Mental health literacy and professional psychological help-seeking behavior in college students.

Objective: To reveal the classification characteristics of college students' mental health literacy and compare their differences in professional psychological help-seeking behavior. Methods: Totally 12 850 college students were selected and assessed with the Mental Health Literacy Questionnaire (MHLQ), Self-made Questionnaire of Professional Psychological Help-seeking Behavior in Non-epidemic and COVID-19 epidemic and Patient Health Questionnaire-9 (PHQ-9). Latent profile analysis was used to classify the mental health literacy of college students. The Chi-square test and logistic regression analysis were used to explore the differences in professional psychological help-seeking behavior of different classes of college students. Results: College students' mental health literacy could be divided into three classes including low-literacy group (7.4%), medium-literacy group (50.2%) and high-literacy group (42.4%). After controlling for demographic variables and depression level, logistic regression analysis found that there was no significant correlation between mental health literacy and professional psychological help-seeking behavior in non-epidemic situations. In the COVID-19 epidemic, compared with the low-literacy group, the medium-literacy group was more likely to seek professional psychological help (OR=1.32). The medium-literacy group and the high-literacy group were more likely to recommend others for help (OR=1.77, 2.45). Conclusion: The mental health literacy of college students has classification characteristics. During the COVID-19 epidemic, the college students with higher mental health literacy have greater possibility of seeking professional help and recommending others for seeking help. (English) [ FROM AUTHOR] 目的: 了解大学生心理健康素养的分类特点, 比较不同分类大学生在专业心理求助行为上的差异。方法: 选取 12 850 名大学生, 采用心理健康素养问卷（MHLQ）、自编非疫情和新冠肺炎疫情中专业心理求助行为自评表、病人健康问卷抑郁量表（PHQ-9）进行调查。采用潜在剖面分析将大学生心理健康素养分类, 采用 χ² 检验和 logistic 回归分析探讨不同类别大学生专业心理求助行为的差异。结果: 大学生心理健康素养可分为低素养组（7.4%）、中等素养组（50.2%）和高素养组（42.4%） 3 类。非疫情中, 心理健康素养与专业心理求助行为无关联;在新冠肺炎疫情中, 相比低素养组, 中等素养更可能寻求专业心理求助（OR=1.32）, 中等素养组、高素养组更可能推荐他人求助（OR=1.77、2.45）。结论: 大学生心理健康素养有类别特征。新冠肺炎疫情中, 心理健康素养较高的大学生的专业求助或推荐求助可能性更大。 (Chinese) [ FROM AUTHOR] Copyright of Chinese Mental Health Journal / Zhongguo Xinli Weisheng Zazhi is the property of Chinese Mental Health Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Stronger than partisanship and motivated reasoning: news exposure and news frames predicting US state-level preventive behaviours against COVID-19

The COVID-19 pandemic has become a partisan issue rather than an independent public health issue in the US. This study examined the behavioural consequences of motivated reasoning and framing by investigating the impacts of COVID-19 news exposure and news frames, as apparent through a Latent Dirichlet topic modelling analysis of local news coverage, on state-level preventive behaviours as understood through a nationally representative survey. Findings suggested that the media effects on various preventive behaviours differed. The overall exposure rate to all COVID-19 news articles increased mask-wearing but did not significantly impact other preventive behaviours. Four news frames significantly increased avoiding contact or avoiding public or crowded places. However, news articles discussing anxiety and stay at home order triggered resistance and countereffects and led to risky behaviours. ‘Solid Republican' state residents were less likely to avoid contact, avoid public or crowded places, and wear masks. However, partisan leanings did not interfere with the impact of differing local COVID-19 news frames on reported preventive behaviours. Plus, statements regarding pre-existing trust in Trump did not correlate with reported preventive behaviour. Attention to effect sizes revealed that news exposure and news frames could have a bigger impact on health behaviours than motivated reasoning.

