Conducting qualitative interviews via VoIP technologies: reflections on rapport, technology, digital exclusion, and ethics

Qualitative research has been strongly affected by the COVID-19 pandemic, highlighting the possibilities that Voice over Internet Protocol (VoIP) technologies such as Skype, WhatsApp, and Zoom offer to qualitative scholars. Based on the experience of using such technologies to collect qualitative data for our PhD studies, we present how we dealt with the challenges of this interview mode. Precisely, we discuss problems related to rapport, technology, digital exclusion, and ethics frequently pointed out in the methodological literature on online interviews. Thereby we put forward strategies and techniques that helped us to 1) build a rapport, 2) manage technical difficulties, 3) reflect on risks of digital exclusion, and 4) comply with the ethical standards of our institution. In doing so, we draw on our qualitative data to support the arguments. The aim of this paper is, thus, to deepen the methodological debate on online interviews in social sciences. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

The impact of maternal SARS-COV-2 infection in early stages of newborn neurodevelopment: preliminary results in a multicenter Spanish study

Introduction: The consequences for the COVID-19 pandemic in the newborns of affected mothers remains unknown. Previous clinical experiences with other infections during pregnancy lead to considered pregnant women and their offspring especially vulnerable for SARS-COV-2. That is, the underlying physiopathological changes caused by the infection (e.g. storm of cytokines, micro-coagulation in placenta or vertical transmission) could clearly compromise fetal neurodevelopment. Objective(s): To analyze the impact of maternal SARS-COV-2 infection during pregnancy in early neurodevelopment of infants gestated during the COVID-19 pandemic period compared to those gestated immediately prior (2017-2021). Method(s): 212 pregnant women (14% infected) were followed throughout their pregnancy and postpartum, including newborn development. SARS-COV-2 infection was serologically confirmed during pregnancy. The Brazelton Neonatal Assessment Scale (NBAS) was administered at 6 weeks old by a trained neonatologist to evaluate neurological, social and behavioral aspects of newborn's functioning. Differences in NBAS scores between cases and controls were tested by ANOVAs. All the analysis were adjusted for maternal age, sociodemographic status, anxious-depressive symptomatology, infant's sex and gestational age at birth and NBAS, and for the period of gestation (previous or during COVID-19 pandemic). Result(s): NBAS social interactive dimension was significantly decreased in those infants exposed to prenatal SARS-COV-2 (F= 4.248, p=.043), particularly when the infection occurred before the week 20 of gestation. Gestation during COVID-19 pandemic did not alter NBAS subscales. Conclusion(s): SARS-COV-2 infection during pregnancy seems to be associated with lower NBAS scores on social dimension in 6 weeks old exposed newborns.

Associations between hemostatic markers and mortality in COVID-19 - Compounding effects of D-dimer, antithrombin and PAP complex.

In this single-center cohort study, we applied a panel of laboratory markers to characterize hemostatic function in 217 consecutive patients that underwent testing for COVID-19 as they were admitted to Linköping University Hospital between April and June 2020. In the 96 patients that tested positive for SARS-CoV-2 (COVID-19+), the cumulative incidences of death and venous thromboembolism were 24.0% and 19.8% as compared to 12.4% (p = 0.031) and 11.6% (p = 0.13) in the 121 patients that tested negative (COVID-19-). In COVID-19+ patients, we found pronounced increases in plasma levels of von Willebrand factor (vWF) and fibrinogen. Excess mortality was observed in COVID-19+ patients with the following aberrations in hemostatic markers: high D-dimer, low antithrombin or low plasmin-antiplasmin complex (PAP) formation, with Odds Ratios (OR) for death of 4.7 (95% confidence interval (CI95) 1.7-12.9; p = 0.003) for D-dimer >0.5 mg/L, 5.9 (CI95 1.8-19.7; p = 0.004) for antithrombin (AT) ˂0.85 kIU/l and 4.9 (CI95 1.3-18.3; p = 0.019) for PAP < 1000 µg/L. Compounding increases in mortality was observed in COVID-19+ patients with combined defects in markers of fibrinolysis and coagulation, with ORs for death of 15.7 (CI95 4.3-57; p < 0.001) for patients with PAP <1000 µg/L and D-dimer >0.5 mg/L and 15.5 (CI95 2.8-87, p = 0.002) for patients with PAP <1000 µg/L and AT ˂0.85 kIU/L. We observed an elevated fraction of incompletely degraded D-dimer fragments in COVID-19+ patients with low PAP, indicating impaired fibrinolytic breakdown of cross-linked fibrin.

