People with metastatic breast cancer face barriers to finding information and support

People with metastatic breast cancer face barriers to finding information and support Background FORCE, a national nonprofit organization developed a health communication tool to help patients assess research relevance, key findings, and the quality of media reporting on cancer to support informed and shared health decision-making. People with metastatic breast cancer (mBC) are a priority population. Methods The organization conducted a survey about awareness of and access to breast cancer information and supportive services for people living with metastatic breast cancer. The organization promoted the survey through e-mail and social media, and a network of partner organizations that serve the metastatic breast cancer community. The survey invited respondents to volunteer to participate in focus groups and a follow-up survey in order to support efforts to serve this priority population. Results and Conclusions While interest in clinical trials was high, many users reported that thy do not know how to find an appropriate clinical trial. A majority of the 335 respondents were interested in information about clinical trials, treatment side effects, research findings, long-term health issues, diet/exercise, fatigue, and emotional health. Three quarters of the respondents indicated that they had never participated in a clinical trial, 67% indicated they would be interested in participating in the future, and about 40% indicated they did not know how to find a clinical trial recruiting people with metastatic breast cancer. Approximately one-third of participants were unable to obtain referrals to services they sought. Other barriers to services included lack of insurance coverage, lack of availability, and the COVID-19 public health emergency. Focus group responses indicate that women with mBC find the health communication tool to be useful, and appropriate in language, images, and tone. Results indicate that women with mBC are interested in finding information about clinical trials and other topics related to treatment side effects and quality of life. FORCE and partners are incorporating these results into tailored online resources to meet the needs of the mBC community.

Farming wellbeing through and beyond COVID-19: Stressors, gender differences and landscapes of support

Although there has been a recent surge in research on drivers of poor farmer wellbeing and mental health, there is still a limited understanding of the state of wellbeing in farming communities around the world and how it can be best supported. This special issue seeks to extend our knowledge of how a combination of different stressors can challenge the wellbeing of farmers, farming families and farm workers, as well as how negative impacts can be unevenly distributed between different individuals. We advance the state of the art in research on farmer wellbeing, illustrating how social, economic and environmental policy drivers combine to create multiple points of stress, which are experienced differently by different individuals (e.g., age, gender). We move beyond an exploration of stressors towards a consideration of how landscapes of support for farmer wellbeing, and packages of support interventions, can improve the social resilience of farming communities. To be effective, these landscapes of support need to be accessible, well-funded, joined-up, and adaptable to evolving crises. This special issue explores farmer wellbeing in the context of global agricultural transitions, which are demanding new ways of farming (e.g., digitalisation, net zero, economic restructuring), and in light of shock events, such as the COVID-19 pandemic, in four countries—Ireland, New Zealand, the UK and the US. In exploring the impacts of future shock events and agricultural transitions on wellbeing, the issue concludes with a call to move beyond broad compilations of stressors and interventions and towards nuanced investigations of why and how poor farmer wellbeing occurs and how it can be best supported in specific contexts. The research from these four countries has wide relevance across European countries (similarity in farming systems, noting some differences), but a key message from the issue is that stressors on farmer wellbeing can be highly context-dependent according to place-based social, environmental, economic and political issues. © 2023 The Authors. Sociologia Ruralis published by John Wiley & Sons Ltd on behalf of European Society for Rural Sociology.

Adoption of autonomous robots in the soft fruit sector: Grower perspectives in the UK

The effects of changing geopolitics, demographic change, and COVID-19 have caused significant disruption to labour in the agricultural sector around the world. In the UK, the challenges to free movement of labour and safe working conditions caused by COVID-19 have exacerbated the labour shortage caused by Brexit. In these circumstances, the use of autonomous robots in those sectors hardest hit by labour shortages, such as soft fruit, is being considered as a potential solution. Autonomous robots for use in the high value crop sector, including soft fruit, are at varying stages of technology readiness with robots for disease treatment, packhouse, and logistic support already commercially used and robots for picking approaching a demonstration phase. However, the pathway to implementation is not determined by technology readiness alone, but rather by the intention and ability of growers to adopt. To date, there has been limited investigation of the views of soft fruit growers towards the introduction of autonomous robots in the sector. We used a mixed methods approach, utilising a grower survey and qualitative interviews conducted in the UK, to explore the factors affecting adoption of autonomous robots on soft fruit farms. In general, the survey shows that growers are optimistic about the prospects of autonomous robots on soft fruit farms, although not necessarily in the short-term and there are several factors affecting uptake, particularly cost and infrastructure, as well as issues such as data ownership, cybersecurity, skills, and trust. We reflect on our findings in the context of existing research on technology adoption by growers and make a series of industry and policy recommendations which have global relevance. © 2022

A MUC5B Gene Polymorphism, rs35705950-T, Confers Protective Effects Against COVID-19 Hospitalization but Not Severe Disease or Mortality.

