Trauma-focused therapy in early intervention for psychosis settings: Results of a feasibility RCT of 'EMDR for psychosis'

Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.

An Emerging Role of Interferon Targeted Therapy in Mucocutaneous Sle: A Prospective Real-World Evaluation of Anifrolumab for Refractory Cutaneous Lupus

Background/Aims Advances in rational drug design and recent clinical trials are leading to emergence of a range of novel therapies for SLE and therapeutic options in clinical practice are expected to broaden rapidly. The optimal real-world place of emerging and established agents will be guided by understanding their differential efficacy on specific SLE manifestations as well as efficacy for more resistant disease. Anifrolumab, a type-I interferon receptor blocking monoclonal antibody, showed efficacy in SLE in phase III trials with a notable effect on mucocutaneous disease although specific lesion subtypes and chroncicity were not explored. Severe refractory mucocutaneous SLE such as scarring discoid lesions are an important and common clinical challenge in current practice. We therefore prospectively evaluated the real-world efficacy and quality of life impact of anifolumab for active mucocutaneous SLE, recalcitrant to multiple biologic and immunosuppressant therapies. Methods Seven patients commenced anifrolumab (300mg by monthly iv infusion) following application to the manufacturer's early access programme (NCT 04750057). Prior biologic therapies were discontinued at least 5 half-lives in advance. Mucocutaneous disease activity was captured by Cutaneous Lupus Disease Area and Severity Index (CLASI) activity score and medical photography. Patient reported health-related quality of life comprising the Dermatology Life Quality Index (DLQI);Lupus-QoL and EQ5D-5L were evaluated at baseline, three and six months. Results Seven female patients with active mucocutaneous SLE (Discoid LE n=5, chilblain LE n=1, subacute cutaneous LE n=1) and median disease duration of 17 years were evaluated. Median baseline CLASI activity score was 17 (range 10-26;higher scores indicating severe disease). Median number of previously failed therapies was 7 and included rituximab in 6/7, belimumab in 2/7 and thalidomide in 4/7. Rapid resolution of scale and erythema in DLE was established within 1 month of anifrolumab treatment. Improvements to chilblain lupus were evident by three months. CLASI activity score was improved >=75% in all patients at 3 months. Clinical responses were associated with significant improvements in DLQI (p<0.001) and EQ5D-VAS (p=0.002) by three months. Lupus-QoL trended toward improvement across all domains but most strongly for fatigue (p=0.01) and pain (p=0.002) by 6 months. One patient discontinued treatment after 4 months due to polydermatomal shingles complicated by sensorineural hearing loss. Infection coincided with background prednisolone dose >15mg daily, recent COVID-19 infection and new on-treatment hypogammaglobulinaemia (IgG <5g/L). Prolonged aciclovir treatment was required for lesion resolution. Conclusion We report rapid real-world efficacy and quality of life impact of anifrolumab on highly refractory mucocutaneous SLE, which exceeded that anticipated from existing clinical trial data. Findings suggest a unique role for emerging interferon targeting therapies in management of mucocutaneous SLE but emphasize need for enhanced VZV precautions among higher risk patients.

Visual Analogue Scale for the Evaluation of Olfactory and Gustatory Dysfunction of COVID-19 Patients in Northwestern Greece.

