Economic Inequality during Covid-19 as a Pathway to Food Insecurity for People who are Disabled and Racialized as Non-White

Covid-19 heightened economic inequality across the U.S., especially for people who are disabled and non-white. These intersecting economic vulnerabilities open pathways to hunger. Using a survey from July 2020 (n = 2,043) in the Intermountain West, we find that economic inequality explained a substantial portion of food insecurity for people with disabilities. Racially stratified models show that people who were also non-white were more likely to be food insecure and receive differential protection from economic resources. Stronger social support will help mitigate food insecurity, yet such programs must grapple with the ways that ableism and racism intersect, especially during economic shock.Copyright © 2022 Taylor & Francis Group, LLC.

Mission Vaccine Suraksha - A Massive COVID 19 Vaccination Drive by Reliance Industries Limited

Introduction: Since the beginning of COVID 19 pandemic, more than 641 million cases and 6.63 million confirmed deaths were reported worldwide. A rapid development of COVID 19 Vaccine was the breakthrough in the prevention and control of COVID 19. India has commenced its vaccination drive from January 16, 2021 and has administered more than 219 crores vaccination to date it its people. On war foot, Reliance Industries Limited also launched its free vaccination coverage program - Mission Vaccine Suraksha for employees, family members, and community by collaborating with local authorities and governments. The organization also provided free vaccination to Kerala, Gujarat, Rajasthan, and Maharashtra besides various other national and regional organisations to speed up the vaccination drive. Methodology: A taskforce including stakeholders form the Medical Services, HR, Procurement, Logistics, transportation, digital systems was formed to oversee, implement, monitor, and evaluate a successful vaccine roll-out drive. The drive included Covishield and Covaxin COVID 19 vaccines. As a single point of contact, Reliance Foundation HN Hospital procured, stored, and transported vaccines to all locations. At par with Govt. protocols, Reliance developed its own workplace COVID vaccination centres (CVCs) at its corporate headquarters and 11 other manufacturing sites in Maharashtra and Gujrat. For Cold chain management, Reliance procured Ice Lined Refrigerators (ILRs), refrigerators, vaccine carriers, icepacks, etc. for each CVC. Dedicated medical and paramedical staffs were recruited and trained to carry out vaccination drive with all the COVID 19 protocols in place. Reliance tied up with multiple hospitals to carry out pan-India vaccination drive. The entire operation was digitally enabled by involving mediums such as Reliance's in-house app JioHealthHub (JHH) that included end-to-end vaccination journey, i.e., from slot booking, CoWIN registration, post-vaccination care, uploading of the certificates, etc. Vaccine inventory was monitored by Reliance's digital system named KiviHealth. A vaccination dashboard was created to track real time vaccination update. Result(s): 40 lakh vaccine doses were provided free of cost to support the nationwide vaccination programme. Till date, 31,63,870 beneficiaries were covered under R-Suraksha under which, 15,94,357 people received their 1st dosage, 13,36,613 received the 2nd dose, and 2,32,900 people have received the precautionary dose. Reliance also commenced vaccination for children aged 12 to 17 years covering 7369 children for 1st dose, 5802 children for 2nd dose. Reliance has achieved 100% compliance for 2 doses of COVID 19 vaccination for its employees and contract workers across manufacturing units. Precautionary dose was administered to 75% of employees and contract workers to date. 25 mild and 3 moderate Adverse Event Following Immunization (AEFI) cases were recorded during vaccination at workplace CVCs, which were managed and sent home. Conclusion(s): Reliance's Mission Vaccine Suraksha has reached to all corners of the country, including people with disabilities, the elderly, homeless, and those in far-flung locations. Reliance faced hurdles in procuring and storing of the vaccines at the beginning of the operation. However, this was tackled effectively with strategic approach. The initiative is still ongoing ensuring maximum precautionary dosage coverage for everyone.

