Coping Orientation of Academic Community in the Time of COVID-19 Pandemic: A Pilot Multi-Country Survey Study

In this paper, we have mapped the coping methods used to address the coronavirus pandemic by members of the academic community. We conducted an anonymous survey of a convenient sample of 674 faculty/staff members and students from September to December 2020. A modified version of the RCOPE scale was used for data collection. The results indicate that both religious and existential coping methods were used by respondents. The study also indicates that even though 71% of informants believed in God or another religious figure, 61% reported that they had tried to gain control of the situation directly without the help of God or another religious figure. The ranking of the coping strategies used indicates that the first five methods used by informants were all non-religious coping methods (i.e., secular existential coping methods): regarding life as a part of a greater whole, regarding nature as an important resource, listening to the sound of surrounding nature, being alone and contemplating, and walking/engaging in any activities outdoors giving a spiritual feeling. Our results contribute to the new area of research on academic community's coping with pandemic-related stress and challenges.

Effect of COVID-19 pandemic on sleep quality of frontline healthcare workers

Background: The 2019 coronavirus disease (COVID-19) outbreak, which was brought on by the SARS-CoV-2 novel coronavirus, has had a significant negative influence on our environment and exposed health-care personnel to a new level of risk. Very few studies have addressed the disturbances in the sleep quality of healthcare workers during COVID-19 pandemic. Aim and Objectives: The primary objective of the study was to examine the sleep quality of frontline healthcare workers during COVID-19 pandemic in a tertiary care center in northern Kerala. Material(s) and Method(s): Healthcare workers belonging to a tertiary care center were invited to participate in the study. An online questionnaire including sociodemographics, Pittsburgh sleep quality index, and Insomnia severity index was used to evaluate sleep disturbances in healthcare workers. Univariate and bivariate analysis of the results were done to identify the predictors of poor sleep quality. Result(s): A total of 250 frontline healthcare workers were enrolled in the study, out of which 243 participants provided usable responses. About 27.6% of health workers showed features of poor sleep quality. The prevalence rate of poor sleep quality was highest among nurses, 55.2% followed by doctors and ambulance drivers, 22.4% and 11.9%, respectively. About 17.7% of the study population had subthreshold insomnia and 1.2% had clinical insomnia of moderate intensity. Conclusion(s): The prevalence of poor sleep quality is high among healthcare workers confronting COVID pandemic. This study emphasizes the need to implement specific protective measures for maintaining the sleep quality and decreasing stress among frontline health care workers during pandemics.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

Assessing perceptions of pedestrian-focused intervention in a car-dependent European island

Apart from the numerous social, economic, and environmental impacts of car dependence, the time people spend sitting in motorised vehicles has been identified as a sedentary behaviour that can negatively impact people's physical and psychological health. The climate breakdown and the COVID-19 pandemic have continued to expose the fragility and vulnerability of the urban environment and the imminent need for response, management, and radical re-thinking through innovation, especially within the transport sector. The incidence of the COVID-19 pandemic has also reiterated the need for urban centres to re-establish a sense of community, extend the benefits reaped from reduced motorised transport usage and boost small/medium-size businesses through the provision of active travel spaces. This paper investigates the role of pedestrian-focused intervention to encourage walking rather than car use for short-distance trips, within the context of the car-dependent small island state of Malta. The research includes the use of semi-structured interviews with a broad range of stakeholders to develop a virtual platform for citizen participation. The platform is an interactive space for participants to identify barriers that discourage walking and explore and evaluate options that encourage walking as a mode of transport. A discussion of preliminary findings sheds light on the impact of pedestrian interventions that encourage active travel and contribute policy-relevant outcomes based on the perceptions and direct feedback from citizens and stakeholders alike. © 2023 The Authors. Published by ELSEVIER B.V.

