Effects of Covid-19 Vaccines on Mental Health of an Individual A Cross-Sectional Clinical Study

Objective: The mains and objectives of the study was to evaluate the impact of Covid'19 vaccination on mental health status. Study Design: A Cross-Sectional Clinical Study. Place and Duration: It is a cross-sectional study which was conducted by the house officers and the faculty of Dow International Dental College from june2022 to January 2023. Methodology: This study was conducted by distributing the questionnaire among the patients coming to the Outpatient Department at Dow International Dental College. A total of 280 Questionnaires were filled among the Vaccinated Patients coming to the OPD. Questions were inquired related to demographics, dosage, history, last dose, and benefit of vaccine, depression, sleep deprivation, feeling low, trouble concentrating and suicidal thoughts. The consent to fill this questionnaire by the patient was taken by 'Implied Consent'. It was in English language but was translated in Urdu by the house officers whenever it was needed to ensure the comprehension of the questions to the patients. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of which 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. Practical Implications: The results of this cross-sectional clinical study have practical implications for the wider community. Encouraging Covid-19 vaccination can have a positive impact on both physical and mental health, and promoting vaccine uptake may lead to improved mental health outcomes for individuals. Such benefits can reduce the overall burden of mental health issues during the pandemic, which is beneficial to the community. Thus, public health campaigns should focus on the potential positive effects of Covid-19 vaccines on mental health to improve community well-being and promote vaccine acceptance. Result(s): Approximately 48% women and 52% male have anxiety, depression or either disorder, respectively. Adults with anxiety and depression were more likely to have low educational attainment, low household income, lack of health insurance and either lack or delay medical care. The filled questionnaire was collected by the house officers of the dental department. A total of more than 280 questionnaires were distributed among the participants out of whom 250 questionnaires were filled correctly giving us a response rate of 89.2% and dropouts of 10.8%. There was a common mental impact that was noticed and brought about people's mental health at stake. Conclusion(s): Forceful vaccination has a potential to affect mental health of an individual. Further studies are required to extrapolate the findings of the present study.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.

Correlates of Covid-19 Vaccine Uptake in Malawian Adults

Background: COVID-19 vaccine uptake has been suboptimal in many lowincome countries. In Malawi, as of end-2022, just over 3.1 million adults have been fully vaccinated, representing ~21% of the adult population. We sought to identify correlates of COVID-19 vaccination among adults in Malawi to inform evidence-based policies and programs. Method(s): A survey was administered among adult (aged >=18) clients at 32 health facilities across Malawi (May-June 2022). We asked about COVID-19 vaccination history and about hypothesized correlates per the WHO Behavioural and Social Drivers of Vaccination model: what people think and feel, social processes, and practical issues. We assessed correlations between these and vaccination status, adjusting for age, HIV status, sex, educational attainment, household wealth, and urban-rural classification using multivariable logistic regression. Result(s): Surveys were conducted with 837 people, median age 39 (IQR 30-49), 56% female, 51% living with HIV and on ART. 33% were up-to-date on COVID-19 vaccination per Malawi guidelines (1 dose for J&J;2 doses of AstraZeneca or Pfizer vaccines), 61% were unvaccinated, and 6% were overdue for a second dose, with no difference by HIV status, religion, or urban-rural classification. Up-to-date individuals were older than those who were not (45 vs 38 years, p< 0.001). The strongest correlates of up-to-date vaccination were believing the vaccine is important and safe, believing vaccination's benefits outweigh its risks, and perceiving social support for vaccination (Table). Of 510 unvaccinated respondents, 54% had been offered the vaccine;the most commonly reported reasons for being unvaccinated were concerns about vaccine side effects (56%) and access-related barriers, such as travel time or cost (19%). Among the unvaccinated, 54% were eager or willing to be vaccinated, 29% were ambivalent, and 18% were opposed. Those opposed were less concerned about COVID-19 infection, did not feel the vaccine is important, and were less confident in the vaccine's safety. Conclusion(s): Up-to-date COVID-19 vaccination status was associated with positive attitudes about its importance and safety and perceiving provaccination social norms. Concerns about vaccine side effects were common, but over half of unvaccinated respondents were willing to get vaccinated. Disseminating messages about vaccine safety and ensuring local availability of the vaccine may help address concerns and access barriers, and thus help increase COVID-19 vaccination in Malawi.

