Differences in traumatic stress among youth with and without chronic medical conditions during the COVID-19 pandemic

Objective: The COVID-19 pandemic is the deadliest pandemic in American history. This study aims to assess the differences in youth reported traumatic stress among those with and without chronic illness, and how those reports are impacted by parental level of concern regarding the COVID-19 pandemic. Methods: Using convenience sampling, parents and their children completed a series of questionnaires focused on demographic information including questions about medical conditions, parental level of concern about COVID-19, and youth-report of posttraumatic stress symptoms. Results: Results of the anonymous survey (n = 164) found that parental reported level of concern of COVID-19 significantly predicted youth report of posttraumatic stress symptoms (F(4, 159) = 2.607, p = .038). There was no significant difference in youth-report of posttraumatic stress symptoms between youth with and without chronic medical conditions (F(1, 162) = .438, p = .509). Conclusions: Children often look to their parents for guidance during stressful life events, as confirmed by our findings. Parental emotional and behavioral responses may influence how youth make sense of highly stressful events and should be considered when determining intervention strategies in the COVID-19 era. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement This study found that youth with and without chronic health conditions did not differ in their report of posttraumatic stress 6 months after the onset of the COVID-19 pandemic. However, youth report of traumatic stress symptoms was predicted by their parents' level of concern regarding the impact of COVID-19 on their families, suggesting the need for targeted parent-based intervention. Clinical interventions to prevent chronic posttraumatic stress responses in youth regardless of medical comorbidity are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Perceptions of food among adult African Americans in the primary care setting

Introduction: The medical population lacks satisfactory information concerning the views regarding food perception among both male and female adult African Americans with consideration of chronic diseases, highest education level and marital status. The idea has not been fully exploited in research which has provoked the study. This study examines the views of food perception in relation to the health care and wellbeing of individuals. It offers satisfactory data that would in turn bring about the easy understanding of different perceptions concerning food choices, evaluating whether level of education and chronic disease play any role in decision making. It aims to make recommendations of the need for deploying healthier diet practices for better health outcomes. Methodology: The research is a mixed qualitative and quantitative study using both recorded interviews and a demographic questionnaire for data collection. Due to COVID-19 restrictions, the demographic questionnaire was transcribed by the investigator according to the volunteer participant's verbalized answers, who were conveniently selected on their scheduled clinic visit day. The participant read and signed the form after hands sanitized containing 70% ethyl alcohol gel. The second part of the study was a telephonic interview, which was recorded, and information transcribed onto an excel worksheet in preparation for analysis. Data was collected and tabulated in an excel worksheet and then uploaded to Statistical Packages and Software Services (SPSS) an IBM application that aided in simplifying data presentation in the form of graphs which made it easier to draw conclusions. Results: There were 65 participants with 48 females and seventeen 17 males, and 56.9% with a college education in the study of which 84.6% were responsible for buying and preparing food. From the research analysis of the collected data, it was discovered that 43.1% of participants admitted to not eating healthy, 23.1% being influenced by maintaining health, 21.5% to being influenced by taste, and 15.4% eating as their medical condition recommends. Conclusion: To promote healthier food choices we need to embrace useful education and motivation strategies to encourage healthy food perception and hence healthy eating. To minimize the risks that may emerge from unhealthy food perceptions, the recommendation is crucial for meaningful collaboration with African Americans to prioritize and implement improved dietary habits and reduce diet-related chronic diseases. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Physical effects of Covid-19 in patients with diabetes 1 year after hospitalisation in the UK: PHOSP-Covid study

