Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19.

BACKGROUND: The management of tracheotomy at home can be very complex, affecting the patient's quality of life. OBJECTIVES: This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. METHODS: Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. RESULTS: 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. CONCLUSIONS: The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.

Life course psychosocial precursors of parent mental health resilience during the COVID-19 pandemic: A three-decade prospective cohort study.

BACKGROUND: There has been widespread interest in the implications of COVID-19 containment measures on the mental health of parents. Most of this research has focused on risk. Much less is known about resilience; yet such studies are key to protecting populations during major crises. Here we map precursors of resilience using life course data spanning three decades. METHODS: The Australian Temperament Project commenced in 1983 and now follows three generations. Parents (N = 574, 59 % mothers) raising young children completed a COVID-19 specific module in the early (May-September 2020) and/or later (October-December, 2021) phases of the pandemic. Decades prior, parents had been assessed across a broad range of individual, relational and contextual risk and promotive factors during childhood (7-8 years to 11-12 years), adolescence (13-14 years to 17-18 years) and young adulthood (19-20 years to 27-28 years). Regressions examined the extent to which these factors predicted mental health resilience, operationalised as lower than expected anxiety and depressive symptoms during the pandemic relative to pre-pandemic symptoms. RESULTS: Parent mental health resilience during the COVID-19 pandemic was consistently predicted by several factors assessed decades before the pandemic. These included lower ratings of internalizing difficulties, less difficult temperament/personality traits and stressful life events, and higher ratings of relational health. LIMITATIONS: The study included 37-39-year-old Australian parents with children age between 1 and 10 years. DISCUSSION: Results identified psychosocial indicators across the early life course that, if replicated, could constitute targets for long-term investment to maximise mental health resilience during future pandemics and crises.

The cross-sectional association of stressful life events with depression severity among patients with hypertension and diabetes in Malawi.

Depressive disorders are a leading cause of global morbidity and remain disproportionately high in low- and middle-income settings. Stressful life events (SLEs) are known risk factors for depressive episodes and worsened depressive severity, yet are under-researched in comparison to other depression risk factors. As depression is often comorbid with hypertension, diabetes, and other noncommunicable diseases (NCDs), research into this relationship among patients with NCDs is particularly relevant to increasing opportunities for integrated depression and NCD care. This study aims to estimate the cross-sectional association between SLEs in the three months preceding baseline interviews and baseline depressive severity among patients with at least mild depressive symptoms who are seeking NCD care at 10 NCD clinics across Malawi. SLEs were measured by the Life Events Survey and depressive severity (mild vs. moderate to severe) was measured by the Patient Health Questionnaire-9. The study population (n = 708) was predominately currently employed, grand multiparous (5-8 children) women with a primary education level. Two thirds (63%) had mild depression while 26%, 8%, and 3% had moderate, moderately severe, and severe depression, respectively. Nearly all participants (94%) reported at least one recent SLE, with the most common reported SLEs being financial stress (48%), relationship changes (45%), death of a family member or friend (41%), or serious illness of a family member or friend (39%). Divorce/separation, estrangement from a family member, losing source of income, and major new health problems were significant predictors of greater (moderate or severe) depressive severity compared to mild severity. Having a major new health problem or experiencing divorce/separation resulted in particularly high risk of more severe depression. After adjustment, each additional SLE was associated with a 9% increased risk of moderate or worse depressive severity compared to mild depressive severity (RR: 1.09; (95% CI: 1.05, 1.13), p<0.0001). Among patients with NCDs with at least mild depressive symptoms, SLEs in the prior 3 months were associated with greater depressive severity. While many SLEs may not be preventable, this research suggests that assessment of SLEs and teaching of positive coping strategies when experiencing SLEs may play an important role in integrated NCD and depression treatment models.

Meanings and metaphors of covid-19 in the experience of adult men who have had the disease / Significados e metáforas da covid-19 na experiência de homens adultos que tiveram a doença / Significados y metáforas del covid-19 en la experiencia de los hombres adultos que han tenido la enfermedad

Objetivo: compreender os significados e metáforas da Covid-19 na experiência de homens que tiveram a doença. Método: estudo qualitativo, realizado em ambiente virtual envolvendo 75 homens adultos, residentes no Brasil, sobreviventes da Covid-19, recrutados nas redes sociais Facebook® e Instagram®. Os dados foram coletados em resposta a um instrumento disponibilizado no Google Forms®. Os dados foram submetidos à análise lexical e à análise temática, e interpretados à luz da socioantropologia da doença. Resultados: do conteúdo temático emergiram três categorias: Percepção de vulnerabilidade à morte; As dores dos sintomas da doença e do isolamento; e Significados atribuídos à doença e ao adoecer. Conclusão: os homens elaboram metáforas da Covid 19 como um mal que os surpreende, desestrutura suas vidas e os isola. Posicionam-na como um sujeito perigoso de tal forma que a discriminação provoca mais sofrimento do que as manifestações clínicas.