Cystic fibrosis fitness during inpatient treatment

Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved

Abstracts From the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health 2022 Scientific Sessions

The proceedings contain 385 papers. The topics discussed include: racial and ethnic differences in the population burden of dementia attributable to modifiable risk factors in the United States;higher visit-to-visit variability in fasting glucose and HbA1c is associated with decline in global cognitive performance: the Multi-Ethnic Study of Atherosclerosis (MESA);prevalence of stroke symptoms among Hispanic/Latino adults in the Hispanic community health study/study of Latinos (HCHS/SOL);educational attainment and dementia risk: mediation by vascular risk factors at mid-life in the atherosclerosis risk in communities (ARIC) study;a healthy plant-based diet was associated with slower cognitive decline in African Americans: a biracial community-based cohort of older adults;outcome preferences related to cardiovascular preventive therapies in older adults: an online survey;subclinical myocardial injury, coagulopathy, and inflammation in Covid-19: a meta-analysis;COVID-19 and type II NSTEMI: a comprehensive overview;association of antecedent statin use with outcomes of people with Covid-19 admitted at northwestern medicine health system;and social determinants of health and ambulatory outcomes among Covid-19 positive patients: differences by race/ethnicity.

Kidney Biopsies during the Covid-19 Outbreak: A Series of Cases

Introduction: Kidney disease due to COVID-19 has been described with several presentations, both in acute phase and in posterior timing of the infection, and kidney biopsy is important for an ideal management. But the process of adequately perform a biopsy during the pandemic entails risks, as being the exposed and infected by the SARS-CoV-2. Besides of the usual potential complications, such as post-biopsy hemorrhage, that may require admission in an already crowded medical structure. For these reasons, attainment of kidney biopsies was limited to those who without an adequate histopathological diagnosis, were at higher risk of inappropriate management, as well as a pathology secondary to the SARS-CoV-2 could be ignored. The aim of this study is to perform a description of the cases biopsied during the SARS-CoV-2 pandemic, being emphasized those whose indication emerged because of the viral infection. Method(s): Descriptive study of the clinical presentation in addition to histopathological findings of cases requiring kidney biopsy during the period of March 2020 - July 2021. Result(s): A total of 37 cases were collected, with a median age of 40 years (range: 60), 51% males and 73% with known history of hypertension. A 35% of the cases presented nephrotic syndrome;with average proteinuria of 4189.5mg/24h. The most frequent histopathological diagnosis was focal segmental glomerulosclerosis (FSGS), accounting for 40% of the cases. 4 patients required biopsy after COVID-19. One of them presented with Acute Kidney Injury (AKI) during the acute phase of the SARS-COV-2 infection with prolonged hemodialysis requirement;presenting histopathological diagnosis of global and segmental glomerulosclerosis. Another case of AKI during the acute phase of infection and subsequent proteinuria presented global and segmental glomerulosclerosis with collapsing characteristics;while 2 cases due to nephrotic syndrome post-infection, presented histological data of minimal change disease and FSGS with acute tubular injury. Conclusion(s): Regardless of the appearance of a new pathology that affects the kidneys, the incidence of entities such as FSGS persists with greater frequency. However, that does not diminish the importance of performing renal biopsies, since this is an essential tool for management in cases where there is overlap of specific glomerual diseases with COVID-19. No conflict of interestCopyright © 2023

Access to medical coverage in newly diagnosed Breast cancer patients a minority population during the COVID 19 pandemic

