The Earthquake Disaster in Turkiye: A Review from Child and Adolescent Psychiatry Perspective

The earthquake has long-lasting various mental and behavioral effects on children and adolescents. The aim of this review was to discuss the nature and extent of psychiatric problems, management options, and the process of organizing psychological interventions for affected children. Individuals show a range of physically, emotionally, and cognitively healthy responses that can help them cope with the aftermath of a disaster. Psychiatric symptoms such as acute stress reactions, post-traumatic stress disorder, depression, anxiety disorder, increased risk of suicide, sleep disorders, substance use disorders, and psychotic disorders may develop in some children. Comorbidities and sub-clinical syndromes are also common. There are many risk factors and protective factors in the development of mental disorders. Close follow-up of children at high risk and interventions for psychosocial support may prevent the development of mental disorders. It is very important to start the intervention at the earliest period. The psychological impacts of young disaster victims can be addressed by skilled local volunteers, medical professionals, and educators in primary health care programs. With the nation's overall social and economic recovery, children can recover more quickly from traumatic experiences.Copyright © 2023, Duzce University Medical School. All rights reserved.

The Care Situation of Children and Adolescents with Obesity - Is a Disease Management Program (DMP) a Solution?

Obesity in childhood and adolescence is a growing public health problem, exacerbated by the COVID-19 pandemic. Multicomponent weight management programmes with a focus on nutrition, exercise, medical and psychosocial care, including parents over a period of 6 to 12 months, have shown the best evidence for treatment. However, there is still no comprehensive care for those affected. This is mainly due to inconsistent cost coverage by different responsibilities and health insurance companies. The development of a disease management programme (DMP) for obesity represents a possible step towards adequate care structures. In order to cope the special features of children and adolescents, a DMP for this age group should be designed in addition to a DMP for adults with obesity. In addition, this DMP Obesity in childhood and adolescence should be embedded in an overall concept, whichis patientcentred and meets the needs of those affected in terms of outpatient and inpatient measures. Additionally, innovative approaches such as community-based counselling centres are also desirable.Copyright © 2023 Georg Thieme Verlag. All rights reserved.

Study of Anxiety, stress and Depression Associated with Breastfeeding in COVID-positive Mothers of block Hazratbal, Kashmir

Background: Coronavirus disease-2019 (COVID-19) has rapidly disseminated worldwide, with a wide variety of clinical manifestations ranging from mild respiratory symptoms to severe pneumonia. Since then, there have been over 62300396 cases of COVID-19 infections worldwide, with 6550033 deaths. Coronavirus disease has presented the world to uncertainty and clinical dilemma with developing and constantly changing management guidelines and protocols. In the backdrop of this pandemic, it thus becomes crucial to study the effects of the infection on pregnancy, childbirth, and the postpartum period. In this study, we analyzed experiences of breastfeeding mothers during the COVID-19 pandemic, specifically concerning how COVID-positive status affected their infant's feeding decisions. Objective(s): To study anxiety, fear and depression associated with breastfeeding in coronavirus disease (COVID)-positive mothers. Method(s): The following DASS scale was used to measure depression anxiety, and stress of coronavirus disease-2019 (COVID-19) among postpartum women along with a self-made breastfeeding questionnaire to assess the association with breastfeeding. Result(s): Among the total of 77 respondents, 13% showed symptoms of depression, 16% anxiety and 9% stress. The breastfeeding questionnaire suggested that most women are afraid of transmitting the infection to their newborns and they lack the knowledge about the importance of breast milk in warding off other infections. Also, women found it difficult to take care of their newborns on their own. Conclusion(s): With this study, we could determine the effects of this pandemic on anxiety depression, and stress levels of COVID infection in postpartum women. It clearly showed that being COVID positive created, affected, and exacerbated mental health issues for mothers. So, there is an urgent need to provide emotional and psychosocial support to this group of the population during the crisis. Otherwise, the adverse outcome is possible involving both mother and newborn.

