ABSTRACT
Introduction: Cancer patients have a high risk of severe COVID-19 and complications from it. Although the COVID-19 pandemic has led to an increase in the conduction of clinical trials (CTs), there is a scarcity of data on CT participation among cancer patients. We aimed to describe the level of participation in a COVID-19 CT, willingness to participate, as well as trust in sources of information for CTs among persons with and without a previous cancer diagnosis in Puerto Rico. Method(s): Data collected from November 2021 to March 2022 from two cross-sectional studies were merged and used for analysis. Informed consent, telephone, face-to-face, and online interviews were conducted among participants >=18 years old living in Puerto Rico (n=987). Descriptive statistics and bivariate analysis (Fisher's exact text and chi-squared test) was done to describe the outcomes of interest, overall and by cancer status. Result(s): Mean age of participants was 41+/-15.5 years. Most participants were women (71.3%), with an educational level greater than high school (89.5%) and with an annual family income below $20,000 (75.1%). Overall, 4.4% of participants (n=43) reported history of cancer diagnosis. Only 1.8% of the population reported to have participated in a COVID-19 CT to receive either a treatment or vaccine;stratifying by cancer, none of the cancer patients had participated in a COVID-19 CT, and only 1.9% of non-cancer patients participated. While 37.0% of the participants indicated being very willing to sign up for a CT assessing COVID-19 treatment, willingness was higher in cancer patients (55.8%) than among participants without cancer (36.1%). Regarding trust in sources of information for CTs, the level of trust ("a great deal/a fair amount") was higher for their physicians (87.6%), researchers (87.0%), the National Institute of Health (86.7%), their local clinics (82.9%), and a university hospital (82.7%), while it was lower for a pharmaceutical company (64.0%), and for friend, relative, or community leader (37.6%);no differences were observed by cancer status. Conclusion(s): While participation in COVID-19 CTs was extremely low in the study population, the willingness to participate was higher among cancer patients. Education on CTs and their availability are necessary to increase participation in this understudied group. Such efforts will enhance the representation of Hispanic and vulnerable populations, such as cancer patients, on COVID-19 CTs, and thus proper generalizability of study findings in the future.
ABSTRACT
This survey (n = 1,356) reports food insecurity (FI) in Puerto Rico (PR) at 38% before, and 40% since, the COVID-19 pandemic. Odds for FI increased for households with annual income <=$15k vs. >=$60k (OR: 3.52;95% CI: 1.20, 10.36);experiencing an income reduction (OR: 2.22 (1.55, 3.18));participating in the United States Department of Agriculture Nutrition Assistance Program (OR: 1.75 (1.14, 2.70));higher food acquisition anxiety (OR: 1.45 (1.29, 1.64));increased home availability of fruit-flavored drinks (OR: 1.52 (1.04, 2.22)), whereas increased fruit availability was protective (OR: 0.63 (0.43, 0.93)). Results heighten the need to examine FI strategies in PR.Copyright © 2021 Taylor & Francis Group, LLC.
ABSTRACT
INTRODUCTION: Puerto Rico has endured three major environmental and public health crises (Hurricane Irma, Hurricane Maria, the unprecedented seismic activity of January 2020) and the coronavirus disease 2019 (COVID-19) pandemic during the past 5 years. All these events might lead to an unquestionable deleterious impact in the prevention of cancer and across the cancer continuum, exacerbating cancer health disparities in the future. Cancer screening plays a critical role in early cancer detection. COVID-19 has significantly hampered screening programs in many countries' cancer screening infrastructure and services, affecting adherence. Cancer is the leading cause of morbidity and mortality in Puerto Rico. Limited information is available about the impact the current pandemic on colorectal cancer screening. In this study, we aim to describe the impact of the COVID-19 pandemic on colorectal cancer screening in 2020 and assess if this impact varied by health regions. METHOD(S): This study analyzed administrative data claims from the Public Health System of Puerto Rico which is managed by the Government of Puerto Rico through the Health Insurance Administration. The Current Procedural Terminology (CPT) codes included for this study were (81528, 82270, G0104, G0105, G0121, G0328, G0464). To assess changes in the numbers of colorectal cancer screening claims between the incurred year (2016 and 2020), Poisson regression was used. Initially, we fitted this model with only the incurred year as the predictor and offsetting the model with the annual average of total insured (univariate model). Based on this model, we estimate the magnitude of association between the number of claims and incurred year using the Prevalence Ratio (PR) of claims. Lastly, Poisson univariate regression model were used for each of the seven health regions (Ponce, Bayamon, Caguas, Mayaguez, Metro, Arecibo and Fajardo) to assess potential geographic disparities. RESULT(S): The numbers of colorectal cancer screening claims significantly decreased by 40% (PRcrude: 0.60, 95%CI: 0.59, 0.62) in 2020 when compared to 2016. However, when adjusting for claim incurred month, sex, health region and offsetting the model with the annual average of total insured, the numbers of colorectal cancer screening claims significantly decreased by 34%, (PRadj: 0.66, 95%CI: 0.64, 0.67). The numbers of colorectal cancer screening claims significantly decreased in all health regions in 2020 when compared to 2016 (p<0.05). However, the most impacted region was the Eastern region, Fajardo, with a 64% (PRFajardocrude: 0.36, 95%CI: 0.30, 0.42) significant decrease in numbers of colorectal cancer screening claims. CONCLUSION(S): COVID-19 had a profound negative effect on colorectal screening in Puerto Rico. Moreover, despite the beneficiaries of this governmental health plan sharing similar sociodemographic and socioeconomic background, regional differences were observed.