Background: Hispanics are among the most significant minorities in the United States, and assessing their health needs is vital in formulating health policies. The social, environmental, and biological background affect their morbidity and mortality, with cancer being the leading cause of mortality in Hispanics. Although implementing the Affordable Care Act improved access to health care, disparities and challenges in Hispanics' access to health care remain. (1) In our study, we are trying to assess the COVID-19 pandemic implications on the socioeconomic status of Hispanics with newly diagnosed breast cancer and how that is affecting their outcome. Method(s): This is a retrospective study demonstrating the nature of breast cancer screening, diagnosis, and management during COVID-19 lockdown and post-vaccine compared to the preCOVID-19 era. The restrospective review was conducted at Mays Cancer Center in San Antonio, IRB approved by UT Health San Antonio. The data were ed from the medical record system (EPIC). Pearson's Chi-squared and logistic regression tests were used to determine the relationship between time and stage at diagnosis and association with funding status Result: 696 subjects with newly diagnosed breast cancer were identified and divided into three cohorts: Cohort A: 264 pts in a pre-covid era: From 2018-February 2020, Cohort B: 171 patients during the covid-19 lockdown, and Cohort C: from April 2020-Dec-2020 with 261 patients in the post-vaccine era. A higher percentage of patients had Tis identified in Cohort A (26%) compared to Cohort B (19%) and Cohort C(12%) (p0.003). These numbers have changed to an increasing percentage of patients with T1 or T2. N0 or N1in Cohort B (62%) and Chohort C (68%), p0.003). Presentation of locally advanced (T3/T4 with any N) and metastatic disease remained relatively similar in all cohorts, with more metastatic cases at presentation in Cohort A (p0.003). Many patients of Hispanic ethnicity (OR 1.47, p0.1) were not funded by commercial insurance or Medicare. (OR 2.33, 95% CI 1.43, 3.77, p< 0.001). A high proportion of Hispanic ethnicity in post covid era (cohort B and C) OR 1.78, 95% CI (1.16,2.79) (p0.009) required neoadjuvant chemotherapy suggesting more advanced and possibly aggressive cancer histology. We observed that unfunded patients are less likely to have hormonal receptor-positive breast cancer (p0.001). Conclusion(s): Population health is likely affected by socioeconomic status, which eventually affects their health care. In a minority Hispanic population, low average income and educational attainment are likely the obstacles to getting timely appropriate health.(2) A higher proportion of Hispanic patients were not insured when compared to non-Hispanics leading possibly to more advanced and aggressive histologies at presentation. (Table Presented).

Navadhanya Functional Traditional Foods : Perfect Healthy Snacks during Covid-19 Pandemic

The fast food dietary life style habits had rapidly put the people in the midst of risky conditions especially showed adverse impacts on snacks. Most of the Indian traditional foods typically contains highly nutritious indigenous foods and bringing slight variation in ingredients formulations proved to be more functional. Navadhanya in the Indian culture occupies auspicious place and provide numerous nutritional and therapeutic benefits. In fact, the current pandemic COVID-19 pandemic scenario requires healthy snacking behaviour. Based on this background, the common traditional foods viz., boondhi laddu, mysorepak, kajjikayalu and muruku were purposefully chosen to develop functional foods with the incorporation of navadhanya mix at 50 per cent level. The acceptability studies carried out organoleptically both at the baseline and after storage period of one week had clearly demonstrated highly acceptable mean organoleptic scores and not significant difference statistically. The findings well explained the retention of freshness even at one-week storage period. On the other hand, the nutrient analysis carried out had shown sufficient evidence that the functional foods prepared were energy dense and rich in essential nutrients such as protein, fat, calcium and iron. Promotion of indigenous healthy foods not only improves healthy but also play crucial role in the attainment of food and nutrition security. Copyright © 2022, Anka Publishers. All rights reserved.

Effect of Covid-19-pandemic on loneliness, well-being, significant others - Results of a national survey of adults in Hungary

Introduction: Covid-19-pandemic is likely to have a substantial and long-term effect on the mental health of the adult Hungarian population. Objective(s): To investigate the self-reported change of loneliness, change in well-being, and change in the numbers of significant others due to Covid-19-pandemic. Method(s): Computer-assisted web interviewing is being conducted. Survey design uses a multistaged sampling and iterative weighting algorithm, both based on the 2016 Hungarian micro census. The sample can be considered representative for age, gender, educational attainment, region, and size of the settlement. Continuous variables will be tested for normality of distribution using the Shapiro-Wilk, and Kolmogorov-Smirnov tests. To check the comparability of the two groups, the Mann-Whitney U tests will be applied. The crosstabulation Pearson chi-square and Fisher's exact tests will be performed to assess the association between categorical variables. Twosample Z-tests will be applied to evaluate the difference between the proportions of the two groups. Multivariable logistic regression models will be also applied to understand the association between the direction of change and sociodemographic variables. Result(s): The survey is currently being conducted;results shall be presented at the conference. Conclusion(s): The survey is currently being conducted;results and conclusions shall be presented at the conference.

