The global impact of COVID-19 on abortion care.

Background: The COVID-19 pandemic placed unprecedented strain on healthcare globally, which exacerbated factors leading to unplanned pregnancies. Objectives: The primary objective was to analyze the effect of COVID-19 on abortion services globally. Secondary objectives were to discuss issues regarding access to safe abortion and provide recommendations on continued access during pandemics. Search strategy: A search for relevant articles was conducted by utilizing multiple databases (PubMed, Cochrane, etc.). Selection criteria: Studies on COVID-19 and abortion were included. Data collection & analysis: The legislation governing abortion services across the globe was examined, inclusive of modifications to service provision during the pandemic. Global data on abortion rates and analyses of selected articles were also included. Main results: 14 countries instituted legislative changes related to the pandemic, 11 relaxed abortion regulations, while three restricted abortion access. An increase in abortion rates was seen particularly where telemedicine was available. Where abortions were postponed, second-trimester abortions increased after services resumed. Conclusions: Legislation, risk of exposure to infection, and access to telemedicine affect access to abortion. The use of novel technologies, maintaining existing infrastructure and enhancing the roles of trained manpower for safe abortion access is recommended to avoid the marginalization of women's health and reproductive rights.

The predictors of health-enhancing physical activity among working women in Singapore two years into COVID-19: a cross-sectional study.

Physical activity (PA) levels may have changed since the COVID-19 pandemic. However, these changes are not well understood. The study aimed to describe the PA level and examine the predictive factors of a health-enhancing PA level among working women in Singapore two years into the COVID-19 pandemic. We undertook a cross-sectional descriptive correlational study. Three hundred participants were recruited and completed the online questionnaire between October and November 2021. In the PA analysis of 217 participants, only 32.7% of the participants achieved a health-enhancing PA level, while 44.7% of the total sample sat for 7 h or more daily. In the univariate analysis, occupation, nationality, monthly income, and average daily sitting hours were significantly associated with a high PA level. The current mode of work, living arrangement, and health-promoting lifestyle profile II_physical activity score remained significant in both univariate and multivariate analyses. Participants who worked from home and stayed with their families were less likely to achieve a health-enhancing PA level than those who had a regular workplace and did not stay with their families. Working women with a health-promoting physically active lifestyle were likelier to achieve a health-enhancing PA level. The long daily sitting time and suboptimal health-enhancing PA participation underscore the need for health promotion initiatives for working women.

A Nurse-Led Integrated Chronic Care E-Enhanced Atrial Fibrillation (NICE-AF) Clinic in the Community: A Preliminary Evaluation.

The current physician-centric model of care is not sustainable for the rising tide of atrial fibrillation. The integrated model of care has been recommended for managing atrial fibrillation. This study aims to provide a preliminary evaluation of the effectiveness of a Nurse-led Integrated Chronic care E-enhanced Atrial Fibrillation (NICE-AF) clinic in the community. The NICE-AF clinic was led by an advanced practice nurse (APN) who collaborated with a family physician. The clinic embodied integrated care and shifted from hospital-based, physician-centric care. Regular patient education, supplemented by a specially curated webpage, fast-tracked appointments for hospital-based specialised investigations, and teleconsultation with a hospital-based cardiologist were the highlights of the clinic. Forty-three participants were included in the six-month preliminary evaluation. No significant differences were observed in cardiovascular hospitalisations (p-value = 0.102) and stroke incidence (p-value = 1.00) after attending the NICE-AF clinic. However, significant improvements were noted for AF-specific QoL (p = 0.001), AF knowledge (p < 0.001), medication adherence (p = 0.008), patient satisfaction (p = 0.020), and depression (p = 0004). The preliminary evaluation of the NICE-AF clinic demonstrated the clinical utility of this new model of integrated care in providing safe and effective community-based AF care. Although a full evaluation is pending, the preliminary results highlighted its promising potential to be expanded into a permanent, larger-scale service.

Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce.

