Chronic Medical Illness Research Articles

The status of prehospital care delivery for COVID-19 patients in Addis Ababa, Ethiopia: The study emphasizing adverse events occurring in prehospital transport and associated factors.

COVID-19 patients may require emergency medical services for emergent treatment and/or transport to a hospital for further treatment. However, it is common for the patients to experience adverse events during transport, even the shortest transport may cause life-threatening conditions. Most of the studies that have been done on prehospital care of COVID-19 patients were conducted in developed countries. Differences in population demographics and economy may limit the generalizability of available studies. So, this study was aimed at investigating the status of prehospital care delivery for COVID-19 patients in Addis Ababa focusing on adverse events that occurred during transport and associated factors. A total of 233 patients consecutively transported to Saint Paul's Hospital Millennium Medical College from November 6 to December 31, 2020, were included in the study. A team of physicians and nurses collected the data using a structured questionnaire. Descriptive statistics were used to summarize data, and ordinal logistic regression was carried out to assess the association between explanatory variables and the outcome variable. Results are presented using frequency, percentage, chi-square, crude and adjusted odds ratios (OR) with 95% confidence intervals. The overall level of adverse events in prehospital setting was 44.2%. Having history of at least one chronic medical illness, [AOR3.2 (95%; CI; 1.11-9.53)]; distance traveled to reach destination facility, [AOR 0.11(95%; CI; 0.02-0.54)]; failure to recognize and administer oxygen to the patient in need of oxygen, [AOR 15.0(95%; CI; 4.0-55.7)]; absent or malfunctioned suctioning device, [AOR 4.0(95%; CI; 1.2-13.0)]; patients handling mishaps, [AOR 12.7(95%; CI; 2.9-56.8)] were the factors associated with adverse events in prehospital transport of COVID-19 patients. There were a significant proportion of adverse events in prehospital care among COVID-19 patients. Most of the adverse events were preventable. There is an urgent need to strengthen prehospital emergency care in Ethiopia by equipping the ambulances with essential and properly functioning equipment and trained manpower. Awareness creation and training of transport staff in identifying potential hazards, at-risk patients, adequate documentation, and patient handling during transport could help to prevent or minimize adverse events in prehospital care.

Opioid Use Disorder Treatment Initiation and Continuation: a Qualitative Study of Patients Who Received Addiction Consultation and Hospital-Based Providers.

BackgroundHospitalizations related to opioid use disorder (OUD) are rising. Addiction consultation services (ACS) increasingly provide OUD treatment to hospitalized patients, but barriers to initiating and continuing medications for OUD remain. We examined facilitators and barriers to hospital-based OUD treatment initiation and continuation from the perspective of patients and healthcare workers in the context of an ACS.MethodsIn this qualitative study, we sought input using key informant interviews and focus groups from patients who received care from an ACS during their hospitalization and from hospitalists, pharmacists, social workers, and nurses who work in the hospital setting. A multidisciplinary team coded and analyzed transcripts using a directed content analysis.FindingsWe conducted 20 key informant interviews with patients, nine of whom were interviewed following hospital discharge and 12 of whom were interviewed during a rehospitalization. We completed six focus groups and eight key informant interviews with hospitalists and hospital-based medical staff (n = 62). Emergent themes related to hospital-based OUD treatment included the following: the benefit of an ACS to facilitate OUD treatment engagement; expanded use of methadone or buprenorphine to treat opioid withdrawal; the triad of hospitalization, self-efficacy, and easily accessible, patient-centered treatment motivates change in opioid use; adequate pain control and stabilization of mental health conditions among patients with OUD contributed to opioid agonist therapy (OAT) continuation; and stable housing and social support are prerequisites for OAT uptake and continuation.ConclusionModifiable factors which facilitate hospital-based OUD treatment initiation and continuation include availability of in-hospital addiction expertise to offer easily accessible, patient-centered treatment and the use of methadone or buprenorphine to manage opioid withdrawal. Further research and public policy efforts are urgently needed to address reported barriers to hospital-based OUD treatment initiation and continuation which include unstable housing, poorly controlled chronic medical and mental illness, and lack of social support.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-021-07305-3.

COVID-19-related anxiety and knowledge toward its preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones, Ethiopia.

Background:Coronavirus disease 2019, also known as 2019-nCoV cluster of acute respiratory illness with unknown causes, which occurred in Wuhan, Hubei Province, in China, was first reported to World Health Organization country office as of December 30, 2019. People with medical illness are at a higher risk for coronavirus disease, and the pandemic influences mental health and causes psychological problems, particularly in those with chronic medical illness. Hence, this study aimed to assess coronavirus disease 2019-related anxiety and the knowledge on its preventive measures among patients with medical illness on follow-up in public hospitals of Bale, East Bale, and Arsi zonesObjective:To assess coronavirus disease 2019-related anxiety and knowledge toward coronavirus disease 2019 preventive measures among patients with chronic medical illness on follow-up in public hospitals of Bale, East Bale, and West Arsi zones.Methods:A hospital-based cross-sectional study was conducted in selected hospitals of Bale and West Arsi zones, Southeast Ethiopia. A total of 633 study participants were included in this study, and data were collected through an interviewer-administered questionnaire. A descriptive summary was computed. Bivariable and multivariable logistic regression analyses were carried out to identify the associated factors.Results:Overall, the prevalence of anxiety among chronic patients in this study was 6.3% (95% confidence interval: 4.6%–8.5%) and 420 (66.35%) had good knowledge on the preventive measures of coronavirus disease 2019. Factors significantly associated with anxiety among chronic patients were being educated (95% confidence interval: adjusted odds ratio = 0.26 (0.09–0.74)), being male (95% confidence interval: 2.69 (1.11–6.53)), and use of mask (95% confidence interval: 0.11 (0.05–0.26)).Conclusion:The prevalence of coronavirus disease 2019-related anxiety among chronic patients was high and being males, uneducated, and not using face mask was significantly associated with coronavirus disease 2019-related anxiety.