Assessment of worries and attitudes towards the COVID-19 pandemic and the vaccine among Tunisian elderly

Introduction: The COVID-19 pandemic poses a threat particularly to the elderly. Although the current vaccination strategy is recognized as an adequate measure to reduce mortality, it still raises concerns about its efficacy and safety. Objective(s): Assessment of worries and attitudes among Tunisian elderly towards the pandemic. Method(s): Adescriptive cross-sectional study on a sample of 50 consultants in a geriatric service, aged between 65 years and over. A questionnaire was formulated based on the recommendations of WHO and INEAS. Result(s): The average age of our population is 74.6 years. The participants were mainly female, retired (76%) and with low educational attainment. Most of the elderly reported that they respected the wearing of the mask in public (90%) and washing their hands regularly (92%). Social distancing was respected by only 44% of the participants. Concerning the vaccine registration, we noted that 48% of the subjects expressed their willingness to register on the Evax.tn platform. On the other hand, 15 people expressed their refusal to receive the anti-Covid vaccine.We noted that only 22% had a dose of the Covid-19 vaccine. Only 4% of the respondents did not have concerns about new variants of the virus. About half (52%) of the subjects expressed significant concern about an increased risk of virulence and mortality due to the new variant. Vaccination was considered ineffective by most of the participants (70%). Conclusion(s): Addressingworries about vaccinewould be an important step to accept it among Tunisian elderly. Adequate information strategy is essential to change attitudes during the pandemic.

The New paradigm of local research and innovations by local health professionals

Background: Health research in Tanzania can be traced to colonial time with their interest of fighting endemic and epidemic infections. Post-independence, in 1979, the National Institute for Medical Research was given legal mandate of undertaking, promoting, controlling, and coordinating health research of national interests in Tanzania. The ongoing International and National commitment to ending COVID-19, pandemics, attaining: Universal Health Converge and Resilient and Sustainable systems for Health by 2030 calls for fundamental reforms and a new Health Research paradigm. Objective(s): The paper assesses the response of national health policies and strategies towards strengthening local health research agenda for UHC and RSSH by 2030. Method(s): Review of relevant documents to include National Vision, National Health Policies, Health Sector Strategic Plan;NIMR Health Research Priorities and Plans, Comprehensive Council Health Plans Guidelines Edition 1-IV and other closely related publications. The roles and prospects of local Professionals in Health Research and Innovations for the attainment of UHC and RSSH are reviewed and summarized. Result(s): NIMR has been responsible for National Health Research to date except for a short spell of a Health Systems Research Unit [HSRU] in the Ministry of Health [MoH] under NHP of 2003. There has not been a National Health Sector Research agenda [NHRA] under MoH to this date. This situation has undermined relevance, accountability, and effectiveness of research initiative at NIMR, MOH, other involved institutions, District councils and local communities. Conclusion and recommendations: Lack of NHSRA will hinder timely attainment of UHC and RSSH. It is recommended that the MoH should organize an NHSRA and re-establish HSRU and other necessary research structures at all levels led by Local Health Professionals, the Role of NIMR should be re-defined to effectively support NHSRS. NHRA should be costed and fully supported by MOH and Development Partners.

MENTAL ABILITY ON HIGHER MATHEMATICS: LEARNING IN THE DIGITAL CLASSROOM

Although online teaching is not anymore new in the field of education, but it has become the trend in teaching during the advent of the COVID-19 pandemic. Countries also differ on online teaching implementation due to the strength and level of sophistication of their internet connectivity. That is why is, it very interesting to determine how students learn through online teaching in a third world countries such as Philippines. This quantitative study employed a descriptive design utilizing the tertiary students’ Mathematics grade during the full conduct of the online teaching. The data revealed that respondents’ mental ability in higher Mathematics was described as “satisfactory” in which they met the minimum competence with average score. In addition, gender did not also indicate a significant difference as a variable. No significant difference between their gender was also found out in the results. This finding points out that online teaching was still the best alternative mode of delivery in the height of the pandemic. Although it has been known that many Filipino students has no personal computers and laptops, most of these students utilized their cellular phone not only for personal use but for academic as well. Thus, this study recommends that teachers may continue employing online teaching or blended teaching to let the students learn on their own with the aid of technology.

Landscape of Attitudes Towards Living Kidney Donation During the SARS-CoV-2 Pandemic in the United States: Results of a Public Opinion Survey