Aim: To investigate the impact of Covid-19 on daily activity, maximal physical performance, and clinical frailty of people living with diabetes (any type) 1-year post-hospitalisation for Covid-19 in the UK. Method(s): This study is part of PHOSP-Covid, a multicentre long-term cohort study that recruited adults (>=18 years) who were discharged from one of the 83 NHS hospitals across the four UK nations following a clinical diagnosis of Covid-19 before March 31, 2021. We compared The Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue, Incremental shuttle walk test (ISWT) distance (m), and clinical frailty (Rockwood frailty level), 5-month and 1-year after discharge in patients with and without diabetes. Result(s): Out of 2545 individuals (538 (21%) with diabetes), the proportion of individuals who classified as either 'mildly frail' or 'moderately or higher frail severity' was higher in individuals with diabetes (month 5: diabetes 9.9%, no diabetes 4.7%;month 12: diabetes 8%, no diabetes 4.9%). ISWT distance in patients with diabetes were significantly lower at both follow-ups but this measure improved from 5-months to 1-year (290 [95% CI: 190-440] vs 370 [250-560] for diabetes and 340 [210-450] vs 420 [270-590] for those without, both p < 0.01). At both time points, people with diabetes reported higher levels of fatigue (36 [24-44] vs 39 [25-46] at 5-month (p = 0.03);37 [26-45] vs 40 [28-47] at 1-year visit (p < 0.01)). Conclusion(s): One year after hospitalisation long Covid is more observed in people with diabetes.

Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis.

BACKGROUND: The purpose of thispaper is to explore the experiences of parents and carers of children with chronic health conditions in accessing healthcare during the Covid-19 pandemic. Children with chronic conditions typically rely on both planned and unplanned care, and contact with healthcare professionals over extensive periods of time. Their distinct care needs render these children vulnerable to even to minor changes in healthcare provision. The wide-ranging care disruptions during the pandemic were therefore likely drastically to affect their health and wellbeing; an assessment of the effects of Covid-19 policies on healthcare access and quality of care delivered for this group is needed. METHODS: From 25/01/2022 to 25/05/2022, four focus groups were held with parents/carers of children with diabetes, neurodivergence, mental health conditions, and medical complexities to explore their experiences in navigating the healthcare system during the pandemic. Interviews were transcribed and then subjected to thematic analysis using NVivo qualitative research software. RESULTS: Our results indicate that children with chronic health conditions (and their parents/carers) experienced difficulties accessing healthcare during the pandemic. Problems with late diagnosis, prolonged waiting times, and deficiencies with telemedicine were identified, as were impacts of healthcare disruptions on children's wellbeing, and the wellbeing of wider families. We found that children with neurodivergence and those with mental health conditions were particularly affected with their health needs repeatedly de-prioritised. Furthermore, the loss of contact with multi-specialty clinical teams profoundly affected parents and carers, leaving them feeling isolated in managing their children's health. These diminished relationships became another vector for uncertainty in supporting children's health. CONCLUSION: The effects of healthcare disruptions on the welfare of children with chronic conditions (and their families), are well evidenced in this work, providing deeper understandings of the relationships between these children, their families and clinicians. The evidence in this paper aims to inform future policy and ethical guidelines so that the needs of children with long-term health conditions can be properly considered in times of crisis.

Reflecting on health and illness through the lens of the HIV epidemic in Uganda

This chapter focuses on how the knowledge and experience of living through the HIV epidemic shape older people's responses (and fears) about chronic illness and health emergencies such as the COVID-19 pandemic. Using the example of Uganda, we examine the ways in which the particular time people first heard about HIV, or encountered it in their lives as a result of their own HIV diagnosis or a diagnosis within their family or wider community, affects their understanding and perception of ill health and the concerns about the risks HIV continues to pose. We describe how the response to information about an asymptomatic chronic condition (at an early stage of potential disease), or a new illness like COVID-19, may be shaped by the experience of living with HIV or taking care of someone with HIV-related illness in the past. Such experiences shape older people's understanding of symptoms and expectations of the timeline for the illness development. © Springer Nature Switzerland AG 2022. All rights reserved.