Severity of Covid-19 Clinical Outcomes and Mortality in Multiple Myeloma Patients over Year 1 of the Pandemic

Introduction In the first weeks of the Covid-19 pandemic when healthcare systems in many areas were overstretched, we documented that hospital mortality in multiple myeloma (MM) patients infected by Sars-Cov-2 was 50% higher than in age matched Covid-19 patients without cancer. In the following months, the pressure on healthcare systems in Spain continued although it did not reach the extreme levels of the first weeks of the pandemic. In this study, we proposed to determine if the severity of Covid-19 outcomes in MM patients has changed over the first year of the pandemic. Patients and methods The Spanish MM Collaborative Group (Pethema-GEM) conducted a survey at national level on plasma cell disorder patients infected by SARS-Cov-2 between March 2020 and February 2021. Sixty-six (69%) out of 96 contacted healthcare centers, from all 17 regions in Spain, reported 502 patients. Data on Covid-19 acute and post-acute phase outcomes (hospitalization, oxygen requirements, severity of symptoms and mortality) were reported first in May 2020 (Martinez-Lopez et al, BCJ 2021) and updated in February 2021. In this study, we compared outcome occurrence between two study periods: P1, a period of extreme stress for the healthcare system in Spain, from March to mid-June 2020;and a second period, P2, up to mid-February 2021 with a sustained but lower burden on the national health care system. Results Among the 451 patients with plasma cell disorders and a Sars-Cov-2 infection documented with an rRT-PCR positive test, 377 (84%) were MM patients, 15 SMM (3%), 40 MGUS (9%) and 19 amyloidosis (4%). The number of MM weekly reported cases was 57% (95%CI, 48-65) lower in P2 (188 cases in 35 weeks) compared to P1 (189 cases in 15 weeks), p<0.001. The mean (SD) age and the proportion of men did not differ between P1 and P2, respectively 69.8 (10.9) vs 68.6 (11.0) years, p=0.6, and 53.3% vs 59.6%, p=0.2. MM patients with active or progressive disease at time of Covid-19 diagnosis were 24% in P1 and 34% in P2, p=0.05;patients on active treatment were more frequent in P1, 89%, than in P2, 79%, p=0.01. MM treatment was withheld in 78% and 82% of patients, p=0.4. Covid-19 treatment changed over time: MM inpatients received more remdesivir and corticoids in the second period (3% vs 31% p<0.001, and 49% vs 73%, p<0.001, respectively). In P1, 90% of the reported MM patients were hospitalized compared to 71% in P2, p<0.001. Thirty-one and 41% of patients did not require oxygen support during P1 and P2, respectively;non-invasive ventilation in 19% and 14%, and mechanical ventilation in 7% and 8%, p=0.12. Overall, acute clinical Covid-19 severity was reduced from P1 to P2: 75% to 51%, p<0.001: moderate/severe pneumonia was reduced from 68% to 36%, p<0.001 but severe distress syndrome increased from 7% to 15%, p=0.03. However, mortality in all reported patients was 30.7% in P1 vs 26.1% in P2, p=0.3;and no differences in mortality were observed in hospitalized patients, 32.2% in P1 and 35.3% in P2, p=0.6. We performed a multivariable adjustment with the predictors identified in our previous study (BCJ 2021) and confirmed that inpatient mortality was similar in both study periods, odds ratio (OR) 0.99 (95%CI 0.59-1.66). Independently of the study period, an increased mortality was observed in men (OR 1.81, 1.08-3.05), patients over 65 (OR 2.40, 1.33-4.36), and patients with active or progressive disease (OR 2.12, 1.24-3.62). The severity of Covid-19 clinical outcomes -besides mortality, was associated with increased age but not with active or progressive disease. Conclusions Although COVID-19 clinical severity has decreased over the first year of the pandemic in multiple myeloma patients, mortality remains high with no change between the initial weeks of the pandemic and the following months. Prevention and vaccination strategies should be strengthened in this vulnerable population, particularly in patients with active or progressive disease at time of Covid-19 diagnosis. Disclosures: Martínez-López: Janssen, BMS, Novartis, Incyte, Roche, GSK, Pfi er: Consultancy;Roche, Novartis, Incyte, Astellas, BMS: Research Funding. Mateos: Oncopeptides: Honoraria, Membership on an entity's Board of Directors or advisory committees;Regeneron: Honoraria, Membership on an entity's Board of Directors or advisory committees;Roche: Honoraria, Membership on an entity's Board of Directors or advisory committees;Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees;Adaptive Biotechnologies: Honoraria, Membership on an entity's Board of Directors or advisory committees;Sea-Gen: Honoraria, Membership on an entity's Board of Directors or advisory committees;AbbVie: Honoraria;Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees;Takeda: Honoraria, Membership on an entity's Board of Directors or advisory committees;Celgene - Bristol Myers Squibb: Honoraria, Membership on an entity's Board of Directors or advisory committees;Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees;Bluebird bio: Honoraria;GSK: Honoraria;Oncopeptides: Honoraria. López-Muñoz: Amgen: Consultancy. Sureda: GSK: Consultancy, Honoraria, Speakers Bureau;Sanofi: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Roche: Other: Support for attending meetings and/or travel;Mundipharma: Consultancy;Bluebird: Membership on an entity's Board of Directors or advisory committees;Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Kite, a Gilead Company: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau;MSD: Consultancy, Honoraria, Speakers Bureau;BMS/Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings and/or travel, Speakers Bureau;Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: Support for attending meetings and/or travel, Research Funding, Speakers Bureau. Rosinol: Janssen, Celgene, Amgen and Takeda: Honoraria. Lahuerta: Celgene, Takeda, Amgen, Janssen and Sanofi: Consultancy;Celgene: Other: Travel accomodations and expenses. San-Miguel: AbbVie, Amgen, Bristol-Myers Squibb, Celgene, GlaxoSmithKline, Janssen, Karyopharm, Merck Sharpe & Dohme, Novartis, Regeneron, Roche, Sanofi, SecuraBio, Takeda: Consultancy, Other: Advisory board.