They Live in an Isolation Chamber: Medicare Fails the Depressed Homebound Elderly

There is significant literature on the existence and adverse effects of social isolation and depression among the elderly, exacerbated by the recent COVID-19 pandemic. A literature review indicates no studies of how the Medicare home health benefit addresses social isolation and depression, including no studies of home care social workers' perceptions of the nature and consequences of Medicare coverage. This article summarizes an initial, exploratory study to address the literature gap, based on interviews of a convenience sample of 44 home care social workers from 5 different home health agencies in the New York City metropolitan area between November 1, 2021 and May 31, 2022. Six themes emerged from the study. Social workers believe: (1) extensive social isolation and depression exist among Medicare home health beneficiaries;(2) Medicare home health policy provides no systematic measure to detect or monitor social isolation and a limited measure for depression among the homebound elderly;(3) Medicare home health policy provides no coverage to treat either depression or social isolation;(4) effective interventions are available to prevent and treat depression and social isolation. Social workers also believe that: (5) the lack of social isolation and depression coverage results in additional mental and physical health conditions;(6) lack of social isolation and depression coverage exacerbates existing mental and physical health conditions. Policymakers are urged to modify the Medicare home health benefit to improve detection and monitoring of social isolation and depression as well as coverage of appropriate evidence-based preventative and treatment interventions. [ FROM AUTHOR] Copyright of Home Health Care Management & Practice is the property of Sage Publications Inc. 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.)

Trends in Palliative Care Consultations in COVID-19 Patients Over Course of Pandemic (Sci257)

Outcomes: 1. Compare characteristics and clinical outcomes of inpatients with COVID receiving palliative care consultation (PCC) versus those who did not. 2. Elucidate evolution of PCC interventions over trajectory of successive COVID surges. Background/objectives: Palliative care (PC) teams have played an integral role in the care of critically ill patients hospitalized with COVID-19. This study describes how an inpatient, hands-on palliative care team adapted as the viral characteristics of the disease evolved. Method(s): Retrospective chart review of 2,879 patients, hospitalized with a primary diagnosis of COVID-19, at a large, urban academic hospital in Washington, DC from March 2020 through March 2022. Data was collected on baseline demographics, clinical characteristics, hospital course, and palliative care consultations (PCCs). Results were compared between patients receiving PCCs and those who did not. Trends in results were studied across the region's three surge periods, "Initial" (March 2020 to June 2020), "Delta" (November 2020 to April 2021), and "Omicron" (December 2021 to January 2022). Result(s): In-hospital mortality declined over the Initial, Delta, and Omicron surges with mortality rates of 17.5% (n=137), 13.6% (n=121), and 11.2% (n=62), respectively. ICU admission rates declined, with 21.6% (n=169), 21.3% (n=189) and 17.0% (n=94) for each of the surges. 393 (13.7%) patients received a PCC, with consult rates of 12.7%, 12.1%, and 14.3% for each surge, respectively. In-hospital mortality for PCC patients was 47.8% (41.1%, 51.2%, 40.9% by surge) vs. 9.3% for non-PCC (14.2%, 7.3%, 5.6%). Majority of PCC patients had COPD in Initial (87.4%, n=83) and Delta (93.7%, n=119) surges (14.8%, n=13 for Omicron). As hospital staff became acclimated to the pandemic and the sense of urgency declined, the days to PCC increased (7.1, 8.8, 10.1 days, respectively). During the Initial surge, the primary PCC interventions were for symptom management (28.5%, n=290), psychosocial support (18.9%, n=193), and goals of care (14.9%, n=152). Psychosocial support (13.5%, n=172) and goals-of-care (6.3%, n=80) interventions declined during the less acute Omicron surge (13.5%, n=172), while symptom management increased (38.2%, n=488). Conclusion(s): The demographic profile and viral characteristics of COVID-19 patients changed over the course of the pandemic, impacting both patient outcomes and palliative care's interdisciplinary response to the needs of patients and families.Copyright © 2023

How COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019-2020 Africa Cancer Research and Control ECHO

Background: The COVID-19 related mitigation measures adversely affected various cancer control activities in Africa, with cancer prevention and screening activities amongst the most significantly impacted. When the COVID-19 pandemic struck, the Africa Cancer Research and Control ECHO utilised their virtual platform to share experiences and knowledge of how to continue cancer service delivery during the pandemic. This analysis describes the evolved strategies, dilemmas, and recommendations to strengthen the health systems for cancer control in Africa. Method(s): Eleven 1-hour-long sessions about the then newly emerging coronavirus infection and its impact on cancer control in Africa were held from April 2020 to August 2020, using Zoom. An average of 39 participants attended the sessions including scientists, clinicians, policymakers and global partners. Sessions were analysed thematically. Result(s): Most strategies to maintain cancer services during the COVID-19 pandemic centred around cancer treatment, with few strategies on maintaining cancer prevention services, early detection, palliative care and research services. The most mentioned challenge during the pandemic was fear of exposure to COVID-19 infection at the health facility during diagnosis, treatment or follow-up for cancer care. Other challenges were disruptions to service delivery, inaccessibility of cancer treatment, disruption of research activities and a lack of psychosocial support for COVID-19 related fear/anxiety. Significantly, this analysis shows that the COVID-19 related mitigation measures exacerbated existing predicaments in Africa, such as inadequate attention to cancer prevention strategies, psychosocial and palliative services and cancer research. The Africa Cancer ECHO recommends African countries to leverage the infrastructure developed in response to COVID-19 pandemic to strengthen the health system along the entire cancer control continuum. This calls for urgent action to develop and implement evidence-based frameworks and comprehensive National Cancer Control Plans that will withstand any future disruptions.Copyright © the authors;licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:// creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Trend of knowledge and attitude toward COVID-19 during 1st & 2nd wave of pandemic in pulmonary tuberculosis patients

Background: COVID-19 pandemic had led to varied psychological distress among Pulmonary Tuberculosis (PTB) patients. An early assessment of knowledge and attitude of the patient towards COVID-19 can aid us in their psychological counselling and healthy well-being during the ongoing treatment. Aims and objectives: To assess the knowledge and attitude towards COVID-19 of Pulmonary Tuberculosis patients during the pandemic. Method(s): This cross-sectional, hospital-based study included 361 PTB patients. A semi-structured pre-defined questionnaires (designed by D. Roy et al.,) using a non-probability snowball sampling technique was done to evaluate knowledge and attitude related to COVID-19 in PTB patients. Result(s): Among the 361 of the Pulmonary Tuberculosis patients, 69% (n=250) had Drug Resistance PTB (DR-TB). Younger age group, 18 to 30 years constituted majority of the study subjects i.e.,61% (n=220). With the help of Likert scaling the trend of knowledge and attitude of COVID-19 in PTB patients were analysed. In our study most of the patients was well versed about COVID-19 pandemic and showed peak of favourable response during the 1st wave (from May 2020- July 2020) and in the initiation of 2nd wave (from March 2021-April 2021). Among DR-TB patients 51% (n=126) had satisfactory knowledge about COVID-19 pandemic. About 52%(n=130) of DR-TB patients had optimistic attitude toward COVID-19. Conclusion(s): As PTB, itself is a devastating disease, proper management & psychosocial support of such patients should be one of the prime issues. It can also assist us to formulate mitigation protocol in our near future.

