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Introduction/Aim: Anxiety and depression in adolescents with cystic fibrosis (CF) is 2-3 times higher than those in the general community. The COVID-19 pandemic has been shown to increase levels of distress and difficulties in secondary students in Western Australia (WA). We aimed to examine the prevalence of anxiety and depression symptoms in adolescents with CF living in WA during the pandemic and investigate associations with respiratory symptoms, lung function and quality of life. Method(s): Adolescents with CF aged between 12 and 18 years old were followed at Perth Children's Hospital (Western Australia) between October 2020 and October 2022. Adolescents completed the General Anxiety Disorder-7 (GAD-7) for anxiety and Patient Health Questionnaire-9 (PHQ-9) for depression when clinically stable. We assessed associations between depression and anxiety scores with respiratory symptoms from the Cystic Fibrosis Respiratory Symptoms Diary and Cystic Fibrosis Respiratory Infection Symptoms Scale (CFRSD-CRISS), lung function outcomes (forced expiratory volume in first second (FEV 1) and lung clearance index (LCI)), and quality of life outcomes from the health-related quality of life questionnaire (CFQ-R). Result(s): In 28 adolescents with CF, 39% had an elevated anxiety score (mild and above) and 28% had an elevated depression score (mild and above). No difference in scores was observed between males and females. Both the anxiety and depression scores correlated with the severity of respiratory symptoms from the CFRSD-CRISS questionnaire. Anxiety and depressions scores were not associated with either FEV 1 or LCI. Depressions scores were associated with most CFQ-R domains whilst anxiety scores were only associated with the social CFQ-R domain. Conclusion(s): Depression and anxiety were common in adolescents with CF in our centre. The results demonstrate the importance of depression/anxiety screening and psychological support for adolescents with CF and their families.
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This volume was originally intended to be published in 2020 to mark the occasion of the 50th anniversary of the founding of the Institute of Medicine (IOM). The COVID-19 pandemic slowed its completion, and, as the chapters that follow detail, led to lasting changes across the organization. The final volume describes events within and outside the organization through the end of 2021. The National Academy of Medicine's (NAM's) response to major events in 2022, such as Russia's invasion of Ukraine, racially motivated and other mass shootings in the United States, and the U.S. Supreme Court's decision to overturn Roe v. Wade, are covered in the Epilogue. © National Academy of Sciences. All rights reserved.
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Introduction: Long-COVID is associated with restrictions in neuropsychological health e.g., depression, anxiety, or cognitive impairments leading to deficits in work ability. Rehabilitation could improve these symptoms but less is known about the benefits of rehabilitation in patients acquiring COVID-19 in the workplace, e.g., healthcare professionals. Aims and objectives: The current study investigates the outcomes of a disease-specific rehabilitation on neuropsychological health in patients after acute COVID-19 acquiring in the workplace. We assumed that neuropsychological health will be improved after rehabilitation. Method(s): Until now, 49 patients (female n=38, age: M=50.86 years) acquiring COVID-19 in the workplace were recruited within a longitudinal study. At the beginning (T1) and the end (T2) of an inpatient rehabilitation (duration: at least 3 weeks) in the German BG Hospital Bad Reichenhall the following measurements were implemented: Hospital Anxiety and Depression Scale (for depression and anxiety), and Digit Symbol Substitution Test (for processing speed). Paired T-tests were used for analysis. Result(s): At T2 patients showed significant improvements in depression (T1: M=7.98, T2: M=7.02;T(1,45)=2.277, p=0.028, d=0.336), anxiety (T1: M=7.00, T2: M=6.02;T(1,45)=2.268, p=0.028, d=0.330), and processing speed (T1: M=47.14, T2: M=52.57;T(1,44)=2.852, p=0.007, d=-0.430). Conclusion(s): The results indicated that rehabilitation in patients acquiring COVID-19 in the workplace has positive effects on neuropsychological health. For long-term results, measurements will be repeated 6 and 12 months after T1.
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BACKGROUND AND AIMS: Factors influencing dialysis choice are multifaceted. Detailed and unbiased information is pivotal in order to assist patients in making decisions. Hence, patient education is a cornerstone in the treatment of advanced chronic kidney disease. At the hospital of Southern Jutland, a kidney school has existed for more than 15 years teaching patients about their illness and treatment options at end-stage renal disease (ESRD). Due to the coronavirus disease (COVID-19) pandemic, an online kidney school (OKS) was established. We present the latest results of this ongoing study regarding the change of preferences of ESRD treatment options among patients after participation in online renal education. METHOD: The OKS consists of a 3-h synchronous class taught by a nephrologist and a dialysis nurse combined with asynchronous short films on treatment options and advice from a dietitian. The OKS has been held six times with 45 patients in total. A questionnaire was distributed to participants before and after the OKS. Patients were asked to choose between center haemodialysis, home haemodialysis, peritoneal dialysis, transplantation, maximal conservative medical treatment and 'not enough information to make the decision'. RESULTS: Out of the 45 patients, 36 patients answered the questionnaire before OKS and of those, 19 also answered the questionnaire after OKS. A total of 76% % of the participants were male, 52% answered the questionnaire on their own and 48% answered the questions together with a relative. The percentage of patients not feeling informed enough to make the decision decreased from 56% prior to participation in OKS in comparison to 32% following participation in OKS. The percentage of patients who prefer peritoneal dialysis as their ESRD treatment of choice increased from 6% to 32%. CONCLUSION: Online education on treatment choices for end-stage renal patients leads to change of treatment preferences. This is especially true for peritoneal dialysis. The OKS is designed to help patients make an informed decision on treatment options in ESRD. Although the number of patients feeling unsure about what kind of treatment to choose is decreased, the number of patients unsure about the best treatment option for them remains high. These patients require a follow-up consultation in order for them to make the final decision for ESRD treatment. The number of patients who answered the questionnaire prior to OKS is higher in comparison to after OKS. However, this is an ongoing study and we will be able to confirm or dismiss these preliminary findings at a later stage. (Figure Presented).