ABSTRACT
Introduction: The COVID-19 pandemic has caused major changes to healthcare services, especially those related to early detection and screening practices like breast cancer. In Puerto Rico, breast cancer is the main cause of death, representing 18.9% of cancer deaths in women, making early detection even more important to prevent morbidity and mortality. This study aims to describe the impact of COVID-19 on breast cancer screening and assess differences in health utilization by age group and health regions in Puerto Rico. Method(s): This study used data on breast cancer screening medical claims from Puerto Rico Track, a project in collaboration with the Puerto Rico Public Health System and the Puerto Rico Institute of Statistics that aims to assess health access and utilization patterns in Puerto Rico. Claims including unilateral and bilateral mammography, sonommamography, and MRI were analyzed. Descriptive statistics and percentual changes between the COVID-19 baseline year (2016) compared with 2020 and 2021 were performed (overall, by age-group and health region). Result(s): A total of 193,793 screening tests were performed in 2016, compared to 66,463 in 2020, and 89,322 in 2021. Overall, a third of the medical claims for breast cancer screening (33.2%) were in the age group of 51-60 years. An overall decreasing percentual change was observed comparing 2016 vs. 2020 (65.7%), where the age group with the broadest gap reduction were among women 41-50 years old (68.2%). When comparing medical claims of 2016 (193,750) versus 2021 (89,320) (pre and post pandemic), an important decreasing change (53.9%) was observed. The age group with the highest decrease comparing 2016 to 2021 was the 41-50 years one (68.2%). The Western region of Mayaguez/Aguadilla had the highest decreasing percentual change, with a reduction of 73.6% in 2020 compared to 2016, and 62.6% when compared 2021 with 2016. Conclusion(s): Breast cancer screening was notably affected by the COVID-19 pandemic in Puerto Rico. A pattern of decreasing breast cancer screening was observed by health regions and by age. These efforts provide evidence of the need of tailored evidence-based interventions to increase breast cancer screening in the island.
ABSTRACT
Objectives: Variant-related differences of SARS-CoV-2 have been reported such as higher transmissibility but less disease severity in omicron sublineages when compared to other variants. Although some studies have examined the outcomes of COVID-19 in systemic lupus erythematosus (SLE), most were conducted during the initial waves. Thus, we sought to compare the clinical outcomes of SLE patients with COVID-19 during the omicron and pre-delta/delta periods. Method(s): A cohort of adults with SLE from a single center in Puerto Rico was studied. SARS CoV-2 infection was confirmed by polymerase chain reaction or antigen tests. The pre-delta/delta variants period was defined as March 2020 to November 2021 and the omicron period as December 2021 to October 2022. Demographic parameters, cumulative SLE manifestations, disease activity, disease damage, lupus treatments, comorbidities, COVID-19 symptoms, SLE exacerbations, and hospitalizations were compared between the study periods using bivariate and multivariate analyses. Result(s): Of the entire SLE cohort (n = 347), 151 patients (43.5%) had COVID-19. In those with COVID-19, the mean (SD) age was 46.7 (12.5) years and 96.0% were women. Overall, clinical outcomes were favorable with low rates of hospitalizations (2.6%), lupus flares (3.3%), and mortality (0.7%). In 14.6% of cases, COVID-19 occurred during the pre-delta/delta period and in 85.4% during the omicron wave. Patients that had COVID-19 during the predelta/ delta period were younger and had a significantly higher proportion of oral ulcers, psychosis, anti-Smith antibodies, coronary artery disease, and chronic kidney disease compared to those during the omicron wave. Among COVID-19 symptoms, runny nose, cough, and sore throat were more common in the omicron period, whereas anosmia and anorexia were more frequent in the pre-delta/delta period. In the multivariable analyses adjusted by age, all variables retained significance except for psychosis, anti-Smith antibodies, and coronary artery disease. No significant differences were observed for other variables. Conclusion(s): In this group of Puerto Ricans with SLE, a higher proportion had COVID-19 during the omicron wave compared to previous periods. No differences were seen for severe outcomes such as hospitalizations, lupus flares, and mortality. Furthermore, COVID-19 did not appear to have a negative impact on the short-term clinical outcomes of these patients, regardless of the variant period examined.