Purpose: Solid organ transplantation decreased during the SARS-CoV-2 pandemic largely due to temporary shutdowns. The pandemic revealed significant gaps in medical knowledge among the public;disinformation, distrust, and the advent of SARS-CoV-2 may have lingering effects on transplantation rates. We hypothesize that the SARS-CoV-2 pandemic has influenced interest in living kidney donation (LKD) among members of the public. Method(s): We surveyed 900 US adults (ages 25-65) in June 2021 about LKD knowledge, attitudes, perceived barriers/facilitators, and impact of the pandemic on their interest in LKD. We evaluated the relationships between self-reported characteristics and interest in LKD using Chi-square tests. Result(s): The experience of the SARS-CoV-2 pandemic increased interest in LKD for 12% of participants, decreased interest for 9%, and had no impact for 79%. Increased interest in LKD was significantly associated with White race (White only vs. Asian only: 12.4% vs. 9.4%, p=0.005), younger age (25-34 vs. 55-65: 16.7% vs. 6.1%, p<0.0001 and 35-44 vs. 55-65: 15.9% vs. 6.1%, p<0.0001), male gender (16.3% vs. 8.5%, p= 0.001), higher income ($100,000-149,000 vs. <$50,000: 18.9% vs. 7.5%, p=0.0008), and higher educational attainment (4-year degree vs. some college: 14.4% vs. 6.07%, p=0.0012 and post-graduate degree vs. some college: 21.5% vs. 6.1%, p= <0.0001). Conclusion(s): The SARS-CoV-2 pandemic only impacted 21% of participants' interest in LKD, highlighting an unexpected externality of the pandemic. These findings unveil new opportunities for community engagement and population groups to target in future education and outreach campaigns.

INEQUITIES IN PHYSICAL DISTANCING PRACTICES IN THE US WORKPLACE DURING THE COVID-19 PANDEMIC

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Physical distancing is a fundamental community mitigation strategy that averts adverse health outcomes from COVID-19 and other transmissible illnesses. Despite national policies in place, racial/ethnic minority groups and individuals with lower socioeconomic status had disproportionately worse COVID-19 outcomes. Barriers to adherence to these public health recommendations may underlie some of these disparities. We, therefore, examined physical distancing practices according to racial/ethnic group, educational attainment, and income level in the US. METHODS: The National Health Interview Survey (NHIS), an annual cross-sectional survey that collects health indicators for noninstitutionalized civilians, was queried for adult respondents interviewed in 2020. We included adults who were working at any point in the past 12 months prior to the interview. Respondents working the week prior to the interview were identified in subgroup analyses. The outcomes of interest were rates of self-reported physical distancing measures in the workplace and non-adherence to these measures. Sample-weighted proportions and 95% confidence intervals were estimated and Pearson χ2 tests (α=0.05) were conducted to compare outcomes across racial/ethnic, educational, and income categories. Data were publicly available and deidentified, therefore institutional review was not sought. RESULTS: 9,501 respondents aged ≥18 years reported working at any point in the past 12 months prior to the interview. After weighting, 88.3% (n=8,427) reported having physical distancing measures in the workplace. In subgroup analyses of 8,394 individuals who worked in the last week, 91.2% (n=7,713) reported currently having physical distancing measures in the workplace. Rates of having social distancing measures in the workplace were higher with increasing educational attainment and income level (Table). Black and Hispanic individuals worked at places with higher rates of non-adherence to physical distancing measures compared with White and Asian respondents. Rates of non-adherence to physical distancing in the workplace were lower with increasing educational attainment and income level (Table). CONCLUSIONS: In 2020, higher rates of having physical distancing measures in the workplace were seen among more educated and higher-income individuals. Higher rates of non-adherence to these measures at the place of work were seen among Black and Hispanic individuals and those with lower educational attainment and income level. Limitations of this study include the self-reported nature of data, small sample sizes of some minority populations, and lack of granularity in work settings. CLINICAL IMPLICATIONS: Varying working conditions are possible barriers to adherence to public policies. Future efforts are needed to elucidate and mitigate the factors behind inequities in the ability to adhere to public health recommendations and disparities in health outcomes. DISCLOSURES: No relevant relationships by Deepak Bhatt No relevant relationships by Edward Christopher Dee No relevant relationships by Enrico Ferro No relevant relationships by Bhav Jain No relevant relationships by Bisola Ojikutu No relevant relationships by Joseph Alexander Paguio No relevant relationships by Jasper Seth Yao