Analyzing the research trends of COVID-19 using topic modeling approach

PurposeThe COVID-19 pandemic has impacted 222 countries across the globe, with millions of people losing their lives. The threat from the virus may be assessed from the fact that most countries across the world have been forced to order partial or complete shutdown of their economies for a period of time to contain the spread of the virus. The fallout of this action manifested in loss of livelihood, migration of the labor force and severe impact on mental health due to the long duration of confinement to homes or residences.Design/methodology/approachThe current study identifies the focus areas of the research conducted on the COVID-19 pandemic. s of papers on the subject were collated from the SCOPUS database for the period December 2019 to June 2020. The collected sample data (after preprocessing) was analyzed using Topic Modeling with Latent Dirichlet Allocation.FindingsBased on the research papers published within the mentioned timeframe, the study identifies the 10 most prominent topics that formed the area of interest for the COVID-19 pandemic research.Originality/valueWhile similar studies exist, no other work has used topic modeling to comprehensively analyze the COVID-19 literature by considering diverse fields and domains.

Binge drinking alcohol and circadian misalignment in night shift nurses is associated with decreased resiliency to COVID-19 infection

Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.

Team Success: A Mixed Methods Approach to Evaluating Virtual Team Leadership Behaviors

The virtuality of organizational teams have gained interest and popularity in recent years, and have become more prevalent amidst the COVID-19 pandemic. Organizational productivity and team relationship-building may suffer certain pitfalls in virtual communication and support without the understanding of the dynamics of short-term, project-based virtual teams. The manuscript aimed to expand what is currently known about short-term virtual team dynamics related to types of effective leadership behaviors. The present study employed a mixed method approach to understanding the dynamics of these teams at both the individual and team level. Small teams were formed and instructed to collaborate on a virtual survival task. Team-related outcomes were measured at the individual level, such as team coordination, team support, and team success. Additionally, distinct latent profiles of leadership behaviors were developed and analyzed at the team level. Team support, more so than team coordination, significantly predicted team success at the individual level, with instrumental support having the strongest effect. Distinct leadership behaviors emerged in teams and were classified through a latent profile analysis, but none of the profiles were significantly related to team performance scores. Demonstrating instrumental support in short-term virtual teams may improve team success. It is important to understand that distinct leadership behaviors exist and future research should explore the impact of these leadership behaviors on other team-related outcomes. © 2023 by the authors.

Trajectories of parental burnout in the first year of the COVID‐19 pandemic

Objectives: The main objective of the study was to identify developmental trajectories of parental burnout during the first year of the COVID‐19 pandemic. The study was designed to assess whether changes in parental burnout were related to levels of perfectionism, sense of parental identity, and COVID‐related stress. Background: Parental burnout is a consequence of chronic stress associated with the role of a parent. However, little is still known about how parental burnout changes over time and which factors are responsible for it. Method: Parents (N = 376;67% women) aged 19 to 30 years (M = 26.85 years, SD = 2.52) participated in all three waves of a longitudinal study spanning 12 months. Latent class growth analysis (LCGA) was used to determine parental burnout change trajectories. The R3STEP procedure was used to analyze the relationship between developmental trajectories identified and the other variables studied. Results: Three different trajectories of parental burnout were identified: high and stable (7%), low and stable (63%), and average and increasing (30%). Trajectories were associated with perfectionistic concerns, a sense of parental identity, and COVID‐related stress. Conclusion: The results revealed that most parents did not experience changes in parental burnout during the first year of the pandemic. However, up to one third of parents may have experienced a significant increase in symptoms during the study period. Implications: The findings from this study may be applicable to planning support programs for emerging adult parents at risk of burnout. [ FROM AUTHOR] Copyright of Family Relations is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Deterioration of the subjective financial well-being during the coronavirus pandemic: a latent transition analysis