Background The visual analogue scale (VAS) has been used as a diagnostic tool for the evaluation of the severity of olfactory and gustatory dysfunction (OGD) caused by SARS-CoV2 infection. The main objective of the present study was the evaluation of OGD with VAS in COVID-19-positive patients in Northwestern Greece and its possible association with the patients' self-reported symptoms of olfactory and gustatory dysfunction. Methods The presence of olfactory and gustatory symptoms and their severity were assessed by questionnaire along with the use of specific odorants and tastant ingredients, in three time periods: prior to COVID-19, during COVID-19 (initial diagnosis) and post-COVID-19 disease (at four weeks from disease onset). Three hundred COVID-19-positive patients (home-quarantined and hospitalized) tested with RT-PCR test in the University Hospital of Ioannina Greece were included in this study. Statistical analysis was performed on SPSS Statistics 26.0 (IBM Corp., Armonk, NY) Results Out of a total of 300 patients, 146 and 190 patients had mild hyposmia and hypogeusia respectively, followed by patients with severe hyposmia or hypogeusia (118 and 88 respectively), at the time of COVID-19 onset (initial diagnosis). An increase in the number of patients with recovery of symptoms was observed during the follow-up period, during which only eight patients had non-resolving severe symptoms (six patients with hyposmia and two with hypogeusia). On further analysis, a statistically significant association was found between the severity of symptoms (assessed by VAS score) and the self-reported symptoms of sensory dysfunction by the patients. There was a significant association between the groups of patients with mild hyposmia and patients that reported no loss of smell; between the patients with moderate hyposmia and the patients who reported "loss of smell"; and between the patients with severe hyposmia and the group of patients who reported a loss of smell, at the COVID-19 onset period. Similarly, patients with mild hyposmia were associated with those that reported a loss of smell at the same time. The severity of hyposmia was also associated with the reported symptom of "loss of taste" at the time of COVID-19 diagnosis. Similar findings were observed regarding the severity of hypogeusia and the reported symptom of "loss of taste" among the groups of patients. Finally, the severity of hypogeusia was associated with smell loss at the time of initial diagnosis of the infection. Conclusion Similar to the literature data, our findings indicate that hyposmia and hypogeusia are common symptoms of COVID-19 disease with varying severity. In our study, most of the patients exerted a complete recovery of these OGD symptoms. In addition, we found an association between olfactory dysfunction and self-reported sensory of taste as well as gustatory dysfunction and sensory of smell. Finally, we found that the VAS score was a reliable diagnostic tool in the estimation of OGD in this cohort of patients. However, our results need to be confirmed by larger-scale trials.

The impact of comorbidities on recovery following hospitalisation from COVID-19

Introduction: It is unknown how pre-existing comorbidities affect recovery after a hospital admission for COVID-19. Aim(s): To explore the impact of comorbidities on symptoms, exercise capacity and QoL 5 months after a hospital admission for COVID-19. Method(s): Patients hospitalised with COVID-19 were recruited to an observational longitudinal cohort study (PHOSPCOVID). Patients were categorised into three comorbid categories (0, 1, >=2). The Incremental Shuttle Walking Test (ISWT), FACIT, Dyspnoea-12 and the EQ5D-VAS were assessed 5 months post-discharge. Patient perceived preadmission EQ5D-VAS scores were collected retrospectively. One-way ANOVA were used to compare groups. Result(s): 1516 patients completed the assessment: 61% male, mean[SD];age 58[12], length of stay 14[19] days, BMI 32[7], number of comorbidities 2[2] with 813(53%) patients having >=2 comorbidities. The EQ5D was reduced pre admission to 5 months for all groups (p<0.01), however the difference between pre EQ5D-VAS and at 5 months was similar between groups (p=0.18). There was a significant difference in ISWT (m, %), FACIT and EQ5D between those that had >=2 comorbidities compared to no, and 1 comorbidity (p<0.01)(table 1). Conclusion(s): Although patients with more co-morbidities have a greater symptom burden and lower exercise capacity at five months post-discharge, important morbidity also persists in adults without pre-existing co-morbidity.

Twenty months follow-up in non-hospitalised adults with post COVID-19 condition: a preliminary longitudinal cohort study

Background: Persistent symptoms and impairments occur after both severe and mild COVID-19 infection. Studies have focused on follow-up after hospitalisation, however studies in non-hospitalised people are warranted. Aim(s): To evaluate long-term impact on physical function and health-related quality of life (HRQoL) in non-hospitalised adults with post COVID-19 condition. Method(s): Preliminary results from assessment in non-hospitalised adults (n=51), with >= 3 months of persistent symptoms after infection, was performed at Karolinska University Hospital. Baseline assessment was in median 9 months after illness onset and follow-up 20 months after illness onset. Assessments consisted of dynamic spirometry, maximal inspiratory pressure (MIP), 6-minute walk test (6MWT), mMRC dyspnoea scale (0-4) and HRQoL (EQ5D VAS: 0-100). Result(s): Mean age was 42 years (SD:10,8) and 92 % were women. Prior to infection 82 % worked and at baseline 47 % were on full-time sick leave compared to 33 % at follow-up. Median BMI was 25 (IQR: 5,6), 16 % had asthma and 35 % were smokers or former smokers. Improvements between baseline and follow-up were seen in 6MWT (75 % vs 82 % of predicted distance, p<0.05), MIP (81 % vs 95 % of predicted, p<0.05) and mMRC (3 vs 2, p<0.05). HRQoL was impaired and unchanged (mean EQ VAS: 34 vs 39). Lung function, expressed as % of predicted, was normal and unchanged (FEV1: 85 % vs 88 %, FVC: 88 vs 89 %). Conclusion(s): The results indicate that although physical function improve to some degree, impairments in physical function and HRQoL remained 20 months after COVID-19 infection. Finding causes and rehabilitation to improve these impairments are urgently needed.