Objetivo: Comprender los significados y las metáforas de Covid-19 en la experiencia de los hombres que han tenido la enfermedad. Método: Estudio cualitativo, realizado en un ambiente virtual con 75 hombres adultos, residentes en Brasil, supervivientes de la Covid-19, reclutados en las redes sociales Facebook® e Instagram®. Los datos se recogieron en respuesta a un instrumento disponible en Google Forms®. Los datos se sometieron a un análisis léxico y a un análisis temático y se interpretaron a la luz de la socioantropología de la enfermedad. Resultados: del contenido temático surgieron tres categorías: Percepción de vulnerabilidad ante la muerte; Los dolores de los síntomas de la enfermedad y el aislamiento; y Significados atribuidos a la enfermedad y al proceso enfermar. Conclusión: Los hombres elaboran metáforas de la Covid-19 como un mal que les sorprende, les desestructura la vida y les aísla. Ella es posicionada como un sujeto peligroso, de tal manera que la discriminación provoca más sufrimiento que las manifestaciones clínicas.

Objective: To understand the meanings and metaphors of Covid-19 in the experience of men who have had the disease. Method: Qualitative study, conducted in a virtual environment involving 75 adult men, living in Brazil, Covid-19 survivors, recruited in the social networks Facebook® and Instagram®. Data were collected by responding to an instrument made available on Google Forms®. The data were subjected to lexical and thematic analysis and interpreted in the light of the Socio Anthropology of illness. Results: three categories emerged from the thematic content: Perception of vulnerability to death; The pains of the symptoms of illness and isolation; and Meanings attributed to the illness and getting sick. Conclusion: Men elaborate metaphors of Covid-19 as an evil that surprises them, disrupts their lives, and isolates and positions them. They put it as a dangerous subject in the way that discrimination causes more suffering than clinical manifestations.

Mental Health Risks after Repeated Exposure to Multiple Stressful Events during Ongoing Social Unrest and Pandemic in Hong Kong: The Role of Rumination: Risques pour la santé mentale après une exposition répétée à de multiples événements stressants d'agitation sociale durable et de pandémie à Hong Kong: le rôle de la rumination.

OBJECTIVES: The co-occurrence of different classes of population-level stressors, such as social unrest and public health crises, is common in contemporary societies. Yet, few studies explored their combined mental health impact. The aim of this study was to examine the impact of repeated exposure to social unrest-related traumatic events (TEs), coronavirus disease 2019 (COVID-19) pandemic-related events (PEs), and stressful life events (SLEs) on post-traumatic stress disorder (PTSD) and depressive symptoms, and the potential mediating role of event-based rumination (rumination of TEs-related anger, injustice, guilt, and insecurity) between TEs and PTSD symptoms. METHODS: Community members in Hong Kong who had utilized a screening tool for PTSD and depressive symptoms were invited to complete a survey on exposure to stressful events and event-based rumination. RESULTS: A total of 10,110 individuals completed the survey. Hierarchical regression analysis showed that rumination, TEs, and SLEs were among the significant predictors for PTSD symptoms (all P < 0.001), accounting for 32% of the variance. For depression, rumination, SLEs, and PEs were among the significant predictors (all P < 0.001), explaining 24.9% of the variance. Two-way analysis of variance of different recent and prior TEs showed significant dose-effect relationships. The effect of recent TEs on PTSD symptoms was potentiated by prior TEs (P = 0.005). COVID-19 PEs and prior TEs additively contributed to PTSD symptoms, with no significant interaction (P = 0.94). Meanwhile, recent TEs were also potentiated by SLEs (P = 0.002). The effects of TEs on PTSD symptoms were mediated by rumination (ß = 0.38, standard error = 0.01, 95% confidence interval: 0.36 to 0.41), with 40.4% of the total effect explained. All 4 rumination subtypes were significant mediators. CONCLUSIONS: Prior and ongoing TEs, PEs, and SLEs cumulatively exacerbated PTSD and depressive symptoms. The role of event-based rumination and their interventions should be prioritized for future research.