PurposeThe authors seek (1) to identify the profiles of subjective financial well-being (SFWB) of bank customers before and during the coronavirus disease 2019 (COVID-19) pandemic, (2) to analyze the transition to profiles of lower SFWB during the pandemic and (3) to identify the factors driving such transitions.Design/methodology/approachThe authors surveyed five countries during 2019 and 2020 to measure SFWB. The authors applied latent class analysis (LCA) to identify profiles of bank customers according to a mix of SFWB indicators in pre-pandemic times (Study 1). The authors validated the profiles during the pandemic and identified the SFWB dimensions that deteriorated during the crisis (Study 2). Finally, the authors applied latent transition analysis (LTA) to explore transitions to profiles of lower SFWB and identify the drivers.FindingsThe authors identified three profiles of customers in pre- and post-pandemic periods for four dimensions of SFWB: control over finances, capacity to absorb financial shocks, ability to track financial goals and financial freedom. Gender, age, trust in banks and bank-supporting policies were related to transitions across profiles of SFWB during the pandemic. These relationships are contingent upon contextual country-related variables.Research limitations/implicationsBanks and policymakers should reduce customers' exposure to the pandemic's long-lasting adverse effects on SFWB and should identify and control the multiplier role that contextual variables play.Originality/valueExtant literature has not fully identified the dimensions of SFWB that changed due to the COVID-19 pandemic. The authors narrow this gap by identifying three SFWB profiles of customers, analyzing the patterns of SFWB change and connecting these changes to individual, provider and contextual factors.

Individual differences in patterns of developmental opportunity and constraint during covid-19: Implications for longitudinal well-being

Individual differences in sociodemographic characteristics and trait-like perceptions of opportunities and constraints may shape how people respond to adversities such as the COVID-19 pandemic. However, little is known about how these factors combine to form multifaceted profiles of developmental opportunity and constraint or the implications of such profiles for longitudinal well-being following major life stressors. Using 1-year data from a national sample of U.S. adults (n = 293), we identified profiles based on relevant sociodemographic characteristics (age, socioeconomic status, chronic conditions, functional status) and trait-like perceptions of opportunity and constraints (perceived mastery, perceived constraints). Results of latent profile analyses showed that three common profiles emerged at pandemic onset (veridical opportunity, perceived constraints, perceived opportunity). Subsequent latent growth models showed that, despite reporting more sociodemographic constraints, the perceived opportunity profile exhibited better 1-year emotional well-being (positive and negative affect) during the pandemic than the perceived constraints profile. Findings advance the literature by identifying multifaceted individual differences in profiles of developmental opportunity and constraint and by showing these profiles have consequences for longitudinal well-being following the pandemic onset. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Relationship between social support and parental burnout in COVID-19 among Chinese young parents.

OBJECTIVE: To explore potential categories of parental social support for young parents under the coronavirus disease 2019 (COVID-19) epidemic, and to examine correlations of different types of parents' social support with parental burnout. METHOD(S): In April 2020, we conducted an online voluntary survey among young parents across China with scales and a self-designed questionnaire. The latent profile analysis method was used to analyze parents' received social support and perceived social support. The social support categories were taken as independent variables and parental burnout as dependent variables, and multiple regression analysis was carried out to explore the relationship between received social support, perceived social support and parental burnout. Finally, the moderating effect of resilience between social support groups and parental burnout was discussed. RESULT(S): The results of latent profile analysis revealed three potential types of received social support, namely isolate, normal, and multi-support and the proportions of the respondents with the three profiles were 14.1%, 78.0%, and 7.9%. Four potential types of perceived social support, namely, indigent, medium, affluent and divergent and the proportions of the respondents with the four profiles were 13.7%, 29.6%, 25.3%, and 31.3%. Among them, the parents with divergent perceived social support had more perception of social support from the couple, family and relatives, but less perception of social support from net-friend, social organizations and the government. Regression analysis showed that there was no statistically significant correlation between different profiles of received social support and parental burnout, and among the groups of perceived social support, there was a statistically significant correlation between indigent and divergent types of social support and parental burnout. The divergent parents had lower levels of parental burnout compared with indigent (beta=-0.120, P=0.003). Also, resilience moderated the effect of divergent perceived social support and parental burnout. Compared with the parents with low resilience, the parents with high resilience perceived divergent social support with lower parenting burnout. CONCLUSION(S): There are prominent latent types of received social support and perceived social support under epidemic. People with divergent perceived social support (more perceived supports from partner, family and friends) are prone to have a relatively lower risk of parental burnout. Parents with higher resilience will be more sensitive to the support of close acquaintances, and can better resist parental burnout.