DISABILITY AND COVID-19 TESTING: A CROSS-SECTIONAL RADx-UP STUDY

Background: Nearly 26% of adults in the U.S. live with disability and are more likely to experience chronic health conditions, barriers to healthcare, and severe COVID-19 illness. Therefore, COVID-19 testing of adults living with disability is important to consider. The purpose of this study was to explore relationships between disability and COVID-19 testing, infection, and related challenges. Method(s): A Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) project in Miami, FL determined disability with a modified version of the Washington Group General Disability Measure. HIV serostatus and COVID-19 vaccination were confirmed with medical records. COVID-19 testing and infection history were self-reported. Statistical analyses included chi-squared tests and multiple binary logistic regression;variance inflation factors were calculated to ensure absence of collinearity. Result(s): A total of 1,689 RADx-UP participants with an average age of 55+/-12.3, 51% male, 49% Black non-Hispanic, 23% living with HIV (86% virally suppressed), and 76% received at least one dose of a COVID-19 vaccine. Nearly 40% were disabled, 37% reported employment disability, and 21% were functionally disabled (disability that interferes with performance of daily activities). Despite recruitment from the same sources, PLWH, compared to those without HIV, were more likely to be disabled (52% vs 36%;p< 0.0001), report employment disability (63% vs 30%;p< 0.0001), and report functional disability (29% vs 18%;p< 0.0001). Those with employment disability were less likely to have ever been tested for COVID-19 compared to those without (81% vs 85%;p=0.026). Employment disability was also associated with lower odds of having ever tested positive for COVID-19 after adjustment for demographics, health insurance, HIV, COVID-19 vaccination, smoking, and lung disease (aOR, 0.62;95% CI, 0.43-0.90;p=0.013). Disability was associated with greater odds of transportation challenges (aOR, 2.33;95% CI, 1.76-3.08;p< 0.0001), illicit drug use (aOR, 1.92;95% CI, 1.49-2.47;p< 0.0001), and smoking (aOR, 1.74;95% CI, 1.39-2.17;p< 0.0001). Compared to those without, those with transportation challenges (14% vs 40%;p< 0.0001) and illicit drug use (18% vs 30%;p=0.001) were more likely to postpone medical care. Conclusion(s): Lower COVID-19 testing rates may contribute to underestimated COVID-19 positivity rates in adults living with disability. Challenges with transportation and substance abuse contribute to less engagement in care.

Home-based treatment with subcutaneous (SC) trastuzumab -only a pandemic solution? Real world evidence (RWE) analysis

Background The pandemic has accelerated the introduction of more flexible and cost-effective treatment forms. The efficacy of trastuzumab in the intravenous (IV) and SC forms is similar both in early and advanced HER2-positive breast cancer (BC) patients. Compared to IV administration, SC enables reduction of treatment costs and time, and saves equipment and human resources. SC formulation is more convenient for both patients and healthcare providers and may be implemented as a home-based therapy. Recently, systemic anticancer treatment (including chemotherapy) has been increasingly performed at home, improving patient comfort and reducing the burden on the healthcare system. Poland has already implemented home-based treatment with some biologic compounds;however, they have not included trastuzumab in BC patients. Objectives This RWE analysis aims to evaluate the organizational and therapeutic procedures related to the home-based treatment with SC trastuzumab and the attitudes of patients and healthcare providers to this approach. Material and methods The study enrolled early HER2(+) BC patients treated with trastuzumab during the COVID-19 pandemic. Monitoring and treatment duration were consistent with SmPC and reimbursement regulations in Poland. The first 3-6 doses of SC trastuzumab (alone or in combination with CHT) were administered at a cancer center in outpatient and inpatient settings. Subsequent doses were administered at home by 3 qualified breast nurses. Post-injection follow-up was used for educational purposes. Data were analyzed with descriptive statistics. The study was reviewed and approved by the local Bioethics Committee. Results The analysis included 20 patients treated in two comprehensive cancer centers in Poland with a median age of 59 years (range, 36-72 years). Seven patients (35%) were professionally active. The average distance from the place of residence to the cancer center was 24 km (range, 2-65 km). A total of 232 doses were administered (mean 11.6 doses per patient;range 6-14), 133 doses at home and 99 at the cancer center. The overall tolerance of trastuzumab was good and consistent with the known safety profile described in Summary of Product Characteristics. Only 1 patient (5%) discontinued treatment prematurely due to decreased LVEF;another 19 patients completed treatment as planned. For 19 patients (95%), the benefits of SC treatment included time savings, the ability to continue working, and avoiding crowded places and infection risk. 2 patients (10%) considered the nurse's visit privacy disturbing, while 18 (90%) would recommend home-based drug administration. The average duration of a nurse's stay at home was 60 minutes (range 30 to 130 minutes). No logistical or technical problems were reported, except for occasional patient lateness. Nurses positively assessed the treatment provided in the nursing office, which was a source of additional knowledge, and experience. The overall impression of home-based therapy was positive for both patients and nurses. The limitation of the study is the declarative nature of the data. Conclusions Home-based treatment with SC trastuzumab should be pursued due to its safety, ease of organization, positive perception by patients and nurses, and reducing healthcare system resources. It can be particularly valuable for disabled patients who have difficulty reaching the hospital and professionally active patients. Specialized, trained nurses can self-sufficiently carry out part of the prolonged trastuzumab treatment, reducing physician involvement.

Virtual clinics in teledermatology: an opportunity for all?