Impact of breathlessness on quality of life and healthcare use in Australia

Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.

COVID-19 and EQ-5D-5L health state valuation.

BACKGROUND: We investigate whether and how general population health state values were influenced by the initial stages of the COVID-19 pandemic. Changes could have important implications, as general population values are used in health resource allocation. DATA: In Spring 2020, participants in a UK general population survey rated 2 EQ-5D-5L states, 11111 and 55555, as well as dead, using a visual analogue scale (VAS) from 100 = best imaginable health to 0 = worst imaginable health. Participants answered questions about their pandemic experiences, including COVID-19's effect on their health and quality of life, and their subjective risk/worry about infection. ANALYSIS: VAS ratings for 55555 were transformed to the full health = 1, dead = 0 scale. Tobit models were used to analyse VAS responses, as well as multinomial propensity score matching (MNPS) to create samples balanced according to participant characteristics. RESULTS: Of 3021 respondents, 2599 were used for analysis. There were statistically significant, but complex associations between experiences of COVID-19 and VAS ratings. For example, in the MNPS analysis, greater subjective risk of infection implied higher VAS ratings for dead, yet worry about infection implied lower ratings. In the Tobit analysis, people whose health was affected by COVID-19 rated 55555 higher, whether the effect on health was positive or negative. CONCLUSION: The results complement previous findings that the onset of the COVID-19 pandemic may have impacted EQ-5D-5L health state valuation, and different aspects of the pandemic had different effects.

Management and outcome of infectious spondylodiscitis in patients with and without neurological deficit: A prospective study

Introduction: The term Infectious Spondylodiscitis involves infection of the vertebra and infection of the intervertebral disc, or both. Any delay in its diagnosis or management may cause serious long-term morbidity and mortality. In this study, we report the experiences in our Institution in the management of severe and complicated cases of infectious spondylodiscitis. Material(s) and Method(s): Over the period of 2 years from 2020-2022 (covid-19) 40 patients were operated in our medical college the management was tailored according to the clinical condition based on VAS, ODI, radiological studies and lab results of each case;and patients were then prospectively followed-up for 2 years. Result(s): The goals of treatment for spondylodiscitis is to relieve pain, restore pain free mobilization of the patient and to eliminate infection. Magnetic resonance imaging (MRI) was considered the main choice of investigating tool other assessments were done by ODI, VAS, Neurologic deficits was assessed by Modified McCormick scale, sepsis, an intraspinal empyema, the failure of conservative treatment, and spinal instability are all indications for surgical treatment. Conclusion(s): The quality of life of patients who have been appropriately treated for infectious spondylodiscitis has been found to be highly satisfactory in general. The risk of recurrence increases in the presence of accompanying illnesses such as diabetes mellitus, renal failure, which were managed by immediate debridement and results were good which was assessed according to above mentioned post-op ODI and VAS. Copyright © 2023 Ubiquity Press. All rights reserved.

The impact of deprivation on patients awaiting planned care.

AIMS: Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care. METHODS: Questionnaires were sent to orthopaedic waiting list patients at the start of the UK's first COVID-19 lockdown to capture key quantitative and qualitative aspects of patients' health. A total of 888 respondents were divided into quintiles, with sampling stratified based on the Index of Multiple Deprivation (IMD); level 1 represented the 'most deprived' cohort and level 5 the 'least deprived'. RESULTS: The least deprived cohort were older (mean 65.95 years (SD 13.33)) than the most deprived (mean 59.48 years (SD 13.85)). Mean symptom duration was lower in the least deprived areas (68.59 months (SD 112.26)) compared to the most deprived (85.85 months (SD 122.50)). Mean pain visual analogue scores (VAS) were poorer in the most compared to the least deprived cohort (7.11 (SD 2.01) vs 5.99 (SD 2.57)), with mean mood scores also poorer (6.06 (SD 2.65) vs 4.71 (SD 2.78)). The most deprived areas exhibited lower mean quality of life (QoL) scores than the least (0.37 (SD 0.30) vs 0.53 (SD 0.31)). QoL findings correlated with health VAS and Generalized Anxiety Disorder 2-item (GAD2) scores, with the most deprived areas experiencing poorer health (health VAS 50.82 (SD 26.42) vs 57.29 (SD 24.19); GAD2: 2.94 (SD 2.35) vs 1.88 (SD 2.07)). Least-deprived patients had the highest self-reported activity levels and lowest sedentary cohort, with the converse true for patients from the most deprived areas. CONCLUSION: The most deprived patients experience poorer physical and mental health, with this most adversely impacted by lengthy waiting list delays. Interventions to address inequalities should focus on prioritizing the most deprived.Cite this article: Bone Jt Open 2022;3(10):777-785.