Life Course Education, Health, and Ageing Well: A Short Inter-Academic Report.

After the first wave of the COVID-19 pandemic, during which the severity of the disease in certain countries was attributed to a lack of basic education of the inhabitants, the authors of this paper initiated a literature review of educational trajectories, health, and ageing well. The findings strongly demonstrate that alongside genetics, the affective and educational family environment, as well as the general environment, greatly interact starting from the very first days of life. Thus, epigenetics plays a major role in the determination of health and disease [DOHAD] in the first 1,000 days of life as well as in the characterization of gender. Other factors such as socio-economic level, parental education, schooling in urban or rural areas, also play a major role in the differential acquisition of health literacy. This determines adherence (or lack thereof) to healthy lifestyles, risky behaviours, substance abuse, but also compliance with hygiene rules, and adherence to vaccines and treatments. The combination of all these elements and lifestyle choices facilitates the emergence of metabolic disorders (obesity, diabetes), which promote cardiovascular and kidney damage, and neurodegenerative diseases, explaining that the less well educated have shorter survival and spend more years of life in disability. After having demonstrated the impact of the educational level on health and longevity, the members of this inter-academic group propose specific educational actions at three levels: (1) teachers and health professionals, (2) parents, (3) the public, emphasizing that these crucial actions can only be carried out with the unfailing support of state and academic authorities.

Experiencing a significant life event during the COVID-19 pandemic: The role of perceived control.

The COVID-19 pandemic represents a context that might influence how people experience significant life events (such as marriage, job change, or relocation). In the present research, we argue that one important factor of how positively or negatively the pandemic influences the experience of significant life events is how much control people perceive in the situation. An online sample of N = 882 participants aged 18-82 years reported a significant life event that occurred during the COVID-19 pandemic. The participants described whether the pandemic influenced the life event, to what extent they perceived control over the life event and how they experienced the life event in terms of valence (i.e., positively or negatively). The results showed that the self-reported pandemic influence was significantly associated with the life-event experience. Furthermore, perceived control partly mediated this association. The results persisted even after controlling for the age of the participants. The present research underscores the important role of control for experiencing significant life events in challenging times such as during the pandemic.

Directed content analysis: A life course approach to understanding the impacts of the COVID-19 pandemic with implications for public health and social service policy.

BACKGROUND: The COVID-19 pandemic has had broad impacts on individuals, families and communities which will continue to require multidimensional responses from service providers, program developers, and policy makers. OBJECTIVES: The purpose of this study was to use Life Course theory to understand and imagine public health and policy responses to the multiple and varied impacts of the COVID-19 pandemic on different groups. METHODS: "The Cost of COVID-19" was a research study carried out in Kingston, Frontenac, Lennox and Addington counties in South Eastern Ontario, Canada, between June and December 2020. Data included 210 micronarrative stories collected from community members, and 31 in-depth interviews with health and social service providers. Data were analyzed using directed content analysis to explore the fit between data and the constructs of Life Course theory. RESULTS: Social pathways were significantly disrupted by changes to education and employment, as well as changes to roles which further altered anticipated pathways. Transitions were by and large missed, creating a sense of loss. While some respondents articulated positive turning points, most of the turning points reported were negative, including fundamental changes to relationships, family structure, education, and employment with lifelong implications. Participants' trajectories varied based on principles including when they occurred in their lifespan, the amount of agency they felt or did not feel over circumstances, where they lived (rural versus urban), what else was going on in their lives at the time the pandemic struck, how their lives were connected with others, as well as how the pandemic impacted the lives of those dear to them. An additional principle, that of Culture, was felt to be missing from the Life Course theory as currently outlined. CONCLUSIONS: A Life Course analysis may improve our understanding of the multidimensional long-term impacts of the COVID-19 pandemic and associated public health countermeasures. This analysis could help us to anticipate services that will require development, training, and funding to support the recovery of those who have been particularly affected. Resources needed will include education, mental health and job creation supports, as well as programs that support the development of individual and community agency.

Coping with COVID-19. Work life experiences of nursing, midwifery and paramedic academics: An international interview study.