Rationale: A common MUC5B gene polymorphism, rs35705950-T, is associated with idiopathic pulmonary fibrosis (IPF), but its role in severe acute respiratory syndrome coronavirus 2 infection and disease severity is unclear. Objectives: To assess whether rs35705950-T confers differential risk for clinical outcomes associated with coronavirus disease (COVID-19) infection among participants in the Million Veteran Program (MVP). Methods: The MUC5B rs35705950-T allele was directly genotyped among MVP participants; clinical events and comorbidities were extracted from the electronic health records. Associations between the incidence or severity of COVID-19 and rs35705950-T were analyzed within each ancestry group in the MVP followed by transancestry meta-analysis. Replication and joint meta-analysis were conducted using summary statistics from the COVID-19 Host Genetics Initiative (HGI). Sensitivity analyses with adjustment for additional covariates (body mass index, Charlson comorbidity index, smoking, asbestosis, rheumatoid arthritis with interstitial lung disease, and IPF) and associations with post-COVID-19 pneumonia were performed in MVP subjects. Measurements and Main Results: The rs35705950-T allele was associated with fewer COVID-19 hospitalizations in transancestry meta-analyses within the MVP (Ncases = 4,325; Ncontrols = 507,640; OR = 0.89 [0.82-0.97]; P = 6.86 × 10-3) and joint meta-analyses with the HGI (Ncases = 13,320; Ncontrols = 1,508,841; OR, 0.90 [0.86-0.95]; P = 8.99 × 10-5). The rs35705950-T allele was not associated with reduced COVID-19 positivity in transancestry meta-analysis within the MVP (Ncases = 19,168/Ncontrols = 492,854; OR, 0.98 [0.95-1.01]; P = 0.06) but was nominally significant (P < 0.05) in the joint meta-analysis with the HGI (Ncases = 44,820; Ncontrols = 1,775,827; OR, 0.97 [0.95-1.00]; P = 0.03). Associations were not observed with severe outcomes or mortality. Among individuals of European ancestry in the MVP, rs35705950-T was associated with fewer post-COVID-19 pneumonia events (OR, 0.82 [0.72-0.93]; P = 0.001). Conclusions: The MUC5B variant rs35705950-T may confer protection in COVID-19 hospitalizations.

HEALTH SYSTEM RESILIENCY AND THE COVID-19 PANDEMIC: A CASE STUDY OF A NEW NATIONWIDE CONTINGENCY STAFFING PROGRAM

BACKGROUND: While health systems researchers have advanced conceptual thinking about the meaning of “resilience”, specific suggestions regarding how systems can become more resilient remain scarce. Moreover, additional work is needed on strategies for developing a resilience-oriented workforce responsive to public healthcare needs during crisis. This study seeks to fill this evidence gap through consideration of a new program recently launched at the Veterans Health Administration (VA) called Clinical Resource Hubs (CRHs). CRHs provide contingency staffing for primary care and mental health services, using predominantly telehealth modalities in 18 regional networks. Drawing upon insights from organizational theory, we describe how CRH resources (e.g., additional primary care providers with telehealth expertise) were leveraged during the early days of COVID-19 to deliver patient care and workforce training and support, and key factors that facilitated these responses. We hypothesize that having flexible contingency providers and staff who specialize in telehealth modalities may increase a health system's resilience (e.g., ability to absorb shocks), while also providing needed contingency care during non-crisis times. METHODS: We conducted semi-structured interviews with CRH directors and national program leaders (n=26) and used a rapid analysis approach to identify actions taken by CRHs to support the resiliency of the VA healthcare system during the pandemic. RESULTS: Respondents reported that almost all CRHs assisted with VA's COVID-19 response by maintaining patient access to care during the pandemic. This was accomplished by providing virtual and in-person contingency staffing for outpatient and inpatient care and triage support in VA clinical settings and the private sector. For example, respondents described how CRHs provided virtual outpatient staffing coverage for primary care providers and nurses reassigned to hospitals during the surge;virtual coverage for inpatient units in social work and pharmacy;and virtual triage for nurse advice lines. In addition, respondents reported that CRHs provided workforce support through training, coaching, and care delivery. Finally, respondents discussed key factors that facilitated CRHs' ability to quickly respond to the pandemic which included hub staff expertise in telehealth and increased acceptability of virtual care among key stakeholders. CONCLUSIONS: We found that the CRH program was flexible and nimble enough to respond to the demands of COVID-19. Having contingent staffing adept at virtual modes of care enabled VA health system resiliency during a public health crisis. As a multi-function program, CRHs may be a model for other similarly resourced healthcare organizations for supporting day-to-day operations through virtual staffing solutions, which can be redirected to meet human resource needs during shocks.