The Persistent Symptoms and Decreased Quality of Life of COVID-19 Patients (A 3-month Follow-up after Discharge)

BACKGROUND: Most coronavirus disease 2019 (COVID-19) patients are still experiencing persistent clinical symptoms even after being discharged from the hospital. The previous studies have reported the remaining symptoms in 29–93% of patients. This condition can have a major impact on a patient’s ability to perform daily activities and have a deleterious effect on their quality of life (QoL). AIM: This study aimed to evaluate persistent symptoms and QoL of COVID-19 patients 3 months after discharge from Dr. Kariadi Hospital Semarang, Central Java, Indonesia. METHODS: Confirmed COVID-19 patients were enrolled in this prospective cohort study after discharge from Dr. Kariadi Hospital Semarang from March 1, 2021, to May 15, 2021. Telephone interviews were conducted each week in the 1st month, and every 2 weeks in the 2nd and 3rd months regarding persistent symptoms. EQ-5D-5L questionnaires were completed and evaluated every month for 3 months after hospital discharge. RESULTS: Of the 104 patients enrolled, 52.9% were male, with a mean age of 48.96 years. The incidence of persistent symptoms in the 1st, 2nd, and 3rd months was 49%, 31.7%, and 25%, respectively. The most common persistent symptoms were fatigue, cough, shortness of breath, and nausea. The characteristics of the patients included being overweight/obese, having one or more comorbidities, having five or more symptoms classified as moderate COVID-19, and requiring supplemental oxygen during hospitalization. Based on the EQ-5D questionnaire, most patients reported worsening in the quality of their ability to perform usual activities, feelings of pain/discomfort, and anxiety/depression. The total values of the EQ-5D and EQ-VAS indices were lower than those of the Indonesian general population, indicating a decrease in QoL. CONCLUSION: The patients developed persistent symptoms and decreased quality of life during the 3-month following hospital discharge.

Frequency, Persistence, and Patient-reported Outcomes of Neurological Symptomsin Mild COVID-19: Resultsfrom the ALBERTA HOPE COVID-19 Trial

Objective: To examine the natural history of neurological symptoms in mild COVID-19. Background: Various neurological manifestations have been reported with COVID-19, mostly in retrospective studies of hospitalized patients. There are few data on patients with mild COVID19. Design/Methods: Consenting participants in the ALBERTA HOPE COVID-19 trial( NCT04329611, hydroxychloroquine vs placebo for 5-days), managed as outpatients, were prospectively assessed 3-months and 1-year after their positive test. They completed detailed neurological symptom questionnaires, Telephone Montreal Cognitive Assessment(T-MoCA), Kessler Psychological Distress Scale(K10), and the EQ-5D-3L(quality-of-life). Informants completed the Mild Behavioural Impairment Checklist(MBI-C) and Informant Questionnaire on Cognitive Decline(IQCODE). We tracked healthcare utilization and neurological investigations using medical records. Results: Among 198 patients (median age:45, IQR:37-54, 43.9% female);28(14.1%) had preexisting neurological/psychiatric disorders. Among 179 patients with symptom assessments, 139(77.7%) reported ≥1 neurological symptom, the most common being anosmia/dysgeusia(56.3%), myalgia(42.6%), and headache(41.8%). Symptoms generally began within 1-week of illness(median:6-days, IQR:4-8). Most resolved after 3-months;40 patients(22.3%) reported persistent symptoms at 1-year, with 27(15.1%) reporting no improvement. Persistent symptoms included confusion(50%), headache(52.5%), insomnia(40%), and depression(35%). Body mass index, prior neurologic/psychiatric history, asthma, and lack of full-time employment were associated with presence and persistence of neurological symptoms;only female sex was independently associated on multivariable logistic regression(aOR:5.04, 95%CI:1.58-16.1). Patients with persistent symptoms had more hospitalizations and family physician visits, worse MBI-C scores, and were less often independent for instrumental daily activities at 1-year(77.8% vs 98.2%, p=0.005). Patients with any or persistent neurological symptoms had greater psychological distress defined as K10≥20(aOR:21.0, 95%CI:1.96-225) and worse quality-of-life ratings(mean EQ-5D VAS:67.0 vs 82.8, p=0.0002). 50.0% of patients had T-MoCA<18 at 3-months versus 42.9% at 1-year;patients reporting memory complaints were more likely to have informant-reported cognitive-behavioural decline (aOR[1-year IQCODE>3.3]:12.7, 95%CI:1.08-150). Conclusions: Neurological symptoms were commonly reported in survivors of mild COVID-19 and persisted in one in five patients 1-year later. These symptoms were associated with worse patient-reported outcomes.