Association between Covid-19 and Fatigue in Patients with Immune-Mediated Rheumatic Diseases in an Outpatient Service

Objectives: Patients with immune-mediated rheumatic diseases (IMRD) constitute an important subgroup of immunosuppressed patients at risk of developing severe infections. Since coronavirus 19 infection (COVID-19) is an international public health emergency, it is necessary to observe the relationship between this viral infection and the development or intensification of the clinical course of IMRD and the persistence of new associated symptoms. The aim of this study is to trace this population's epidemiological profile and evaluate the frequency of chronic fatigue syndrome in patients with IMRD and COVID-19 compared to uninfected patients. Method(s): This is a descriptive cross-sectional observational study with a comparison group. The sociodemographic, clinical, and FACIT-F Fatigue Scale data were from patients with IMRD of Project Reumacov, organized by the Brazilian Society of Rheumatology, locally inManaus/Amazonas. The statistical analysis was performed through the inferential method to demonstrate the prevalence. Result(s): 268 patients were evaluated, those who had contact with COVID-19 had fatigue according with the fatigue assessment scale compared to unexposed patients. There was a statistically significant correlation between fatigue post-COVID-19 infection in the patients studied. Conclusion(s): Clinically relevant fatigue was a prevalent and commonly reported symptom in the post-COVID-19 period in the evaluated population. These data should direct attention to the reported manifestations as they affect the functioning of individuals' socioeconomic and health well-being throughout the pandemic period and beyond.

Peripartum mental health and the role of the pharmacist: A scoping review.

BACKGROUND: The global prevalence of peripartum mental illness is 20%, though estimates have increased since the start of the COVID-19 pandemic. Chronic illnesses affect one in five pregnancies and may be associated with higher rates of peripartum mental illness. Though pharmacists are well-positioned to facilitate appropriate and timely care of co-occurring mental and physical health conditions during this period, little is understood regarding their potential roles. OBJECTIVES: To understand the current evidence examining the role of pharmacists to improve the outcomes of women with peripartum mental illness, with and without chronic illness. METHODS: A scoping review was performed with assistance from an interdisciplinary team following the Joanna Briggs Institute framework. MEDLINE, Embase, PsychNet and International Pharmaceutical Abstracts databases were searched. English-language articles (published up to May 30, 2022) were screened and assessed for eligibility, and data were charted to collate results, by dual independent reviewers. RESULTS: The search strategy produced 922 articles. After screening, 12 articles were included (5 narrative reviews, 7 primary research). There was limited discussion or empirical data regarding specific interventions (screening, counseling), opportunities (accessibility, managing stigma, forming trusting relationships and building rapport with patients) or barriers (lack of privacy, time constraints, adequate remuneration, training) associated with an expanded role of pharmacists in peripartum mental health care. The clinical complexity arising from co-occurring mental health and chronic illnesses was not explored, other than a small pilot study involving pharmacists screening for depression among pregnant women with diabetes. CONCLUSIONS: This review highlights the limited evidence available on the explicit role of pharmacists in supporting women with peripartum mental illness, including those with comorbidity. More research, including pharmacists as study participants, is required to fully understand the potential roles, barriers, and facilitators of integrating pharmacists into peripartum mental healthcare to improve the outcomes of women in the peripartum period.

Financial resilience of two-worker households from a health perspective

The COVID-19 pandemic highlighted the significant impact of health conditions on household finance. Traditional measures of financial resilience ignored households' ability to adjust to labor income disruptions. We proposed a more comprehensive two-tier measure of financial resilience by accounting for nonlabor income and spending adjustments in the face of income loss associated with health situations. Using this measure, we evaluated the financial resilience of two-worker households with members having COVID-19 health risk conditions and other mental and physical chronic diseases. Our findings showed that households with cancer patients were more financially resilient yet those having obese members were less financially resilient. Decomposition of the financial resilience measure revealed differences in financial resources allocation-households with cancer patients allocated more wealth to noncash financial assets, whereas households with obese members saved less and spent more. Our findings shed light on financial planning practices and public policies of emergency assistance. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Impact of medical disorders