The COVID-19 pandemic has been a catalyst in the slow-moving transition to telemedicine services: dermatology has been particularly affected by this move to 'teledermatology' and the use of virtual clinics. However, the COVID-19 pandemic has also exposed and exacerbated pre-existing health inequalities. Dermatological services are prone to inequalities in service access, disease burden and equity. There are 13 million general practice consultations for skin conditions every year (https://www.not tingham.ac.uk/research/groups/cebd/documents/hcnaskinc onditionsuk2009.pdf), yet only 611 dermatology consultants provide specialist care (https://www.statista.com/statistics/ 594431/dermatologists-in-the-united-kingdom-uk-by-staffgrade/). Teledermatology with the adoption of virtual clinics has the potential to increase accessibility to dermatology patients in geographically isolated areas. However, access and use of virtual clinics for dermatology patients poses several challenges. In 2018, five million people in the UK were noninternet users (https://www.ons.gov.uk/peoplepopulationa ndcommunity/householdcharacteristics/homeinternetandsoc ialmediausage/articles/exploringtheuksdigitaldivide/2019-03-04). A geographical divide exists in the UK concerning knowledge and application of basic digital skills, with the North, the Midlands and Wales falling short in a national average of 79%. The Department for Work and Pensions has impairment listings on a range of skin conditions that are most likely to be disabling (https://www.gov.uk/governme nt/publications/medical-guidance-for-dla-and-aa-decision-ma kers-adult-cases-staff-guide). Yet, 22% of all disabled people lack internet access. Ethnic disparities on the use of pre-existing online healthcare infrastructure like NHS Direct already exist (Cook EJ, Randhawa G, Large S et al. Who uses NHS Direct? Investigating the impact of ethnicity on the uptake of telephone based healthcare. Int J Equity Health 2014;13: 99). Cultural factors and those living in overcrowded housing lack the privacy needed for dermatological consultations. With austerity measures, people are unable to afford internet access or goodquality computers to make video calls to talk about their skin problems, making teledermatology an unsuitable alternative. The digital divide also exists across an age gradient, with older people more likely to report not using the internet. Dermatology patients tend to be elderly, with the median age of patients referred being 51 years. With virtual clinics projected to be significant in the future delivery of dermatology services, it would be prudent to mitigate the risks of digital exclusion for our most vulnerable patients and tackle the persisting inequalities.

Participating in the digital world: a consensus statement on digital social contact for people with disabilities living in sheltered care facility homes

Introduction: Digital social contact is increasingly being used, which accelerated during the COVID-19 pandemic. This study aimed to determine the consensus among stakeholders regarding recommendations for the use and facilitation of digital social contact for people with intellectual disabilities living in sheltered care facility homes. Method(s): This consensus statement was developed in three consecutive rounds of questionnaires (rapid online modified Delphi design). The expert-groups included people with disabilities (N = 6) and their families (N = 10), support professionals (N = 9), behavioural consultants (N = 7), managers of sheltered care facility homes (N = 10), scientists and industry experts (N = 15). Finding(s): Four main themes were identified: 1. Reasons for and types of digital social contact;2. Support and training needs;3. Materials and other requirements needed to enable digital social contact;and 4. Best practices and future developments. For each theme, several recommendations were formulated. Discussion and conclusion: This study resulted in a consensus statement aimed mainly at care professionals, families of people with intellectual disabilities and managers of sheltered care facility homes. Findings show that digital social contact can contribute to societal participation of people with disabilities. Additionally, tailored exploration of digital contact is recommended, as well as aiming for inclusive-by-design technology developments with developers and stakeholders working together.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Building an expert and patient peer based internet system to support young patients with cancer

Introduction: Approximately 16,500 patients develop cancer in Germany in the ages between 18 und 39 years. Many of them experience fnancial and social problems as a consequence of the disease and its treatment. Young patients represent a small proportion of all cancer patients (3%) and their social situation is very heterogenous. Tey face difculties to get helpful counseling and support. Method(s): Young Cancer Portal (www.junges-krebsportal.de) is an internet-based support system for young cancer patients. It has fve sections:.,First Aid" provides hints and experiences how to cope and how to organize oneself in the first time after diagnosis.,Knowledge Base" provides medical, organizational and legal informations on fertility preservation, on the SARS-CoV-2 pandemia, information for students with cancer, young families, how to deal with insurance companies, problems of severely disabled etc. It is built in intensive interaction with young cancer patients from the.,meeting points" of the foundation. The sections.,Online Consultation Hour" and.,Webinars" provide further informations in an easy understandable format. In the section.,Individual Counseling" expert counseling on social and medical topics is offered as chat on a protected sever and in direct contact. As a new feature support from patient peers with special expertise will be realized. These peers are recruited from the editorial teams who were involved in the development of the information pages on the different topics. Result(s): As on march 23rd, 1,098 patients have been registered for.,individual counseling" and 677 consultations have been performed plus by now 100 consultations on reimbursement for fertility preservation. There have been more than 30,000 visits on the Corona pages. Seven patients' editorial teams have been formed. The pages on fnancial and social problems of students and young families are in final editing. Conclusion(s): We present a new way to provide information on medical, fnancial and social problems to support young cancer patients. By involving active patients from the meeting points of the foundation and organizing them in editorial teams the focus of the information pages is sharpened. Based on their work in the editorial teams these patients are enabled and mobilized to support other patients as peers.