Urban mobility evolution and the 15-minute city model: from holistic to bottom-up approach

In recent years, urban planners have mentioned the importance of implementing alternative city models that encourage short trips and neighborhood-scale activities such as the 15-minute city model. Several studies show that improvements in the transportation networks encourage the citizens to move themselves into their neighborhoods' borders. People seem to respond to these actions by increasing their visits to many local places such as restaurants, bars, sports centres etc. Even though during the post-covid era, people decreased significantly their movements, it is vital to encourage the creation of friendly for walking transportation networks inside the neighborhoods of the cities, based on the concept of the 15-minute city model. Large cities are becoming bigger and bigger as they offer many job opportunities. However, the massive peoples' relocation in big cities has as a result the creation of huge transportation problems. Neighborhoods have been downgraded as they were not ready to offer several services in larger populations. The 15-minute city model is designed to ensure that each citizen has quick access (15 minutes on foot) to essential services of various types. Moreover, the implementation of the 15-minute city model demands the strengthening of transportation networks promoting sustainable solutions that can support the daily walking of the habitants. This paper focuses on a literature review of the implementation of the 15-minute city model in different big cities worldwide, starting from Paris where the model is indeed a well-suited concept and focuses to the need of a cultural change rather than urban planning. The research points out not only the fact that this model can help the neighborhoods to grow up socioeconomically but the fact that the citizens can cooperate with the local authorities and participate in the redesign of their neighborhood based on the 15-minute city model. © 2023 The Authors. Published by ELSEVIER B.V.

Experiences of delivering virtual therapy groups for children with osteogenesis imperfecta during the Covid-19 pandemic

OBJECTIVE: To explore the experiences of a virtual group therapy programme for children with Osteogenesis Imperfecta (OI) who were unable to access face to face therapy due to a global pandemic. In a regional OI service up to 3 face to face 6-week therapy groups are offered for children during summer school holidays. Throughout the Covid-19 pandemic, OI children were at risk of deconditioning due to government restrictions in school attendance, exercise and socialisation. An alternative means of delivering therapy was required. METHOD(S): 30 families with school age children were invited to attend a virtual therapy group. Following initial interest from 21 children, 14 (age range 4-14 years) participated in a 5 week therapy group. Children were split into 3 age groups (4-7/8-12/13-14). Weekly 75 minute sessions comprised functional gross and fine motor activities. Educational elements with opportunities to explore thoughts and feelings were included. Each group were set a challenge to compete a virtual race from Bristol to Lands' End, recording their distance (walking, wheeling, cycling) throughout the week. Feedback was collected from participants and parents. RESULT(S): Feedback was received from 12/14 of attendees and parents and 4/7 who did not attend. Reasons for non-attendance included anxiety around video calls, other commitments and injuries. Of those that attended 100% (n=12) enjoyed the group and reported increased activity levels. Scavenger Hunt was cited as the favourite activity. 16.6% (n=2) children reported discussion on personal feelings uncomfortable. 16.6% (n=2) reported exercises were hard. 100% (n=9) of parents reported no significant difficulties with IT. Parent reported benefits included positive social interaction with other children with OI (66%, n=6), improving routine in preparation for school return (55%, n=5). Challenges for therapy team included identifying appropriate IT platform, choosing activities appropriate for various abilities and virtual instruction. Successes included time efficiency, full inclusion regardless of geographic location, increased activity levels of children with OI in preparation for school return. CONCLUSION(S): A safe, socially distanced method of delivering group therapy during a pandemic was achieved. Virtual therapy can be a useful adjunct, however this should not replace face to face therapy where possible.

RHEUMATOLOGISTS BEWARE OF LOW ALP: A CASE OF HYPOPHOSPHATASIA MISDIAGNOSED AS FIBROMYALGIA, CAUSING LONG DIAGNOSTIC DELAY