Diagnostic Concordance between the Visual Analogue Anxiety Scale (VAS-A) and the State-Trait Anxiety Inventory (STAI) in Nursing Students during the COVID-19 Pandemic.

Anxiety is one of the most common problems among nursing students. The State-Trait Anxiety Inventory (STAI) is used to detect anxiety in this population; however, its length hinders speedy detection. For this reason, a faster and more efficient instrument is needed for early detection. This study aimed to determine the relationship between the anxiety measurement scales State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale for Anxiety (VAS-A) by establishing a discrimination threshold through the contrast of true positive rates (VPR) and false positive rates (FPR). To this end, a cross-sectional quantitative observational and analytical study was carried out on 185 fourth-year nursing students. The data collected were anxiety (STAI and VAS-A) and socio-demographic variables during the COVID-19 pandemic. The results showed a correlation between the two scales (VAS-A and STAI). The VAS-A is a useful instrument for assessing students in a crisis that could potentially generate anxiety. The study established a reasonably safe error probability range (>5%), allowing the VAS-A scale to be used as a rapid diagnostic or pre-diagnostic tool, depending on the scores. The study shows that speedy detection of anxiety using the VAS-A and an in-depth approach with the STAI by teaching staff in crises is possible.

A high-fibre personalised dietary advice given via a web tool reduces constipation complaints in adults.

Constipation can greatly impact the quality of life (QoL), which can be relieved by dietary fibres; however, preserving a higher fibre intake remains a challenge. We investigated the effects of a personalised dietary advice (PDA) on fibre intake and mild constipation complaints. A total number of twenty-five adults with mild constipation complaints were included in a 4-week observation period followed by a 4-week personalised intervention. The PDA provided high-fibre alternatives via a web tool. In weeks 1, 4 and 8, dietary intake, constipation complaints and QoL were assessed. Furthermore, participants collected a faecal sample at weeks 1, 4 and 8 to determine microbiota diversity and composition, and short-chain fatty acids (SCFA). Participants completed questions daily for 8 weeks regarding abdominal complaints, stool frequency and stool consistency. Fibre intake in week 8 was significantly higher compared to week 1 (Δ = 5·7 ± 6·7 g, P < 0·001) and week 4 (Δ = 5·2 ± 6·4 g, P < 0·001). Constipation severity and QoL significantly improved at week 8 compared to the observation period (P < 0·001). A higher fibre intake significantly reduced constipation severity (ß = -0·031 (-0·05; -0·01), P = 0·001) and the QoL (ß = -0·022 (-0·04; -0·01), P = 0·009). Stool consistency (P = 0·040) and abdominal pain (P = 0·030) improved significantly during the intervention period (P = 0·040), but stool frequency did not. Average microbial alpha diversity and composition and SCFA concentrations did not change over time, but indicated individual-specific dynamics. Several SCFAs were associated with constipation complaints. To conclude, a PDA effectively increased fibre intake and subsequently reduced constipation complaints, indicating that guided dietary adjustments are important and feasible in the treatment of mild constipation complaints.

