%) reported living with long term disability resulting from arthritis (n=33), degenerative disk disease (n=18), stroke (n=6), and other conditions (n=18). Interventions Not applicable. Main Outcome Measures Health promotion self-efficacy was measured using the Self-Rated Abilities for Health Practices Scale [3]. Independent predictors of performance including performance accomplishment, vicarious learning, verbal persuasion, and affective states [4] were assessed using the health directed behavior subscale of the Health Education Impact Questionnaire [5], positive social interaction subscale of the Medical Outcomes Survey - Social Support Scale (MOS-SSS) [6], informational support subscale of MOS-SSS, and the Depression Anxiety Stress Scale [7], respectively. Results After controlling for age and sex, linear regression analyses revealed statistically significant associations between health promotion self-efficacy and: (i) performance accomplishment (health-directed behavior;β=2.98, p=0.04);(ii) verbal persuasion (informational support;β=5.30, p=0.01);and (iii) affective state (depressive symptoms;β=-0.84;p< 0.001). Vicarious learning (positive social interaction;β=-1.23;p=0.55) did not significantly predict health promotion self-efficacy. Overall, this model was statistically significant (p< 0.001) and explained 48% of the health promotion self-efficacy variance. Conclusions Verbal communication supports and strategies to address depressive symptoms and facilitate health-directed behaviors may improve health promotion self-efficacy in the context of physical and social distancing (i.e., COVID prevention strategies). A lack of relationship between self-efficacy and vicarious learning highlights the overall impact COVID had on in-person engagement. Author(s) Disclosures We report no real or perceived conflicts of interest.

Allokation knapper medizinischer Ressourcen auf COVID-19-PatientInnen. Ergebnisse einer Vignettenstudie

ZusammenfassungZiel der StudieIn der vorliegenden Studie werden Knappheitsentscheidungen von medizinischen Laien bei der Behandlung von COVID-19(„Coronavirus Disease 2019“)-Patienten untersucht.MethodikIn den multivariaten clusterkorrigierten Regressionen werden die Antworten auf 1802 Fallsituationen einer Vignettenstudie ausgewertet, die von 181 medizinischen Laien eingeschätzt wurden.ErgebnisseJüngere Patienten, Männer, Erkrankte mit hohen Genesungschancen, eigenen Kindern und einem Beruf in einem Krankenhaus werden von den medizinischen Laien bevorzugt eingestuft.SchlussfolgerungMedizinische Laien wenden bewusst oder unbewusst soziale Kriterien der Entscheidungsfindung bei Knappheit der medizinischen Ressourcen an, die aus professioneller medizinischer und ethischer Sicht unzulässig sind. Zur Einschätzung der Akzeptanz in der allgemeinen Bevölkerung sollte dieser Umstand berücksichtigt werden.

Describing the Function, Disability, and Health of Adults and Older Adults during the Early Coronavirus Restrictions in 2019: An Online Survey

The restrictions in 2019 due to Coronavirus impacted Canadians' daily living, especially those at higher risk of compromised health conditions. This study aimed to describe the physical, psychological, and social well-being of adults with disabilities, and older adults from May to June 2020. Participants from the group of community-dwelling adults (≥19 years of age), who communicated in English, lived in British Columbia, and had Internet access via a computer, tablet, or smartphone with special focus on populations who had stroke, spinal cord injury and other disabilities were included. For measurement outcomes, an online survey was used to administer standardized measures of level of participation, mobility, anxiety and depression, boredom, resilience, technology readiness, social support, and social networks. Seventy-two participants were recruited, with a mean age (SD) of 61.2 (13.8). This study was comprised of two groups: the adult group consisted of individuals with disabilities under the age of 65 (48.6%) and the older adult group consisted of individuals over the age of 65 with and without self-identified disability (51.4%). There was no significant difference in the proportion of participation restriction between adult (83%) and older adult' (81%) groups (p = 0.69). In the study population, 27.8% and 16.7% of participants exceeded the anxiety and depression cut-off scores, respectively. Boredom was experienced by 76.4% of participants. Participants' mean (SD) resilience and life space scores were 72.4 (14.0) and 51.9 (24.0), respectively. The older adults (≥65 years) showed significantly lower depression (p = 0.012) and better resilience (p = 0.038), social support (p = 0.043), and social network (p = 0.021) than the younger adults. Issues with anxiety, boredom, participation, and life space activity were identified in both study groups. This information may provide supporting evidence when creating policies to mitigate existent health and social inequities.