Physicians have observed the connection between many medical disorders and sleep for centuries. Our current understanding of the interplay between sleep and sickness has advanced as we have grown in our knowledge of sleep physiology. There is often a bidirectional relationship between the two. It is commonly understood that illness may cause poor sleep. Still, it is becoming more apparent that poor sleep can negatively affect various physiologic processes in other organ systems. As we work to improve our patient's overall health, an understanding of this interplay will be vitally important for clinicians and researchers alike. © 2023 Elsevier Inc. All rights reserved

The Role of Communications in the Resilience of Risk Group in Kuching, Sarawak, During The Dispersal of COVID-19 Virus

The Covid-19 Pandemic has significantly interfered with all aspects of human life. Notably, this dangerous epidemic has a more significant impact on the risk group. It has caused them to feel stress, fear, and suffering from the ripple effect of Covid-19. Hence, this disruption occurred instantaneously, requiring people to demonstrate noteworthy adaptability and resiliency through communication. Therefore, this study examined the two dimensions of communication, namely self-centred communication (knowledge and optimistic thinking) and external communication (family support and media exposure), in predicting the resilience among the risk group in Kuching, Sarawak. The data collection was during the movement control order, so the distribution of the online questionnaire used voluntary response sampling to the target respondents through WhatsApp and social media accounts. Data collected was analysed using Partial Least Squares analyses. The results show that knowledge, optimistic thinking, and family support significantly correlate with the resilience of the risk group. Moreover, the self-centred communication constructs were the best predictor for resilience. However, media exposure was insignificant because they were in survival mode when it threatened the risk group's lives. So, this makes them prone to rely more on their knowledge, optimistic thinking, and their own family to help their resilience. Hence this has made them think the role of media is less important in resilience. This study has managed to contribute some useful suggestions for helping risk groups protect themselves during a pandemic. Critically, these findings can update relevant authorities in designing effective interventions to support risk groups by strengthening communication factors associated with resilience. © 2023, Penerbit Universiti Kebangsaan Malaysia. All rights reserved.

COVID-19 and the reimaging of compassionate release.

PURPOSE: The purpose of this paper is to provide a historical overview of compassionate release policies in the USA and describe how these policies have been used during the COVID-19 pandemic. The authors then describe how these programs have been shaped by COVID-19 and could be reimagined to address the structural conditions that make prisons potentially life limiting for older adults and those with chronic illness. DESIGN/METHODOLOGY/APPROACH: This paper is primarily descriptive, offering an overview of the history of compassionate release policies before and during the COVID-19 pandemic. The authors augmented this description by surveying state Departments of Corrections about their utilization of compassionate release during 2019 and 2020. The findings from this survey were combined with data collected via Freedom of Information Act Requests sent to state Departments of Corrections about the same topic. FINDINGS: The findings demonstrate that while the US federal prison system saw a multifold increase in the number of individuals released under compassionate release policies in 2020 compared to 2019, most US states had modest change, with many states maintaining the same number, or even fewer, releases in 2020 compared with 2019. ORIGINALITY/VALUE: This paper provides both new data and new insight into compassionate release utilization during the COVID-19 pandemic and offers new possibilities for how compassionate release might be considered in the future.

Impact of the COVID-19 pandemic on people with epilepsy: findings from the US arm of the COV-E study.