ABSTRACT
On 7 September 2017, Hurricane Irma made landfall on Puerto Rico. Two weeks later, Hurricane Maria devastated the island. Recovery efforts and repairs were still underway by the time the island was rocked by a series of earthquakes in early 2020. By 15 March 2020, a lockdown was instituted due to the COVID-19 global pandemic. Mass migration, austerity measures, neoliberal privatization and a perpetual battle against colonialism have exacerbated these traumas. Repeated disaster, both natural and unnatural, leave Puerto Rican communities in a continuous loop of preparing and recovering. In the wake of disaster, the San Juan-based theatre collective Y no había luz (f. 2005), has functioned as both survivor and witness, enduring traumatic events themselves even as they assemble to assist those in need. In this article, I draw upon fieldwork I conducted in San Juan, Puerto Rico, as well as Imani Perry's concept of defiant joy to argue that Y no había luz forms a legacy of solidarity that persists through the mobilization of defiant joy in disaster response. Moreover, in collaborating with each other and with intergenerational communities, Y no había luz creates multidisciplinary performances of care that are characterized by joy, whimsy, and celebration. In multiple iterations of familiar narratives, the collective activates afterlives for stories that extend beyond performance to give community participants access to reenact, reshape, and re-remember events. These collective experiences produce a solidarity model of care and a shared understanding among and between artists and communities. Through acts of defiant joy, Y no había luz produces mutually beneficial and sustainable expressions of care-based solidarity in virtual and in-person spaces.
ABSTRACT
To date, the severe acute respiratory syndrome coronavirus 2 that causes the disease Coronavirus 2019, has infected 601 million people, claiming the lives of 6.4 million people worldwide. Of the patients who survive, 60% suffer from inflammatory problems leading to post-acute sequelae of COVID-19 (PASC). Inflammation in these patients is marked by an increase in pro-inflammatory cytokines which ultimately damage the body's organs, contributing to PASC. Understanding the main mechanism by which this cytokine storm occurs is of utmost importance in order to develop therapeutic strategies for counteracting inflammation in people suffering from COVID-19 and PASC. This project seeks to find out if an innate anti-inflammatory mechanism, the cholinergic anti-inflammatory response (CAR), works properly in patients suffering from COVID-19 and PASC by interrogating its functioning in its cellular substrate, macrophages.We hypothesized that disruption of the CAR in primary human monocytederived macrophages (MDMs) exposed to the SARS-CoV-2 spike protein trimer contributes to the chronic inflammation/ cytokine storm exhibited in these patients. To this end, we exposed MDMs to the SARS-CoV-2 spike protein in order to assess levels of the anti-inflammatory alpha-7 nicotinic acetylcholine receptor (alpha7-nAChR) by means of confocal imaging. Our results demonstrate a statistically significant reduction (P <= 0.01) of alpha7-nAChR expression in MDMs, in a time-dependent manner, after the addition of SARS-CoV-2 spike protein concentrations (30 nM and 100 nM), at different time points. Interestingly, when the receptor employed by the virus to infect, Angiotensin-converting enzyme 2 (ACE-2), was blocked, we detected a significant reduction in the levels of alpha7- nAChRs (P <= 0.001). Collectively, our results support the hypothesis of this work given that the SARS-CoV-2 spike protein is capable of compromising the functioning of the CAR by reducing the levels of alpha7-nAChRs available in macrophages to suppress inflammation. These results could position the alpha7- nAChR as a key target for the development of novel anti-inflammatory therapeutic strategies to counteract the inflammatory problem found in patients suffering from COVID-19 and PASC. We would like to acknowledge Dr. Negin Martin & Dr. Jerrel Yakel, for providing the Purified Spike Protein expressed by SARS-CoV-2 and Pseudotyped Virions in this collaborative study. Also, these experiments are being supported by the University of Puerto Rico - Rio Piedras NIH-RISE program. RISE Grant Number: 5R25GM061151-20.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
ABSTRACT