The impact of COVID-19 on quality of life among patients with inflammatory bowel diseases - A Danish prospective population-based cohort study

Background: The coronavirus disease 2019 (COVID-19) pandemic raised concerns among patients with ulcerative colitis (UC) and Crohn's disease (CD) fearing an increased susceptibility to infection and increased risk of poor outcomes. Furthermore, the impact of COVID-19 on subsequent health-related quality of life (HRQoL) has so far not been described. We aimed to evaluate the HRQoL in relation to the severity of COVID-19 in a cohort of survivors. Methods: We conducted a population-based study investigating the outcomes of COVID-19 among patients with UC and CD in Denmark. The Danish COVID-19 IBD Database is an extensive populationbased database which prospectively monitors the disease course of laboratory-confirmed COVID-19 among patients with UC and CD. Severe COVID-19 was defined as COVID-19 necessitating intensive care unit admission, ventilator use, or death, while adverse COVID- 19 was defined as requirement of COVID-19 related hospitalization. HRQoL was assessed using several validated questionnaires, including the EuroQol five-dimension five-level (EQ-5D-5L) questionnaire, EuroQol Visual Analogue Scale (EQ-VAS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), IBD Disability Index (IBD-DI), and IBD Fatigue Score. Results: HRQoL after COVID-19 was assessed among 137/319 (42.9%) patients with UC of whom 125 (91.2%) and 12 (8.8%) patients experienced mild and adverse COVID-19, respectively. Furthermore, HRQoL was assessed among 85/197 (43.1%) patients with CD of whom 74 (87.1%) and 11 (12.9%) patients experienced mild and adverse COVID-19, respectively. HRQoL was assessed after a median of 5.1 months (IQR 4.5-7.9) after infection. Baseline characteristics are presented according to the availability of HRQoL data in Table 1. No difference was observed in terms of EQ-5D-5L among patients with UC and CD or patients with mild, adverse, or severe COVID-19 (Table 2). Accordingly, the SIBDQ scores were similar among patients with mild, adverse or severe COVID-19 and UC (mild: median 59 (IQR 50-65), adverse: 62 (54-65), severe: 62 (54-65), p=0.89) or CD (mild: 57 (46- 65), 58 (49-64), 58 (49-64), p=0.91) as well, and no difference was observed in the subscores (Table 2). In line with these results, the IBD Disability Index (UC: median 10 (IQR 6-16), CD: 13 (6-20), p=0.16) were not associated with the severity of COVID-19 (Table 3). Finally, CD patients with adverse COVID-19 experienced more fatigue than patients with mild COVID-19 (26 (IQR 25-35) vs. 41 (IQR 29-46), p=0.03). Conclusion: This Danish population-based study found no durable impact of COVID-19 on health-related quality of life among patients with inflammatory bowel disease providing further assurance for the clinical guidelines for IBD care during the pandemic.

The COVOSMIA-19 trial: Preliminary application of the Singapore smell and taste test to objectively measure smell and taste function with COVID-19.

Sudden loss of smell and/or taste has been identified as an early symptom of SARS-CoV-2 2019 (COVID-19) infection, and presents an effective target for prompt self-isolation and reducing community spread. The current study sought to develop and test a novel, rapid, self-administered test to objectively measure smell and taste losses associated with COVID-19, and administered self-report questionnaires to characterise symptoms associated with COVID-19 in Singapore. Participants (N = 99) completed questionnaires to record recent changes in smell and taste ability. This was followed by the 'Singapore Smell and Taste Test' (SSTT), a personal, objective testing kit for daily self-assessment of smell and taste function at their place of residence. Seventy-two recruited participants were confirmed as COVID-19 positive at baseline, of which 58 completed the SSTT at home. Of these, 36.2% had objectively measured smell and/or taste loss. The SSTT measures of smell and taste function were positively associated with participants' self-reported smell and taste acuity, and rated smell intensity of 6 common household items. This study presents the first application of the SSTT as a rapid, cost-effective, objective tool to self-monitor smell and taste function in a residential setting, and ensures comparability across individuals through the use of standardised stimuli. The SSTT has potential for future application in populations with limited access to formal COVID-19 testing as a self-administered objective method to monitor sudden changes in smell and taste, and to prompt early self-isolation, in order to reduce community transmission of COVID-19.