P.859COVID-19 lockdown in people with severe mental disorders in Spain: do they have a specific psychological reaction?

Introduction: After the outbreak of a new coronavirus subtype SARS-CoV-2 in China in late 2019, a global pandemic developed, generating a health, economic, and social emergency [1]. In Spain, the COVID-19 pandemic crisis forced the government to declare a state of emergency on 14 March 2020 and to implement unprecedented lockdown restriction. In this context, patients with severe mental disorders (SMD) may be particularly exposed to stress and social distancing measures [2, 3] and thus disproportionately vulnerable to public health interventions to fight the COVID-19 [4]. However, the early psychological impact of the pandemic and the lockdown in this population is still mostly unknown. Aims of the study: Here, we aim to compare the early psychological impact (depression, anxiety, and stress responses, intrusive and avoidant thoughts, and coping strategies) in a sample of people with SMD compared with two control groups: other mental disorders (OMD) and healthy controls (HC). Methods: An anonymous online questionnaire using a snowball sampling method was conducted from March 19-26, 2020 and included sociodemographic and clinical data along with the Spanish versions of the Depression, Anxiety, and Stress Scale (DASS-21) and the Impact of Event Scale (IES). A total of 21,279 people living in Spain answered the questionnaire, and 125 people with SMD were included in the analysis. Subjects in each of the two control groups (OMD, n = 250;HC, n = 250) were matched (ratio 1:2) for sex and age (± 1 year) with the SMD group. We performed descriptive and bivariate analyses and multinomial and linear regression models. Results: People with SMD [mean age = 43.25 years (SD = 14.41);61.6% females] had statistically significantly higher scores on anxiety, stress, and depression subscales of the DASS-21 compared with the HC group, but lower scores than OMD in all domains (p < 0.05). Most people with SMD (87.2%) were able to enjoy free time, although control groups had higher percentages. After controlling for confounding factors, anxiety was the only significant psychological domain with lower scores in HC than people with SMD (OR = 0.721;95% CI: 0.579 - 0.898). In the SMD group, the multiple linear regression model (R2 = 0.580, F = 41.027, p < 0.001) found that higher anxiety was associated with being single (ẞ = 0.144, t = 2.291, p = 0.024), having COVID-19 symptoms (ẞ = 0.146, t = 2.395, p = 0.018), and a higher score on the stress subscale (ẞ = 0.538, t = 7.635, p < 0.001);whereas being able to enjoy free time was a protective factor (ẞ = -0.244, t = -3.692, p < 0.001). Conclusions: Our results showed that patients with SMD reacted to the pandemic and the lockdown restrictions with higher anxiety levels than the general public, suggesting that this domain could be a criterion for early intervention strategies and closer follow-up. No conflict of interest

