The sense of loneliness in couples and the impact of the health crisis: A review of literature

Objective: The purpose of this review is to define the feeling of loneliness within a couple while taking into consideration the factors that lead a person to feel lonely in a couple or in a romantic relationship. Our goal is to understand the effects of the feeling of loneliness on these individuals during the global health crisis brought on by COVID-19 and to take these factors into account in designing effective therapeutic care. The different manifestations of loneliness in a couple should also be highlighted. Method(s): We used the PRISMA methodology to select the relevant studies. The keywords ("Solitude" or "Loneliness") and ("Couple" or "Married" or "Partnership") allowed us to select 19 references dealing with the theme. We conducted searches of the following databases: "Cairn", "PsychInfo and Psycarticle", "PubMed and Medline", "ScienceDirect" and finally, "Web of Science" in order to find articles covering a ten-year period. Result(s): There are different definitions for the subjective experience of loneliness. The review of the literature highlights the fact that loneliness can lead to positive or negative psychological consequences (it can lead to the development of creative capacity or, on the contrary, result in depression in some cases). Attachment patterns have been shown to be the basis for the tolerance of feelings of loneliness. Indeed, an anxious attachment would encourage the couple to avoid the feeling of loneliness. According to the literature, this defensive mechanism of seeking presence in the couple would make it possible to limit the impact of loneliness. This solitude depends on the level of relational quality within the couple. A poor relational quality would lead to greater loneliness and would impact intimate relationships. Loneliness is supposedly not experienced in the same way by men and women: Men seem to be more protected by marriage while women's level of loneliness may be higher because of the household chores they have to do. Men and women would nevertheless remain subject to the phenomena of contamination, i.e., when one of the partners feels lonely, the other will also be lonely. However, it seems that marriage protects against feelings of loneliness and its negative consequences. Loneliness does not have only negative effects. It can be beneficial for developing creativity and finding oneself. The periods of confinement during the COVID-19 crisis provided people with an increase in the amount of time they didn't normally have on a daily basis. This may have been beneficial for some people and can be associated with positive emotions. Individuals who spent the lockdowns with others felt less alone and experienced less psychological distress. However, confinements did produce some negative effects on couples. The increased stress of the pandemic and the constant proximity led to an increase in spousal abuse. The consequences of confinement for couples whose relationships were already troubled resulted in frequent separation and/or divorce. The potential for conflict was related to limited financial resources, not working, and the significant risk of contracting SARS COV-2. Conclusion(s): The articles dealing with the feeling of loneliness that we reviewed presented quantitative methods to the detriment of qualitative aspects and focused largely on the negative aspects of the feeling of loneliness. Other academic disciplines, such as sociology, demonstrate a lack of understanding concerning what is at stake with the feeling of loneliness. The articles intersect and tend to highlight the attachment relationships that are formed in childhood as a determining factor in the feeling of solitude later in life. The quality of the relationship, gender, and marital status are also factors to be considered. Loneliness has a clear influence on the well-being of the relationship but it is not an individual characteristic of the relationship itself. It finally appears as an individual characteristic with an impact on the assessment of the quality of the relationship and on the appreciatio of the spouse.Copyright © 2023 Elsevier Masson SAS

Cystic fibrosis legal information hotline: A reliable resource for the cystic fibrosis community during the pandemic and beyond

Background: The Cystic Fibrosis Legal Information Hotline (CFLIH) provides information on legal issues affecting people with cystic fibrosis (CF). Since 1998, it has provided the CF community with confidential information on health insurance, Social Security, employment, and education. Method(s): The CFLIH tracks each call according to the age of the person with CF, the caller's relationship to the person with CF, and the subject matter of the call. Result(s): The CFLIH received 10 870 calls in 2021;63% were related to a person with CF aged 18 and older and 37% to a child younger than 18;55% were from a person with CF, 7% more than in 2020;and 22% of calls came from CF centers. Of the 2444 calls from CF centers, 95% were from nonphysician staff and 5% from physicians. Twenty-two percent were from a parent of a person with CF, and 1% of callers were the spouse or someone with another relationship to the person with CF. Fifty-seven percent of calls were related to Social Security benefits, 9% more than in 2020. These calls were evenly divided between Supplemental Security Income and Social Security Disability Insurance. Sixteen percent of calls were related to benefits and coverage under a private or public health benefit plan: 34% of these related to private health benefit plans and 66% related to public health benefit plans. Of the public benefit plans, 53% related to Medicare and 47% to Medicaid. Nine percent of calls were related to CF in primary, secondary, and higher education, 22% more than in 2020, and 18% were related to employment. Conclusion(s): Total calls in 2021 stabilized after a record high of 13 405 in 2020. The surge in calls that began in 2020 was driven by problems caused by the COVID-19 pandemic and continued into 2021. Calls in 2021 exceeded pre-pandemic levels. In 2021, calls related to Social Security were 9% higher than in 2020. The increase in Social Security calls is attributed to persons with CF becoming unable to work because of the progression of CF symptoms, many of whom are not eligible for CF transmembrane conductance regulator (CFTR) modulator therapy. Calls also increased from those whose health had improved with CFTR modulator therapy who sought information about maintaining Social Security or health insurance while returning to work. The increase in Social Security calls is also attributed to an increase in the number of Social Security beneficiaries undergoing reviews of their disability status by the Social Security Administration. Employment calls continued to be higher than pre-pandemic levels. Remote work during the pandemic tended to help workers with CF maintain employment. Return to in-person work raised concerns about workplace safety, reasonable accommodations, and other workplace issues. Loss of employment with reasonable accommodations for CF was a common experience. The CFLIH increased health equity by helping maintain health coverage for vulnerable members of the CF community, which avoids disruptions in coverage and care. During the global COVID-19 pandemic, the CFLIH continues to be a reliable source of information in obtaining Social Security benefits, health insurance, employment, and safe access to educationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Self-care Neglect Of Heart Failure Caregivers Before And Early After The Pandemic Began