Purview of teleconsultation during COVID- 19 pandemic

Introduction: Telehealth is 'the delivery and facilitation of health and health-related services including medical care, provider and patient education, via telecommunications'. Because of apprehension and statutory issues its use were limited. This study provides clinical profile of the patients who availed teleconsultation and we discuss the experience at our center. Method(s): A retrospective, descriptive study among 400 patients between the age group of 10-70 years, who took appointment for teleconsultation through online based platform from 1st June 2020 to 31st June 2021. Patient healthcare was provided based on Telemedicine Practice Guidelines by Medical Council of India. We also correlated data with the covid waves. Result(s): 88% of the study population was having one or more symptoms, among which fever was the most common (43%) followed by sore throat and rhinorrhoea. 65% were either COVID suspect or COVID positive. During the peak of first (July-September 2020) and second wave (April-May 2021) of COVID-19, number of COVID suspects and positive population was also high, while flu like symptoms and anxiety brought the patients for consultation during remaining time period. We were further able to review reports or any queries via email. Conclusion(s): Teleconsultation is helpful not only for triage of mild- moderate COVID cases but also their treatment, education, psychosocial support avoiding risk of spread to others, avoiding travel, thus beneficial to both patients and healthcare workers. Home based advise, investigations is possible and it provides an ideal channel. We were also effectively able to time the consultations to cater to non stop appointments with minimal staff involvement.

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).

Approaches of patients to health care before and during the COVID-19 pandemic

Aim: In the present study, the aim is to determine the approaches of patients to healthcare services before and during the pandemic by comparing the rates of outpatient admissions and hospitalizations to Selcuk University Medical Faculty Hospital throughout the present study. Material(s) and Method(s): The present study is a retrospective, descriptive study. Patients diagnosed with COVID were admitted to Selcuk University Medical Faculty Hospital on March 5, 2020. During the pandemic, no patients diagnosed with COVID were admitted to the adult cardiology, neurology, internal medicine, psychiatry, emergency, general surgery and pediatric emergency, pediatric psychiatry, pediatrics and pediatric surgery polyclinics and services. Hence, these clinics were included in the study. In the study, patients' data who applied to the relevant clinics of Selcuk University Medical Faculty Hospital or were hospitalized in the relevant clinics, including the years 2019, 2020 and 2021, were examined as pre-pandemic (2019) and pandemic period (2020, 2021) quarterly. The parameters of the present study were the pre-pandemic and pandemic period. The data obtained in the study were evaluated with descriptive statistics (as frequency and percentage). Result(s): In the first year of the pandemic, it was determined that both the number of outpatient clinic referrals and hospitalizations to the relevant clinics decreased significantly. Although the impact of epidemic diseases, emerging throughout human history has decreased, the risk they carry is systematically exaggerated, and the fears of the public fueled constantly by the media. Discussion(s): Unfortunately, this fear in society was also reflected in hospital admissions. Therefore, to manage medical services correctly during pandemics, planned and organized psychosocial support services are needed to preserve the mental health of the community as well as to enable appropriate medical interventions.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Meaningful interactions of alcoholic men in times of the COVID-19 pandemic

This study aimed to understand the meaningful attitudes of alcoholic men and their expressions of feelings in the face of family and community interactions in times of the COVID-19 pandemic. This is a qualitative, descriptive, exploratory study, based on the Oral History of Life method. The participants of this study were five men who experience alcoholism, living in a municipality in the state of Bahia, accompanied by the Psychosocial Care Center for alcohol and other drugs. A semi-structured interview was used to collect information, from March to April 2021, through videoconferences through the Google Meet Digital Platform. The content of the oral reports was analyzed using a content analysis technique. It was observed that the significant attitudes of the alcoholic man were impacted by the unfolding of the pandemic, mainly due to the adoption of sanitary measures, such as social distancing. Some expressions of feelings were also identified of these men facing family and community interactions during the pandemic, such as fear, distrust, and affective insecurity, and social exclusion, in addition to expressions such as faith, gratitude, and hope. The participants' discourses expressed attitudes of changes in social life and habits during this pandemic period, including the use of masks and gel alcohol in addition to the decrease in alcohol consumption for most of them. Therefore, the symbolic interactions arising from the pandemic scenario promoted protective attitudes that encompass self-care and collective care, in addition to interactions marked by family conflicts. © 2022 Centro Universitario Sao Camilo. All rights reserved.