This study aimed to quantify the immediate psychological effects and psychoneuroimmunity prevention measures of a workforce returning to work during the COVID-19 epidemic. Workforce returning to work was invited to complete an online questionnaire regarding their attitude toward the COVID-19 epidemic and return-to-work along with psychological parameters including the Impact of Event Scale-Revised, Depression, Anxiety, Stress Scale- 21 (DASS-21) and Insomnia Severity Index (ISI). Psychoneuroimmunity prevention measures include precautions at personal and organization levels. From 673 valid questionnaires, we found that 10.8% of respondents met the diagnosis of post-traumatic stress disorder (PTSD) after returning to work. The respondents reported a low prevalence of anxiety (3.8%), depression (3.7%), stress (1.5%) and insomnia (2.3%). There were no significant differences in the severity of psychiatric symptoms between workers/technicians and executives/managers. >95% reported psychoneuroimmunity prevention measures including good ventilation in the workplace and wore a face mask as protective. Factors that were associated with the severity of psychiatric symptoms in the workforce were marital status, presence of physical symptom, poor physical health and viewing return to work as a health hazard (p < 0.05). In contrast, personal psychoneuroimmunity prevention measures including hand hygiene and wearing face masks as well as organizational measures including significant improvement of workplace hygiene and concerns from the company were associated with less severe psychiatric symptoms (p < 0.05). Contrary to expectations, returning to work had not caused a high level of psychiatric symptoms in the workforce. The low prevalence of psychiatric symptoms could be due to confidence instilled by psychoneuroimmunity prevention measures before the resumption of work. Our findings would provide information for other countries during the COVID-19 pandemic.

Impacts of COVID-19 and partial lockdown on family functioning, intergenerational communication and associated psychosocial factors among young adults in Singapore.

BACKGROUND: The COVID-19 pandemic has changed our daily lives. Most of the working adults adopted the work-from-home arrangement while students shifted to home-based learning. Being confined together allows families to foster stronger bonds. On the other hand, the on-going pandemic could have negative impacts on family relationships. The COVID-19 outbreak is still on-going worldwide, understanding more about the changes in family functioning and its associated psychological impacts in a pandemic would allow the authorities to provide more targeted support to families. OBJECTIVES: This study aimed to examine the factors associated with family functioning among young adults in Singapore during the COVID-19 pandemic. Family functioning refers to the quality of interactions among family members, and consists of cohesion, flexibility and communication. METHODS: A cross-sectional online survey was conducted (N = 390). The Family Adaptability and Cohesion Evaluation Scale Short Form (FACES-IV-SF) and Global Perceptions of Intergenerational Communication Scale (GPIC) were used to examine family functioning and intergeneration communication during the partial lockdown. Center for Epidemiologic Studies Depression Scale (CESD), Social Support Questionnaire-Brief (SSQ-B), Perceived Stress Scale 4 (PSS), UCLA Loneliness Scale, and Brief Resilient Coping Scale (BRCS) examined the psychosocial impact. Descriptive statistics, Pearson's correlation coefficients, and regression model were employed in the analysis. RESULTS: The FACES-IV-SF score for total circumplex ratio has a mean of 1.57(SD = 0.58), suggesting that participants generally perceived their families as functioning relatively well. The mean scores for CESD, PSS, Loneliness and BRCS were 12.4(6.2), 8.0(2.6), 5.7(1.9) and 12.6(3.1) respectively. The mean scores of the 4 domains of GPIC were 21.5(4.0) for Accommodation, 25.0(6.7) for Non-Accommodation, 17.2(3.3) for Respect-Obligation, and 18.9(4.8) for Avoidant. CONCLUSION: The results suggested that family functioning is significantly associated with intergenerational communication and satisfaction with social support in a pandemic. Participants with balanced levels of cohesion and flexibility in their families are more likely to be able to cope with the psychological impacts of the pandemic. The findings serve to inform intervention and preventive efforts to improve family functioning and reduce the risk of psychological distress in a pandemic.

The impact of COVID19 on advanced practice nursing education and practice: A qualitative study.