VA PRIMARY CARE HEALTHCARE WORKER EMPLOYEE ENGAGEMENT, BURNOUT, AND TURNOVER INTENT DURING THE COVID-19 PANDEMIC

BACKGROUND: The COVID-19 pandemic drove burnout and turnover among healthcare workers (HCWs), but working environments may have differentially buffered or exacerbated the pandemic's effects. Primary care HCWs faced pandemic-related challenges, like changes in staffing and space requirements, and a rapid shift to telehealth care. HCWs who were engaged at their workplace may have had better well-being, despite these challenges. Our aims were to measure the prevalence of burnout and turnover intent among HCWs in VA primary care during the COVID-19 pandemic and;(2) to understand the association between individual-level burnout, turnover intent, and employee engagement, and facility-level COVID-19 burden, prior year burnout, and telehealth. METHODS: We obtained data on burnout, turnover intent, employee engagement, and individual demographics from the 2020 VA All Employee Survey (AES) for 19,909 primary care HCWs (providers;registered nurses;clinical associates;administrative associates) in 141 facilities. We linked these data at the facility-level to burnout from the 2019 AES, COVID test and death rates from the 2020 VA COVID Shared Data Resource, the proportion of telehealth primary care visits from the 2020 VA Corporate Data Warehouse, and facility complexity levels from the 2020 VHA Support Service Center. We modeled relationships between burnout, turnover intent, employee engagement, demographics, and facility-level characteristics using logistic regressions with standard errors clustered by facility. RESULTS: Thirty-seven percent of primary care HCWs reported burnout, and 31% reported their intent to leave their job within two years. From March to September 2020, by facility average, COVID tests were 56.5 per 1000 unique patients, COVID deaths were 0.46 per 1000 unique patients, and approximately 29% of primary care visits were conducted by phone, video, or other telehealth medium. Highly engaged employees were less likely to be burned out (odds ratio [OR] 0.29;95% confidence interval [CI] 0.28-0.33) and had a lower intention to leave their job (OR 0.35;95% CI 0.32-0.38). Greater than average facility-level burnout in 2019 was related to higher HCW burnout in 2020 (OR 8.19, 95% CI 2.11-31.82), but 2019 and 2020 turnover intent did not have similar relationship. High COVID tests and deaths, and telehealth measures were not associated with burnout or potential turnover. CONCLUSIONS: While COVID-19 burden and use of telehealth were not associated with worse primary care HCW burnout or turnover intent, our results suggest that interventions to improve employee engagement might mitigate both outcomes. Burnout and turnover intent were high, but similar to pre-pandemic levels, indicating the persistent influence of non-COVID drivers of these outcomes. Future research should focus on understanding elements of the working environment that contribute to burnout and turnover, and interventions should be developed to improve working environments, and therefore HCW well-being, in primary care.

Association of Kidney Comorbidities and Acute Kidney Failure With Unfavorable Outcomes After COVID-19 in Individuals With the Sickle Cell Trait.