Allocating resources in cancer care during pandemic. Findings from a qualitative interview study with oncologists and ethical analysis

Background: Allocation of resources towards the treatment of patients with Sars-CoV-2 may affect the quality of care of cancer patients. Medical societies have issued statements on priority setting in cancer care in the wake of the Sars-CoV-2 outbreak (1). However, there is a lack of empirical data on how resources are prioritized and which criteria these decisions are mainly based on by those involved in decision making. Method(s): 15 semi-structured interviews were conducted with oncologists in Germany between February and July 2021. Transcripts are analysed following principles of qualitative content analysis based on Kuckartz (2). Result(s): According to preliminary analysis three main topics emerge: 1. Experiences with scarcity regarding specific diagnostic procedures and treatment 2. Effects of priority setting on coping and psycho-social support 3. Criteria for priority setting and decisions on deviations of standards of care. Reported criteria could be further distinguished into three subcategories: a) criteria related to the health condition of the patient (e.g. diagnosis, urgency of the procedure), b) pandemic-related organizational issues (e.g. hygiene requirements), c) systemic aspects not related to the pandemic (e.g. priorisation of well-paid interventions). Discussion(s): Our data indicate that pandemic-related organizational issues influenced priority setting, which needs to be addressed. Furthermore, interviewees agree in posteriorising palliative and follow up care, which needs to be discussed regarding possible negative side effects. Conclusion(s): Data will be interpreted focussing on the possible contribution to an informed guidance for priority setting regarding cancer care in times of pandemic.

The psychosocial situation of families caring for children with rare diseases during the COVID-19 pandemic: results of a cross-sectional online survey.

BACKGROUND: The COVID-19 pandemic is affecting many areas of life and has posed additional strains on the highly vulnerable group of caregivers of children with rare diseases (RDs). The psychosocial situation of the family caregivers deserves more attention, both in research and practice. The current study explores the distress level of caregivers of children with RDs, their psychosocial information needs, and caregiver-reported health-related quality of life (HRQoL) of children with RDs in times of the COVID-19 pandemic. METHODS: Data from a cross-sectional online survey conducted within the German CARE-FAM-NET project (children affected by rare diseases and their families-network) between March and August 2020 were examined. The study sample included 149 family caregivers, mostly mothers (83.2%) of 167 children with RDs. The survey assessed demographic and disease-related characteristics, distress and everyday problems of caregivers (Distress Thermometer for Parents; scale 0-10), psychosocial information needs (self-developed items; scale 0-100), and caregiver-reported HRQoL of the children with RDs (DISABKIDS Chronic Generic Measure, short-form; scale 0-100). Using descriptive statistics, we analyzed the psychosocial situation of families during the COVID-19 pandemic. We further conducted correlation analysis to investigate interrelations. RESULTS: The distress level among caregivers was high (M = 6.84, SD = 2.43); 89.6% reported clinical distress (≥ 4). Everyday problems (e.g., sleep problems, fatigue, being out of shape, fears, feeling tense or nervous, and worry) were frequent. Caregivers reported a wide range of psychosocial information needs. In about half of the children (49.5%), caregiver-reported HRQoL was low, while average HRQoL (M = 58.7, SD = 19.5) was comparable to parent-reported norm data of children with severe clinical conditions. Distress correlated positively with psychosocial information needs (r = 0.40), and negatively with the caregiver-reported HRQoL of the children (r = - 0.46). CONCLUSIONS: This study indicates a high psychosocial burden on family caregivers of children with RDs during the early COVID-19 pandemic, characterized by high distress levels and wide-ranging everyday problems, unmet psychosocial information needs, and reduced caregiver-reported HRQoL in children with RDs. The findings highlight the ongoing need for target group-specific, low-threshold support services (e.g., websites) during and after the pandemic.