Low-rank latent matrix-factor prediction modeling for generalized high-dimensional matrix-variate regression.

Motivated by diagnosing the COVID-19 disease using two-dimensional (2D) image biomarkers from computed tomography (CT) scans, we propose a novel latent matrix-factor regression model to predict responses that may come from an exponential distribution family, where covariates include high-dimensional matrix-variate biomarkers. A latent generalized matrix regression (LaGMaR) is formulated, where the latent predictor is a low-dimensional matrix factor score extracted from the low-rank signal of the matrix variate through a cutting-edge matrix factor model. Unlike the general spirit of penalizing vectorization plus the necessity of tuning parameters in the literature, instead, our prediction modeling in LaGMaR conducts dimension reduction that respects the geometric characteristic of intrinsic 2D structure of the matrix covariate and thus avoids iteration. This greatly relieves the computation burden, and meanwhile maintains structural information so that the latent matrix factor feature can perfectly replace the intractable matrix-variate owing to high-dimensionality. The estimation procedure of LaGMaR is subtly derived by transforming the bilinear form matrix factor model onto a high-dimensional vector factor model, so that the method of principle components can be applied. We establish bilinear-form consistency of the estimated matrix coefficient of the latent predictor and consistency of prediction. The proposed approach can be implemented conveniently. Through simulation experiments, the prediction capability of LaGMaR is shown to outperform some existing penalized methods under diverse scenarios of generalized matrix regressions. Through the application to a real COVID-19 dataset, the proposed approach is shown to predict efficiently the COVID-19.

Not all home drinking is equal: A latent class analysis of drinking patterns and alcohol consumption levels following initial COVID-19 restrictions in Australia, New Zealand and the United Kingdom.

INTRODUCTION: Initial COVID-19 restrictions forced changes in the contexts (e.g., with who and where) within which individuals consumed alcohol. We aimed to explore different profiles of drinking contexts during initial COVID-19 restrictions and their association with alcohol consumption. METHOD: We used latent class analysis (LCA) to explore subgroups of drinking contexts among 4891 respondents of the Global Drug Survey from the United Kingdom, New Zealand and Australia who reported drinking alcohol in the month prior to data collection (3 May-21 June 2020). Ten binary LCA indicator variables were generated from a survey question about last month alcohol settings. Negative binomial regression was used to explore the association between the latent classes and respondents' total number of drinks consumed in the last 30 days (i.e., alcohol consumption). RESULTS: The LCA found six distinct classes of individuals who reported drinking in the following contexts: household (36.0%); alone (32.3%); alone and household (17.9%); gatherings and household (9.5%); party (3.2%); and everywhere (1.1%), with the last group associated with the highest probability of increased alcohol consumption during this time. Male respondents and those aged 35 or older were most likely to report increased alcohol consumption. DISCUSSION AND CONCLUSIONS: Our findings suggest that drinking contexts, sex and age influenced alcohol consumption during the early stages of the COVID-19 pandemic. These findings highlight a need for improved policy targeting risky drinking in home settings. Further research should explore whether COVID-19-induced shifts in alcohol use persist as restrictions are lifted.

The Psychology of COVID-19 Booster Hesitancy, Acceptance and Resistance in Australia.