Importance: Sickle cell trait (SCT), defined as the presence of 1 hemoglobin beta sickle allele (rs334-T) and 1 normal beta allele, is prevalent in millions of people in the US, particularly in individuals of African and Hispanic ancestry. However, the association of SCT with COVID-19 is unclear. Objective: To assess the association of SCT with the prepandemic health conditions in participants of the Million Veteran Program (MVP) and to assess the severity and sequelae of COVID-19. Design, Setting, and Participants: COVID-19 clinical data include 2729 persons with SCT, of whom 353 had COVID-19, and 129 848 SCT-negative individuals, of whom 13 488 had COVID-19. Associations between SCT and COVID-19 outcomes were examined using firth regression. Analyses were performed by ancestry and adjusted for sex, age, age squared, and ancestral principal components to account for population stratification. Data for the study were collected between March 2020 and February 2021. Exposures: The hemoglobin beta S (HbS) allele (rs334-T). Main Outcomes and Measures: This study evaluated 4 COVID-19 outcomes derived from the World Health Organization severity scale and phenotypes derived from International Classification of Diseases codes in the electronic health records. Results: Of the 132 577 MVP participants with COVID-19 data, mean (SD) age at the index date was 64.8 (13.1) years. Sickle cell trait was present in 7.8% of individuals of African ancestry and associated with a history of chronic kidney disease, diabetic kidney disease, hypertensive kidney disease, pulmonary embolism, and cerebrovascular disease. Among the 4 clinical outcomes of COVID-19, SCT was associated with an increased COVID-19 mortality in individuals of African ancestry (n = 3749; odds ratio, 1.77; 95% CI, 1.13 to 2.77; P = .01). In the 60 days following COVID-19, SCT was associated with an increased incidence of acute kidney failure. A counterfactual mediation framework estimated that on average, 20.7% (95% CI, -3.8% to 56.0%) of the total effect of SCT on COVID-19 fatalities was due to acute kidney failure. Conclusions and Relevance: In this genetic association study, SCT was associated with preexisting kidney comorbidities, increased COVID-19 mortality, and kidney morbidity.

COVID pandemic versus pre-pandemic care of stroke patients within the Florida Stroke Registry

Background: The coronavirus 2019 (COVID-19) pandemic has affected all aspects of stroke care delivery and resource allocation. We sought to study this effect utilizing the Florida Stroke Registry (FSR), which collects data from hospitals in large metropolitan cities and small communities, each facing pandemic peaks at different timepoints and within various healthcare system organizations. Methods: From March 2019 to March 2021, the FSR identified 82,899 patients with the final diagnosis of ischemic stroke and TIA. Stroke care metrics were compared in patients enrolled during the COVID-19 pandemic (March 2020 to February 2021) to those enrolled in the immediate pre-pandemic year. These metrics included utilization of intravenous thrombolytic (IVT), Endovascular therapy (EVT), Door-To-Needle time (DTN), Door-To-Puncture time (DTP), Door-To-Computed Tomography time (DTCT) and overall Defect-Free Care (DFC). Results: Pre-pandemic patients (n= 41,929, 49.0% female, mean age 70.1 ± 14.6 years, 64.3% white, 20.4% black, 15.3% Hispanic) had similar demographics to pandemic patients (48.8% female, mean age 69.9 ± 14.4 years, 65.4% white, 19.9% black, 14.7% Hispanic). Pandemic stroke patients had more severe presentations (median NIHSS 3 [IQR 8] vs 3 [7], p < .0001), longer onset-to-arrival time (242 [677] vs 229 [654] minutes, p = 0.002), and were more likely to arrive via emergency medical services (62.3% vs. 60.8%, p < .0001) than pre-pandemic stroke patients. Although both groups received IVT equally (13.4% vs. 13.5%, p = 0.67), pandemic stroke patients were more likely to receive EVT (7.0% vs. 6.5%, p = 0.005) and had longer DTP (84 [60] vs. 81 [64] minutes, p = 0.01), shorter DTCT (22 [52] vs 23 [56] minutes, p = 0.01) and similar DTN (36 [22] vs. 37 [22] minutes, p = 0.05) times, with an increased DFC rate of 2.2% (86.6% vs. 84.4%, p < .0001). Conclusions: In this large registry based study, we found that compared to pre-pandemic care, ischemic stroke patients treated during the COVID19 pandemic presented sicker and later to the hospital and were more likely to receive EVT, but had longer door-to-puncture times. Despite many healthcare delivery challenges imposed by COVID19, Florida hospitals within the FSR maintained high quality of stroke care overall.

Recovery from pandemic: insights from those affected

Introduction: In 2021 the WHO observes over 20 disease events worldwide with endemic or pandemic potential. The SARS-CoV-2 pandemic highlighted the vulnerability of the globally connected workplace. As part of pandemic planning, preparing for a return to normal operations is required. With the support of the German scientific societies for occupational medicine and safety engineering, companies in Germany were surveyed on the current status of recovery planning. Methods: From March 2020 to August 2021 German companies completed an online checklist on operational and occupational health issues concerning the return to normal operations. This descriptive evaluation focused on occupational health aspects. Results: A total of 2606 people participated (answering at least one question). There were: 1117 data on occupational group (36% managers, 62% EHS staff);992 data on pandemic planning (yes/partially/no: 48%/24%/28%);911 data on recovery planning (yes/preparation/no/don't know: 27%/46%/20%/7%);986 data on relevance of recovery planning (important/not important/no statement possible: 92%/6%/2%);352 data on involvement of occupational health professionals (yes/no/does not apply: 68%/17%/15%);352 data on infection screening (yes/no/does not apply: 61%/15%/24%);348 data on hygiene training (yes/no/does not apply: 78%/13%/9%). Conclusions: The relevance of structured pandemic/recovery planning is confirmed. Occupational health aspects such as occupational health care or hygiene training are important components. The course of the pandemic shows that continuous review and adaptation of recovery planning are necessary.