ADVANCE CARE PLANNING VIRTUALLY DURING A PANDEMIC Debbie Ripley

The Marie Curie Virtual Advance Care Planning service was set up in response to the vulnerability of care home residents during the COVID-19 crisis. The high degree of variation in completed Coordinate My Care (CMC) records pan-London was identified. Many care home residents and their families had not had discussions about their end-of-life care preferences recorded. As well as providing holistic person-centred information, documenting evidence for the transfer to hospital for those for whom it would be appropriate is vital to enable the health and social care system to provide better person-centred care. Marie Curie had existing experience of working with care home staff and GPs to create CMC records. This experience was used to initiate and provide this virtual service across several areas in London involving care home residents and the service has expanded to receive referrals from hospital consultants for their out-patients who they believe would benefit from advance care planning and the creation of a CMC record. The project is staffed with registered nurses, initially with those who were shielding, and Marie Curie were able to recruit these staff from widespread locations because of its virtual nature. A training programme was established involving recognised CMC training, using webinars on advance care planning and issues surrounding mental capacity of patients, including Lasting Power of Attorneys Best Interest Decisions for patients who lack capacity. This was underpinned by the experience of Marie Curie Nurses with excellent communication skills as well as foundational mandatory training such as general data protection, safeguarding and mental capacity assessment. On receipt of the referral, the Marie Curie Nurse identified individual needs and began liaising with necessary parties in order to create an advance care plan that was of a high quality and would contain the most useful information about personal preferences to the multi-disciplinary teams.

PEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY-ASSOCIATED with SARS-COV-2-A PORTUGUESE SINGLE CENTRE CASE SERIES

Background: Across the globe, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 appears to affect paediatric population in a milder and non-threatening way, when compared to adults. However, since April 2020 case reports of previously healthy children presenting with unremitting fever, biologic infammatory syndrome and cardiac dysfunction have been emerging. This syndrome, which has been termed Pediatric Infammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 infection (PIMS-TS), represents a rare complication of COVID-19 in children1. Objectives: To describe the clinical, laboratory and imaging characteristics, course, management and outcomes of hospitalized children diagnosed with PIMS-TS in a Portuguese tertiary care hospital. Methods: A retrospective study including children (< 18 years) that attended our hospital from April 2020 to December 2021 was performed. All the children included fulflled the case defnition of PIMS-TS published by the Centre for Disease Control and Prevention. Sociodemographic and clinical data, laboratory markers and imaging fndings were collected. Results: A total of 19 children met the criteria for PIMS-TS, 68% male with a mean age at diagnosis of 8 years old (IQR 5.8-15). They were all caucasian, except for a mixed-race patient, and all previously healthy, except one patient who was obese. Twelve had recent infection by SARS-CoV-2 detected by reverse transcriptase (RT) PCR and 18 had positive IgG serology. All had fever at diagnosis, with a median duration of 6 days (IQR 5-6) and 89.5% had mucocutaneous, gastrointestinal and hematological attainment, respectively. Other affected systems were respiratory (73.7%), cardiovascular (63%), lymphoid organs (52.6%), musculoskeletal (47%), genito-urinary (31.6%) and neurological (26.3%). Laboratory fndings can be found in Table 1. Thirty-six percent were admitted in intensive care unit for a median duration of 8 days (IQR 4-9). 42.1% needed respiratory support, 87.5% with supplemental oxygen therapy, 62.5% with mechanical ventilation and 12.5% with non-invasive ventilation. All patients received intravenous (IV) immunoglobulin, 52.6% IV cor-ticosteroid (CS) pulses and 78.9% IV and oral CS. Other treatments included acetylsalicylic acid (n=18), heparin (n=8) and antibiotic therapy (n=19)-Table 3. Seventeen fully recovered and 2 had sequalae: one of them with coronary artery aneurysms and other exertional dyspnea. Conclusion: In this case series, there was a broad spectrum of clinical symptoms and disease severity, ranging from fever and systemic infammation to critical care admission with myocardial injury, shock, and development of coronary artery aneurysms. Despite short-term morbidity, there were no mortality cases, with most of them recovering without sequelae. All physicians providing clinical care to children should consider this rare but severe delayed syndrome in paediatric population.

THE IMPACT of the COVID-19 PANDEMIC on WORK PRODUCTIVITY in PATIENTS with SPONDYLOARTHRITIS: RESULTS from the DUTCH SPA-NET REGISTRY