COVID-19 booster vaccinations have been recommended as a primary line of defence against serious illness and hospitalisation. This study identifies and characterises distinct profiles of attitudes towards vaccination, particularly the willingness to get a booster dose. A sample of 582 adults from Australia completed an online survey capturing COVID-related behaviours, beliefs and attitudes and a range of sociodemographic, psychological, political, social and cultural variables. Latent Profile Analysis (LPA) identified three subgroups: Acceptant (61%), Hesitant (30%) and Resistant (9%). Compared to the Acceptant group, the Hesitant and Resistant groups were less worried about catching COVID-19, used fewer official COVID-19 information sources, checked the news less, were lower on the agreeableness personality dimension and reported more conservatism, persecutory thinking, amoral attitudes and need for chaos. The Hesitant group also reported checking the legitimacy of information sources less, scored lower on the openness to new experiences personality dimension and were more likely than the Resistant and Acceptant groups to report regaining freedoms (e.g., travel) and work requirements or external pressures as reasons to get a booster. The Resistant group were higher on reactance, held more conspiratorial beliefs and rated their culture as being less tolerant of deviance than the Hesitant and Acceptant groups. This research can inform tailored approaches to increasing booster uptake and optimal strategies for public health messaging.

Exploring E-Health Literacy and Technology-Use Anxiety among Older Adults in Korea.

The COVID-19 pandemic has increased the importance of health literacy in disseminating information on health in a non-contact society. This study focused on examining the acceptance capacity by older adults of smart devices in Korea and investigating the potential differences between men and women in terms of e-health literacy and technology-use anxiety. The study included 1369 respondents who were adults over 50 years of age and used welfare centers, public health centers, senior citizen centers, and exercise centers in Seoul and Incheon. An online survey was conducted from 1 June 2021 to 24 June 2021. The study found that the older adults' low levels of digital literacy could limit their access to health information and negatively impact their health. The difference between men and women in terms of technology-use anxiety was statistically significant, with the latent mean for men being higher than that for women. The effect sizes of the potential mean differences were found to be at a medium level for e-health literacy and a significant level for technology-use anxiety. With Korea's aging population and the need for the continuous management of chronic diseases among older adults, it is essential to discuss internet-based health information for disease maintenance and treatment.

Perceived Stress, Psychological Flexibility Profiles, and Mental Health During COVID-19: A Latent Profile Analysis.

Purpose: Although the link between psychological flexibility and healthy functioning has been widely analyzed, the employed measurements often lacked accuracy. The current study introduced a person-centered approach that identified subgroups of college students across the dimensions of the Personalized Psychological Flexibility Index (PPFI) and explored how these subgroups relate to a risk factor (perceived stress) and mental health outcomes (depression, anxiety, negative affect, and positive affect) in the context of COVID-19. Methods: A sample of 659 participants (Mage = 19. 99, SD = 1.27; 57.97% females) completed the questionnaires online. Latent profile analysis (LPA) was employed to determine the optimal number of subgroups or profiles. Then, multinomial logistic regression and analyses of variance were used to identify variables associated with profile membership. Results: LPA identified three distinct profiles (active strategy, inconsistent strategy, and passive strategy). Furthermore, multinomial logistic regressions indicated that students with high perceived stress were more likely to be in the passive strategy group than the active strategy group (ß = -0.104, OR = 0.901, p < 0.001) and the inconsistent strategy group (ß = -0.087, OR = 0.917, p < 0.001). Additionally, analyses of variance revealed that the three profiles differed in depression (η2 = 0.062, p < 0.001), anxiety (η2 = 0.059, p < 0.001), negative affect (η2 = 0.047, p < 0.001), and positive affect (η2 = 0.048, p < 0.001). Conclusion: The current study employed LPA based on the PPFI to identify and confirm three profiles of psychological flexibility. We found that perceived stress and mental health outcomes were associated with these three profiles. This study offers a new perspective on understanding psychological flexibility through a person-centered approach. Furthermore, interventions aimed at reducing college students' perceived stress during the COVID-19 crisis are critical for preventing the deterioration of psychological flexibility.