Behavioral benefits of the COVID lockdown have been suggested for patients with heart failure (HF) but little is known about the effects of the pandemic on the family and loved ones who care for these patients. The purpose of this study was to compare self-reported self-care neglect among HF caregivers in the months preceding the pandemic (August 2019 through March 2020) to the self-care neglect reported by HF caregivers in the early months of the pandemic (May 2020 through December 2020). Method(s): Baseline data from an ongoing study with HF caregivers were used for this analysis. All potentially eligible caregivers are screened for self-care neglect;those who score >=2 on the 10-item Health Self-Care Neglect scale (construct validity, alpha reliability.90) are eligible for study enrollment. Possible scores range from 0-10;lower is better. Baseline data before randomization were used for this analysis. Before the pandemic, 40 caregivers were enrolled. In the early months after the pandemic began, we enrolled another 55 caregivers. Participants' demographic and clinical characteristics were compared between groups. Regression analysis was used to identify group differences in self-care neglect, adjusting for group differences at baseline. Result(s): The sample of 95 HF caregivers was predominately White (64%), female (89.5%), spouses (66%), age 54.7 +/- 13.5 years, and caregiving 9.2 +/- 8 hours/day. Only sex differed significantly between the groups;pre-pandemic the sample was 97.5% female but during the early months of the pandemic it was 83.6% female. Health Self-Care Neglect scores were higher (worse) pre-pandemic compared to the early months of the pandemic after accounting for sex (5.3 +/- 0.5 vs. 4.3 +/- 0.4, p=0.04). When individual items on the scale were analyzed, only the proportion of caregivers who put off going to the doctor significantly differed between pre-pandemic (62.5%) and early-pandemic (40%, p=0.03) groups. Conclusion(s): Health Self-care Neglect was higher in HF caregivers before the pandemic began. It may be that the pandemic encouraged caregivers to focus on their health.Copyright © 2022

Mpox first skin lesion location: A reflection of mode of transmission?

The 2022 mpox outbreak affected 84,318 individuals in 110 countries. Mpox is transmitted by multiple modalities, including direct contact, respiratory droplets, and fomites among others. Identifying skin lesions aids prompt diagnosis. Variation in initial skin lesion location is not well understood;it is hypothesized that mode of transmission may determine primary inoculation site and subsequent clinical presentation. This study sourced healthcare provider-reported data from the AAD/ILDS Dermatology COVID-19, Mpox, and Emerging Infections Registry to explore factors related to the location of the first skin lesion in mpox cases. Out 119 mpox cases,115 had primary lesion location data. 97% were male with a median age of 37. Most (83/115, 72%) patients had first skin lesions in the genito-anal area, and 32/115 (27%) had lesions elsewhere or had morbilliform rash. 74% of males had the first lesion in the genito-anal region compared to females (25%, p=0.03). Males in same-sex relationships had ano-genital lesions more often than men in other relationships (77% vs. 44%, p=0.03). The type of mpox exposure was also associated with first lesion location: 83% of patients who contracted mpox from a spouse or other sexual contact had ano-genital lesions as compared to a non-sexual contact (0%, p=<0.01). This analysis characterized factors associated with the first mpox skin lesion location, which can aid healthcare providers in diagnosis and shed light on transmission. This data suggests that type of exposure and mode of transmission may be associated with primary lesion location;patients who contracted mpox from sexual contact were more likely to have ano-genital lesions.Copyright © 2023

Does social distancing make the heart grow fonder? The impact of work spouse interaction frequency on organizational outcomes

PurposeThe shift to remote work brought about by the COVID-19 pandemic dramatically limited spontaneous workplace interpersonal interactions. For one interpersonal relationship in particular, the work spouse, the sudden physical distance may impact the energy work spouses draw from one another. Drawing on interactional ritual theory, this study aims to investigate the relationship between interaction frequency and organizational outcomes mediated by relational energy amid the pandemic.Design/methodology/approachDuring the COVID-19 pandemic, working adults who indicated they had a work spouse were recruited via Qualtrics to participate in a two-part online study.FindingsComplete data from 120 participants across both time periods revealed that more frequent interaction between work spouses is associated with increased job satisfaction and affective commitment mediated by relational energy.Originality/valueThis study represents the first empirical examination of individual and organizational outcomes of a unique interpersonal workplace relationship. Additionally, this study enhances our understanding of the impact of relational energy in socially distanced situations between employees in a close, intimate (non-sexual) pair bond.