BackgroundHypophosphatasia(HPP), a rare, inherited metabolic disease featuring low serum alkaline phosphatase (ALP) activity due to ALPL (encoding tissue non-specific alkaline phosphatase) gene mutation[1,2]. A wide-ranging clinical spectrum is often seen due to defective mineralisation affecting teeth, bones, joints and muscles[1]. This disease has a prevalence of 1/6370 in Europe and is often misdiagnosed and underdiagnosed with a diagnostic delay of more than ten years[1] The treatment is often supportive for milder cases and enzyme replacement therapy in severe cases.ObjectivesTo share this case to raise awareness among Rheumatologists.MethodsThis 58-year-old Caucasian female had her first HPP symptom as early eruption of deciduous teeth, along with recurrent dental infections and gum problems. She was diagnosed with flat feet at age five, had a big toe fracture at sixteen, followed by a metatarsal fracture. She experienced leg muscle cramps and aches, affecting her performance in sport during school life.At the age of thirty she began noticing weakness in arms and legs, which progressed over the years. She faced significant early morning stiffness along with painful ribs, hips, knees, shoulders, and small joints of feet when walking.She was diagnosed with Fibromyalgia at the age of forty-four. The following ten years she met numerous specialists including rheumatologist, pain specialist and physiotherapists. She was also diagnosed with early osteoarthritis, pernicious anaemia, hyperlipidemia, functional neurological syndrome, and central sensitization syndrome. She had multiple trials of steroids and opioids, all of which were stopped either due to side effects or inefficiency.A major flare of symptoms five years ago rendered her bedbound for three months, following which a chemical pathologist noticed a persistent low ALP levels and decided to investigate for HPP. It took another four years to complete these investigations due to the coronavirus pandemic.Currently, she is unable to weight bear or climb stairs and must stay indoors or in bed during flareup. She moved into a ground floor flat at the age of 54 and use a walking stick occasionally. By 58, she is unable to work and had given up her own business due to pain, weakness, and disability.ResultsOn clinical assessment, her height is 160 cm, faced difficulty getting up from chair, has an antalgic waddling gait, with a 6-minute walking distance of 60 metre, stopped after three minutes, and had a Brief Pain Inventory pain severity score of 7/10. Her ALP level is 24 U/L and PLP/PA ratio is 18.8 (ref < 5), and genetic testing showed heterozygous missense variant of ALPL gene mutation.ConclusionIt took more than forty years to reach a conclusive diagnosis of childhood onset HPP. Low ALP level is a signature of HPP and warrants investigations. Diagnosis can be challenging due to the rareness and variable presentation, however recognition of HPP features is crucial for timely referral, optimal disease management and potential improvement in quality of life.References[1]Högler W, Langman C, Gomes da Silva H, Fang S, Linglart A, Ozono K, Petryk A, Rockman-Greenberg C, Seefried L, Kishnani PS. Diagnostic delay is common among patients with hypophosphatasia: initial findings from a longitudinal, prospective, global registry. BMC Musculoskelet Disord. 2019 Feb 14;20(1):80. doi:10.1186/s12891-019- 2420-8. PMID: 30764793;PMCID: PMC6376686.[2]Injean P, Lee S, Downey C. Hypophosphatasia May Be Misdiagnosed as Fibromyalgia: A Single Center Experience []. Arthritis Rheumatol. 2020;72 (suppl 10). https://acrs.org//hypophosphatasia-may-be-misdiagnosed-as- ibromyalgia-a-single-center-experience/. Accessed January 14, 2023.[3]Lefever E, Witters P, Gielen E, Vanclooster A, Meersseman W, Morava E, Cassiman D, Laurent MR. Hypophosphatasia in Adults: Clinical Spectrum and Its Association With Genetics and Metabolic Substrates. J Clin Densitom. 2020 Jul-Sep;23(3):340- 48. doi: 10.1016/j.jocd.2018.12.006. Epub 2018 Dec 21. PMID: 30655187.Acknowledgements:N L.Disclosure of InterestsNone Declared.

Effects of training and protein/carbohydrate supplementation by food on strength, body composition and bone metabolism in postmenopausal women