Serum Amyloid A (SAA) is an apolipoprotein found in the serum of many vertebrate species and is associated with the acute-phase reaction in the body with expression levels reaching up to a 1000-fold increase. The loss of its alpha-helix conformation during its expression peak is directly linked to secondary amyloidosis. Recent studies have been suggested to play a role in cholesterol and HDL metabolism, retinol transport and tumor pathogenesis. Moreover, high SAA concentration in blood have been correlated with severe symptoms or death in patients with COVID-19. However, how this protein is involved in so many diseases is uncertain or not completely understood. Therefore, the purpose of this research is to determine which protein-protein interactions with SAA occur in human cells, and to predict its biochemical role based on new discovered complexes. Two major isoforms overexpressed during an acutephase reaction, human SAA1 and SAA2, are the focus of this study. Both are primarily produced in hepatocytes. HepG2 cells were cultured and induced with interleukin-1b, interleukin-6, LPS and retinol. Protein complexes associated with SAA will be isolated through a co-Immunoprecipitation technique, resolved by SDS-PAGE, and characterized by mass spectrometry. Our hypothesis focus on those protein complexes with SAA to explain how this protein lead other undiscovered metabolic pathways involved in both cellular and survival regulation. Special thanks to The Science and Technology Competency & Education Core (Stce) for Undergraduate and Graduate Junior Research Associates Working Program from the Puerto Rico IDeA Network Biomedical Research Excellence for funding part of this research.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.
ABSTRACT
OBJECTIVES/GOALS: Evaluate the impact of COVID-19 on oral clefts services including surgical and dental treatments in Puerto Rico. METHODS/STUDY POPULATION: This Observational retrospective cohort study will consider patients 0-21 y/o with CL/P that visited the UPR school of Dental Medicine, Pediatric University Hospital Dr. Antonio Ortiz and ongoing case-control research project Face-Genes. Records to be used are classified as follow: Pandemic (March 15, 2020 to March 15 2022) Pre-pandemic (March 15, 2015 to March 15, 2017) Power analysis (power=0.80 alpha=0.05) will be calculated. Unavailable and incomplete medical records and those that did not attended study clinic during study period will be excluded. Data extraction instrument will be based on previous published study. Descriptive statistics, Chi-square, Odds Ratios at 95% confidence intervals and multiple logistic regression will be estimated. RESULTS/ANTICIPATED RESULTS: We hypothesize that surgical and dental services in Puerto Rico will be adversely impacted because of COVID-19 pandemic. DISCUSSION/SIGNIFICANCE: CL/P are common congenital diseases that require early interdisciplinary attention. Lack of timely care as well as surgery and treatment delays, could be associated with poorer prognosis, increased morbidity and mortality. If there is high risk of dh services during emergency situations, our findings will help to allocate the available resources
ABSTRACT
OBJECTIVES/GOALS: The COVID-19 pandemic has impacted nursing frontline professionals. The aims of this study were to explore experiences of nursing professionals in Puerto Rico during the pandemic, examine the impact on their health and provide research development opportunities enhance research capacity. METHODS/STUDY POPULATION: This interpretative phenomenological study recruited graduate nurses who participated in one in-depth semi-structured virtual interviews. Interviews were audio recorded and transcribed. The data analysis process was guided using the following steps: 1. Reading and re-reading, 2. Initial noting, 3. Developing emergent themes, 4. Searching for connections across emergent themes, 5. Moving to the next case, 6. Looking for patterns across cases, and 7. Writing up. In addition, Van Manen's thematic structure of four foundations was used as a complement to guide reflection and interpretation. Faculty and students participated throughout the process. RESULTS/ANTICIPATED RESULTS: Seven nursing professionals'lived experiences caring for Covid-19 patients were gathered. Their ages ranged from 31 to 45 and had worked between 2 and 14 years providing direct care. Themes that emerged from narrations include compassion fatigue, teamwork, working beyond clinical role, and gratification. Nurses expressed dealing with a very difficult situation, fear of being infected , or infecting my family , and working together to get through it and better help patients . Nurses also expressed feelings of anxiety and lack of institutional support. Additionally, the impact of working with patients, feeling good for being there, good or bad and support from families. DISCUSSION/SIGNIFICANCE: Nurses'narrations point to the complexities of their experiences working during the pandemic. They had to transcend usual demands even though they often lacked needed support. We must recognize the value of nursing and reflect upon changes in healthcare that are essential to move nursing forward.