The COVID-19 Pandemic Related Lived Experiences of Individuals With a Spinal Cord Injury/Disease

Introduction COVID-19 related restrictions and recommendations have impacted everyone. Those living with a disability, such as individuals with a spinal cord injury (SCI), may have had pandemic related changes made yet more challenging by societal failures to accommodate their mobility, physical abilities, and health care needs. To better understand participants experiences we drew upon Heidegger's phenomenology and the mobilities paradigm. The objective of this study was to explore COVID-19 pandemic related lived-experiences of individuals with an SCI. Materials and Methods This study used an interpretive phenomenological methodology. Semi-structured interviews were the primary means of data collection. These were conducting in May and June of 2020, roughly 2–3 months into the pandemic. Transcript data were analyzed using a phenomenological methodology. Results We interviewed 22 participants with SCI, the mean age was 54 years, and nine were females. We identified three themes: (1) Experiencing changes to mobility and daily life described how new rules had impacted everyday life and usual routines, particularly in regard to mobility. (2) Struggling with new challenges explored some of the negative experiences of the pandemic. (3) Being resilient in the face of a new normal conveyed the resilience participants exhibited despite challenges. Conclusion Although our findings indicate some positive changes and highlight the strengths that many individuals with SCI have, they also accentuate issues with ableism within the medical system. Certain changes were made primarily because people without disabilities needed them, and several COVID-19 changes were made without consulting individuals with disabilities. With physical movement restricted, our findings emphasize the importance of the movement of information and a need for increased dialogue with people in the SCI community about their ongoing pandemic related needs.

Acceptance of Different Self-sampling Methods for Semiweekly SARS-CoV-2 Testing in Asymptomatic Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial.

Importance: Closure of day care centers (DCCs) to contain the COVID-19 pandemic has been associated with negative effects on children's health and well-being. Objective: To investigate the acceptance of self-sampling methods for continuous SARS-CoV-2 surveillance among asymptomatic children and childcare workers (CCWs) in DCCs. Design, Setting, and Participants: This nonrandomized pilot study included children and CCWs at 9 DCCs in Wuerzburg, Germany, from May to July 2021. Interventions: Twice weekly testing for SARS-CoV-2 was conducted by self-sampled mouth-rinsing fluid (saliva sampling [SAL], with subsequent pooled polymerase chain reaction test) plus nasal rapid antigen self-test (RAgT) (group 1), SAL only (group 2), or RAgT only (group 3) in children and CCWs. Main Outcomes and Measures: Main outcomes were rates for initial acceptance and successful (≥60% of scheduled samples) long-term participation. The probability of SARS-CoV-2 introduction into DCCs was modeled as a function of age-adjusted background incidence and DCC size. Results: Of 836 eligible children, 452 (54.1%; 95% CI, 50.7%-57.4%) participated (median [IQR] age: 4 [3-5] years; 213 [47.1%] girls), including 215 (47.6%) in group 1, 172 (38.1%) in group 2, and 65 (14.4%) in group 3. Of 190 CCWs, 139 (73.2%; 95% CI, 66.4%-79.0%) participated (median [IQR] age: 30 [25-46] years; 128 [92.1%] women), including 96 (69.1%) in group 1, 29 (20.9%) in group 2, and 14 (10.1%) in group 3. Overall, SARS-CoV-2 PCR tests on 5306 SAL samples and 2896 RAgTs were performed in children, with 1 asymptomatic child detected by PCR from SAL. Successful long-term participation was highest in group 2 (SAL only; children: 111 of 172 [64.5%]; CCWs: 18 of 29 [62.1%]). Weekly participation rates in children ranged from 54.0% to 83.8% for SAL and from 44.6% to 61.4% for RAgT. Participation rates decreased during the study course (P < .001). The probability of SARS-CoV-2 introduction into a DCC with 50 children was estimated to reach at most 5% for an age-adjusted SARS-CoV-2 incidence below 143. Conclusions and Relevance: Self-sampling for continuous SARS-CoV-2 testing was well accepted, with SAL being the preferred method. Given the high number of negative tests, thresholds for initiating continuous testing should be established based on age-adjusted SARS-CoV-2 incidence rates. Trial Registration: German Registry for Clinical Trials Identifier: DRKS00025546.