BACKGROUND: The COVID-19 global pandemic was declared in March 2020. By June 2022, the total deaths worldwide attributed to COVID-19 numbered over 6.3 million. Health professionals have been significantly impacted worldwide primarily those working on the frontline but also those working in other areas including nursing, midwifery, and paramedic higher education. Studies of occupational stress have focused on the clinical health professional roles but scant attention has been drawn to the pressures on university-based academic staff supporting and preparing professionals for frontline health work. DESIGN AND OBJECTIVES: This qualitative study sought to explore the challenges experienced by health academics (nurses, midwives and paramedics), during COVID-19 and identify strategies enlisted. SETTING AND PARTICIPANTS: Six Australian and two United Kingdom universities collaborated, from which 34 health academics were individually interviewed via video or teleconference, using six broad questions. Ethical approval was obtained from the lead site and each participating University. DATA ANALYSIS: Thematic analysis of the data was employed collaboratively across institutions, using Braun and Clarke's method. RESULTS: Data analysis generated four major themes describing academics': Experiences of change; perceptions of organisational responses; professional and personal impacts; and strategies to support wellbeing. Stress, anxiety and uncertainty of working from home and teaching in a different way were reported. Strategies included setting workday routine, establishing physical boundaries for home-working and regular online contact with colleagues. CONCLUSIONS: The ability of nursing, midwifery and, paramedic academic staff to adapt to a sudden increase in workload, change in teaching practices and technology, while being removed from their work environment, and collegial, academic and technological supports is highlighted. It was recognised that these changes will continue post-COVID and that the way academics deliver education is forever altered.

Differences in Work-Life Experiences of Physicians by Parenting Status, Gender, and Training Level During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has presented new challenges for physicians, and physician-parents specifically. Few studies have focused on work-life changes in this population. The present study investigated work-life changes in a group of physicians during the first six months of the COVID-19 pandemic. METHODS: A survey was distributed electronically to physicians affiliated with a U.S. medical school inquiring about experiences during the first six months of the COVID-19 pandemic (March 2020 to September 2020). RESULTS: In logistic regression models adjusted for age, significantly more female physician- parents reported increased burnout, increased time with kids, and increased fear of going to work compared to male physician-parents. Around 1 in 2 attendings reported burnout, regardless of parenting status. CONCLUSION: While high rates of burnout were found across all groups in this study, differences were found by gender and parenting status. Further research is needed to understand burnout during the COVID-19 pandemic and to support physician-parents.

Impact of COVID-19 on life experiences reported by a diverse cohort of older adults with diabetes and obesity.

OBJECTIVE: This study aimed to measure the impact of the COVID-19 pandemic on self-reported life experiences in older adults with diabetes and obesity. METHODS: Participants were surveyed in 2020 regarding negative and positive impacts of the pandemic across domains of personal, social, and physical experiences. A cumulative negative risk index (a count of all reported negative impacts of 46 items) and a positive risk index (5 items) were characterized in relation to age, sex, race/ethnicity, BMI, and multimorbidity. RESULTS: Response rate was high (2950/3193, 92%), average age was 76 years, 63% were women, and 39% were from underrepresented populations. Women reported more negative impacts than men (6.8 vs. 5.6; p < 0.001 [of 46 items]) as did persons with a greater multimorbidity index (p < 0.001). Participants reporting African American/Black race reported fewer negative impacts than White participants. Women also reported more positive impacts than men (1.9 vs. 1.6; p < 0.001 [of 5 items]). CONCLUSIONS: Older adults with diabetes and obesity reported more positive impacts of the pandemic than negative impacts, relative to the number of positive (or negative) items presented. Some subgroups experienced greater negative impacts (e.g., for women, a greater multimorbidity index). Efforts to reestablish personal, social, and physical health after the pandemic could target certain groups.

The Pendulum Has Swung: How Do We Ensure a Life Course Approach to Immunisation in Australia?

Rather than concentrating primarily on children and adolescents, there has been a shift in the discourse around immunisation to encompass a whole-of-life approach. Despite this acknowledgement and ongoing high burdens of vaccine preventable diseases in adults, coverage for some adult risk groups remains sub-optimal. This study aimed to explore key informant's and stakeholder's perceptions of factors impacting provision of immunisation programs for Australian adults and to identify strategies to promote acceptance and uptake. Semi-structured telephone interviews were undertaken with people involved in adult immunisation program delivery, advocacy, policy or research between September 2020 and June 2021. Transcripts were inductively analysed, with the resulting themes categorised into the five influences on vaccination gaps that have informed program planning in other countries: Access, Affordability, Awareness, Acceptance and Activation. Participants spoke of improvements in the provision of vaccines to adults, however, ongoing challenges persisted. Participants agreed that the focus or emphasis of policies and the promotion/communication strategies has been on childhood vaccination in Australia, however there is a sense that the "pendulum has swung." These included understanding of eligibility amongst the Australian population and the reluctance of some health providers to dedicate time to exploring immunisation needs with adult patients. In comparison to the childhood vaccination program, there has been a lack of data available on coverage for adult vaccines on the national immunisation program. This has contributed to the ongoing challenges of identifying and promoting certain vaccines. At a government level, questions were raised about why the Australian government has never set an aspirational target for adult vaccination (i.e., influenza or pneumococcal) coverage. While significant improvements have been made in adult immunisation uptake, there are still gaps across the program. While the system remains under stress because of the COVID-19 pandemic, it is not appropriate to implement any additional programs. There needs to be strong commitment to establish the value of adult vaccination in the eyes of community members, policy makers and healthcare professionals. Having a national adult immunisation strategic plan would help advance action.