AIM: To explore Master of Nursing students' perspectives toward the impact of coronavirus disease 2019 (COVID-19) on the advanced practice nurse preparatory education and practice. BACKGROUND: Like many nursing education programmes, the advanced practice nurse preparatory training was greatly affected and had to radically change to adapt to the disruptions caused by the pandemic. The COVID-19 pandemic has created a strain on the healthcare system and advanced practice nurses have been expected to modify their normal practice to provide care in unprecedented ways. METHODS: The study used a descriptive qualitative design. Semi-structured video-conference interviews were conducted in an autonomous university (June-July 2020). The recruitment of participants (n = 14) concluded upon data saturation. A thematic analysis was conducted. The COnsolidated criteria for REporting Qualitative research (COREQ) guidelines were used. FINDINGS: Three main themes were identified: (1) overcome adversity through innovation, (2) acceptance of remote learning and (3) versatility of advanced practice nurses in an ongoing pandemic. Each theme was further explained by two subthemes to further elucidate the impact of COVID-19 on the advanced practice nurse preparatory training and practice. DISCUSSION: The evolution of the advanced practice nurse preparatory education catalysed by the COVID-19 pandemic brought on innovation. The ability of advanced practice nurses to adapt to evolving healthcare needs was also highlighted. CONCLUSION: Although face-to-face teaching and services are gradually returning, some innovations that arose during the pandemic may be worth keeping. IMPLICATIONS FOR NURSING: Nursing educators in higher education institutions can benefit from adopting technology to mitigate the challenges posed by the ongoing pandemic IMPLICATIONS FOR NURSING POLICY: Nurse leaders should review the role of advanced practice nurses to determine how best to capitalise on their practice to meet rising healthcare needs.

Effectiveness of home-based cardiac telerehabilitation as an alternative to Phase 2 cardiac rehabilitation of coronary heart disease: a systematic review and meta-analysis.

AIMS: The onset of the COVID-19 pandemic saw the suspension of centre-based cardiac rehabilitation (CBCR) and has underscored the need for home-based cardiac telerehabilitation (HBCTR) as a feasible alternative rehabilitation delivery model. Yet, the effectiveness of HBCTR as an alternative to Phase 2 CBCR is unknown. We aimed to conduct a meta-analysis to quantitatively appraise the effectiveness of HBCTR. METHODS AND RESULTS: PubMed, EMBASE, CENTRAL, CINAHL, Scopus, and PsycINFO were searched from inception to January 2021. We included randomized controlled trials (RCTs) comparing HBCTR to Phase 2 CBCR or usual care in patients with coronary heart disease (CHD). Out of 1588 studies, 14 RCTs involving 2869 CHD patients were included in this review. When compared with usual care, participation in HBCTR showed significant improvement in functional capacity {6-min walking test distance [mean difference (MD) 25.58 m, 95% confidence interval (CI) 14.74-36.42]}; daily step count (MD 1.05 K, 95% CI 0.36-1.75) and exercise habits [odds ratio (OR) 2.28, 95% CI 1.30-4.00)]; depression scores (standardized MD -0.16, 95% CI -0.32 to 0.01) and quality of life [Short-Form mental component summary (MD 2.63, 95% CI 0.06-5.20) and physical component summary (MD 1.99, 95% CI 0.83-3.16)]. Effects on medication adherence were synthesized narratively. HBCTR and CBCR were comparably effective. CONCLUSION: In patients with CHD, HBCTR was associated with an increase in functional capacity, physical activity (PA) behaviour, and depression when compared with UC. When HBCTR was compared to CBCR, an equivalent effect on functional capacity, PA behaviour, QoL, medication adherence, smoking behaviour, physiological risk factors, depression, and cardiac-related hospitalization was observed.

Association between air quality, meteorological factors and COVID-19 infection case numbers.

The coronavirus disease (COVID-19) has become a global pandemic affecting many countries, including Singapore. Previous studies have investigated the relationship of air pollutant levels and meteorological factors with respiratory disease risk and hospital admission rates. However, associations between air pollutant concentrations and meteorological factors with COVID-19 infection have been equivocal. This study aimed to assess the association between core air pollutant concentrations, meteorological variables and daily confirmed COVID-19 case numbers in Singapore. Data on air pollutant levels (particulate matter [PM2.5, PM10], ozone [O3], carbon monoxide [CO], nitrogen dioxide [NO2], sulphur dioxide [SO2], pollutant standards index [PSI]) and meteorological factors (rainfall, humidity, temperature) was obtained from the Singapore National Environment Agency (NEA) from January 23, 2020 to April 6, 2020. The daily reported COVID-19 case numbers were retrieved from the Singapore Ministry of Health (MOH). Generalized linear models with Poisson family distribution and log-link were used to estimate the model coefficients and 95% confidence intervals (CIs) for the association between air pollutant concentrations and meteorological factors (8-day and 15-day moving averages (MA)) with COVID-19 case numbers, adjusting for humidity, rainfall and day of week. We observed significantly positive associations between NO2, PSI, PM2.5 and temperature with COVID-19 case numbers. Every 1-unit increase (15-day MA) in PSI, 1 µg/m3 increase (15-day MA) in PM2.5, NO2 and 0.1 °C increase in temperature were significantly associated with a 35.0% (95% CI: 29.7%-40.5%), 22.6% (95% CI: 12.0%-34.3%), 34.8% (95% CI: 29.3%-40.4%) and 28.6% (95% CI: 25.0%-32.4%) increase in the average daily number of COVID-19 cases respectively. On the contrary, PM10, O3, SO2, CO, rainfall and humidity were significantly associated with lower average daily numbers of confirmed COVID-19 cases. Similar associations were observed for the 8-day MAs. Future studies could explore the long-term consequences of the air pollutants on COVID-19 infection and recovery.