Background: Menopause is associated with impairments of health, e.g. cardiovascular disease, changes in body composition, decrease in bone density. Physical activity and nutrition strategies have been demonstrated to counteract some of these disabilities. Aim of the present study was to analyze the impact of 3 months of strength and endurance training combined with protein/carbohydrate supplementation on strength, body composition and bone metabolism in postmenopausal women. Method(s): 62 postmenopausal women were recruited. Measurements: Body composition by BIA. Strength of leg, chest and handgrip. delta44Ca/42Ca in blood and urine as proxies for bone metabolism, samples were analyzed by mass spectrometry. Participants completed 2/week endurance training (walking) for 60 minutes (60-75% km/h of 4mmol threshold) and a whole-body strength training 1/week for 60 minutes (online). In addition, the intervention group (IG) received 100g of sour milk cheese and 76g of white bread (35.3 g carbohydrate, 36.1 g protein, 3.5 g fat, 321 kcal) after each training. Result(s): Training results in an anabolic effect on bone metabolism, here protein/carbohydrate supplementation does not show additive effects. Training resulted in an increase of leg and hand grip strength. For hand grip strength an additive effect could be demonstrated after protein/carbohydrate supplementation. Both groups increased muscle mass and reduced fat mass, although the results were not significant. Discussion(s): Training was effective, showing an increase in strength. Additive effects of the nutritional intervention could be only observed for hand grip strength. This may be due to a weak compliance of the protein/carbohydrate supplementation by a meal while corona pandemic. Also, because of the endurance parts, the training was not specifically designed to increase strength. Nevertheless, even this mild training has a remarkably strong impact on bone metabolism. Conclusion(s): Even if the effects are faint, the data of this study provide evidence that protein/carbohydrate supplementation, also by food, supports the events of training on strength. Training has a strong impact on bone metabolism in postmenopausal women. The subjects respond very individually to training and nutrition interventions. Training consequentially is to be personalized.Copyright © 2023

The nomadic life of the district general hospital haematology registrar: Reviewing how far we travel

As a district general hospital (DGH) registrar, clinical duties are varied. The geographical location of these clinical duties can vary in different hospital settings. In our trust, the inpatient Haematology ward was reallocated to become the designated 'COVID ward' at the start of the pandemic, due to a lack of availability of side rooms in the hospital. Haematology inpatients are now managed on general medical wards, with no specific Haematology ward available. This has further increased the geographical spread of registrars' clinical duties. In order to quantify the impact of this geographical spread, we undertook an audit of physical activity over a four-week period. We included the physical activity during working hours recorded by the attending haematology registrar and an on call medical registrar for comparison. We collected data using smart devices on steps walked, distance travelled, time spent walking and calories burnt whilst walking. We collected data for all day shifts worked from 09:00-17: 00 for all days of the week. Overall, the attending haematology registrar walked an average of 10 241 steps a day, covering 7.87 km over a period of 107 min and burning 410 calories whilst active. The medical registrar walked an average of 7498 steps a day, covering 5.76 km over a period of 79 min and burning 300 calories whilst active. By comparison the attending haematology registrar covered 37% more steps per day than the medical registrar, a statistically significant difference (p-value 0.002, students unpaired t-test). During a 7.5 h working day (taking into account a contractual 30-min unpaid lunch break), our DGH haematology registrars spend 107 min walking, which is 24% of their working hours. Our results highlight the time pressures on DGH haematology registrars. Time pressures on registrars in London have become more important as a result of Health Education England's (HEE) medical specialty redistribution programme, which will see the number of specialty trainees in London reduced by 46% over 5 years. Addressing the geographical spread of clinical duties could help to reduce the time pressures on registrars allowing them to spend more time on providing a clinical service. We have presented our data to trust management as evidence to lobby for the creation of a new haematology ward, which has now been included in the plans for a new hospital at our trust.

Managing Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting

BACKGROUND: One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations. CASE REPORT: A nulliparous 29-year-old woman in her 21st week of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination. CONCLUSION(S): Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.Copyright © 2023 Muhammad Habiburrahman, Triya Damayanti, Mohammad Adya Firmansha Dilmy, Hariyono Winarto.

Barriers and facilitators affecting physical activity among adults in Saudi Arabia during COVID-19 quarantine.

The quarantine period in Saudi Arabia from May to June 2020 due to the coronavirus disease (COVID-19) pandemic prevented many people from engaging in physical activity (PA), which may have had negative effects on their health. Therefore, it is important to understand the factors, barriers, and facilitators affecting PA of people during quarantine. This cross-sectional study was conducted using an electronic survey that was distributed to adults between 18 and 69 years old. The survey included demographic-related questions and the International Physical Activity Questionnaire-Short Form. The survey was completed by 1859 participants ranging in age from 18 to 69 years old (42.5% male, 57.5% female). The major factors influencing exercise were being male (odds ratio [OR] = 1.26; 95% confidence interval [CI] 1.03-1.53), being single (OR = 1.37; 95% CI 1.12-1.67), completing higher education at a Master/Doctorate level (OR = 1.83; 95% CI 1.23-2.72), and being resilient (OR = 1.05; 95% CI 1.03-1.08). The facilitators for doing regular exercise were having enough space at home (OR = 1.62), free time (OR = 1.77), good motivation (OR = 1.56), and being free from work (OR = 1.43) and family responsibilities (OR = 1.40). Sex, marital status, level of education and resilience were important factors affecting the type and level of PA during the quarantine period resulting from the COVID-19 pandemic.