ABSTRACT
PurposeThis paper discloses the risk management response strategies and the perceived effectiveness of the strategies employed by companies operating within manufacturing clusters in Puerto Rico from 2016 until 2020, the second year of the coronavirus disease 2019 (COVID-19) pandemic.Design/methodology/approachThe research design consists of questionnaire-based survey responses from companies belonging to manufacturing clusters, followed by semi-structured interviews and secondary sources of information.FindingsThe results reveal the risk responses used to manage specific risk types. Albeit respondents' dependency on an assortment of company-centric and cluster-bound risk response strategies, the perception is that the former is more effective when adequate local sources are available and the latter when the cluster has strong interconnectedness among the cluster's members.Research limitations/implicationsFurthermore, there is a generalized belief that long-term cluster-bound strategies are required to complement individual companies' overall risk management strategies.Originality/valueThis paper demonstrated that due to the volatility, uncertainty, complexity and ambiguity (VUCA) nature of the Caribbean region, mixed risk management might result in better and more favorable long-term performance.
ABSTRACT
Background: Adhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. Objectives: To describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). Methods: The Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25-65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. Results: PROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. Conclusions: If PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.
ABSTRACT
Prior to the COVID pandemic, Puerto Rico (PR) had one of the highest Human Papillomavirus (HPV) vaccine rates in the United States. The COVID pandemic and administration of COVID vaccines might have impacted attitudes toward HPV vaccination. This study compared attitudes toward HPV and COVID vaccines with respect to school-entry policies among adults living in PR. A convenience sample of 222 adults (≥21 years old) completed an online survey from November 2021 to January 2022. Participants answered questions about HPV and COVID vaccines, attitudes toward vaccination policies for school-entry, and perceptions of sources of information. We assessed the magnitude of association between the agreement of school-entry policies for COVID and HPV vaccination by estimating the prevalence ratio (PRadjusted) with 95% Confidence Intervals (95% CI). The most trusted source of information for HPV and COVID vaccines were healthcare providers (42% and 17%, respectively) and the CDC (35% and 55%, respectively), while the least trusted were social media (40% and 39%, respectively), and friends and family (23% n = 47, and 17% n = 33, respectively). Most participants agreed that HPV (76% n = 156) and COVID vaccines (69% n = 136) should be a school-entry requirement. Agreement with school policy requiring COVID vaccination was significantly associated with agreement of school policy requiring HPV vaccination (PRadjusted:1.96; 95% CI:1.48-2.61) after controlling for potential confounders. Adults living in PR have an overall positive attitude about mandatory HPV and COVID vaccination school-entry policies, which are interrelated. Further research should elucidate the implications of the COVID pandemic on HPV vaccine attitudes and adherence rates.
Subject(s)
COVID-19 , Papillomavirus Infections , Papillomavirus Vaccines , Humans , Adult , United States , Young Adult , Puerto Rico/epidemiology , Papillomavirus Infections/epidemiology , Papillomavirus Infections/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , Surveys and Questionnaires , Policy , Vaccination , Schools , Health Knowledge, Attitudes, PracticeABSTRACT
After a year and a half of experimenting individual and collective changes that the pandemic restrictions have brought due to COVID-19, there is a growing literature in different disciplines documenting the effects the global population is experiencing. Due to this continuous reality, we proposed a theory article that would connect neuroscientific theories with recent literature to expose the emotional and learning effects COVID-19 is having on Puerto Rican children. Additionally, we proposed to summarize applicable recommendations to the home, educational, clinical contexts, as well as potential applications for public policy. For this end, the following objectives were established: 1) state how the neurophysiological perspective allows us to explain the emotional and learning effects, 2) state how Puerto Rican children have been emotionally and cognitively affected by the COVID- 19 pandemic, 3) state assertive practices to mitigate the discussed effects. The neuroscientific theories were applied to the effects that recent literature has shown, and found recommendations were also included (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (Spanish) Al ano y medio de haber experimentado cambios individuales y colectivos por las restricciones de la pandemia ocasionadas por COVID-19, ya comienza a haber literatura en distintas disciplinas indicando sobre los efectos que estan trastocando a la poblacion global. Ante esta continua realidad, se propuso redactar un escrito de modelo teorico que enlace teorias neurocientificas con la literatura actual para exponer los efectos emocionales y de aprendizaje que COVID-19 esta teniendo en la ninez puertorriquena. De igual manera se propuso resumir las recomendaciones de literatura reciente aplicables a contextos del hogar, de aprendizaje, clinicos, y aplicaciones de politica publica. Para este fin, se plantearon los siguientes objetivos: 1) exponer como la perspectiva neurofisiologica nos permite explicar los efectos emocionales y de aprendizaje, 2) conocer como la ninez puertorriquena se ha visto afectada emocional y cognitivamente por la pandemia COVID-19 y, 3) exponer practicas acertadas para aminorar los efectos discutidos. Las teorias neurocientificas se aplicaron a los efectos que estan siendo mostrados por la literatura reciente, al igual que se redactaron las recomendaciones encontradas. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Architect Alexis Rochas, founder of Stereobot, has a history of producing spectacular light shows and urban interventions using space-frame technology. Art and architecture writer Eva Menuhin records the firm's creative trajectory and further explores their recent developments, using the same techniques, that can provide homes for those hit by disaster, whether financial or physical, or both. Copyright © 2023 John Wiley & Sons, Ltd.