P.690 Post-traumatic stress symptoms during the COVID-19 in different regions of Spain

Background: COVID-19 is the pandemic most affected since the 1918 influenza. In order to control its effects, the governments of different countries, including Spain, adopted exceptional measures such as lockdown and the suspension of non-essential economic activity. Studies carried out in China, where the population was also confined, have found an increase in the prevalence of post-traumatic stress symptom among the most affected regions compared to other less affected [1] Aim: To describe the presence of post-traumatic symptom among a large sample from the general population in the different regions of Spain after two weeks from the declaration of the state of alarm in Spain. Methods. The data was obtained through an online questionnaire two weeks after the declaration of the state of alarm in Spain (performed between 19 and 26 March, 2020) addressed to general population over eighteen years old [2]. It was spread using an online “snowball” method. Assessment sociodemographic, clinical variables and psychometric scales. Post-traumatic stress symptoms were measured by the Stressful Impact Scale (EIE), which consists of 15 items, divided into two subscales related to symtoms of intrusion and avoidance. The SPSS v24.0 program was used in the statistical analysis. Results: The sample consists of 21,153 individuals [30.3% men] with an average age of 39.75 ± 14.04 (18 to 100 years). A) Intrusive response: regions with the highest prevalence of intrusive response are Castilla La Mancha (31.2%), Andalusia (30.7%) and Extremadura (26.2%);regions with the lowest prevalence of intrusive response are Aragon (18.9%), Navarra (16.0%) and La Rioja (21.4%). B)Avoidance response: regions with the highest prevalence of avoidance response are Andalusia (55.7%), Extremadura (53.7%) and Castilla La Mancha (51.3%);regions with the lowest prevalence of avoidance response are Galicia (39%), Aragon (37.6%) and Navarra (32.7%). In Madrid, the prevalence of avoidant and intrusive symptoms was 43.1% and 26.0%, respectively. Conclussions: Avoidance symptoms were more frequent than intrusion symptoms in all regions. Andalusia, Extremadura and Castilla La Mancha are the regions with the highest prevalence of post-traumatic stress symptoms, both intrusive and avoidant. In addition, Aragon and Navarra presented low post-traumatic symptoms prevalence. The situation in the Community of Madrid is particularly garish. Despite being the region most affected by the COVID-19 pandemic in Spain, the prevalence of post-traumatic stress symptoms, both intrusive and avoidant, is close to average. The representativeness of the regions in the sample is a limitation of our study. However, the Madrid region is well represented in terms of the percentage share of the total sample. The results obtained do not seem consistent with the epidemiological situation of these regions at that time. It neither are according to the findings of other studies, so it would be necessary to investigate the existence of other factors that contribute to explaining these results. No conflict of interest

P.661 Psychological impact of the COVID-19 outbreak and lockdown in Spanish sample with anxiety disorder: differences according to sex

Introduction: We have experienced the effects of an unprecedented pandemic due to the new coronavirus SARS-CoV-2. This is the causative agent of COVID-19. There are precedents for the imposition of lockdown in previous outbreaks that caused a great psychological impact. Specifically, an increase in the mean post-traumatic stress scores, high depressive symptoms and an increase in completed suicides was reported [1,2]. The severity of the impact on mental health is greater in vulnerable people such as those with a psychiatric history [3,4]. Aims: This study aims 1) to assess the psychological impact on a large sample of participants with an anxiety disorder during the onset of the pandemic and lockdown in Spain;2) to Explore differences in the magnitude of the psychological impact of the people with an anxiety disorder according to the sex. Methods: Secondary analyses of a descriptive and comparative cross-sectional study of the data provided by the participants in an anonymous online survey conducted between March 19 and 26. The ad hoc questionnaire included sociodemographic, clinical data and variables related to COVID-19 as well as questions on coping strategies, and the Spanish versions of the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale (IES). From the entire sample of 21207 participants, we analyzed 1617 (7.6%) people with an anxiety disorder at that time [mean age = 35.6 (SD = 12.47);women = 1347 (83.3%)]. For the statistical analysis, the sample was divided into two groups according to sex. We used a chi-square test and Student's t test to detect differences among groups. Next, we analyzed the associations between sex and scores on psychometric scales using logistic regression to control for potential confounding factors. Results: Of the individuals with an anxiety disorder, 55.7% were single, 10.2% lived alone and only 2.4% live with family members infected by SARS-CoV-2. 72.8% do not have children in charge, and 89.1% do not have elderly people dependent on them. Comparing the psychological impact between groups, we observed that it is greater in women. We found statistically significant differences in every DASS-21 subscale: depression (4.35 ± 1.19 vs 4.10 ± 1.28;T= -3.076, p<0.002), anxiety (3.20 ± 2.14 vs 2.41 ± 2.03;T= -5.625, p< 0.001) and stress (4.60 ± 2.15 vs 3.86 ± 2.49;T= -4.540, p< 0.001);and in intrusive (3.63 ± 2.07 vs 2.83 ± 2.09;T= -5.751, p< 0.001) and avoidance subscales of IES (4.72 ± 1.89 vs 3.80 ± 2.06;T= -6.850, p< 0.001). Multivariate analysis revealed a statistically significant association of intrusive thoughts (OR 1.12;IC 95%:1.05-1.21, p=0.001), avoidant thoughts (OR 1.19;IC 95%:1.01-1.29, p<0.001) and age (OR 0.99;IC 95%:0.98-0.99, p=0.004) with being female. Conclusions: Our data indicated that the COVID-19 outbreak and lockdown harmed the mental health of people with mental disorders such as anxiety disorders. After considering confounding variables, we observed that women with an anxiety disorder suffer greater negative repercussions such as intrusive and avoidant thoughts compared to men. No conflict of interest