The Pem/Pese Activity Questionnaire: A Novel Health-Related Quality of Life Measure for Post-Exertional Disablement

PURPOSE/HYPOTHESIS: Physical therapy practice depends on valid and reliable patient reported outcomes measures (PROMs). Post exertional malaise (PEM) and post exertional symptom exacerbation (PESE) are features of myalgic encephalomyelitis, Long Covid, and related conditions. They comprise a constellation of symptoms and signs including profound physical fatigue. Existing fatigue-specific instruments often are inappropriate to measure functional effects of accompanying symptoms and signs and demonstrate substantial floor effects. The purpose of this study was to determine the psychometric properties of a novel PROM for people living with PEM/PESE, the PEM/PESE Activity Questionnaire (PAQ). NUMBER OF SUBJECTS: 981 people living with PEM/PESE who completed a web-based questionnaire. MATERIALS AND METHODS: Respondents chose a function from a dropdown menu, consisting of the International Classification of Function core set for myalgic encephalomyelitis, and rated it on 2 different 0 to 10 scales. Each scale was anchored at 0 being Completely unable to perform, and 10 being Can perform at the same level as a time I have good energy and Can perform at the same level as before I became ill, respectively. Respondents also provided an estimate of effort intensiveness on a 0 to 10 scale, anchored at 0 being the activity took No time, effort, and resources at all and 10 being All of my time, effort, and resources. Respondents took the PAQ twice;they completed a demographic questionnaire after the first PAQ and before the second PAQ. Backward navigation was disabled so respondents could not view the first PAQ while completing the second PAQ. Descriptive statistics were calculated for the participants who completed versus did not complete the entire survey. Subgroup analyses by completion status and function were undertaken by chisquare analysis for binomial variables and one-way analysis of variance for continuous variables. Intraclass correlation coefficients were calculated for each scale to assess testretest reliability. Floor effects were the proportion of participants reporting the lowest score. RESULT(S): 981 surveys were available for analysis, including 675 complete surveys. All participants reported PEM/PESE. Respondents reported less frequent flu-like symptoms and pain, shorter recovery times after physical activity (i.e., less than 24 hours), and lower thresholds for physical and mental fatiguability than respondents who did not complete the survey (P< 001). Activities most frequently chosen for rating were Carry out my normal routine, Prepare meals, and Maintain employment for financial reward. Test-retest reliability was generally fair to excellent, depending on function and scale. Floor effects were noted in 9.2% to 24.7% of responses, also with notable variation based on function and scale. CONCLUSION(S): The PAQ provides valid, reliable, and sensitive outcome measure for people living with PEM/PESE. Survey completion may be limited by severity of PEM/PESE. CLINICAL RELEVANCE: Physical therapists could use the PAQ to assess illness severity and intervention efficacy for people living with PEM/PESE.

Strategies To Assist People With Disabilities During Health Emergencies, Concerning The COVID-19 - Systematic Review

Introduction. The COVID-19 pandemic has affected thousands of people worldwide. The collapse of health systems led to increased difficulties in accessing health care for people with disabilities. The objective was to define strategies to support the implementation of health care for people with disabilities. Methods. The protocol for the systematic review was registered on PROSPERO (CRD42021266341). Searches were done in seven databases, using MeSH terms related to COVID-19 and disability, in 2021. We included interventions that addressed health, education and social assistance. Results. Twenty-nine studies were included. A meta-synthesis identified strategies to assist individuals with disabilities: creation of emergency accommodation and protection programs;flexible work arrangements;cash transfer programs;community participation in planning;establishment of support networks;social assistance even in periods of health emergency;teleconsultation services, telerehabilitation and systems that facilitate the use of digital technologies for telemedicine;inclusive guidelines for computer literacy and learning. The main implementation action was comprehensive health care centered on the needs of people with disabilities, with a focus on training community informants, continuing education of health professionals and caregivers for emergency situations, decentralization of care, identification and elimination of barriers to access. Conclusions. Even though the focus was on telehealth and social assistance, achieving comprehensive healthcare requires a range of interventions that together will support the reduction of inequity faced by people with disabilities.

Cross-Sectional Research on the Development of Case Management Approach for Disability Patient Based on the Workability Index and Quality of Life Measures