Military spouse well-being during the COVID-19 pandemic

Mindful of the unique challenges that military spouses face, including frequent moves, distance from family networks, long duty hours of the soldier, and multiple family separations due to training and deployments, the military has emphasized the enhancement of resilience through programs and support organizations and in empirical evaluations of resilience-related interventions. Though these programs offer many to foster resilience, little research has been conducted to identify the characteristics associated with resiliency among military spouses. Given the lack of research in this area and the continued need to study military spouses' resiliency, research aimed at identifying correlates of resilience among military spouses was needed to enhance understanding of their subjective well-being. Psychological resilience represents a process of adapting well in the face of adversity. Resilience is the ability to power through difficult time;however, it does not mean that a resilient individual does not feel stress as others do. The key difference is they manage their stress to keep it under control. Subjective well-being and resilience may counter stress related to a global pandemic. For this study, data was collected from an online survey completed by 597 military spouses of active-duty service members. Quantitative data included demographics and Likert-style items about perceived stress scale, military, and COVID-19. Qualitative data were collected from four open-ended question and analyzed thematically. Quantitative and qualitative findings were documented in the final analysis. A main finding was military spouses have higher-than-average levels of perceived stress. There were slightly higher average scores among the military services with Army, Air Force, and Coast Guard spouses. While Navy and Marine spouses were slightly below the high level of stress, they remained well above the average level of stress for a general population. No significant differences were found for race, gender, and socioeconomic status. Two primary themes evolved from the analysis of the open-ended question for contributors to stress: employment and loneliness and separation. Additionally, findings of the open-ended questions were the top resources that respondents used during COVID-19 were family and friends. The top resources highlighted that would have been helpful or needed were financial assistance and none. For the military lifestyle, the top support or resources needed are employment, housing, and medical security. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Understanding the Impact of COVID-19 on Chronic Lymphocytic Leukemia (CLL) Caregiving and Related Resource Needs.

Chronic lymphocytic leukemia (CLL) caregivers play a central role in disease management-a role that has been heightened during the COVID-19 pandemic given the healthcare system's reliance on frontline family caregivers and CLL patients' increased risk of infection and mortality. Using a mixed-method design, we investigated the impact of the pandemic on CLL caregivers (Aim 1) and their perceived resource needs (Aim 2): 575 CLL caregivers responded to an online survey; 12 spousal CLL caregivers were interviewed. Two open-ended survey items were thematically analyzed and compared with interview findings. Aim 1 results showed that two years into the pandemic, CLL caregivers continue to struggle with coping with distress, living in isolation, and losing in-person care opportunities. Caregivers described experiencing increasing caregiving burden, realizing the vaccine may not work or didn't work for their loved one with CLL, feeling cautiously hopeful about EVUSHELD, and dealing with unsupportive/skeptical individuals. Aim 2 results indicate that CLL caregivers needed reliable, ongoing information about COVID-19 risk, information about and access to vaccination, safety/precautionary measures, and monoclonal infusions. Findings illustrate ongoing challenges facing CLL caregivers and provide an agenda to better support the caregivers of this vulnerable population during the COVID-19 pandemic.

Military spouse well-being during the COVID-19 pandemic

Mindful of the unique challenges that military spouses face, including frequent moves, distance from family networks, long duty hours of the soldier, and multiple family separations due to training and deployments, the military has emphasized the enhancement of resilience through programs and support organizations and in empirical evaluations of resilience-related interventions. Though these programs offer many to foster resilience, little research has been conducted to identify the characteristics associated with resiliency among military spouses. Given the lack of research in this area and the continued need to study military spouses' resiliency, research aimed at identifying correlates of resilience among military spouses was needed to enhance understanding of their subjective well-being. Psychological resilience represents a process of adapting well in the face of adversity. Resilience is the ability to power through difficult time;however, it does not mean that a resilient individual does not feel stress as others do. The key difference is they manage their stress to keep it under control. Subjective well-being and resilience may counter stress related to a global pandemic. For this study, data was collected from an online survey completed by 597 military spouses of active-duty service members. Quantitative data included demographics and Likert-style items about perceived stress scale, military, and COVID-19. Qualitative data were collected from four open-ended question and analyzed thematically. Quantitative and qualitative findings were documented in the final analysis. A main finding was military spouses have higher-than-average levels of perceived stress. There were slightly higher average scores among the military services with Army, Air Force, and Coast Guard spouses. While Navy and Marine spouses were slightly below the high level of stress, they remained well above the average level of stress for a general population. No significant differences were found for race, gender, and socioeconomic status. Two primary themes evolved from the analysis of the open-ended question for contributors to stress: employment and loneliness and separation. Additionally, findings of the open-ended questions were the top resources that respondents used during COVID-19 were family and friends. The top resources highlighted that would have been helpful or needed were financial assistance and none. For the military lifestyle, the top support or resources needed are employment, housing, and medical security. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Silver Linings: The Experience of Posttraumtic Growth in Neuro-Oncology Caregivers