Background: Since early 2020, governments have initiated local and nationwide measures to contain the spread of the coronavirus disease 2019 (COVID-19). In the Netherlands, people were strongly recommended to work from home, and several work sectors were shut down. In addition, hospitals had to reduce regular care. These changes, together with the risk of contracting COVID-19 and becoming ill, could have affected people's employment perspectives and work productivity. It is unknown to what degree this affected persons with chronic disorders, such as spondyloarthritis (SpA). Objectives: To investigate whether work productivity in patients with SpA changed following the onset of the pandemic and the associated government-initiated containment measures in the Netherlands. Methods: Data from the Dutch eHealth monitoring system SpA-Net were used. Since 2016, patients in SpA-Net completed outcome measurements when they attended outpatient rheumatology visits. Employment and work productivity were assessed with the Work Productivity and Activity Impairment questionnaire (WPAI, work productivity loss range 0-100%), capturing both sick leave and reduced at-work productivity. Covariables of interest were age, gender, education (high vs. low) and disease activity (ASDAS, BASDAI, patient global). The proportions of patients employed and their work productivity losses were compared during a 1-year period before and after the onset of the pandemic (March 2020). Generalized Estimating Equations (GEE) analysis of all assessments over time explored if work productivity in employed patients had changed with the onset of the pandemic, adjusting for potential confounders. Similar analyses with disease activity as outcome were used to facilitate interpretation of work productivity results. Results: Of 238 patients, data were available during the 1-year period both before and after onset of the pandemic. Pre-pandemic, 128 (54%) patients were employed. These employed patients had a mean age of 49.0 (SD 10.2) years, 66 (54%) were male and the mean ASDAS was 2.1 (0.9). After the onset of the pandemic, 7 (5.5%) were no longer employed. In addition, 8 out of 110 (7.3%) originally unemployed patients had become employed by this time. Work productivity loss (0-100%) was worse after the onset of the pandemic (37.0) compared to the pre-pandemic year (27.0) (p<0.01). In multivariable GEEs with work productivity loss as outcome (and stratifed by education due to interaction), patients with low education had work productivity losses that were almost 10% (absolute) higher after onset of the pandemic compared to pre-pandemic (B = 9.57, 95%CI 5.63-13.51) (Table 1). This was independent of ASDAS and other confounders. In patients with high education, however, no such association between pandemic onset and work productivity was seen. Analyses adjusting for other measures of disease activity (BASDAI, patient global) showed similar results. In GEEs with disease activity as outcome, disease activity before and after pandemic onset did not differ (B =-0.05, 95%CI-0.15 to 0.06 for ASDAS, model not shown). Conclusion: Work productivity has worsened in patients with SpA since the onset of the pandemic, especially in patients with lower educational attainment, while disease activity remained stable. Care should be taken to support patients in their work role during the pandemic, and thereafter.

Abuse of Marginalized Older Adults during COVID-19: Proxy Findings from the Canadian Longitudinal Study on Aging

Child and spousal abuse rates tend to increase during various disasters. This study sought to determine the prevalence and determinants of older adults' experiences of increased verbal or physical conflict (+VPC) as a proxy for elder abuse during the COVID-19 pandemic. Data stem from the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study of 51,338 Canadians aged 45-85 at baseline. We analyzed the data of participants aged 55 or older at core follow-up 1 who also participated in a CLSA COVID-19 substudy (n = 24,306). Experiencing +VPC was the main outcome variable;explanatory variables included gender identity, sexual orientation, age group, race/ethnicity, educational attainment, marital status, household income, working status, living arrangement (alone vs. with others), social support availability, cohesion in the community, self-rated health, anxiety, depression, and previous history of elder abuse. The overall weighted prevalence of +VPC was 7.4%. Gay/bisexual men, 55-64 age group, living with others, low social support, poor social cohesion, low self-rated health, poor mental health, and history of psychological or physical abuse were each significantly associated with +VPC. Weighted multivariable logistic regression revealed that male gender, living with others, higher depression and anxiety scores, and a history of psychological abuse were independent predictors of +VPC. Implications for postpandemic recovery and prevention strategies during future disasters include targeted outreach programs for the most vulnerable group, which included males and younger older adults between 55 and 64 years as well as those with mental health issues and/or history of elder psychological abuse.

REMOTE DECISION-MAKING AND COMMUNICATION AROUND DO NOT ATTEMPT CARDIO-PULMONARY RESUSCITATION (DNACPR) ORDERS IN CARE HOMES DURING COVID-19