A quantitative and qualitative study on the neuropsychiatric sequelae of acutely ill COVID-19 inpatients in isolation facilities.

This study examined the neuropsychiatric sequelae of acutely ill patients with coronavirus disease 2019 (COVID-19) infection who received treatment in hospital isolation wards during the COVID-19 pandemic. Ten COVID-19 patients who received treatment in various hospitals in Chongqing, China; 10 age- and gender-matched psychiatric patients; and 10 healthy control participants residing in the same city were recruited. All participants completed a survey that collected information on demographic data, physical symptoms in the past 14 days and psychological parameters. Face-to-face interviews with COVID-19 patients were also performed using semi-structured questions. Among the COVID-19 patients, 40% had abnormal findings on the chest computed topography scan, 20% had dysosmia, 10% had dysgeusia, and 80% had repeated positivity on COVID-19 reverse-transcription polymerase chain reaction testing. COVID-19 and psychiatric patients were significantly more worried about their health than healthy controls (p = 0.019). A greater proportion of COVID-19 patients experienced impulsivity (p = 0.016) and insomnia (p = 0.039) than psychiatric patients and healthy controls. COVID-19 patients reported a higher psychological impact of the outbreak than psychiatric patients and healthy controls, with half of them having clinically significant symptoms of posttraumatic stress disorder. COVID-19 and psychiatric patients had higher levels of depression, anxiety and stress than healthy controls. Three themes emerged from the interviews with COVID-19 patients: (i) The emotions experienced by patients after COVID-19 infection (i.e., shock, fear, despair, hope, and boredom); (ii) the external factors that affected patients' mood (i.e., discrimination, medical expenses, care by healthcare workers); and (iii) coping and self-help behavior (i.e., distraction, problem-solving and online support). The future direction in COVID-19 management involves the development of a holistic inpatient service to promote immune and psychological resilience.

Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry.

This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of 2019 coronavirus disease (COVID-19) epidemic with strict lockdown measures. Seventy-six psychiatric patients and 109 healthy control subjects were recruited from Chongqing, China and completed a survey on demographic data, physical symptoms during the past 14 days and a range of psychiatric symptoms using the Impact of Event Scale-Revised (IES-R), Depression, Anxiety and Stress Scale (DASS-21) and Insomnia Severity Index (ISI). IES-R measures PTSD symptoms in survivorship after an event. DASS-21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. The mean IES-R, DASS-21 anxiety, depression and stress subscale and ISI scores were higher in psychiatric patients than healthy controls (p < 0.001). Serious worries about their physical health, anger and impulsivity and intense suicidal ideation were significantly higher in psychiatric patients than healthy controls (p < 0.05). More than one-third of psychiatric patients might fulfil the diagnostic criteria post-traumatic stress disorder (PTSD). More than one-quarter of psychiatric patients suffered from moderately severe to severe insomnia. Respondents who reported no change, poor or worse physical health status and had a psychiatric illness were significantly more likely to have higher mean IES-R, DASS depression, anxiety and stress subscale scores and ISI scores (p < 0.05). This study confirms the severity of negative psychological impact on psychiatric patients during the COVID-19 epidemic with strict lockdown measures. Understanding the psychological impact on psychiatric patients during the COVID-19 pandemic has the potential to provide insight into how to develop a new immunopsychiatry service. Further research is required to compare pro-inflammatory cytokines between psychiatric patients and healthy controls during the pandemic.