BACKGROUND: Posttraumatic Growth (PTG) refers to positive psychological changes resulting from a traumatic event. A brain cancer diagnosis may be experienced as traumatic-not only for patients, but also for their caregivers. While caregivers in neuro-oncology consistently report significant emotional distress throughout the disease trajectory, their experience of PTG is unknown. METHOD(S): Cross-sectional data were obtained from patients (N = 101, Mage = 50 years, 59% female, 86% White, 47% high-grade) diagnosed with primary brain tumors and their caregivers (N = 62, Mage = 50 years, 79% female, 92% White, 58% spouses) during routine clinic visits or online following the precautions of COVID-19. Patients and caregivers completed the Post Traumatic Growth Inventory, where > 46 and > 3 represent the clinical cutoffs for high versus low PTG. We compared caregiver and patient PTG using descriptive statistics and independent samples t-test. RESULT(S): Caregivers' total PTG score was in the low range (M = 44.58, SD = 20.95) and significantly lower than patients' total PTG (M = 51.78, SD = 21.96, p = .04). All five of caregivers' subscale scores were also considered to be in the low range. Nevertheless, 45% of caregivers demonstrated moderate-to-high total PTG (compared to 67% of patients), and 65% reported moderate-to-high PTG in at least one subscale (compared to 85% of patients). Similar to patients, caregivers reported the most growth in Appreciation for Life (M = 2.98, SD = 1.05) and the least growth in New Possibilities (M = 1.71, SD = 1.17). CONCLUSION(S): Results mirror previous findings in neuro-oncology, where caregivers consistently demonstrate greater emotional distress than patients. The current study suggests caregivers may also experience fewer positive changes. Overall, caregivers would benefit from increased support to process traumatic experiences associated with the disease. Future research should continue to investigate predictors of PTG in this vulnerable sample.

Clear Gender Disparity in Living Donor Kidney Transplants

Purpose: Over the last years, the number of kidney transplants from living donors (LD) increased. However, more male than female patients received a LD transplant while increasing more females donated a kidney. Method(s): This study included all 109,038 primary adult living donor kidney transplants reported to UNOS/OPTN and performed between 2000 and 2021. To account for annual fluctuations, 2-year intervals were assessed. Comprehensive univariate and multivariate analyses were performed to describe changes and risk factors for female living donor kidneys transplants. Result(s): Figures 1 and 2 show the proportion of female donor and kidney recipients over time. Table 1 and 2 show the gender differences for donor and recipients. Women continued to donate more even during the COVID-19 years 2020/21. For female kidney recipients increased the relative disparity index constantly from 1.39 in 2000/01 to 1.75 in 2020/21. The likelihood for a woman to receive a LD kidney increased by not having diabetes as underlying disease, being Black , and having a high PRA level, and being not working;the likelihood decreased with increasing age and being on dialysis. almost 3 times more often donated female spouses a kidney. Conclusion(s): (1) the disparity of receiving a LDK has continued in favor of men;(2) the likelihood to receive a LDK kidney was higher for a black vs white woman;(3) the likelihood to receive a non-biological LDK (spouse) was significantly lower for women vs men;(4) while women are significantly more often sensitized, the likelihood to receive a LDK was higher for sensitized women vs men. Gender disparity in 2020/21 remains real in LDK transplantation. (Figure Presented).

The impact of classic Hodgkin lymphoma (cHL) on informal caregivers: Results from the cHL-Real-world observations from physicians, patients, and caregivers on the disease and its treatment (CONNECT) study