Objectives: Analyzing the factors associated with improving the work ability index and quality of life in patients with disabilities participating in a return-to-work (RTW) program utilizing a case management system. Method(s): A total of 154 patients, who are disabled workers administered in the Centre of Return To Work in Indonesia, participated in this study during the outbreaks of COVID 19. Utilizing descriptive statistics, the profile of RTW participants has been outlined. Utilizing specific sociodemographic and occupational factors, the association between RTW outcomes was examined. In this study, quality of life has been measured by a validated questionnaire of WHOQoL-BREF and Work Ability Index by WAI questionnaire from The Finnish Institute of Occupational Health. Meanwhile, correlation and logistic regression have been used to study the association between identified factors of quality of life and work ability index. Result(s): The findings indicate that scores of physical health and social domain for quality of life among patients reach higher than other domains in this study which remain 72.93 and 76.14, respectively. However, patients' work ability index is generally considered moderate to excellent with a mean score of 39.3(S.D 4.4). The level of education and all quality of life domains have proven statistically correlated with Work Ability Index (WAI). The level of education and physical health as the domain of quality of life significantly can explain factors associated with the work ability index of patients (p<0.05) who have been involved in the framework of case management. Conclusion(s): Endeavors to strengthen the workability index and quality of life among disabled patient throughout the RTW program might start by ensuring that the case manager made every effort to meet the worker's and employer's commitments to the RTW program outcomes. The factors that may contribute to the association of the work ability index are physical health and level of education. Copyright © 2022

Facing COVID: Engaging participants during lockdown

People with disability may experience anxiety when wearing facemasks and being exposed to people wearing them. With COVID-19 public health orders stipulating the wearing of masks when outside of a private home, exposure to facemasks cannot be avoided. This paper presents a case study outlining a project by Mercy Connect, a disability service provider in Albury (Australia), to 'normalize' facemasks to participants during the period when a public health order to 'stay at home' was in place. Participants were offered the opportunity to create a mask design and enter it into a competition for a participants' and a people's choice award. The winning designs have been produced for distribution among participants and for sale to staff and the wider public. Inclusion and a reduction in anxiety were the key outcomes, along with a heightened sense of self-worth and achievement for the winners. Copyright © Nova Science Publishers, Inc.

A survey on problems faced by physically challenged people during the corona pandemic

INTRODUCTION: The Covid- 19 pandemic has caused many drastic changes in the lines of the general population. Moreover, the people with physical disabilities were affected more, as they commonly encounter day to day life challenges in their life, such as barriers to mobility, reduced access to healthcare services, and high depression. AIM: The study aims to create awareness and survey the problems faced by the physically disabled people during the Covid- 19 pandemic. MATERIALS AND METHODS: The present study was conducted survey through online mode with the help of google forms through an e-questionnaire.The survey was conducted among the general population with a second of 101 responses. The obtained results were statistically analysed using SPSS software version 23. RESULT(S): Most of the general population have an awareness of the problems faced by the physically challenged people during the corona pandemic. Most of the population found this survey was useful. CONCLUSION(S): Because of the lack of access to hospitals, drastic changes in lifestyle and social habits, no physical activity were all noted. From the present study, it is evident that most of the people are aware of the various problems faced by physically challenged people during COVID. Copyright © 2022 Ubiquity Press. All rights reserved.

Poliomyelitis survivors in the time of a covid-19 pandemic

Introduction: Poliomyelitis is an inflammatory viral disease that causes destruction of motoneurons. Despite being eradicated in Brazil, it left sequelae on survivors, making them need continuous treatments. Considering the sequelae and new symptoms related to Post-Polyomyelitis Syndrome (PPS), these patients may be vulnerable in the Covid-19 Pandemic. Objective(s): To characterize and analyze the prevalence of risk factors for contracting COVID-19 as well as developing its severe form in patients with Sequelae of Poliomyelitis and Post-polio Syndrome. Method(s): An epidemiological study was carried out through an online questionnaire, where epidemiological, physical and psycho-emotional health issues were addressed in the pandemic. Approved by CEP UNIFESP under Ndegree4,087,073. Result(s): 383 responses were obtained in the following groups: Sequelae of Poliomyelitis (GP-49%;n=190) and PPS (GPPS-50.4%;n=193). Female and age 50-59 years were more prevalent. The most common disorders were monoparesis (38.9% GP;21.7% GSPP), followed by paraparesis in GP (18.9%) and tetraparesis in GSPP (16.6%). As for comorbidities, 37.4% of the GP and 37.3% of the GSPP reported Hypercholesterolemia;42.6% (GP) and 47.1% (GSPP) Hypertension and 19.5% (GP) and 14.5% (GSPP) Diabetes. About 29% of the GP were obese against 35.2% (GSPP). In the physical aspects, 57.9% (GP) and 65.8% (GSPP) reported worsening in the quarantine and 19.7% (GSPP). Discussion(s): Patients affected with Poliomyelitis had a proportion of Hypercholesterolemia, Hypertension and Diabetes about twice that of the Brazilian population over 18 years (14.6%;23.9 and 7.7%, respectively) (1). In this sense, research shows an increased risk for severity and death from COVID- 19 in patients with Hypertension (2,3), Diabetes (2,3) and Hypercholesterolemia (2). People with disabilities can be disproportionately impacted by emergencies and the disruption of services can be a contributing factor (4). This impact could be perceived by the reports of worsening in the physical aspect during the quarantine, especially in GPPS who have a higher frequency of tetraparesis, which can difficult to carry out the necessary hygiene measures. Conclusion(s): Poliomyelitis survivors have comorbidities, in addition to limitations and dependence in their activities of daily living that can make them more vulnerable to contagion by COVID-19 as well as making them more susceptible to the severe form of the disease.