Impact of COVID-19 on the Health-Related Quality-of-Life of Pregnant and Postpartum Persons

Objectives: To assess the impact of COVID-19 on health-related quality-of-life (HRQoL) of those who were pregnant or recently pregnant during the pandemic. Methods: Individuals who were pregnant any time since January 2020, the beginning of the pandemic, were invited to participate in an online, national US survey (EuroQol grant: 260-2020RA). Respondents were asked to self-report their experiences with COVID-19, to complete the EQ-5D-5L, and other measurements of HRQoL. To estimate the association between COVID-19 infection with the EQ-5D-5L outcomes, we used median regression for the EQ-5D utility and EQ-VAS scores, and ordinal logistic regressions for the EQ-5D-5L health items. Post-stratification weights were used to ensure representation by age, race and US census region. Results: Among pregnant or postpartum persons, the median EQ-5D-5L utility score was 0.87 and EQ-VAS was 0.80. The median EQ-5D-5L utility score increased by 0.0058 (95% CI 0.0026, 0.009) for each additional year of age of the respondent. We observed no change in EQ-5D-VAS utility measures by maternal age (ß= 0.00;95% CI -0.09, 0.09). On average, comparing Black pregnant persons to White, EQ-5D-5L utility values were 0.44 points lower, and EQ-5D-VAS scores were 0.31 points lower. Although median EQ-5D-5L utility values were similar for those with and without a diagnosis of COVID-19 (0.87 and 0.88), utility values declined by 0.022 (95% CI -0.040, -0.010) for each unit increase in perceived COVID-19 severity. Similar results were observed for the EQ-5D-VAS scores. When we evaluated EQ-5D-5L items individually, respondents diagnosed with COVID-19 reported more problems related to anxiety/depression compared with those who did not (OR 2.43;95% CI 1.35, 4.40). No other items were significantly associated with COVID-19. Conclusions: We observed lower HRQoL measures associated with severe COVID-19 infection during pregnancy. In particular, problems with anxiety and depression contributed most strongly to lowered HRQoL during pregnancy.

Impact of COVID-19 on Health-Related Quality-of-Life in the United States, Sweden and Norway: A Cross-Country Comparison Using a Panel Survey

Objectives: To assess and compare the impact of the COVID-19 pandemic on health-related quality-of-life (HRQoL) in the United States, Sweden and Norway. Methods: Two waves of web-based survey were conducted in April 2020 and January 2021 to collect demographic data, COVID-19 status, behavior and employment changes related to COVID-19 in each country (EuroQol Grant: 246-2020RA). EQ-5D-5L was used to assess health status of respondents. Results were compared between the two waves to measure changes in HRQoL. One-way ANOVA was used to detect significant differences between countries, and t-tests for differences between waves. Results: We collected 2,734, 1,003 and 1,020 responses in Wave 1, and 2,252, 1,013 and 1,011 responses in Wave 2 for the US, Sweden, and Norway respectively. Corresponding mean (SD) EQ-VAS scores were 74.6 (±19.2), 68.7 (±21.4), and 69.2 (±20.8) in Wave 1 (p<0.001), and 76.4 (±18.6), 68.2 (±20.3), and 67.8 (±21.7) in Wave 2 (p<0.001). Between waves, only the VAS scores in the US were significantly different (p<0.001). Mean (SD) utility scores were 0.822 (±0.222), 0.768 (±0.260), and 0.808 (±0.248) in wave 1 (p<0.001), and 0.823 (±0.221), 0.783 (±0.237), and 0.777 (±0.271) in wave 2 (p<0.001);there were no significant differences between waves for all three countries. Anxiety/depression was consistently the most problematic EQ-5D-5L subdomain among Swedish and Americans (>50%), followed by pain/discomfort. >45% Norwegians also reported problems in anxiety/depression subdomain in both waves. The proportions reporting problems in anxiety/depression increased in wave 2 for Sweden and Norway, but decreased for the US. Conclusions: Population HRQoL in Sweden and Norway has been similar throughout the pandemic, while a rebound in population mean VAS was observed in the US. However, the large proportions reporting problems in anxiety/depression across waves in all 3 countries indicates that mental health issues resulting from the pandemic are a major concern.