OBJECTIVES: As part of the COVID-19 and Epilepsy (COV-E) global study, we aimed to understand the impact of COVID-19 on the medical care and well-being of people with epilepsy (PWE) in the United States, based on their perspectives and those of their caregivers. METHODS: Separate surveys designed for PWE and their caregivers were circulated from April 2020 to July 2021; modifications in March 2021 included a question about COVID-19 vaccination status. RESULTS: We received 788 responses, 71% from PWE (n = 559) and 29% (n=229) from caregivers of persons with epilepsy. A third (n = 308) of respondents reported a change in their health or in the health of the person they care for. Twenty-seven percent (n = 210) reported issues related to worsening mental health. Of respondents taking ASMs (n = 769), 10% (n= 78) reported difficulty taking medications on time, mostly due to stress causing forgetfulness. Less than half of respondents received counseling on mental health and stress. Less than half of the PWE reported having discussions with their healthcare providers about sleep, ASMs and potential side effects, while a larger proportion of caregivers (81%) reported having had discussions with their healthcare providers on the same topics. More PWE and caregivers reported that COVID-19 related measures caused adverse impact on their health in the post-vaccine period than during the pre-vaccine period, citing mental health issues as the primary reason. SIGNIFICANCE: Our findings indicate that the impact of the COVID-19 pandemic in the US on PWE is multifaceted. Apart from the increased risk of poor COVID-19 outcomes, the pandemic has also had negative effects on mental health and self-management. Healthcare providers must be vigilant for increased emotional distress in PWE during the pandemic and consider the importance of effective counseling to diminish risks related to exacerbated treatment gaps.

Long covid and medical gaslighting: Dismissal, delayed diagnosis, and deferred treatment.

While we know a lot more about Long Covid today, patients who were infected with Covid-19 early on in the pandemic and developed Long Covid had to contend with medical professionals who lacked awareness of the potential for extended complications from Covid-19. Long Covid patients have responded by labeling their contentious interactions with medical professionals, organizations, and the broader medical system as "gaslighting." We argue that the charge of medical gaslighting can be understood as a form of ontological politics. Not only do patients demand that their version of reality be recognized, but they also blame the experts who hold gatekeeping power over their medical care for producing a distorted version of said reality. By analyzing results from an online survey of Long Covid patients active on social media in the United States (n â€‹= â€‹334), we find that experiences of contention and their reframing as "gaslighting" were common amongst our respondents. In short answer responses about their experience obtaining medical care for Long Covid, our respondents described encountering medical professionals who dismissed their experience, leading to lengthy diagnostic odysseys and lack of treatment options for Long Covid. Even though we are limited by characteristics of our sample, there is good reason to believe that these experiences and their contentious reframing as medical gaslighting are exacerbated by gender, class, and racial inequalities.

Relationship among grit, social support, optimism, illness-related distress and psychosocial outcomes in COVID-19 long haulers

The emergence of SARS-CoV-2 (i.e., COVID-19) led to the death of more than 6 million individuals globally. This viral infection manifests differently in individuals, with some experiencing mild symptoms and others experiencing severe symptoms that result in hospitalization or even death. Survivors of COVID-19 may recover in days, while others experience prolonged symptoms for weeks or months after initial illness manifestation (Navabi, 2020). These prolonged symptoms, termed "long-covid," can be continuous or relapsing and remitting and may be new or the same symptoms of acute COVID-19 (Raveendran et al., 2021). Research on chronic illness indicates that individuals with chronic health conditions experience higher rates of depression and anxiety, which are associated with reduced quality of life (QoL;Gerontoukou, 2015;National Institute of Mental Health, 2021;Obo et al., 2014). Long-covid patients also experience increased rates of depression and anxiety and decreased QoL (Frontera et al., 2021;Ismael et al., 2021;Ma et al., 2020;Mendez et al., 2021;Talman et al., 2021;Temperoni et al., 2021). However, resilience (i.e., successfully adapting to adversity;VandenBos, 2007), can protect against the harmful psychological effects of chronic illness (Manning et al., 2016). Specifically, grit, social support, and optimism are associated with better mental health outcomes in chronic illness populations (Ratajska et al., 2020;Sharkey et al., 2018;Zenger et al., 2010). Another important component of adjustment to chronic illness is cognitive appraisal of illness, which can facilitate or impede mental health outcomes in patients. Illness intrusiveness (II;i.e., disruption of lifestyles, activities, and interests) and illness uncertainty (IU;i.e., cognitive experience where illness outcomes are unpredictable and ambiguous) are both associated with poorer adjustment to chronic illness and poor mental health and QoL outcomes (Devins, 1994;Gromisch et al., 2019;Pai et al., 2006;Schiele et al., 2019;Szulczewski et al., 2017). However, research suggests that resilience variables can decrease II and IU (Carroll & Arthur, 2010;Neri et al., 2011;Sajjadi et al., 2015). The current study examined the resilience variables of grit, optimism, and social support and their effect on anxiety, depression, and QoL. Mediators of II and IU were assessed. A total of 217 long-covid patients recruited through snowball sampling were asked to complete questionnaires measuring the related constructs. It was hypothesized that resiliency would be negatively associated with poor mental health outcomes and positively associated with QoL. It was also hypothesized that II and IU would mediate these relationships. The data was analyzed using Model 4 of the PROCESS macro for SPSS by Andrew Hayes. Results indicated that social support and optimism were negatively associated with anxiety and depression and positively associated with QoL. Grit was negatively associated with anxiety and depression but did not influence QoL outcomes. IU and II were negatively associated with grit, social support, and optimism. There was partial support for IU mediating the relationships between grit and anxiety and depression, social support and anxiety and depression, and optimism and anxiety. IU did not mediate the relationship between optimism and depression. II did not mediate the relationships between grit and anxiety and depression, social support and anxiety and depression, and optimism and anxiety and depression. II and IU fully mediated the relationship between grit and QoL and social support and QoL. There was partial mediation for II and IU between optimism and QoL. These results were discussed in terms of effective interventions for reducing negative outcomes in long-covid patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Multidimensional Assessment of Dyspnea in Postcovid Patients Referred to Pulmonary Rehabilitation