Background DNACPR decisions must be discussed with patients and, where patients lack capacity to be involved in DNACPR decision-making, with a legal proxy or next of kin. COVID-19 posed several challenges to DNACPR decisionmaking and communication including rapid, untimely clinical deteriorations and the prohibition of visitation in care homes. Simultaneously, there were concerning reports of blanket DNACPR orders being placed on care home residents. The Department of Health and Social Care (DHSC) issued guidance during the pandemic around remote capacity assessments. Aims This project reviewed practice around remote capacity assessments and communication around DNACPR decisions in care home residents in 2020. Methods Secondary analysis of data from a trust-wide audit was performed. 30 DNACPR forms from 2020 were randomly selected from Salford Care Homes Medical Practice. Results Capacity assessments were undertaken in line with DHSC guidance in all notes reviewed. Clinicians considered previous capacity assessments, remote assessments via iPad or telephone, and the views of care home staff, patients' relatives, legal proxy and IMCAs. 2 of 30 patients were deemed to have mental capacity. All DNACPR decisions were discussed with the patient, or where the patient lacked capacity, with the next of kin or legal proxy. Conclusion We identified good uptake of DHSC guidance around remote capacity assessments during 2020, however since undertaking this analysis, the MCA guidelines have been revoked. There is now no guidance to support clinicians should capacity assessments need to be undertaken remotely. There is an urgent need for policy makers to address this, due to the possibility of further outbreaks and the clinically vulnerable nature of the care home population.

Gender Analysis of Journal of Perinatology Authorship During COVID-19

Background: Gender disparities are well documented in many facets of medical careers, especially career advancement and scholarly work. Although the majority of neonatologists in the US are female, they are underrepresented as authors in pediatricfocused journals. Early reports show the COVID-19 pandemic amplified these baseline gender disparities. Our objective was to examine gender distributions of authorship and how they may have changed since the beginning of the COVID-19 pandemic in the Journal of Perinatology, the journal for the Section of Neonatal-Perinatal Medicine. Methods: We collected data from the Journal of Perinatology website;variables included name of first and last author, date of publication, country and institution of first author, and if article was listed as supported by any funding. Gender (female, male, nonbinary, or undetermined) was determined using Genderize.io, institutional websites, ResearchGate, social media outlets including LinkedIn and Doximity, or a general Google search. Our primary outcome was the difference between the number of articles authored by women during the pandemic period (March 2020-May 2021, period 2), compared with the preceding 15 month period (December 2018-February 2020, period 1). We analyzed the data using chi-square test. Results: Author characteristics are presented in Table 1. The number of publications increased from period 1 to 2. Of the 1,230 first and last authors from the combined periods, we were unable to determine binary gender for 24 authors (1.9%). Less than half (42.6%) of articles were supported by funding, with the majority having a female in either the first or last author position. Table 2 demonstrates the change in authorship by gender and time period. There were slightly fewer female authors overall (47.7%) and as last author (38.7%) for the combined time periods, compared with nonfemale authors. There was no significant difference in the proportion of female authors to non-female authors from time period one to time period two in regard to overall, first, or last authorship. Conclusion: The distribution of author gender in the Journal of Perinatology did not change significantly during the COVID-19 pandemic. Female authors still remain underrepresented overall and specifically as last author, which raises concerns about under-attainment in career advancement. As the majority of the neonatology workforce is female, this trend warrants further investigation. (Table Presented).

Digital aging and mental health deteriorations: Risk mitigation in the older people with liver disease in Indonesia

Objectives: Indonesia is entering an aging society with an older people population reaching 26.82 million people or 9.92% of the total population in 2020 and it is predicted that around one-fifth of Indonesia's population in 2045 will be older people. The senior citizen is the covid-19 most at risk due to comorbidities and low digital literacy. In Indonesia, the liver is one of the highest comorbid factors in increasing the risk of death by 13.5 times and increasing to 16.8 times in the elderly due to COVID-19. This condition increases the aging market in Indonesia but low digital literacy will affect the lower QoL. Materials and Methods: Using data from the 2014 Indonesia Family Life Survey (IFLS), this study aims to analyze mental health problems and mobile phone ownership in older adults (60) with Liver disease. Results: The analysis shows that the proportion of older people with liver disease reaches 4,07% and 59,18% are male. 57,5% of them experienced mental health problems and the percentage is higher in men. However, the percentage of elderly with liver disease experiencing mental health problems will decrease by 6,78% when they have a cellphone. The elderly SES in Indonesia has a fairly diverse distribution between provinces and 55,8% of them are still working. Nearly half of older people's education attainment is elementary school, which reaches 46.05 percent. In general, the elderly with higher digital literacy prefer to seek treatment at a formal health facility than traditional practitioners such as shamans. They tend to seek outpatient care treatment at a community health center or Puskesmas (44,11%), specialist (29,41%), and private hospital (11,76%). Conclusion: Increasing digital aging encourages elderly health literacy, as well as decreases mental health problems. Mainstreaming the digital aging issue can help various information and services needed by the elderly to be healthier, independent, and with dignity.