ABSTRACT
The unprecedented uncertainty associated with the COVID-19 pandemic has been widely acknowledged. However, uncertainty and the complex psychological responses that it generates have not often been the core or centerpiece of writings on pandemic distress. In this paper, we discuss why it is crucial to understand pandemic distress reactions as a psychological response to uncertainty, in and of itself. To inform this discussion, we have drawn on writings and research on the topic of uncertainty within psychology and other disciplines (e.g., public health). We attempt to apply some of these ideas to the Puerto Rican context, where the COVID-19 pandemic has been one among many "uncertainty disasters." The importance of autogestion in Puerto Rico is discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) La incertidumbre sin precedentes asociada con la pandemia del COVID-19 ha sido ampliamente reconocida. Sin embargo, la incertidumbre y las complejas respuestas psicologicas que genera no han sido a menudo el nucleo o la pieza central de los escritos sobre la angustia pandemica. En este articulo, discutimos por que es crucial comprender las reacciones de la angustia pandemica como una respuesta psicologica a la incertidumbre, en si misma. Para informar esta discusion, nos hemos basado en escritos e investigaciones sobre el tema de la incertidumbre dentro de la psicologia y otras disciplinas (por ejemplo, salud publica). Intentamos aplicar algunas de estas ideas al contexto puertorriqueno, donde la pandemia del COVID-19 ha sido uno entre muchos "desastres de incertidumbre". Abordamos la importancia de la autogestion en Puerto Rico. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The coronavirus (COVID-19) pandemic has brought adverse consequences in several areas of a person's functioning, including economic, work, family, and academic. One area that has been little investigated in Puerto Rico is the effect of confinement on couples' sexual behavior. The objectives of the present study were: (1) analyze whether there are statistically significant differences between the sexual satisfaction of the participants before and during quarantine;(2) examine whether there have been significant changes in the quality of intimate relationships during the quarantine;and (3) evaluate whether anxiety and COVID-19 anxiety significantly predict participants' sexual satisfaction during quarantine. The sample consisted of 392 adults, primarily women (87.5%). The main results reflected a decrease in the quality of the couple's relationship and sexual satisfaction during the quarantine. In addition, the relationship between COVID-19 anxiety and sexual satisfaction during quarantine was low and negative. Although some differences turned out to be statistically significant, a look at these differences highlights that the differences were minimal at a practical and clinical level. Recommendations and practical implications are discussed from a clinical and counseling angle. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Spanish) La pandemia por coronavirus (COVID-19) trajo secuelas adversas en varias areas del funcionamiento de las personas, entre ellas economicas, laborales, familiares y academicas. Un area que no se ha investigado en Puerto Rico es el efecto de los encierros en la conducta sexual de las parejas. Los objetivos del presente estudio fueron: (1) analizar si existen diferencias estadisticamente significativas entre la satisfaccion sexual de las personas participantes antes y durante la cuarentena;(2) examinar si se han producido cambios significativos en la calidad de las relaciones de pareja durante la cuarentena;y (3) evaluar si la ansiedad y la ansiedad por COVID-19 predicen la satisfaccion sexual de las personas participantes durante la cuarentena. La muestra consistio de 392 personas adultas en su mayoria mujeres (87.5%). Los resultados reflejaron una disminucion en la calidad de la relacion de pareja y en la satisfaccion sexual durante la cuarentena. La relacion entre ansiedad por COVID-19 y satisfaccion sexual durante la cuarentena fue significativa, baja y negativa. A pesar que algunas diferencias resultaron ser estadisticamente significativas, una mirada a dichas diferencias resalta que a nivel practico y clinico las diferencias fueron minimas. Se discuten recomendaciones e implicaciones para la clinica y consejeria. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Introduction: Efficient and comprehensive trial oversight and data management ensures valid, robust outcomes necessary to inform health policy and improve patient outcomes. This is particularly challenging in the context of multicenter trials. The format of this session will include four introductory presentations (15 min each), followed by 30-min panel discussion/Q&A focusing on recent experiences and innovative approaches utilized within the Wake Forest NCI Community Oncology Research Program Research Base (WF NCORP RB). Since 2017, WF has managed 15 studies with approximately 3000 patient and 1000 provider/stakeholder accruals across 1000 potential participating community oncology practices within the United States and Puerto Rico. These practices often operate differently from academic medical centers, with varying patient capacity, provider number and level of engagement, use of advanced practice providers, and services offered. In addition, practices within this network have heterogeneous utility of electronic health records (EHRs) and display a wide range of clinical research staffing models. The COVID-19 pandemic has highlighted the need for streamlining research visits and maximizing telehealth technologies when applicable, particularly for intervention non-therapeutic clinical trials. As such, research expectations must be standardized to ensure quality trial conduct and data collection across diverse practices. Recently, the WF NCORP RB has taken many steps to improve efficiency and data quality across our studies. This session will discuss a comprehensive approach to data quality and management across the lifespan of a trial. This starts with consent/ recruitment strategies and general oversight/ monitoring of our portfolio of trials. WF RB now utilizes REDCap for all data capture, as this allows direct data entry for site personnel and participant entered patient-reported outcomes using surveys. In addition, REDCap facilitates data monitoring, query, and auditing strategies. We will also introduce a team-based approach to adjudicate complex outcomes. Talk 1 (15 min): Specifically, Karen Craver, our RB administrator, will discuss approaches to obtain robust data as a result of strong screening and recruitment. She will provide an overview on how we survey practice research staff within the Landscape assessment and brief, pre-trial interest surveys to identify optimal target populations during the planning stage. We utilize our internal EHR to create custom screening reports to identify potential participants and generalize these for other practices to customize and use as a screening tool within their clinic. The RB has integrated remote consenting in part due to the pandemic, but we realize the need to continue offering flexibility in consent modality moving forward. Talk 2 (15 min): Emily Dressler, lead Biostatistician, will discuss oversight of the RB portfolio using dynamic reports within Tableau. These reports update daily and provide a comprehensive assessment of all ongoing and completed studies. RB personnel can filter reports to create custom results subset by timeframe, practice or set of practices, trial type, and/or other demographic characteristics. This has greatly reduced the request for study-specific accrual reports and has standardized our reporting across studies. She will also discuss the rationale for transitioning to REDCap, including strengths and weaknesses for integrating in multicenter studies. Talk 3 (15 min): Bill Stanfield, lead data manager, will demonstrate our utilization of the REDCap Data Resolution Workflow and Data Quality modules to efficiently manage data collection, data quality, and audits. He will show how REDCap can be used to seamlessly communicate with research staff to obtain missing or late data, verify out of range values, and then validate and lock responses for analysis. Talk 4 (15 min): Glenn Lesser, WF NCORP multiple principal investigator (mPI), will discuss a team approach to adjudicating cancer treatment information that often consists of combination of surgery, radiation, chemotherapy, or immunotherapy/targeted agents. This remains a particularly challenging problem in large trials enrolling patients with multiple types of cancer who may be treated with a wide spectrum of standard therapeutic regimens. This diversity limits both the effectiveness of automated reviews of remote data entries and the study-specific training of data management staff at sites. Data are pulled in real time from multiple forms within REDCap and collated into participant-level summaries of treatment, starting with the time of baseline assessment and sorted sequentially for each drug administration or event. A multidisciplinary team of data managers, biostatisticians, and clinicians meet to adjudicate each participant as data collection completes. Particularly for trials with multiple cancer types or treatment regimens, our experience with this approach has shown it identifies significant data gaps in treatment, with at least 75% of entries requiring clarification from research staff prior to finalizing and locking data. This process highlighted the challenge of real-time adjudication of treatment data in patients receiving multiple anti-cancer agents, given at varying doses and schedules, and in multiple combinations and/or phases over an individual patient's course of therapy. Panel (30 min): We will conclude with a panel discussion and Q&A. The panel will contribute additional perspective on implications of these strategies in the conduct of multilevel cancer care delivery research studies. We will also incorporate perspectives from NCORP community sites implementing these strategies. Panelists will discuss the broad applicability of these strategies for diverse trials, with attention to size/ complexity, database vendor, and patient population.