MULTIDIMENSIONAL ASSESSMENT OF DYSPNEA IN POSTCOVID PATIENTS REFERRED TO PULMONARY REHABILITATION In patients who suffer sequels after severe acute respiratory syndrome caused by Coronavirus 2 (SARS-CoV2), dyspnea is the most prevalent respiratory symptom. We aimed to analyze a subgroup of patients under follow-up in the pulmonology rehabilitation units after hospitalization for moderate-severe SARS-CoV2 pneumonia. We prospectively studied 455 patients until November 2021. We analyzed: dyspnea by mMRC scale, grade of fatigue by FACIT-F (0 without fatigue-4 intense fatigue), spirometry and DLCO, 6-minute walk test (Osses'equations), isometric strength of dominant quadriceps (weakness threshold <70%), maximal sniff nasal inspiratory pressure test (weakness thresholds <70 cmH2O for men and <60 cmH2O for women), body composition and physical activity IPAQ-7. We grouped our sample according to the severity of the mMRC dyspnea (>= 2 vs < 2) and results were compared for the global sample and separately for men and women. Table 1 shows the baseline characteristics. 41.5% of women and 19.5% of men showed inspiratory muscle weakness. 52.7% of the patients reported dyspnea mMRC >= 2 and studied variables were significantly worse (Table 2). In the women group, only the 6-minute walk distance, the level of physical activity and the fatigue grade were significantly worse in patients with greater dyspnea (Table 2). Conclusion(s): In our sample, multifactorial moderate-intense dyspnea becomes a good marker of functional capacity, muscle function, grade of fatigue and physical activity in patients who have suffered from moderate-severe Covid-19 pneumonia.