Background: The health and work productivity burden informal cHL patient (pt) caregivers face is unknown. As part of the US-based CONNECT study, we evaluated caregivers' burden and role in treatment (tx) decisions by relation to the pt: spouse/partner (SP) vs other (parent, child, friend, other relative). Methods: The CONNECT caregiver survey was an IRB-approved online survey administered from Dec 2020-Mar 2021 to self-identified current or former adult cHL pt caregivers. Health-related quality of life (HRQoL, PROMIS-Global), work impact (WPAI), decision-making, tx selection, and physician communication were assessed. Statistical significance was at the 95% confidence level. Results: 209 caregivers (58% women;median age 47 yrs;54% employed;53% SP) completed the survey. At completion, 69% cared for pts diagnosed in the past 1-2 yrs;48% of pts cared for had stage III/IV cHL and 58% were in remission/not receiving active tx. While caregiver HRQoL was similar to that of the general population on the PROMIS-Global, employed caregivers had work impairment (29%) from caregiving activities (Table) which was higher when the pt was on vs off tx. Caregiving began at pt symptom onset for more SP vs other caregivers (61 vs 27%), and after the pt's first tx for more other vs SP caregivers (34 vs 5%). 88% of caregivers discussed tx options with the pt. Cure, caregivers' top tx goal (49%), was rated higher by SP vs other caregivers (56 vs 42%). Tx decisions with the pt (54 vs 23%) and tx option discussions with the doctor (52 vs 28%) were more common for SP vs other caregivers. More SP vs other caregivers had extensive tx option discussions with the pt (88 vs 68%), said it was important the doctor discussed managing side effects (94 vs 84%), felt the doctor provided adequate information about side effects (91 vs 71%), and felt aligned with the pt's tx goals (93 vs 79%). Caregivers noted COVID-19 impacts like limiting daily activities to reduce COVID-19 risks (72%). Conclusions: Although cHL pt caregivers reported good HRQoL, caregiving impacted their work productivity regardless of relation to the pt. Cure was caregivers' top tx goal. SP vs other caregivers were more involved and earlier, reporting alignment with pt tx goals and decision-making.

LONGITUDINAL FOLLOW-UP of HUMORAL RESPONSE AGAINST SARS-COV-2 and VIRAL PERSISTENCE in 96 DMARDS-TREATED PATIENTS with PREVIOUS COVID-19 INFECTION

Background: Although it prevents severe forms of the disease, vaccination does not completely protect against the occurrence of COVID19 disease. If, DMARDs used have been associated with variable humoral response to SARS-CoV-2 vaccination, the impact of their use after SARS-CoV-2 natural infection have been poorly studied. Objectives: To characterize humoral response after SARS-CoV-2 infection and viral persistence in the nasopharyngeal sphere (NP), stools and blood of patients with rheumatic disease under DMARDs, and compared to healthy controls. Methods: Prospective monocentric longitudinal study including patients with rheumatoid arthritis or spondyloarthritis under DMARDs and with a confrmed SARS-CoV-2 infection (positive NP PCR and/or positive serology and/or pathognomonic thoracic tomography (CT)) during the frst or second wave of the COVID pandemic. Patients were followed up until one year after infection and humoral response was assessed before vaccination. Serum IgG and IgA antibodies against spike (S) and nucleocapsid (N) proteins were measured at every visit. Viral persistence was assessed at the early visit in the NP and stools using conventional RT-PCR and in the blood using a high sensitive technique (droplet digital PCR). Results: Between June 2020 and July 2021, we include 96 patients (50 SpA and 46 RA) with a mean age of 53 +/-14 years and 20 healthy controls (mean age 49 ± 16 years) corresponding to relatives of patients (spouses, children) living together and infected at the same time. The immune responses were analyzed according to 6 treatment groups: methotrexate (MTX)/salazopyrine (SLZ) monotherapy (n=17/2);anti-TNF monotherapy (n=24), anti-TNF + MTX (n=23);rituximab (RTX) (n=11);anti-IL17 or-23 (n=8);others (n=11). Visits were made at 1 month (29 ±13 days;n=18), 3 months (110 ±23 days;n=67), 6 months (231 ±35 days;n=48) and 12 months (368 ± 19 days;n=19) after infection. The anti-S and anti-N IgG Ab titers were not signifcantly different in the 6 treatment groups and the control population at 3 months. A signifcant decrease in anti-S IgA Ab titers was noted in the group treated with RTX (p=0.007) and with molecules targeting the IL17/23 pathway (p=0.007). A similar but non-signifcant trend was observed in these same treatment groups for anti-N IgA Ab (p=0.07). The titers of anti-SARS-CoV-2 antibodies at M3, was not associated with a severe COVID disease. Detection of SARS-Cov-2 RNA in stools and serum was negative for all samples taken at 1 month or 3 months. 4 patients (2 RA treated with abatacept/RTX and 2 SpA treated with anti-TNF/secukinumab) had a positive RT-PCR NP with low to very low viral load at the 1-month visit (mean Ct 36). None of these 4 patients had had a severe form of COVID19 infection. Conclusion: DMARDs-treated patients with previous proven COVID-19 did not seem to alter IgG Ab response but RTX and anti-IL17/-IL-23 might alter IgA humoral response. This lower immune response was not associated with a more severe disease. In these patients, new infection may not be considered as a full boost for the immune system. DMARDs did not induce viral persistence in the serum, the NP or in the stool.