Online Science Instruction Can Promote Adolescents' Autonomy Need Satisfaction: a Latent Growth Curve Analysis.

This research examined the differential motivational effects of a pre-college science enrichment program delivered in both online and in-person learning formats. Using self-determination theory as a guiding framework, we hypothesized that (a) students would exhibit growth in their perceived satisfaction of needs for autonomy, competence, and relatedness, (b) online learning would be associated with greater growth in autonomy, and (c) in-person learning would be associated with greater growth in both competence and relatedness. Using a sample of 598 adolescent participants, results of latent growth curve modeling indicated that satisfaction of the three needs grew unconditionally over the course of the program. However, format type was unrelated to growth in need satisfaction. Rather, this effect was found to be conditional upon the type of science project undertaken by students: astrophysics students exhibited significantly greater autonomy growth when receiving online instruction than did biochemistry students. Our findings suggest that online science learning can be just as effective in motivating students as in-person learning provided that the learning tasks are conducive to remote instruction.

Who would continue to work from home in Hong Kong as the COVID-19 pandemic progresses?

This study aims a more thorough understanding of individuals' motivations and determinants of working from home (WFH) at various phases of the pandemic. To achieve this research goal, we analyze attitudes towards WFH, the profiles of various types of workers engaged in WFH, and the determinants of the current and future expected frequency of WFH among 816 workers in Hong Kong. We identify four types of teleworkers: (1) those with little employer support, (2) those distracted with tech problems, (3) those with good home office, and (4) those with substantial employer support. Separate latent-class choice models present that WFH frequencies in early phases of the pandemic (and at the moment), attitudes towards WFH, and certain constraining/facilitating factors affect the (expected) frequency of WFH. This study provides valuable insights into the types of teleworkers and the determinants of WFH, which will help policymakers create ways to encourage (or discourage) the future frequency of WFH.

Non-commuting intentions during COVID-19 in Nanjing, China: A hybrid latent class modeling approach.

Non-commuting travel is essential for people to meet daily demands and regulate mental health, which is greatly disrupted due to the COVID-19 pandemic. To explore non-commuting intentions during COVID-19 across different groups of residents, this paper uses online survey data in Nanjing and constructs a hybrid latent class choice model that combines sociodemographic characteristics and psychological factors. Results showed that the respondents can be divided into two groups: the "cautious" group versus the "fearless" group. The "cautious" group with lower willingness to travel tend to be older, higher-income, higher-educated, female and full-time employees. Furthermore, the "cautious" group with higher perceived susceptibility is more obedient to government policies. In contrast, the "fearless" group is significantly affected by perceived severity and is more inclined to turn to personal protection against the pandemic. These results suggested that non-commuting trips were influenced not only by individual characteristics but also by psychological factors. Finally, the paper provides implications for the government to formulate COVID-19 management measures for the heterogeneity of different groups.

Tuberculosis and Hiv Infection - So Many Questions Pending

Since the early days of HIV infection, back in the eighties, TB - particularly extrapulmonary TB emerged as one of the opportunistic infections affecting these patients, specifically as a reactivation of latent TB infections. A diagnosis of TB in the context of HIV infection was then considered as an 'AIDS defining condition' according to classification systems used at that time. It has been recognized for a long time that there are many interactions between HIV and Mycobacterium tuberculosis, which lead to further immune deterioration and to worsening of both conditions due to complex biological and mechanistic interactions between these two agents. Many methods and techniques have been proposed in order to improve diagnosis of TB in HIV-infected subjects, knowing that TB is the most frequent opportunistic infection;and, if not treated in a timely fashion, it may easily take the lives of affected patients. It is not easy to have a diagnosis of TB in HIV-infected subjects, because of the difficulties for obtaining adequate sputum samples, or because of lack of adequate facilities for making a timely diagnosis, particularly in the so-called developing world. On the other hand, extrapulmonary TB is most frequently found in HIV-infected individuals compared to non-infected subjects, and its diagnosis poses significant difficulties, since so many times invasive procedures must be performed in order to obtain an adequate tissue sample and then be able to identify the pathological characteristics of tuberculous disease. In the first days of HIV infection when no antiretroviral therapy was available, a diagnosis of TB was made on clinical grounds, considering a history of contact or some characteristics of the disease, and those of us who are old (or experienced) enough offered antituberculosis therapy for these subjects, obtaining an adequate response many times, but in all cases, the natural history of HIV infection took place, and ultimately these patients died because of the occurrence of another opportunistic infection (or malignancy). With the advent of antiretroviral therapy in the late nineties, another problem occurred. The possibility of drug-drug interactions, taking into account hepatic metabolism of rifampin and the alterations of antiretroviral drug blood - or tissue - concentrations. On top of this, the occurrence of IRIS became another problem, and strategies and protocols have been designed in order to establish the adequate timing of antituberculosis therapy and sometime later antiretroviral therapy. A last point to be considered is the COVID-19 pandemic. The question to be asked is what the influence of the pandemic has been for affecting TB and HIV diagnosis and therapy strategies and programs, particularly in the developing world, knowing that health systems in these countries have many limitations, and that - scant - resources had to be dedicated for the fight against the pandemic.Copyright © 2023

Real-World Single-Centre Experience of Jak Inhibitor Use in Ra

Background/Aims The use of Janus Kinase Inhibitors (JAKi) has been gradually increasing overtime in the management of rheumatoid arthritis (RA) and other inflammatory arthritis and these appeal to patients. being oral agents. Nevertheless, rheumatologists have become cautious about their use since recent trials have shown safety concerns about VTEs, MACE and malignancies. Methods We decided to study use of JAKi at our centre in Princess of Wales Hospital Bridgend. The aim was to assess whether appropriate patients were selected (considering cautions about MACE, VTEs and malignancies). We also wanted to see whether all patients had required pretreatment safety testing and post-treatment monitoring performed. Results These were 70 patients;59 were females and 11 were males. All of them were diagnosed as RA. Average age was 61.1 years (20-85), average duration of disease 129.9 months (16-340) and average duration of treatment was 58.1 weeks. The most common JAKi being used was baricitinib (84%) followed by tofacitinib (12%) and upadacitinib (4%). 50% patient were on concomitant csDMARDs among whom two-thirds were on methotrexate. Looking at previous biologic use, 9 patients were biologic naive, 22 had one biologic, 15 had two biologics used in the past. All patients were appropriately selected (severe RA and no significant risk factors for MACE, VTEs and malignancies). All patients had pre-treatment Hepatitis B, Hepatitis C, latent TB, FBC and LFTs checked. All patients had FBC and LFTs monitored post treatment. No patient developed VTE, MACE or cancer on treatment. 84.2% patients had lipids tested before starting JAKi. 22.8% patients had abnormal lipids before Rx initiation and 62.5% of these were on lipid lowering Rx. All patients had lipids tested post treatment, but the timing was quite variable and only 62.5% of patients had lipids tested on the recommended time. There were 2 deaths recorded in this cohort. One of those was an 80-year-old RA patient on baricitinib 2mg OD, who died due to chest infection on the background of ILD. He was not on steroids or csDMARDs. The second patient was 63 years' old (on baricitinib 4mg OD), and died due to respiratory sepsis, and was also on azathioprine. She had RA with advanced ILD. The reasons for discontinuing JAKi were inefficacy (46%), side effects (39%) and both inefficacy and side effects (15%). 41.4%of patient experienced side effects due to JAKi. These included infection 28%, deranged lipids 17%, cytopenia 14%, deranged LFTs 14%, GI side effects 10%, skin rash 7% and varicella zoster 3%. Conclusion There has been steady increase in the use of tsDMARDs for RA and other rheumatic conditions. Due to short half-life, these drugs became a popular choice during COVID-19 pandemic but on the other hand safety monitoring became extremely challenging during this time.