P.247 Psychological impact of COVID-19 confinement among people with history of mental disorders (bipolar, anxiety, depression) and general population in Spain

Background: Previous studies have shown that epidemic outbreaks have significant effects on mental health and psychological wellbeing, increasing psychiatric morbidity among population [1]. During the initial phase of the COVID-19 outbreak in China, more than half of the general population reported a strong psychological impact and approximately a third moderate to severe anxiety [2]. Furthermore, there is evidence that the psychological effects of infection outbreaks can affect months or years later [3]. A better understanding of the psychological impact of the COVID-19 outbreak is crucial to design coping programs that may mitigate these responses during such outbreaks. Aim: The objective of this study is to determine the early impact of the COVID-19 on mental health among people with history of mental disorders (anxiety, depression and bipolar disorder) and the General Population and people in Spain. Methods: In this study 252 people were included. Sixty three people with a history of bipolar disorder (hBD) were matched by sex and gender with 63 people with a history of anxiety disorders (hAD), 63 people with a history of depression (hDD) and 63 healthy controls (HC). The assessment was made by an online survey during the first days of the national lockdown due to COVID-19 (from 19 March to 26 March 2020) in Spain. Assessment: ad hoc sociodemographic, physical and clinical data questionnaire and the Spanish versions of the Depression, Anxiety and Stress Scale (DASS-21) and the Impact of Event Scale (IES). Results: Mean age was 45 (range 19-69, SD 14.8) years;69.8% were females for the total example and the four groups. Regarding clinical symptoms, 61.9%hBD, 54.0% hAD, 54.0% hDD and 28.6% HC reported depressive symptoms (χ² =15.922, p <0.001);19.0% hBD, 12.7% hAD, 20.6% hDD and 1.6% HC reported anxiety symptoms (χ² =12.104, p = 0.007);38.1%hBD, 34.9% hAD, 41.3% hDD and 19.0% HC reported stress symptoms (χ² =8.286, p = 0.040). Regarding psychological impact, 27.0%hBD, 17.5% hAD, 25.4% hDD and 14.3% HC reported intrusion style (χ² =4.277, p =0.273);38.1% hBD, 47.6% hAD, 57.1% hDD and 30.2% HC reported avoidance style (χ² =10.525, p =0.015). There were differences between groups in the three DASS-21 subscales scores: Depression (F=4.599, p= 0.004), Anxiety (F = 5.443, p <0.001) and Stress (F=3.537, p = 0.015) and in the IES total score (F=6.018, p<0.001) and each IES subscale: Intrusion (F=3.030, p = 0.030) and Avoidance (F=6.041, p <0.001). Conclusions: The emergency confinement by COVID-19 has an impact on mental health, but especially among people with history of mental disorders (anxiety, depression and bipolar disorder). Depressive symptoms were the most frequent symptoms in all groups, followed by stress symptoms. People with history of Bipolar Disorder was the group with the highest percentage of depressive symptoms. The most frequent style was avoidance in all groups. People with history of Bipolar Disorder was the group with the highest percentage of people with an intrusion style. People with history of Depression Disorder was the group with the highest percentage of people with an avoidance style. No conflict of interest