Losing an Ex-Spouse: Navigating Disenfranchised Grief during the COVID-19 Pandemic

The experience of loss and grief during the COVID-19 pandemic provided an opportunity to explore the connections between the individual and society through the use of the autoethnographic method. In writing this autoethnography, the authors confront questions about grieving as an individual and social process, and explore the importance of social norms in thinking about everyday events such as the death of a loved one. In this article, we discuss “grieving rules” as they pertain to “normal” incidences of death, and then explore what happens when extenuating circumstances such as a global pandemic make adherence to predictable norms difficult or impossible. While recent studies of grief related to the global pandemic focus on the survivors of COVID-19 victims, this study explores the social implications of losing a loved one during a pandemic when the death is not due to COVID-19. This autoethnography relies on grief experienced during the pandemic following a non-COVID death as a possible context for disenfranchised grief. © 2022 by The Regents of the University of California. All rights reserved.

Social Determinants Predict Poor Exercise Self-Efficacy Outcomes in Cardiac Rehabilitation

Background: Building confidence to exercise regularly (exercise self-efficacy) in the face of constraints is a key goal of cardiac rehabilitation (CR) because these beliefs are predictors of sustained exercise behaviours. This study identifies patient subgroups at risk of poor self-efficacy to enable targeting and tailoring of CR interventions. Methods: Patients with coronary heart disease at four CR sites in Australia completed the Exercise Self-Efficacy Scale at CR entry and completion (6-8 weeks). A General Linear Model was used to identify independent predictors of least change in exercise self-efficacy. Data collection included COVID-19 pandemic time, so delivery mode (in-person versus remote) was included in the analyses. Results: Patients (n=194) had a mean age of 65.9 (SD 10.5) years, 81% were males. The majority (80%) were married/partnered, 76% were White, and 24% were from an ethnic minority background. Patients received CR in-person (47%) or remote-delivered (54%). At CR entry, the mean exercise self-efficacy score was 24.9 (SD 6.0) of potential 30 points, which improved significantly by completion (p=0.027). Independent predictors of least improvements in exercise self-efficacy were being an ethnic minority (β= -2.96, 95%CI -4.90, -1.02), not having a spouse/partner (β=-2.42, 95% CI -4.49, -0.35), attending in-person CR (β= -1.75, 95%CI -3.39, -0.12), and having higher exercise self-efficacy at entry (β= -0.37, 95%CI -0.51, -0.23). Conclusions: Confidence to exercise improves in CR programs. Assessing exercise self-efficacy at CR entry is recommended to ensure interventions can be tailored for patients’ needs. The relative lesser increase in confidence in ethnic minorities and solo patients should be explored.

RISK FACTORS FOR INCOMPLETE TELEHEALTH APPOINTMENTS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Introduction: The start of the COVID-19 pandemic in March 2020 led to an increased rate of telehealth visits. Older adults, however, may be more vulnerable to missing appointments given cognitive, physical, and technological gaps. We looked to determine the completion rate of telehealth appointments for older adults with inflammatory bowel disease (IBD), as well as predictors of incomplete appointments. Methods: We conducted a retrospective analysis of all patients with IBD who had at least one telehealth visit at the NYU IBD Center between 3/1/2020-8/31/2021. Only the status of the first telehealth appointment was considered, with an incomplete visit defined as left before being seen, a cancellation or noshow. Medical records were parsed for relevant co-variables, and logistic regression was used to estimate the adjusted association between demographic factors and telehealth appointment completion rates. Results: From 3/1/2020 to 8/31/2021 there were 2,508 patients with inflammatory bowel disease (IBD) who had at least one telehealth appointment, with 1088 (43%) having Crohn's disease (CD), 1037 (41%) having ulcerative colitis (UC), and 383 (15%) with indeterminate colitis (Table 1). Of the 2,508 initial telehealth visits, 519 (21%) were not completed, including 435 (20%) among patients under the age of 60-years as compared to 84 (23%) among patients over the age of 60-years. On multivariable analysis, patients with CD had higher odds of an incomplete appointment as compared to patients with UC (adjOR 1.37, 95%CI 1.10-1.69). Additionally, females had significantly higher odds of an incomplete appointment vs. males (adjOR 1.26, 95%CI 1.04-1.54), and patients who had a non-1st degree relative listed as an emergency contact also had significantly higher odds of an incomplete appointment vs. those with a spouse listed (adjOR 1.69, 95%CI 1.16-2.44;Table 2). Age over 60-years, partnership status, and comorbidities were not associated with appointment completion rates. Among the 361 patients over the age of 60-years who had a telehealth appointment, sex, emergency contact information, IBD subtype, and partnership status were not found to be associated with odds of completing a telehealth appointment. Conclusions: In our study, older patients with IBD were not at higher risk for missed telehealth appointments as compared to younger patients. On multivariable analysis, patients with CD as compared to patients with UC, females as compared to males, and patients who had a non-1st degree relative listed as an emergency contact as compared to those who had a spouse listed were more likely to miss telehealth appointments. Future studies should explore the role of these factors, including the role of social support, in order to design interventions aimed at limiting missed telehealth appointments. (Table Presented) (Table Presented)

Informal dementia care: The carer's lived experience at the divides between policy and practice.