Saudi Arabia, like many countries, implemented social distancing, quarantining, travel restrictions and closing recreation facilities to prevent the spread of coronavirus disease (COVID-19). As a result, many people were prevented from engaging in physical activity (PA), which may have had negative effects on their health. This study aims to understand the barriers and facilitators affecting PA of people during quarantine due to COVID-19. We distributed an electronic survey to adults aged between 18 and 69 years old. The survey included demographic-related questions and the 'International Physical Activity Questionnaire-Short Form' to measure their PA levels. There were 1859 survey respondents, of which 42.5% were male and 57.5% were female. The results showed that being a male, being single, completing higher education at a Master/Doctorate level and being resilient were the major factors influencing exercise. In addition, having enough space at home, free time, good motivation and being free from work and family responsibilities were the facilitators for doing exercise regularly.

The social and emotional wellbeing needs of Aboriginal staff in out of home care: Walking in two worlds.

BACKGROUND: There is a disproportionate representation of Aboriginal children in the Australian Out of Home Care system. An important strategy to ensure Aboriginal children experience trauma informed care that is culturally situated is to have access to Aboriginal practitioners. The experiences of Aboriginal practitioners working in Aboriginal Out of Home Care have not been explored thoroughly. PARTICIPANTS AND SETTING: This community led research was undertaken on Dharawal Country on the South Coast of the Illawarra region, Australia with an Out of Home Care program managed by an Aboriginal Community Controlled Organisation. The study included Aboriginal (n = 50) and non-Aboriginal (n = 3) participants connected through employment or community membership to the organisation. OBJECTIVE: We aimed to explore the wellbeing needs of Aboriginal practitioners working with Aboriginal children in Aboriginal Out of Home Care. METHODS: This co-designed qualitative research project used yarning sessions (individual and group), co-analysis with co-researchers, document analysis and reflexive writing. FINDINGS: Aboriginal practitioners are required to bring their cultural expertise to their work and with this, there is an expectation of cultural leadership and the fulfilling of cultural responsibilities. These elements bring with them emotional labour that must be acknowledged and accounted for in working in the Out of Home Care sector. CONCLUSION: The findings point to the importance of establishing an organisational social and emotional wellbeing framework in recognition of Aboriginal practitioner's specific needs, centring cultural participation as a key wellbeing and trauma informed strategy.

Making Chile More Pedestrian-Friendly for Older Persons: Expert Perspectives.

Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.

Navigating COVID-19 linguistic landscapes in Vancouver's North Shore: official signs, grassroots literacy artefacts, monolingualism, and discursive convergence

This article describes the changing linguistic landscape on the North Shore of Vancouver, British Columbia, Canada, during the first three months of the COVID-19 pandemic. I present an account of the visual representation of change along the area's parks and trails, which remained open for socially-distanced exercise during the province's lockdown. Following the principles of visual, walking ethnography, I walked through numerous locations, observing and recording the visual representations of the province's policies and discourses of lockdown and social distancing. Examples of change were most evident in the rapid addition to social space of top-down signs, characterised mainly by multimodality and monolingualism, strategically placed in ways that encouraged local people to abide by social-distancing. However, through this process of observation and exploration, I noticed grassroots semiotic artefacts such as illustrated stones with images and messages that complemented the official signs of the provincial government. As was the case with the official signs and messages, through a process of discursive convergence, these grassroots artefacts performed a role of conveying messages and discourses of social distancing, public pedagogy, and community care.