Paralization and online adaptation of an ongoing clinical trial in La Paz University Hospital (Madrid, Spain) during the COVID-19 worldwide pandemic

Introduction: Spain went into lockdown in March of 2020 due to the COVID-19 outbreak. We had to stop the third randomization of our ongoing clinical trial (Mediavilla et al., 2019), pausing weekly group psychotherapy for 12 people with a first episode of psychosis. Only 5 weekly sessions had been delivered, thus many were just starting to form a therapeutic link with the group. In a public health emergency context, psychotherapeutic groups are considered avoidable gatherings. However, stopping psychological therapy abruptly can make participants more vulnerable. The intervention groups were launched in an online format because we could not let anyone go without psychological support in such a difficult time. Objective(s): Communicate how we adapted an ongoing clinical trial to an online format during the lockdown in Spain. Method(s): In light of our participants' needs and their acute deterioration the first two weeks of lockdown, we adapted our intervention. First, both arms (mindfulness-based v. psychoeducational multicomponent intervention) began online adaptations of the interventions. Second, a research assistant made weekly phone calls to provide basic psychosocial support, assure participants groups would continue, and later remind them of each online session. Third and last, the phoneline was accessible 24/7 (WhatsApp). Result(s): The third randomization concluded in December. Six participants were lost in the transition to online groups. However, adherence was comparable to the previous two randomizations (4/12 completed the intervention). Conclusion(s): Online psychotherapy may be used in emergencies such as a lockdown. However, the psychological mid- and longterm effects of a lockdown and online group therapy remain unknown.

Healthcare workers' knowledge and management skills of psychosocial and mental health needs and priorities of individuals with COVID-19

Introduction: Individuals confirmed with COVID-19 were isolated or treated in medical and well-designated units;however, such a situation probably causing psychological and mental health problems that require prompt intervention. Objective(s): The purpose of this study was to identify the knowledge and management of healthcare workers regarding psychosocial and mental health priorities and needs of individuals with COVID-19. Method(s): This is a cross-sectional descriptive study. The data collected conveniently at one single point in time from 101 healthcare workers in Jordan directly managing the health of individuals with COVID-19. Result(s): healthcare workers have moderate to a high level of knowledge of psychological distress related to COVID-19;mean ranged from 50-70% agreement and confidence. Healthcare workers had moderate to a high level of management of psychosocial and mental health needs. In general, healthcare workers were able to identify mental and psychosocial health needs and priorities at a moderate level. Healthcare workers' knowledge had a positive and significant correlation with age (r = .24, p = .012) and years of experience (r = .28, p =.004), and a significant difference was found in their management towards using mental and psychosocial care between those who are trained on psychological first aids and those who are not (t = - 3.11, p = .003). Conclusion(s): there is a need to train healthcare workers to integrate psychosocial and mental health care while managing psychological distress related to COVID-19.

Use of mobile medical teams to fill critical gaps in health service delivery in complex humanitarian settings, 2017-2020: a case study of South Sudan.

The vulnerable populations in the protracted humanitarian crisis in South Sudan are faced with constrained access to health services and frequent disease outbreaks. Here, we describe the experiences of emergency mobile medical teams (eMMT) assembled by the World Health Organization (WHO) South Sudan to respond to public health emergencies. Interventions: the eMMTs, multidisciplinary teams based at national, state and county levels, are rapidly deployed to conduct rapid assessments, outbreak investigations, and initiate public health response during acute emergencies. The eMMTs were deployed to locations affected by flooding, conflicts, famine, and disease outbreaks. We reviewed records of deployment reports, outreach and campaign registers, and analyzed the key achievements of the eMMTs for 2017 through 2020. Achievements: the eMMTs investigated disease outbreaks including cholera, measles, Rift Valley fever and coronavirus disease (COVID-19) in 13 counties, conducted mobile outreaches in emergency locations in 38 counties (320,988 consultations conducted), trained 550 healthcare workers including rapid response teams, and supported reactive measles vaccination campaigns in seven counties [148,726, (72-125%) under-5-year-old children vaccinated] and reactive oral cholera vaccination campaigns in four counties (355,790 vaccinated). The eMMT is relevant in humanitarian settings and can reduce excess morbidity and mortality and fill gaps that routine health facilities and health partners could not bridge. However, the scope of the services offered needs to be broadened to include mental and psychosocial care and a strategy for ensuring continuity of vaccination services and management of chronic conditions after the mobile outreach is instituted.