The psychological well-being of family caregivers of autistic people during the COVID-19 lockdown in Italy

Introduction: People with autism spectrum disorder (ASD) frequently need support due to the elevated prevalence of psychiatric and medical comorbidities. The Covid-19 outbreak has severely affected the routinary functioning of healthcare services, thus causing severe consequences for autistic people and their caregivers, an already fragile population prone to mental health diseases. Objective(s): 1. To compare the levels of psychological well-being, insomnia, and family distress perceived by caregivers of autistic people to those perceived by caregivers of people with other types of disability. 2. To evaluate predictors of individual and family distress reported by caregivers of autistic individuals. Method(s): We collected data through a cross-sectional web-based observational study from April 19 to May 3, 2020. Sociodemographic information were collected, and psychopathological variables were assessed using the General Health Questionnaire-12, the Insomnia Severity Index, the Brief Resilient Coping Scale, and the Family Distress Index. Result(s): No significant differences emerged between the two groups of caregivers in terms of well-being, sleep quality, family distress, and level of resilience. The risk of individual distress during the pandemic was higher in people caring for younger autistic people. Lower levels of resilience predicted higher levels of individual distress among caregivers of autistic people. Conclusion(s): Our study confirmed that caregivers' mental health is worthy of attention and that people with disabilities may benefit for well-organized healthcare support networks (e.g. in-home services). The non-significant differences found between caregivers of ASD and non-ASD individuals may be related to the severe distress that Covid pandemic caused on the entire population.

The new role of telemedicine in child psychiatry in the period of pandemic caused by spreading of the COVID-19

Introduction: In the period of Covid-19 both adults and children have a great number of the most varied negative social and psychological factors. Objective(s): The study of the necessity of telemedicine technologies for child and teenage psychiatric service. Method(s): During two month, parents of 128 children, aged 3-18, have applied for consultative help to the Department of Psychiatry, Psychotherapy and Narcology of the Ural State Medical University. Result(s): In total, the number of consultations has grown by 23% compared to the same period of the previous year. The greatest number was connecting with emotional and behavioral disturbances that usually begin in childhood - 23.0%, neurotic connected with stress and somatoform disorder - 21.1%, and affective disorders -14.1%. The least amount of cases were of children and teenagers with psychiatric diagnoses: disorders of a schizophrenic character - 7% and the mentally retarded - 6.2%. These data points that the limitation of the possibility of receiving a psychiatric consultation in person did not lessen the number of instances when parents of children and teenagers applied for help. On the contrary, this period showed a growth of the number of parents who applied for help, mainly due to the increase in the proportion of anxiety and phobia disturbances, plus behavioral disruptions. At this, the number of neurotic cases connected with stress and somatoform disturbances in children increased by 92.0%, whereas emotional and behavioral disturbances that usually begin in childhood increased by 45.0%. Conclusion(s): Thus, telemedicine technologies in child psychiatry have proved to be an effective and necessary means.

ACAPELLA: Real-World Experience with Ocrelizumab: An Observational Study Evaluating Safety in Patients with Relapsing and Progressive MS, Late Breaking Data

Introduction: Ocrelizumab (OCR) is a humanized monoclonal antibody therapy targeting CD20+ B cells for relapsing remitting (RRMS) and primary progressive MS (PPMS). The ACAPELLA trial is a prospective study with a primary objective of assessing OCR-associated adverse events (AEs) in a real-world MS population. ACAPELLA includes patients who would have been exempted from the phase II & III clinical trials because of pre-existing conditions such as a prior history of malignancy, prior immunosuppressive treatment, and advanced age and/or disability. Objective(s):To document the frequency of infections, incidence of cancer and other adverse events in patients treated with ocrelizumab at the Elliot Lewis Center (ELC). Aim(s): We sought to compare the frequency of adverse events in patients similar to those in the pivotal trials with those who would have been excluded based on age > 55, higher EDSS scores, and/ or pre-existing medical conditions. Method(s): The study includes all subjects treated with OCR at the (ELC) since its release in March 2017. Assessments include EDSS, brain MRI, mammograms (standard of care), collection of medical history including prior serious or recurrent infections, history of malignancy and exposure to immunosuppressive treatment, JCV index, and CD19 count. Result(s): As of June 1, 2022, 375 subjects were enrolled, 328 subjects completed 2 cycles of OCR, 289 subjects completed 3 cycles, 250 subjects completed 4 cycles, 218 subjects completed 5 cycles, 173 subjects completed 6 cycles, 130 patients completed 7 cycles, 102 subjects completed 8 cycles, 53 subjects completed 9 cycles, and 18 subjects completed 10 cycles. The population was 73% female, with an age range of 18-75. Sixty-five percent had RRMS and 35% PMS (PPMS and SPMS) with an EDSS range of 0-7.5;22% had a baseline EDSS of >= 6.0 (median 3.0). Twenty-two patients (6%) had serious non-COVID infections (requiring hospitalization) with no correlation to age or disability. Seven patients (2%) were hospitalized with COVID-19, 2 of whom died. Patients with an EDSS >= 6.0 had a slightly higher rate of UTIs as compared to the 5-year clinical trial data. There was no increase in HSV or zoster in older and/or more disabled patients. Malignancies occurred at a rate similar to that in the general MS population. Conclusion(s): With the exception of UTIs, which were more prevalent in patients with an EDSS > 6, we did not observe a higher rate of AEs in older and/or more disabled patients.