Support for informal dementia care at a local community level is not working for most carers today. Carers looking after a person with dementia have long lamented the absence of an empowered named support and an effectively actioned care plan. Drawing on literary writing and social research, we argue in this article that these challenges have existed since dementia emerged as a major condition in the West during the 1980s. Based on this historical context, we ask: Why has this issue persisted over the last four decades? How have healthcare politics and policy initiatives responded to these requests? And what can we learn from this for the current, COVID-19 exacerbated crisis of care? This article focuses on the English context, to discuss these ongoing challenges in the light of a series of policy papers, and to ask what is hampering the implementation of such policy initiatives. In England, local authorities are responsible for dementia support. This article focuses on the situation in a county in the Midlands where one of us (AB) has been lobbying local government for over a decade. The discussion contextualises the lived experience of dementia care within the situation exacerbated by the COVID-19 pandemic, ensuing politics of crises and persistent emphasis on cure over care. We find that the absence on two points centrally challenges care: a joined-up approach between health and social care and adequate information on available care support services, accessible through an empowered named contact. To enhance the lived experience of dementia care, consistent provision of individual named support and professional care support, as and when required, should become essential to local implementation of the care policy.

RELATIONSHIPS BETWEEN PRE-PANDEMIC TRAUMA AND STRESS WITH SLEEP DURING THE COVID-19 PANDEMIC IN YOUNG ADULTS

Introduction: Young adults, particularly those with histories of interpersonal trauma or stress, are more likely to experience to adverse psychosocial outcomes (e.g., depression) during the COVID- 19 pandemic, compared to those without these histories. However, few studies have examined sleep and most rely on retrospectivelyreported pre-pandemic experiences. We tested whether prepandemic trauma and stress were prospectively related to worse ecological momentary assessment (EMA)-reported sleep during the pandemic. Methods: The sample includes 114 regular drinkers aged 21-30 years from two ongoing studies of alcohol use and sleep who completed a shared assessment battery and a 10-17-day EMA protocol before and during the pandemic (conducted July- November 2020;M=13.9 months after baseline). Participants reported past-month perceived stress (10-item Perceived Stress Scale) and interpersonal traumas (e.g., abuse, conflict), via scores on the Current Partner and Personal (persons other than spouse/ partner) subscales of the Difficult Life Circumstances Scale. The EMA protocol measured daily sleep (total sleep time [TST];sleep efficiency [SE]), relational stress (1-5 ratings for family, spouse/ partner, friends), and alcohol use. Paired t-tests compared prepandemic vs. pandemic sleep. Separate linear regressions tested associations between pre-pandemic trauma and stress with average pandemic TST and SE, adjusted for baseline age and sleep, racial identity, assigned sex at birth, time between assessments, and drinking days (averaged across timepoints). Results: Participants were on average 23.8 years old (61% female;7% Asian;39% Black;1.8% Mixed race;0.9% Other race;0.9% Pacific Islander;55% White). Average TST increased from baseline to pandemic (7.5 vs. 7.8;t(113)=-2.57, p=.01);no change was observed in SE (95% vs. 94%;t(113)=1.01, p=.31). Pre-pandemic perceived stress (B[SE]=-.003[.001], p=.02) and average EMAreported family stress (B[SE]=-.04[.02], p=.05) predicted worse pandemic SE. No associations emerged with friend or partner stress, trauma, or TST (ps>.11). Conclusion: Pre-pandemic perceived stress (but not trauma nor relational stress) predicted worse sleep during the pandemic. Perceived stress reflects feeling overwhelmed and difficulty coping, which is relevant given dramatic pandemic-related impacts on daily life. The overall accumulation of stress, versus day-to-day stress in specific relationships, may be most detrimental for sleep during the pandemic. Perceived stress is amenable to evidence-based (and remotely-delivered) interventions, including mindfulness-based stress reduction.

Prevalence of Postpartum Depression Following the COVID-19 Pandemic at an Urban Academic Institution

INTRODUCTION: Postpartum depression (PPD) is a complication of pregnancy commonly occurring within the first month of delivery. Numerous risk factors are associated with PPD, including financial stressors, inadequate emotional support, and perceived social isolation. This study evaluated the impact of the implemented social restrictions to mitigate the spread of the COVID-19 virus on the overall prevalence of PPD at an urban academic center. METHODS: Following institutional review board approval, a retrospective cohort study was performed of 1,097 subjects between 1 and 8 weeks postpartum. Group 1, the control group, included 420 women with routine PPD screening prior to the COVID-19 pandemic (April 1-December 31, 2019). Group 2, our case group, included 677 women with routine PPD screening during the pandemic (April 1-December 31, 2020). Both groups completed the Edinburgh Postnatal Depression Scale (EPDS), and the prevalence of PPD (defined as having an EPDS score greater than 11) was determined. Postpartum patients following fetal demise were excluded. RESULTS: The prevalence of PPD was higher in postpartum women before the COVID-19 pandemic (13.10%) when compared to postpartum women screened during the pandemic (10.78%). This increased prevalence, however, was not found to be statistically significant (P=.2474). CONCLUSION: Our study revealed no statistically significant difference in the prevalence of PPD before or during the COVID-19 pandemic. Nevertheless, the downward trend of PPD during the pandemic may be due to quarantine recommendations allowing families/spouses to work from home. The association of PPD and specific social support systems should be evaluated further.