COVID-19 in patients with multiple sclerosis despite SARS-CoV-2 vaccination

Introduction: Several studies have demonstrated reduced serological response to SARS-CoV-2 vaccines in multiple sclerosis (MS) patients treated with anti-CD20 and sphingosine 1-phosphate receptor (S1PR) modulator disease modifying therapies (DMTs). However, there are limited data on the factors affecting protective immunity. Objectives: Investigating factors affecting protective immunity in a population of patients with MS Methods: MS Patients on DMT diagnosed with COVID-19 following at least one dose of a SARS-CoV-2 vaccine were identified in the Cleveland Clinic COVID-19 registry or during routine clinical care. Cases outside the registry were confirmed to have positive SARS-CoV-2 by PCR at time of diagnosis. Demographics, disease history, DMTs, comorbidities, exposures, vaccination status, and COVID-19 outcomes were collected from the registry or chart review. Additional data collection is ongoing for patients vaccinated outside the Cleveland Clinic. Results: 18 patients were identified (13 relapsing remitting, 2 secondary progressive, and 2 primary progressive MS): 13(72.2%) female, 14(77.8%) Caucasian, median age 43 years, median disease duration 12.5 years. Of the 10 patients for whom detailed vaccination data are readily available, 80% completed a full vaccination series. All received an mRNA vaccine. In the registry population, 8/629 (1.3%) fully vaccinated and 2/130 (1.5%) partially vaccinated patients tested positive for COVID- 19 after vaccination. 11(61.1%) were on anti-CD20 therapies, 5(27.1%) S1PR modulators, and 2(11.1%) dimethyl fumarate. 4 patients were hospitalized. Median length of stay was 8, range 1-15. No patients required supplemental oxygen, intubation, or ICU stay. 1 patient was discharged to a rehabilitation hospital and 3 home Conclusions: Patients treated with anti-CD20 agents and S1PR modulators still may be at risk for COVID-19 despite vaccination. While still at risk for hospitalization, intubation and death from COVID-19 appear rare. Larger studies analyzing the temporal relation between DMT administration and vaccination, and the relationship of serological response and overall protective immunity are needed to guide patient counselling.

ANALYSIS OF SARS-COV-2 GENOME SEQUENCES FROM THE PHILIPPINES: GENETIC SURVEILLANCE AND TRANSMISSION DYNAMICS (preprint)

The spread of the corona virus around the world has spurred travel restrictions and community lockdowns to manage the transmission of infection. In the Philippines, with a large population of overseas Filipino contract workers (OFWs), as well as foreign workers in the local online gaming industry and visitors from nearby countries, the first reported cases were from a Chinese couple visiting the country in mid-January 2020. Three months on, by mid-March, the COVID-19 cases in the Philippines had reached its first 100, before it exploded to the present 178,022 cases (as of August 20, 2020). Here, we report a genomic survey of six (6) whole genomes of the SARS-CoV-2 virus collected from COVID-19 patients seen at the Philippine General Hospital, the major referral hospital for COVID-19 cases in Metro Manila at about the time the Philippines had over a hundred cases. Analysis of commonly observed variants did not reveal a clear pattern of the virus evolving towards a more infectious and severe strain. When combined with other available viral sequences from the Philippines and from GISAID, phylogenomic analysis reveal that the sequenced Philippine isolates can be classified into three primary groups based on collection dates and possible infection sources: (1) January samples collected in the early phases of the pandemic that are closely associated with isolates from Wuhan, China; (2) March samples that are mainly linked to the M/V Diamond Princess Cruise Ship outbreak; and (3) June samples that clustered with European isolates, one of which already harbor the globally prevalent D614G mutation which initially circulated in Europe. The presence of community-acquired viral transmission amidst compulsory and strict quarantine protocols, particularly for repatriated Filipino workers, highlights the need for a refinement of the quarantine, testing, and tracing strategies currently being implemented to adapt to the current pandemic situation.