ABSTRACT
Introduction: The Latin American Dialysis and Renal Transplantation Registry (LADRTR), founded in 1991, has collected data and reports on patients receiving kidney replacement therapy (KRT) since 1993. The main goals of the LADRTR is to promote the development of national registries, consolidate a data system for KRT in Latin America (LA), return the data provided by nephrologist to the different stakeholders that participate in the decision making process, while contributing to the universal knowledge of prevention, incidence and evolution of the disease in the region. This summarizes the registry data for 2020. Method(s): Participating countries complete an annual survey collecting aggregated data on incident and prevalent patients on KRT in all modalities. The different treatment modalities considered were hemodialysis (HD), peritoneal dialysis (PD) and living functioning kidney graft (LFG). National gross domestic product per capita (GDP, expressed in US dollars) and life expectancy at birth (LEB) corresponding to the year 2020 were collected from the World Bank Data Bank. Prevalence and incidence were compared with previous years and were also correlated with GDP and LEB. Result(s): On 31 December 2020 the prevalence of KRT in LA was 848 per million population (pmp), which shows a drop in the rate compared to the previous year (Figure 1). The prevalence ranged from 2129 pmp in Puerto Rico to 111 pmp in Nicaragua. Eight countries had a rate >700 pmp (Argentina, Brazil, Chile, Colombia, Ecuador, Panama, Puerto Rico and Uruguay). The states of Mexico, Jalisco and Aguas Calientes, also had a rate >700 pmp (Figure 2). Regarding treatment modality, 67,0% of the prevalent patients were treated with HD (n= 290 099) and 9.3% with PD (n= 40 450) while 23,6% of the patients had an LFG (n= 102772). The total unadjusted incidence rate of patients that started KRT was 158 pmp. The majority of the patients started KRT with HD modality, while only 6,08% used PD, varying the rate of incidence from 477 pmp in Jalisco and Aguas Calientes to 2 pmp in Bolivia. The kidney transplant rate in the region was 15 pmp, showing a drop from the previous year, and 89% of KT were from a deceased donor (Figure 3). The total prevalence of KRT correlated positively with GDP per capita (r 2 = 0.6, P < 0.01) and LEB (r 2 = 0.27, P < 0.05). The overall unadjusted mortality rate was 18%, cardiac disease was the leading cause of death (31%), followed by infectious diseases (21%) and other causes (16%). [Formula presented] [Formula presented] [Formula presented] Conclusion(s): For the first time in the last decade the overall prevalence and kidney transplant rate decreased, being this associated with COVID-19 pandemic. Although the incidence and prevalence of KRT in the LA region have increased over the years, there is still a need to improve accessibility to KRT, develop programs that facilitate better control of risk factors, early diagnosis and the treatment of chronic kidney disease, as well as the implementation of an effective kidney transplant program, to reduce the gap that exists between the countries of LA. No conflict of interestCopyright © 2023
ABSTRACT
The COVID-19 pandemic has completely disrupted and possibly permanently changed the way humans travel. In Puerto Rico, major travel restrictions to the island have persisted at different levels since March 2020, which heavily influenced residents' travel behaviors. However, it remains unclear about how big the impact is and how inequitable it might be. The goal of this study is to evaluate COVID-19's impacts on Puerto Rican's travel behaviors by analyzing travel flows from Puerto Rico to the contiguous US with a modified gravity model. The roles of socioeconomic factors regarding the Puerto Rican travelers and COVID-19 factors regarding the destination US states have been assessed. COVID-19 was a strong deterring factor of travel at the beginning of the pandemic and also in the winter of 2020, but it did not keep Puerto Ricans from traveling during the summer 2020 when most travel restrictions were lifted. We found that the elderly population of Puerto Rico, despite being more vulnerable to COVID-19, were much more likely to travel during the pandemic. We also found that, during the holiday season in 2020, some socioeconomically disadvantaged populations were more likely to be traveling, a direct contradiction to their travel flows the year prior. These findings shed light on about how disproportionately affected populations behavior changed from pre-pandemic to after the pandemic started. With the continuance of the pandemic, this information is extremely valuable for future planning with respect to emergency management, travel regulation, and social benefit. © 2023 Wuhan University. Published by Informa UK Limited, trading as Taylor & Francis Group.