Implementation of a Dedicated Social Worker/Coach for Emergency Medicine (EM) Residents

Learning Objectives: The pandemic exposed the mismatch between trainee mental health needs and their access to support services;therefore, the objective of our innovation was to support an opportunity for residents to work with a social worker/coach who could provide coaching on an emergent, urgent, or regular basis. Introduction/Background: EM training requires sleep-wake disruptions, includes potentially traumatizing encounters, all during the COVID-19 pandemic while many residents relocate away from their customary psychosocial supports for training. The shift-based training model limits access to psychosocial care and services, so trainees need just-in-time resources which can support them before mental health concerns develop. Educational Objectives: The objective of our innovation was to support an opportunity for our residents to work with a professional social worker who could provide coaching on an emergent, urgent, or regular basis. Curricular Design: The leadership team identified a clinical social worker and trained coach to provide small group and individual coaching sessions to residents (4-year urban safety-net program with 68 residents) budgeted at an initial cost of $15,000. It was agreed that what was shared in the discussion would not be shared without consent and legal limits to confidentiality were followed. Impact: From October 1, 2020 when implemented to October 1, 2021 there were 49 group and 73 individual sessions. After implementation in 2021, we compared this rotational mean score as ranked by all residents to all other wellness initiatives. Overall response rate was 80.88%. The overall mean score of the initiative was 2.25 (1-lowest and 4-highest) versus 3.73, the mean of all other wellness initiatives. Summary comments from the residents revealed the innovation was useful but shared concern regarding ability to attend sessions and capacity of social worker to relate with them. If other programs are considering implementation of a similar program recruiting someone with ED/graduate medical education experience or making sure they are oriented is key. Application of a social worker coaching program in an EM residency appears to be a feasible novel wellness intervention with potential to improve well-being, but needs framing to benefit trainees.

Legislative framework and policies for mental health in india: A study of emerging trends

Mental health issues impose an enormous disease burden on societies across the world. Despite its enormous social burden, mental disorders continue to be driven into the shadows by stigma, prejudice and fear. The issue is becoming ever more urgent in light of the forced migration and sustained conflict in many countries of the world. The status of mental health care varies widely from country to country. Many countries already have policies to deliver services for mental health conditions in primary care settings but require system strengthening to achieve integration. Many countries deliver care mainly in institutional settings and need dedicated advocacy and support in phasing out long-stay institutions and developing community-based alternatives. Some countries may require support for policy development or to implement mental health reform efforts. Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID-19 response plans, but major gaps and concerns remain.For much of the pandemic, services for mental, neurological and substance use conditions were the most disrupted among all essential health services reported by WHO Member States. Many countries also reported major disruptions in life-saving services for mental health, including for suicide prevention. Various legislative provisions and Policies have been formulated. Post pandemic, the government of India paid more attention to the concern of mental health and introduced initiatives hitting the target areas. World Health Organization’s most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health and many low-income countries reported having fewer than one mental health worker per 100000 people. The addition of National Tele Mental Health Programme will bridge the critical gap and make the whole digital health ecosystem holistic. Respecting the rights of persons with mental health problems will reduce stigmatizing and discriminatory behaviours.

Quality of Life of Myasthenia Gravis Patients During COVID-19 Pandemic - One Year Follow Up