Ocrelizumab treated patients who developed Coronavirus disease-19 despite being vaccinated

Introduction: In the Phase III trials of ocrelizumab (OCR), the most common infections were upper respiratory infections, and several data bases have reported OCR-treated persons with MS are more susceptible to Coronarvirus disease-19 (COVID-19). In addition, patients on OCR may have a more severe course resulting in hospitalizations. The VELOCE study indicated a reduction in the immune humoral response to non-live vaccines which may contribute to the increased risk. Objective(s): To report the demographics of patients who developed SAR-CoV-2 after being vaccinated. Method(s): Adult MS patients who have been prescribed OCR were eligible. Chart reviews were conducted every 6 months by a trained RN. Cases reported are patients who tested positive for COVID-19 after receiving at least one vaccine while on OCR. Demographics, disease duration, EDSS, hospitalizations, time on OCR, vaccine status, type of vaccine administered were summarized as percentages, means (SD) or medians [interquartile range (IQR) =Q1, Q3] as appropriate. Result(s): Of 293 OCR patients vaccinated, 31 patients developed a documented COVID-19 infection with a mean age of 46.8 (12.7) and a median disease duration of 11.3 [4.0. 19.6] years. 17% had PMS. Median time on OCR was 42.8 [20.1, 50.4] months. 60% had been on OCR for 3 years or more. Median time from first vaccine to positive COVID-19 test was 7.3 [4.8, 8.9] months. Median time from last dose of OCR to positive COVID-19 test was 4.5 [3.2, 5.7] months. COVID-19 negative patients were older with a mean age of 52.3 (12.3), p=0.03. There were no other significant differences based on median disease duration, MS pattern, and median time on OCR. Median EDSS for patients who developed COVID-19 (19 patients) was 2 [2.0, 6.5]. 71% (22) had received the Pfizer- BioNTech or Moderna vaccines, and 45% of patients had received one booster vaccine before they developed COVID- 19. Hospitalizations occurred in 9 patients with a mean age of 53.9 (12.5) years, and 4 of them were boosted. 2 patients were admitted to the intensive care unit, and 1 patient required intubation. 1 death occurred in a 62-year-old patient with an EDSS of 8.0, who had received OCR for 3.6 years and received one dose of the Johnson and Johnson vaccine. Discussion(s): Patients hospitalized for a COVID-19 infection were older, and the patient who died had an EDSS of 8.0.This data is alignment with previous reports that older and more disabled patients are at risk for more severe disease.

Embedding equity in the Australian Cancer Plan: Engaging priority populations to improve equitable outcomes for all Australians

Aim: Despite Australia having some of the best cancer outcomes in the world these are not shared equitably across population groups. Disparities are strongly associated with cultural and social determinants of health including ethnicity, systemic racism, language, education, age, gender, faith, mental health, disability, health literacy and sexual orientation. The aim was to embed health equity into the Australian Cancer Plan to achieve equitable outcomes for all Australians. Method(s): An evidence-informed stakeholder engagement strategy was used to engage priority populations as follows: Led by cultural, policy, clinical and consumer experts in developing a 'health equity in cancer outcomes' framework, underpinned by an environmental scan. Driven by the health equity framework, a mixed method approach to data analysis was used to inform the engagement strategy. Examined qualitative data from community consultation and stakeholder workshops in conjunction with statistical data from population level registries. Priority populations engaged: Aboriginal and Torres Strait Islander people, people living in rural, remote and lower socioeconomic areas;people from culturally diverse backgrounds;children;adolescents;young adults;older people;LGBTQI+ community;people with disability or mental health conditions. Conducted tailored focus groups with priority population peak bodies and consumer organizations. Result(s): Preliminary findings from tailored focus groups include: the value of population focused Optimal care pathways (in addition to tumour-specific OCPs);a systems approach to consumer navigation;community organizations as facilitators of access to care;bolstering workforce capability;preserving national system innovation gains from COVID-19 telehealth, teletrials, rapid access clinics;addressing systemic racism and barriers to access (language, health literacy);delivery of strength-based, age-appropriate, culturally responsive care. Conclusion(s): Undertaking early engagement of priority populations and being guided by a health equity framework ensures that lived experiences of inequity will be addressed in the Australian Cancer Plan's 10-year ambition statements, 2 and 5 years goals, and associated actions. .