Childhoodnature: Applying a Sympoietic Approach to Child-Outdoor-Nature Encounters

Childhoodnature encounters can flourish in the Anthropocene. Assembled theories supporting childhoodnature can produce sparks when knocked together. The chemical composition of all living things is composed of the shared building blocks of all life: carbon, hydrogen, nitrogen, oxygen, phosphorus, and sulphur. Indeed, even beyond our own planet, recent research has demonstrated that humans and our galaxy share 97% of the same atoms. Indeed, we are all merely matter circulating with and through bodies, places, and time. This entanglement of matter can be known as sympoiesis. Making together or making with, sympoiesis is a philosophical, ontological, and epistemological concept that rejects notions of human exceptionalism. Rather it supports an entangled and relational view;beings forever adapting, changing, and evolving in relation with one another. Boundaries are blurred between bodies, what is being human and what is being nonhuman is no longer clear. Applying a sympoietic approach to outdoor encounters this chapter explores the doing of childhoodnature and its relationship with outdoor environment education (OEE). Childhoodnature as a concept explicitly recognises children as ecologically congruent to all entities who are currently manifesting liveability on a dying planet. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Higher levels of physical activity is associated with better walking ability and fall-related fitness of older adults during COVID-19 in China

This study analyzed the relationship of physical activity levels with walking ability and fall-related fitness in older adults in the Henan Provence, China. Physical activity levels of 288 older adults were assessed using the short form of the International Physical Activity Questionnaire. The participants were divided into low (LPAG, n = 81), moderate (MPAG, n = 106), and high physical activity groups (HPAG, n = 101). The 10-m walking test (10MWT), 3-m backward walking (3MBW), and Berg Balance Scale (BBS) were used to evaluate walking ability. Thirty seconds Sit to Stand Test (30SST), Time up and Go Test (TUGT), and figure-of-8 walk test (8WT) were evaluated for fall-related fitness. One-way ANOVA was used to detect between group differences, whilst Pearson's correlation was used to evaluate the relationship between total physical activity level and the measured variables. Logistic regression analyses were used to compute the odds ratios (ORs) of LPAG and MPAG relative to HPAG. There were significant differences between the groups for walking ability, 10MWT (p < 0.01), 3MBW, and BBS (p < 0.01), and also for variables of fall-related fitness, TUGT (p < 0.01), and 8WT (p < 0.01). Total physical activity levels had significant correlations with all variables except 30SST. In the walking ability, OR for 10MWT was 2.42 and 2.53 times for the LPAG compared to that for HPAG by model 1 and model 2. OR for BBS was 3.24 and 3.54 times for the LPAG and 9.31 and 9.65 times for the MPAG compared to for the HPAG by model 1 and model 2. In the fall-related fitness, OR for 8WT was 14.09 and 16.76 times for the LPAG compared to that for HPAG. High levels of physical activity are positively correlated with good walking ability and fall-related fitness. Increasing physical activity levels can reduce the risks associated with impaired walking ability and fall-related fitness.Copyright ©2023 The Author(s). Published by MRE Press.

Ndegree39 - Fulminant life-threatening myopathy of the genetic origin

Objectives: Acute myopathy are seen in critically ill patients, in severe SARS-CoV2 pneumonia requiring mechanical ventilation, and other infection illness, toxin and drug-induced complications, or systemic inflammation. Periodic paralysis or carnitine disorders are known genetic causes of acute muscular weakness, besides genetically determined muscle diseases rarely have an acute clinical course. Content: Case presentation: 61-years old, healthy woman, after a one-time vaccination against Covid-19 about 2 weeks earlier, was admitted to the Neurological Department due to symptoms lasting for 2 days. On the first day of the disease she complained of vertigo and double vision, on the following day dysarthia and dysphagia appeared, she stopped walking. On the second day of hospitalization, the patient required mechanical ventilation. The initial diagnosis of Guillaine-Barre syndrome was not confirmed in the electrophysiological and laboratory (CSF) studies. Myopathic pattern with polyphasic potentials of short duration and low amplitude was observed in EMG, without spontaneous activity. In the electron microscope numerous fat drops between bundles of myofibrils in most muscle fibers were seen. She received intravenous immunoglobulins, and steroid therapy, together with high doses of vitamin B2 with very good motor improvement. Multiple acyl-CoA dehydrogenase deficiency (MADD) was suspected, and the Whole Exome Sequencing (WES) was performed. Conclusion(s): The authors note the possibility of acute, life-threatening myopathy, which may be caused by a genetic defect. MADD is a very rare genetic entity which can manifest for the first time very suddenly, especially in the presence of triggers, including but not limited to after vaccinations. Keywords: Acute myopathy;Multiple acyl-CoA dehydrogenase deficiency;Vitamin B2.Copyright © 2023