Purpose: The coronavirus disease 2019 (COVID-19) is the largest pandemic of our times. Pandemics are severe stressors to vulnerable groups (such as patients with chronic diseases) and this highly contagious disease exerts considerable impacts on mental health. We wanted to investigate the possible impact of COVID-19 pandemic on the quality of life (QoL) of myasthenia gravis (MG) patients and potential changes during the period of one year. Methods: Data on the epidemiological and clinical characteristics of MG was collected. We used a selfdesigned questionnaire (consisting of 12 questions), a revised 15-item Myasthenia Gravis Quality of Life Questionnaire (MGQOL15r), a 36-item health survey of the Medical Outcomes Study Short Form (SF36), Hamilton scales for the assessment of anxiety (HAM-A) and depression (HAMD) were used. The actual severity of the clinical manifestation was estimated using MG activities of daily life (MGADL). We reassessed patients in April and May 2021, who were tested during April 2020 using the same questionnaires. Results: The study included 57 adult MG patients. We noticed a statistically significant difference between the results obtained at these two time points regarding scores on MGQOL15r (p<0.05). The obtained scores were significantly better in 2021. Some scores on SF-36 subscales were also better in 2021 than in 2020 (such as social functioning, emotional well-being, role limitation due to emotional problems) (p<0.05). MGQOL15r and SF36 scores correlate with severe clinical manifestation, high scores on HAM-A and HAM-D (p<0.01). Higher scores on HAM-D and fear that MG symptoms will be worse if the patient gets an upper respiratory infection were independent predictors of the lower SF36 scores. Regarding MGQOL15r independent predictors of the higher score were higher scores on HAM-D. Conclusions: QoL of myasthenia gravis patients improved during the pandemic. It is important for healthcare workers to provide professional therapeutic advice and psychosocial support for this population of patients during the pandemic. eP01.04.07 COVID Spike Antibodies in Neuromuscular Conditions: A KU Experience Pasnoor M1, Tajuddin A1, Jawdat O1, Farmakidis C1, Jabari D1, Heim A1, Higgs K1, Dimachkie M1 1The University of Kansas Medical Center, Kansas City, United States Background: Little is known about the immune response to COVID vaccination in immune suppressed neuromusuclar patients. Multiple studies showed variable data regarding the effect of immunosuppression on the immune response to the vaccination. Objective: To evaluate the COVID spike antibody levels in patients with various neuromuscular conditions who received vaccination and assess the effect of immunosuppressive therapies on antibody levels. Method: We performed a retrospective chart review of patients in neuromuscular clinic who had COVID antibody testing. We collected demographic, clinical, diagnostic and treatment information. Descriptive statistics was performed on the data obtained. Results: The total number of patients enrolled in the study were129, 64 male and 65 female . The mean age of the patients enrolled was 64.82 ±14.50 and the mean duration of antibody acquisition since date of last vaccination dose was 172 days. The number of patients on immunosuppressive therapies was 88(68.2%), 47(53.41%) had high antibody titer (>250), 31(35.23%) had low antibody titer (0.4- 250), 9(10.23%) had undetected antibody titer (<0.4) and 1 (1.1%) had detected unmeasured titer. Immunosuppressive therapies included steroids, methotrexate, azathioprine, myophenolate mofetil, eculizumab, efgartigimod, intravenous immunoglobulin and rituximab. The other group of patients who were not on immunosuppressive medication were 41 (31.8%) , 28 (68.29%) showed high antibody titer (>250), 9(21.95%) showed low antibody titer (0.4-250) , 1(2.44%) showed undetected titer (>0.4) and 3(7.32%) had detected unmeasured titer. 50% of patient who were on rituximab showed undetected antibody titer and 60% of patients who received eculizumab had low antibody titer. 4 % of patients on immunosuppressive drugs did not develop adequate spike antibodies levels to vaccination, compared to 24% on no immunosuppressive therapies. Conclusions: Our study reveals modest impact of immunosuppression on COVID spike antibody titer. While this finding is limited by small number of patients and heterogeneity in therapies, age and interval between vaccination and antibody testing, our finding supports the importance of booster vaccine in this patient population.

Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions.

OBJECTIVE: Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care. DESIGN: Observational, cross-sectional. SETTING AND PARTICIPANTS: A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021. METHODS: We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v. 28. RESULTS: Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ2 (1) = 5.206, P = .022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (ß = -0.037; SE = 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions. CONCLUSIONS AND IMPLICATIONS: Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions.