Feasibility, Safety and Efficacy of a Combined Supervised Physical Exercise and Nutritional Program in a Selected Population of Luminal Metastatic Breast Cancer Patients: Oncare01 Pilot Study

Background: Supervised exercise programs (SEP) have demonstrated an improvement in quality of life (QoL), cardiovascular health, treatment tolerance and disease outcomes in early breast cancer patients. In metastatic breast cancer (MBC), previous data suggest SEP are safe but no impact on QoL and a low adherence to programs were shown. These studies included a heterogenous population in terms of type of treatments received, numbers of previous lines or comorbidities. From our perspective, MBC profile that could benefit most from SEP needs to be explored. Thus, we conducted a pilot study to assess adherence, safety and impact on QoL of a combined SEP and nutritional program (NP) in a selected population of MBC of patients treated with cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6). Method(s): This is a prospective, single center, single arm pilot study. SEP consisted in a 12-week intervention with twice a week in-person resistance exercise session. Patients also completed weekly aerobic exercise goals in self-managed sessions monitored with activity trackers. SEP was conducted by registered Physical Activity and Sports Science instructors that followed American College of Sports Medicine guidelines. In addition, participants had an initial nutritional assessment and personalized counselling by a qualified nutritionist. Adherence to treatment, biological variables and QoL assessments (FACIT-Fatigue and QLQ-C30 questionnaires) were collected at baseline (B) and week-12 (w12). Primary endpoint was global adherence (>=70% of attended sessions relative to scheduled sessions). Secondary endpoints included safety, changes in biological variables and QoL. Paired samples t-tests (Wilcoxon) were used to assess biological changes and QoL. Result(s): Patients (n=26) were recruited from October 2020 to November 2021. Median age was 47,5 years (45-55);84,6% of patients were ECOG 0. 42,3% of patients were receiving Abemaciclib;34,6% Ribociclib and 23,1% Palbociclib in first (73,1%) or second (26,9%) line treatment. Patients had bone (69,2%);visceral metastasis (57,7%) or both (30,8%). 2 patients did not start the intervention and additional 7 patients discontinued the program prematurely, the majority of them due to COVID-related concerns. Considering all patients who at least attended one session, global adherence was 66% (39-77,5%) and 45,8% of patients achieved an adherence of >= 70%. Patients reported an improvement in QoL [B global QLQ-C30 66,6 (50-75), w12 75 (66,6-83,3);p 0,0121] and fatigue [B FACIT-Fatigue 37 (30-44), w12 42 (38-48);p 0,0017]. Sit-to-stand repetitions in 30-second period also improved [(B 15 (12-17), 19 (15-23);p 0,0002]. Same benefits were seen in patients with adherence >= 70%. No statistically significant changes were seen in body fat or muscular composition and handgrip scores. Importantly, no safety issues related to study intervention were reported. Conclusion(s): Even though the study was conducted during COVID-19 pandemic, global adherence was 66%. For the first time in MBC, SEP and NP combined program demonstrated to be safe and improved QoL in patients with first or second line MBC treated with iCDK4/6. Further research is needed to identify strategies that improve QoL in MBC.

Water safety management during the initial phase of the Covid-19 pandemic: challenges, responses and guidance

Water safety plans address both routine operations and incident responses to support risk management in drinking water utilities. Their use and relevance in facing the challenges of the Covid-19 crisis were investigated via a survey distributed to water utilities and health or environmental agencies across the globe. Responses from 86 respondents from 38 countries were analysed to identify the water safety challenges faced and responses. Water safety plans appear to provide some preparedness and organizational advantages to utilities in facing the Covid-19 crisis, including stronger communication links between utilities and governing agencies. Guidance for future water safety planning is provided.

Policy Mix During a Pandemic Crisis: A Review of the Debate on Monetary and Fiscal Responses and the Legacy for the Future

We review the debate on the monetary and fiscal policy measures that were adopted in response to the pandemic shock in advanced economies, as well as others that could be taken in the near future, once the health emergency is over. The pandemic is an exceptional global health shock, which has negatively affected the income, liquidity, and financial conditions of households and firms worldwide. Policy responses adopted in advanced economies in 2020—based on extraordinary large-scale, swift, targeted monetary and fiscal measures—were appropriate to sustain liquidity, income, and aggregate demand and, thus, helped to avert a devastating financial crisis. Once the health emergency is over, the legacies of the shock will be a recovery of uncertain strength and timing, a low interest rate environment, and high corporate and public debts. Support measures should be removed with caution. A cross-country coordinated policy mix based on (i) accommodative monetary policies (if consistent with central bank objectives), (ii) public investments and (iii) a gradual rebalancing of government accounts, could be effective in sustaining a strong global recovery and reduce private and public debt. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Working at home during the Covid-19 pandemic: impact on quality of working and quality of life

The restrictions implemented by governments in order to contain Covid-19 pandemic have forced millions of people around the world to adapt to new demands in their daily lives, work and studies. Such reformulation of personal, work and social experiences has increased the perception of precariousness and instability, and has questioned the routines and the habits linked to the working and personal behaviours. The aim of the study was to explore: (a) the psychological impact of the restrictions on work activity and on the perceived quality of life;(b) the way in which people using their psychological resources, adapted or changed their daily habits and behaviours according to the limitations imposed by the pandemic. The survey used was composed as follows: satisfaction with life scale;flourishing scale;ad hoc questionnaire exploring quality of life and work during the pandemic, and personal resources. Data were analysed through mixed methods. The results have highlighted the different impact of the restrictions on the quality of life, the quality of work and the perceived work performance according to the different psychological resources deployed by participants and to their perception of social distancing, time at home, and life-work balance. Furthermore, gender differences were explored. Finally, the study provided useful insights for psychologists and career counselling professionals, who have to face new challenges in supporting their clients even in adverse conditions. © 2021 Sapienza Universita Editrice. All Rights Reserved.

Water safety management during the initial phase of the Covid-19 pandemic: challenges, responses and guidance

Water safety plans address both routine operations and incident responses to support risk management in drinking water utilities. Their use and relevance in facing the challenges of the Covid-19 crisis were investigated via a survey distributed to water utilities and health or environmental agencies across the globe. Responses from 86 respondents from 38 countries were analysed to identify the water safety challenges faced and responses. Water safety plans appear to provide some preparedness and organizational advantages to utilities in facing the Covid-19 crisis, including stronger communication links between utilities and governing agencies. Guidance for future water safety planning is provided. [ FROM AUTHOR] Copyright of International Journal of Water Resources Development is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)