Feasibility of SARS-CoV-2 Surveillance Testing Among Children and Childcare Workers at German Day Care Centers: A Nonrandomized Controlled Trial.

Importance: Closure of day care centers has been implemented globally to contain the COVID-19 pandemic but has negative effects on children's health and psychosocial well-being. Objective: To investigate the feasibility of surveillance among children and childcare workers and to model the efficacy of surveillance on viral spread prevention. Design, Setting, and Participants: This nonrandomized controlled trial was conducted at 9 day care centers in Wuerzburg, Germany, from October 2020 to March 2021. Participants included children attending day care, childcare workers, and household members. Participating day care centers were assigned to different surveillance modules in a nonrandomized feasibility study. A mathematical model for SARS-CoV-2 spread in day care centers was developed to identify optimal surveillance. Interventions: Modules 1, 2, and 3 involved continuous surveillance of asymptomatic children and childcare workers by SARS-CoV-2 polymerase chain reaction testing of either midturbinate nasal swabs twice weekly (module 1) or once weekly (module 2) or self-sampled saliva samples twice weekly (module 3). Module 4 involved symptom-based, on-demand testing of children, childcare workers, and their household members by oropharyngeal swabs. All participants underwent SARS-CoV-2 antibody status testing before and after the sampling period. Questionnaires on attitudes and perception of the pandemic were administered in weeks 1, 6, and 12. Mathematical modeling was used to estimate SARS-CoV-2 spread in day care centers. Main Outcomes and Measures: The primary outcomes were acceptance of the respective surveillance protocols (feasibility study) and the estimated number of secondary infections (mathematical modeling). Results: Of 954 eligible individuals (772 children and 182 childcare workers), 592 (62%), including 442 children (median [IQR] age, 3 [2-4] years; 214 [48.6%] female) and 150 childcare workers (median [IQR] age, 29 [25-44] years; 129 [90.8%] female) participated in the surveillance. In total, 4755 tests for SARS-CoV-2 detected 2 infections (1 childcare worker and 1 adult household member). Acceptance for continuous surveillance was highest for biweekly saliva testing (150 of 221 eligible individuals [67.9%; 95% CI, 61.5%-73.7%]) compared with biweekly (51 of 117 individuals [43.6%; 95% CI, 35.0%-52.6%]) and weekly (44 of 128 individuals [34.4%; 95% CI, 26.7%-43.0%]) midturbinate swabbing (P < .001). Dropout rates were higher for midturbinate swabbing (biweekly, 11 of 62 participants [18%]; once weekly, 11 of 55 participants [20%]) than for saliva testing (6 of 156 participants [4%]). Mathematical modeling based on study and literature data identified biweekly testing of at least 50% of children and childcare workers as minimal requirements to limit secondary infections. Conclusions and Relevance: In this nonrandomized controlled trial, surveillance for SARS-CoV-2 in 9 German day care centers was feasible and well accepted. Mathematical modeling estimated that testing can minimize the spread of SARS-CoV-2 in day care centers. These findings enable setup of surveillance programs to maintain institutional childcare. Trial Registration: German Registry for Clinical Trials Identifier: DRKS00023721.