Physical Therapy effectiveness applied through telerehabilitation during the state of exception in Ecuador due to the health emergency of SARS-COV2 (COVID 19)

Due to the global conjuncture caused by SARS-CoV-2 (COVID 19), health centers and providers have been forced to take alternative measures to provide treatments while safeguarding the health of patients and professionals. In the area of Physical Therapy, telerehabilitation has been the chosen method that allows permanent contact with the patient and at the same time satisfies the requirements of social distancing, without interrupting the recovery process. To determine the effectiveness of the physiotherapeutic interventions applied through telerehabilitation to the patients of the Physical Therapy Laboratory of the Technical University of Ambato, is the purpose of the research, during the state of exception provided by the Government of Ecuador for the health emergency SARS-CoV-2. The study was non-experimental and retrospective, with a quali-quantitative approach, the medical records were classified according to age, sex and diagnosis. The SF-12 Health questionnaire and the Visual Analogue Scale (VAS) were applied to the patients;then the comparative statistical analysis between the SF-12 and VAS was performed before and after the treatment period, using the SPSS software. of the 38 initial participants, in 23.7% the pain disappeared completely;On average, the SF-12 score increased by 14 points (initial 29.9 vs final 43.7) while the T test found significant differences, since when examining the initial and final results of the VAS and the SF-12 questionnaire, A value of 0.00 was obtained, the reference being p = 0.05;thus confirming that the affirmative hypothesis is accepted. All participants showed improvement in quality of life and decrease in pain, concluding that physiotherapy through telerehabilitation is an effective alternative method, in situations in which physical contact with the patient must be avoided.

What can we learn from the experiences and expectations of patients on growing waiting lists for planned care in the COVID-19 pandemic?

AIMS: COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms. METHODS: A minimum representative sample of 824 patients was required for quantitative analysis to provide a 3% margin of error. Sampling was stratified by body region (upper/lower limb, spine) and duration on the waiting list. Questionnaires were sent to a random sample of elective orthopaedic waiting list patients with their planned intervention paused due to COVID-19. Analyzed parameters included baseline health, change in physical/mental health status, challenges and coping strategies, preferences/concerns regarding treatment, and objective quality of life (EuroQol five-dimension questionnaire (EQ-5D), Generalized Anxiety Disorder 2-item scale (GAD-2)). Qualitative analysis was performed via the Normalization Process Theory. RESULTS: A total of 888 patients responded. Better health, pain, and mood scores were reported by upper limb patients. The longest waiters reported better health but poorer mood and anxiety scores. Overall, 82% had tried self-help measures to ease symptoms; 94% wished to proceed with their intervention; and 21% were prepared to tolerate deferral. Qualitative analysis highlighted the overall patient mood to be represented by the terms 'understandable', 'frustrated', 'pain', 'disappointed', and 'not happy/depressed'. COVID-19-mandated health and safety measures and technology solutions were felt to be implemented well. However, patients struggled with access to doctors and pain management, quality of life (physical and psychosocial) deterioration, and delay updates. CONCLUSION: This is the largest study to hear the views of this 'hidden' cohort. Our findings are widely relevant to ensure provision of better ongoing support and communication, mostly within the constraints of current resources. In response, we developed a reproducible local action plan to address highlighted issues. Cite this article: Bone Jt Open 2021;2(8):573-583.

Efficacy of broccoli and glucoraphanin in COVID-19: From hypothesis to proof-of-concept with three experimental clinical cases.

COVID-19 is described in a clinical case involving a patient who proposed the hypothesis that Nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-interacting nutrients may help to prevent severe COVID-19 symptoms. Capsules of broccoli seeds containing glucoraphanin were being taken before the onset of SARS-CoV-2 infection and were continued daily for over a month after the first COVID-19 symptoms. They were found to reduce many of the symptoms rapidly and for a duration of 6-12 h by repeated dosing. When the patient was stable but still suffering from cough and nasal obstruction when not taking the broccoli capsules, a double-blind induced cough challenge confirmed the speed of onset of the capsules (less than 10 min). A second clinical case with lower broccoli doses carried out during the cytokine storm confirmed the clinical benefits already observed. A third clinical case showed similar effects at the onset of symptoms. In the first clinical trial, we used a dose of under 600 µmol per day of glucoraphanin. However, such a high dose may induce pharmacologic effects that require careful examination before the performance of any study. It is likely that the fast onset of action is mediated through the TRPA1 channel. These experimental clinical cases represent a proof-of-concept confirming the hypothesis that Nrf2-interacting nutrients are effective in COVID-19. However, this cannot be used in practice before the availability of further safety data, and confirmation is necessary through proper trials on efficacy and safety.