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As the health care community recognizes the need to address health disparities, practitioners are working diligently to promote health equity. It is each of our responsibilities to identify and work to overcome barriers to equitable health care that our patients experience. Many factors contribute to health care disparities across the country, and because of this, health care providers must employ different strategies to resolve gaps in equity. Precision medicine and its constituent element of pharmacogenomics offer a unique opportunity to lead the way in serving patients as individuals with varying needs. Pharmacogenomics can be used as a solution for breaking down barriers including the lack of diversity in research, access for rural or underserved geographical locations, overcoming economic factors, improving education, and increasing technological portability. In this article, we review how clinical pharmacists using pharmacogenomics can play a key role in identifying and overcoming some of these barriers that lead to health care disparities.
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BACKGROUND: COVID-19 transmission and disease dynamics in sub-Saharan Africa are not well understood. Our study aims to provide insight into COVID-19 epidemiology in Malawi by estimating SARS-CoV-2 prevalence and immunity after SARS-CoV-2 infection in a hospital-based setting. METHODS: We conducted a hospital-based, convenience sampling, cross-sectional survey for SARS-CoV-2 in Lilongwe, Malawi. Participants answered a questionnaire and were tested for SARS-CoV-2 by enzyme-linked immunosorbent assay and real-time reverse-transcription polymerase chain reaction (RT-PCR). A surrogate virus neutralization test (sVNT) was performed in seropositive samples to estimate immunity. Poisson regression was used to assess SARS-CoV-2 point prevalence association with demographic and behavioral variables. FINDINGS: The study included 930 participants. We found a combined point prevalence of 10.1%. Separately analyzed, RT-PCR positivity was 2.0%, and seropositivity was 9.3%. Of tested seropositive samples, 90.1% were sVNT positive. We found a high rate (45.7%) of asymptomatic SARS-CoV-2 infection. SARS-CoV-2 point prevalence was significantly associated with being a healthcare worker. INTERPRETATION: Our study suggests that official data underestimate COVID-19 transmission. Using sVNTs to estimate immunity in Malawi is feasible and revealed considerable post-infection immunity in our cohort. Subclinical infection and transmission are probably a game-changer in surveillance, mitigation and vaccination strategies.
Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiology , Cross-Sectional Studies , Hospitals , Humans , Malawi/epidemiology , PrevalenceABSTRACT
Mitigation measures should be specific to economy, politics, culture and health care context of a given country. Public health measures disproportionately affect young people, hindering the expected outcome. Although these negative effects can be mitigated in high-income countries with social security systems, the injection of liquidity and capacity to improve medical capacity, many LDC countries do not have these safety devices net. Therefore, the different risk-benefit analyzes in populations and they must be adapted to the particular process of domestic translation. For Africans in particular countries experience very different patterns of global pandemics, they aim to be more pragmatic, context-specific and consider negative effects of measures in place. Otherwise they may get in the way expected outcomes and put young people at greater risk with health, education and a prosperous future.
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Background: The burning of fossil fuels, including coal, is the primary source of greenhouse gas emissions driving anthropogenic climate change and its associated health harms: heat-related illnesses, arboviral diseases, trauma from extreme weather events, allergies, and chronic disease exacerbations. Coal-fired power plants (CFPP) supply 23% of electricity in the USA and 42% for the state of Wisconsin. Air pollution from CFPP has been associated with respiratory diseases, cancers, cardiovascular and neurological disorders, especially for vulnerable populations. In this cross-sectional study, we aim to measure associations between respiratory diseases and residential proximity to CFPP. Methods: We obtained cross-sectional, population-based health data for non-institutionalised, non-active-duty adults from the Survey of the Health of Wisconsin database from 2008 to 2013. Pulmonary function was measured by spirometry as a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC). An average of three or more FEV1/FVC readings <80% was considered abnormal and indicative of an obstructive disorder. We used multivariate regression analyses to evaluate pulmonary function and distance from CFPP, controlling for sex, education, race/ethnicity, age, asthma, and total years smoking history. Findings: We included data from 2327 adults aged 21–74 years in analysis. Adults living in close proximity to one of 11 CFPP had worse pulmonary function than did adults living more than 35 km away from CFPP with an odds ratio of 1·24 (95% CI 0·90–1·70). Although not statistically significant, trends suggest higher odds of obstructive pulmonary diseases in those living within 35 km of CFPP. Protective factors, in addition to distance, were higher education and younger age. Risk factors identified were older age and having a history of smoking. Although Black residents made up 4·8% of the total sample population, they accounted for 13·3% of people living within 35 km of CFPP. Similarly, Hispanic residents accounted for 4·8% of those living within 35 km of CFPP but only made up 2·8% of the sample population. Interpretation: Wisconsin CFPP might be associated with worse pulmonary function in people living at or within 35km of their locations, with possible consequences related to costly inhaler medications, health-care visits, and hospitalisations. When linked with socioeconomic factors, and race and ethnicity, closing down CFPP should be considered when addressing health disparities and environmental injustices. Affordable, clean energy solutions are readily available and just transitions have recently been demonstrated in North America. As nations recover from COVID-19, there is a profound opportunity for leaders across sectors to build healthier communities and prioritise climate action for health. Funding: Dr Elaine Kohler Summer Academy of Global Health Research and Wisconsin Partnership Program.