Working With a Holocaust Survivor's Daughter DURING THE CORONAVIRUS PANDEMIC.

Through a detailed clinical vignette, this essay explores the impact of a life-threatening pandemic on a Holocaust survivor's daughter whose father was a victim of life-threatening events. The following issues are discussed: intermingling of the patient's perception of the pandemic with her mental representation of the Holocaust, changes in analytic technique necessary during the period of lockdown, and the disentanglement of the patient's perception of current reality from her fantasies regarding her father's Holocaust past.

Investigating the work-life experiences of nursing faculty in Canadian academic settings and the factors that influence their retention: protocol for a mixed-method study.

INTRODUCTION: While all research-oriented faculty face the pressures of academia, female faculty in fields including science, engineering, medicine and nursing, are especially susceptible to burnout. Nursing is unique in that it remains a predominantly female-dominated profession, which implies that there is a critical mass of females who are disproportionately affected and/or at higher risk of burnout. To date, little is known about the experiences of nursing faculty especially, new and early career researchers and the factors that influence their retention. This study aims to understand the work-life (the intersection of work with personal life) experiences of nursing faculty in Canadian academic settings and the factors that influence their retention. METHODS AND ANALYSIS: A mixed-method design will be used in this study. For the quantitative study, a sample of approximately 1500 new and early career nursing faculty across Canadian academic institutions will be surveyed. Eligible participants will be invited to complete a web-based structured questionnaire in both French and English language. Data will be evaluated using generalised linear regression model and structural equation modelling. Given the complexities of work-life issues in Canada, qualitative focus group interviews with about 20-25 participants will also be conducted. Emerging themes will be integrated with the survey findings and used to enrich the interpretation of the quantitative data. ETHICS AND DISSEMINATION: This study has received ethical approval from the Hamilton Integrated Research Ethics Board (#1477). Prior to obtaining informed consent, participants will be provided with information about study risks and benefits and strategies undertaken to ensure confidentiality and anonymity. The study findings will be disseminated to academics and non-academic stakeholders through national and international conference presentations and peer-reviewed open-access journals. A user-friendly report will be shared with professional nursing associations such as the Canadian Associations of Schools of Nursing, and through public electronic forums (e.g., Twitter). Evidence from this study will also be shared with stakeholders including senior academic leaders and health practitioners, government, and health service policy-makers, to raise the profile of discourses on the nursing workforce shortages; and women's work-life balance, a public policy issue often overlooked at the national level. Such discussion is especially pertinent in light of the disproportionate impact of COVID-19 on women, and female academics. The findings will be used to inform policy options for improving nursing faculty retention in Canada and globally.

The 3D-Transition Study: Objectives, Methods, and Implementation of an Innovative Planned Missing-Data Design.

The prevalence of mental health problems represents a significant burden on school and community health resources as early as preschool. Reducing this burden requires a better understanding of the developmental mechanisms linking children's early vulnerabilities with mental health after the transition to formal schooling. The 3D-Transition Study (2017-2021) follows 939 participants from a pregnancy cohort in the province of Québec, Canada, as they transition to kindergarten and first grade to examine these mechanisms. Biannual assessments include completed questionnaires from 2 parents as well as teachers, parent-child observations, anthropometric measurements, and age-sensitive cognitive assessments. Saliva is also collected on 11 days over a 16-month period in a subsample of 384 participants to examine possible changes in child salivary cortisol levels across the school transition and their role in difficulties observed during the transition. A combination of planned missing-data designs is being implemented to reduce participant burden, where incomplete data are collected without introducing bias after the use of multiple imputation. The 3D-Transition Study will contribute to an evidence-based developmental framework of child mental health from pregnancy to school age. In turn, this framework can help inform prevention programs delivered in health-care settings during pregnancy and in child-care centers, preschools, and schools.