Fatigue and functional capacity post COVID-19

Background: We explored if fatigue influenced the long-term functional capacity of patients post COVID-19. Method(s): People after COVID -19, grouped by treatment setting (home - H, hospital ward - HW or intensive care unit - ICU), were studied 12 months after discharge. Fatigue-Functional Chronic Illness Assessment Questionnaire Fatigue Subscale, FACIT-F and functional capacity-6min walk test, 6MWD and 1min sit-to-stand test, 1minSTS were assessed. Groups were compared with one-way ANOVA or Kruskal-Wallis H test. Spearman's rho and multiple regression analyses were performed between fatigue-functional tests. Result(s): 148 subjects (H, n=44;HW, n=60;ICU, n=44) participated. Fatigue was clinically relevant at 12 months although not significantly different among groups [H: 41(35-49);HW: 42(33-50);ICU;42(32-48) points;p=.979). Functional capacity was significantly higher in those treated at home (6MWD: H,626 114m, HW: 527 146m, ICU: 528 129m, p<.001;1minSTS: H,29 11reps, HW: 23 8reps, ICU: 24 8reps, p<.002). Fatigue was significantly correlated with functional tests within each group (FACIT-F-6MWD,.317<rho<=.550, p<.01;FACIT-F-1minSTS, .364<rho<=.485, p<.01). Each point of FACIT-F could change 6MWD by 5-6m and 1minSTS by. 3-.5reps, explaining between 12-33% of change in 6MWD and 17-22% of change in 1minSTS (Table 1). Conclusion(s): Fatigue seems to influence functional capacity of patients post COVID-19. Early management of this symptom seems important for their long-term management.

Prevalence of tuberculosis, COVID-19, chronic conditions and vulnerabilities among migrants and refugees: An electronic survey

Objective: to analyze the prevalence of tuberculosis, coronavirus, chronic conditions and vulnerabilities among migrants and refugees in Brazil. Method: this is a cross-sectional study of the electronic survey type conducted with international migrants during the COVID-19 pandemic. Descriptive statistics was applied for the analysis, with calculation of position and dispersion measures. Regarding the categorical variables, relative and absolute frequencies were estimated. Results: the study participants were 553 migrants and refugees, verifying 3.07%, 7.2% and 27.3% prevalence of tuberculosis, COVID-19 and chronic conditions, respectively. Among the vulnerabilities, 32% reported unemployment, 37.6% moved to Brazil as a result of the social situation in their countries and 33.6% were living as refugees or sheltered people. Conclusion: tuberculosis, chronic diseases and COVID-19 presented higher prevalence values in migrants and refugees than in the general population. As this is a population group that still has significant difficulty accessing health services and social protection systems, based on diverse evidence, the study will subsidize public policies, Nursing care and the incorporation of new routines in the service. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Feasibility, Safety and Efficacy of a Combined Supervised Physical Exercise and Nutritional Program in a Selected Population of Luminal Metastatic Breast Cancer Patients: Oncare01 Pilot Study

Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.

The Impact of COVID-19 on Systems of Care for Children and Youth With Special Health Care Needs

Introduction: This article describes the challenges and opportunities that the COVID-19 pandemic presented for providing and coordinating care for children and youth with special health care needs (CYSHCN) who rely on a diverse array of systems to promote their health, education, and well-being. Method(s): Peer-reviewed published literature and reports from the national government and nonprofit organizations that advocate for CYSHCN were examined, particularly concerning systems that impacted CYSHCN during COVID-19. Result(s): Pre-COVID-19, CYSHCN and their families faced challenges accessing and coordinating care across diverse systems. COVID-19 exacerbated these challenges because of disruptions in care and services that negatively impacted CYSHCN. COVID-19 also highlighted opportunities for positive change and care innovations. Discussion(s): Understanding the systems of care that CYSHCN rely on and the effects of COVID-19 on these systems can enhance access to and quality of care. Recommendations are made for practice, leadership, research, and policy.Copyright © 2022 National Association of Pediatric Nurse Practitioners

Affective scaffolding and chronic illness

Current attempts to understand unusually high rates of psychiatric illness in complex, chronic illnesses can be guilty of operating within an explanatory framework whereby there are two options. Either (a) that the psychiatric predicaments are secondary to the bodily condition, and (b) that they are primary. In this paper, I draw upon philosophical work on affect, contemporary empirical work, and qualitative first-person patient data to illustrate a much messier reality. I argue that affective experience is generally more complex in such conditions, and that a variety of pre- and post-morbid causal factors dynamically interact such that the resultant psychiatric predicaments do not permit to classification as strictly primary or secondary to the bodily condition. Affective scaffolding, in my view, provides an apt theoretical framework for capturing this nuance. (PsycInfo Database Record (c) 2022 APA, all rights reserved)