Predictors of poor exercise self-efficacy improvements after cardiac rehabilitation

Background/Introduction: Building confidence to exercise regularly (exercise self-efficacy (ESE)) in the face of constraints and barriers, is a key goal of cardiac rehabilitation (CR) because such self-efficacy beliefs are predictors of sustained exercise behaviours. Therefore, identifying patient subgroups at risk of poor ESE enables tailoring of CR and appropriate targeting of support interventions. Purpose: To identify independent predictors of poor ESE and poor improvements in ESE in CR participants. Methods: The study used a prospective observational cohort design and recruited patients with coronary heart disease at CR entry across four sites in Metropolitan Sydney, Australia (2019-2020). Data were also compared for traditional in-person and remote-delivered CR during COVID-19 pandemic restrictions. The Exercise Self Efficacy Scale was used to measure ESE at CR entry and completion, and General Linear Models were used for analyses. Results: Participants (n=194) had a mean age of 65.94 (SD 10.46) years, with 80.9% males;and 80.0% were married or partnered, with 23.6% from an ethnic minority background. Referral diagnosis included elective percutaneous coronary intervention (PCI) (40.2%), coronary artery bypass surgery (26.3%), and myocardial infarction with or without PCI (33.5%). At CR entry, the mean ESE score was 24.93 (SD 5.99) points, which improved significantly by completion (p=.027). The GLM of ESE change (Adjusted R2=.247) identified that predictors of less change in ESE scores by CR completion included ethnic minorities (β=2.96, p=.003), not having a spouse or an intimate partner (β=-2.42, p=.023), and attending in-person CR (β=1.75, p=.036). Having higher ESE scores at entry was also associated with less ESE change on completion, such that for every point increase in ESE at entry, there was a reduction of .37 points in change (p<.001). These variables were also the same predictors of poor ESE at CR completion. Conclusions: Confidence to exercise improves in CR, and screening for ESE at CR entry enables identification of patients at-risk of poor improvements. Tailoring of interventions to provide appropriate support such as extending CR should be considered for patients from ethnic minorities and those who are single/widowed. Exploring the reasons for differences in outcomes from in-person and remote-delivered CR using appropriate methods should be the focus of future research.

THE STATISTICS OF HUMAN SEXUALITY

INTRODUCTION AND OBJECTIVE: In 2015, English statistician and academic David Spiegelhalter wrote a book backed by the History of Medicine of the Wellcome Foundation entitled Sex by Numbers: What Statistics Can Tell Us About Sexual Behaviour. This represents an investigation into the statistics of human sexual activity to update the statistics of Kinsey and show the startling influence by the COVID-19 pandemic. METHODS: The investigation of the statistics of sexual activity is as enlightening as it is entertaining and there is a plethora of literature on modern sexual practices. This represents a concerted effort to track down these numbers and this data. The largest pornographic site, Pornhub®, also tracks its own statistics since its founding in 2007. RESULTS: An intriguing statistic is that the average number of sexual partners is about 9.9 (6.6 at Kinsey Center) for males and about 3.4 (4.3 at Kinsey) for females in their lifetimes. The exception to this is with homosexual persons, where the averages are much higher. Nature versus nurture is the classic tale of which is more important, genetics or environment, but most often there is a bit of both behind the scenes. Sexual activity is one of the most difficult topics of historical significance, because it is interleaved with so many socio-religious overtones. The average male loses his virginity at age 16.9, compared to age 17.4 for females. About 1 in 10 married adults sleep alone and not with their married spouse - shades of Dick Van Dyke and Mary Tyler Moore in The Dick Van Dyke Show. Only 29% of females achieve orgasm during sexual encounters, compared to 75% in their male counterparts. Currently, 66% of male college students report having “friends with benefits.” Also, currently 50% of sexually active men and women are infected with HPV at some point in their sexual lives. Sexual activity burns about 100-200 calories in males and about 69 calories in females but the heart rate at orgasm is about 140 and equal in both sexes. CONCLUSIONS: Spiegelhalter dedicated his statistical analysis “to everyone in history who has struggled with sex. And eventually called it a draw.” There is something like 900,000,000 acts of just heterosexual intercourse per year in Great Britain alone or roughly 100,000 per hour. This can all be extrapolated to the 7 billion humans around the world making close to 166,667 copulations per minute (or almost 4,000 per second).