Differences in Acceptance to the Kidney Transplant List

Purpose: During the COVID-19 pandemic, kidney transplant (KT) evaluations shifted from in-person evaluation (IPE) to telemedicine evaluation (TME). Given differences in access to electronics and internet, we thought that TME may advantage some social groups' access to the KT list. We evaluated if differences in acceptance to KT listing exist between pre- and post-pandemic eras, or between IPE and TME. We identified associations between other socioeconomic factors and KT listing. Method(s): Demographic and social data were collected from charts of patients evaluated for KT in the pre- (3/13/2019-3/13/2020) and post-pandemic era (3/14/2020- 3/14/2021). Categorical data are presented in proportions and frequencies;continuous data in means+/-SDEV. Independent group t-tests and Fisher's exact tests were used for bivariate comparisons. Result(s): Of 1061 charts, 1015 included data on race/ethnicity: 608 (59.1%) Black, 335 (33.6%) White, 40 (3.9%) Hispanic, 29 (2.8%) Asian, and 3 (0.3%) other. Overall, 629 (59%) evaluations were pre- and 430 (41%) post-pandemic. 734 (72%) were IPE and 288 (28%) TME. 553 (54%) candidates were denied for medical (310, 56%) and social (184, 33%) reasons;469 (46%) were accepted for listing. Employment status was known in 979 candidates: 278 (28%) employed, 368 (38%) disabled, 66 (7%) unemployed, and 267 (27%) retired. Evaluation in the post-pandemic era (p=0.002) was associated with acceptance for listing. TME was also associated with acceptance for listing (p<0.001). Pre-pandemic, there were 604 IPE and 1 TME of whom 253 (42%) were accepted, including the TME (p=0.238). Post-pandemic 130 evaluations were IPE and 287 TME, of whom 215 (52%) were accepted, including 58 (45%) IPE and 157 (55%) TME (p=0.061). Employment status (p<0.001) and mental health status (p=0.009) were associated with acceptance for listing. There was no association between race/ethnicity (p=0.809) or distance from home to the transplant center (p=0.693) and acceptance for listing. There were no differences in race/ ethnicity (p=0.951), employment status (p=0.202), or mental health status (p=0.742) between pre- and post-pandemic eras. Assessment of social support (p=0.002) and overall social work assessment (p<0.001) were associated with acceptance for listing. The level of social support (rated on a 1-5 scale) was associated with being accepted for listing pre-pandemic (p=0.001) but not post-pandemic (p=0.769). Conclusion(s): KT evaluations decreased by about one third during the post-pandemic era. Evaluation in the post-pandemic era, evaluation by TME, employment status, mental health status, assessment of social support and overall social work assessment were all associated with being listed for KT. There were no differences in race/ethnicity, employment status, or mental health status between eras, which is unexpected given the additional stressors of the pandemic on employment and mental health.

Patient and Provider Perspectives on Telehealth Clinic Visits Precipitated by the Covid-19 Viral Pandemic

Purpose: The transplant community had to adjust to a new way of practicing medicine during the COVID-19 viral pandemic. Our transplant center quickly adapted to virtual clinic visits to maintain the safety of our immunosuppressed patients. The purpose of this study was to examine how patients and providers regarded this new method of delivering healthcare. Method(s): Patients with a telehealth transplant clinic visit between March 2020 and April 2021 were recruited to participate in a telephone survey, which consisted of 19 statements rating their experience on a 5-point Likert Scale. Two additional questions allowed participants to offer suggestions for improvement. Demographic information was also collected. Multi-specialty healthcare providers and support staff in the transplant division who had conducted telehealth visits were contacted via email to participate in an electronic survey, consisting of 25 statements that asked providers to assess their telehealth experience on a 5-point Likert Scale. They were also able to provide additional comments regarding their experience. Result(s): Results are summarized in Table 1. The majority of patients and providers had an electronic device that allowed access to video telehealth visits and felt that the telehealth platform was easy to navigate. Statistical significance was found between not pursuing higher education and not having a video visit-capable device (p=0.035). Retired or disabled patients were more likely to find that setting up an account and navigating the video platform was difficult (p=0.022). Both patients and providers agreed that when they experienced connectivity issues with the video platform, it was easy to convert to a telephone call. Both groups reported having ample time during their telehealth visit and felt that all questions and concerns were adequately addressed. More patients than providers preferred the telehealth visit to an in-person clinic visit, as they mentioned the convenience of the telehealth visit when a lengthy commute was involved. Conclusion(s): The viral pandemic required both patients and providers to adapt to telehealth visits. Social determinants of health should be taken into consideration to provide sufficient care, as certain populations may require extra assistance to utilize this platform effectively. Overall, most providers and patients agreed that adequate care can be provided via telehealth, supporting the continued use of this platform in the future.