A Case Report of an Atypical Neurological Presentation of COVID-19 in Pregnancy

Symptomatic patients with coronavirus disease 2019 (COVID-19) mostly have flu-like symptoms. However, neurologic manifestations are common and may be the early findings of COVID-19. Data for COVID-19 do not indicate an increased risk of infection in pregnant individuals, but the risk of disease severity and mortality is high in this patient population. We report a case of a pregnant woman in the 10th gestational week, who presented with neurological symptoms of sudden impairment in walking, balance, speech, and consciousness, started the night before, and a seven-day history of fever, chills, myalgia, and general weakness before admission. The polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was positive for the cerebrospinal fluid sample a day before the positive nasopharyngeal sample. Axial brain magnetic resonance imaging revealed the involvement of the spinothalamic tract. Following treatment with intravenous immunoglobulin, the patient's neurological condition gradually recovered, except for lower limb muscle strength, and she was discharged from the hospital on the 10th day of admission. This case is unique as it emphasizes the importance of considering COVID-19 when uncommon neurologic manifestations with negative nasopharyngeal PCR are present.Copyright © 2023, Author(s).

Evaluation of the Perceived Pedestrian Level of Service in the post COVID-19 era: The case of Thessaloniki, Greece

The promotion of active transportation modes in urban areas is a key challenge towards the minimization of motor traffic externalities. After the COVID-19 outbreak, cities around the world started investing heavily in infrastructure for pedestrians and cyclists towards the enhancement of social distancing. However, infrastructure adequacy in the post COVID-19 era needs to be evaluated. Level of Service (LOS) as it is proposed by the Highway Capacity Manual (HCM) is the most common methodological tool to assess pedestrian facilities. Nonetheless, pedestrians' perceptions are more than needed especially in the post COVID-19 era. In this paper an online survey is conducted for the assessment of the main pedestrian facilities in the city of Thessaloniki, Greece. Respondents' sociodemographic characteristics, their social distancing perception as well as their travel habits after the COVID-19 outbreak are concerned. The main research goal is to reveal the most significant factors that affect pedestrians' perceived level of service (PLOS) using regression modeling. The results can shed light on respondents' perceptions about PLOS in the post COVID-19 era. Last, results can assist in policy making for the promotion of active transport modes in urban areas with respect to the current health recommendations for public spaces. © 2023 The Authors. Published by ELSEVIER B.V.

Assessing perceptions of pedestrian-focused intervention in a car-dependent European island

Apart from the numerous social, economic, and environmental impacts of car dependence, the time people spend sitting in motorised vehicles has been identified as a sedentary behaviour that can negatively impact people's physical and psychological health. The climate breakdown and the COVID-19 pandemic have continued to expose the fragility and vulnerability of the urban environment and the imminent need for response, management, and radical re-thinking through innovation, especially within the transport sector. The incidence of the COVID-19 pandemic has also reiterated the need for urban centres to re-establish a sense of community, extend the benefits reaped from reduced motorised transport usage and boost small/medium-size businesses through the provision of active travel spaces. This paper investigates the role of pedestrian-focused intervention to encourage walking rather than car use for short-distance trips, within the context of the car-dependent small island state of Malta. The research includes the use of semi-structured interviews with a broad range of stakeholders to develop a virtual platform for citizen participation. The platform is an interactive space for participants to identify barriers that discourage walking and explore and evaluate options that encourage walking as a mode of transport. A discussion of preliminary findings sheds light on the impact of pedestrian interventions that encourage active travel and contribute policy-relevant outcomes based on the perceptions and direct feedback from citizens and stakeholders alike. © 2023 The Authors. Published by ELSEVIER B.V.