Prevalence of pelvic floor dysfunction in women in Riyadh, Kingdom of Saudi Arabia: A cross-sectional study.

Objective:Pelvic floor dysfunction has a high prevalence among women worldwide. However, in the Kingdom of Saudi Arabia, it is underreported. Thus, we aimed to estimate the prevalence and risk factors of pelvic floor dysfunction in women in the Kingdom of Saudi Arabia.Methods:We conducted a cross-sectional study on literate non-pregnant women aged ⩾18 years who agreed to participate in our survey. We used the validated and translated Australian pelvic floor questionnaire and conducted a multivariate logistic regression analysis to assess the risk factors of pelvic floor dysfunction.Results:A total of 824 participants completed the questionnaire. While 60.2% of the participants had pelvic floor dysfunction, 67.7% reported signs of bowel dysfunction. Urinary dysfunction, prolapse, and sexual dysfunction were present in 44.1%, 67.7%, and 55.4% of the participants, respectively. Age, high body mass index, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bladder function problems. Meanwhile, chronic medical illness, heavy weight lifting, and multiparity were found as the risk factors of bowel dysfunction and prolapse. Age group and marital status were the independent factors associated with sexual dysfunction.Conclusion:We noted a high rate of pelvic floor dysfunction in the Kingdom of Saudi Arabia, which calls for the need to provide holistic approaches for the prevention and management of pelvic floor dysfunction among women.

Relation of Depression and Anxiety Disorders in Choosing Obesity Management in Obese Patients.

Obesity is a chronic medical illness with a higher risk of physical and mental cascade. People who seek obesity treatment were reported to have some psychiatric disorders affecting their disease and selection of management. This study aims to estimate the prevalence of depressive and anxiety disorders in obese patients seeking obesity management and explore the relationship between common psychiatric disorders (depression and anxiety disorders) and selection of the type of obesity management (surgical or non-surgical). Patients were recruited from Alazhar Universityhospitals, Egypt, and the total number completing the study was 1115 patients. All subjects underwent psychiatric interview through Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5 for DSM-5) for diagnosis of psychiatric disorders and completed two questionnaires, Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA). The prevalences of depressive and anxiety disorders were 29.23% and 25.56%, respectively, in all subjects. The most prevalent diagnoses were dysthymic disorder (20.7%), general anxiety disorder (16.95%), major depressive disorder (13.04%), and social phobia (12.4%). Our sample was divided into two groups (surgical and non-surgical). Dysthymia was more common in the surgical group (21.4% versus 19.8% P = 0.560), whereas major depressive disorder was more common in the non-surgical group (7.4% versus 5.4 P = 0.593); also, the non-surgical group was more likely to have "anxiety disorders" (29.23% versus 22.4%, P = 0.840), but severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference. A high prevalence of depression and anxiety disorders was found among patients who sought obesity treatment. Severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference, which may affect selection of treatment, so psychiatric evaluation and management are needed before and after obesity management to improve the outcome.

Prevalence of Generalised Anxiety Disorder among Urban Omani Patients Attending Primary Care Centres: A Cross-Sectional Study

Background: Anxiety disorders are common mental health illnesses in primary care. Undiagnosed and thus untreated mental disorders can interfere with the patient’s quality of life, ultimately resulting in poor daily functioning, a greater number of doctor consultations, and increased disability. Objective: The objective of this study was to establish the prevalence of generalised anxiety disorder (GAD) among an urban adult Omani population as well as associated sociodemographic and clinical variables. Methodology: This study utilised a cross-sectional design and was performed between December 2019 and January 2020. A total of 250 Omani patients were recruited from eight randomised government-funded primary care centres in Muscat, Oman. The prevalence of GAD among the participants was determined by utilising an Arabic version of the validated 7-item General Anxiety Disorder tool delivered during face-to-face interviews. Results: Overall, a total of 33 patients had GAD (13.2%). According to the univariate analysis, a personal history of anxiety (P = 0.001), chronic medical illnesses (P = 0.025), low monthly income (P = 0.018), divorced individuals (P = 0.015), and housewives with extra part-time employment (P = 0.032) were significantly associated with GAD. However, only the absence of a personal history of anxiety (P = 0.001), and high monthly income (P = 0.002) remained a statistically significant protector against GAD in the multivariate analysis. Conclusion: We found a high prevalence of GAD among an adult urban Omani population. Moreover, certain clinical and sociodemographic variables were found to be significantly associated with the disorder, including a personal history of anxiety and low monthly income. The quality of life of Omani GAD patients may be improved via rapid screening of the general population.

COVID-19 vaccine acceptability and determinants among pregnant mothers attending antenatal care services at Debre Markos town public health institutions, Debre Markos Northwest Ethiopia: mixed study.

Introductioncoronavirus is a communicable disease that produces severe morbidity and mortality in the globe and more than three million people died due to COVID-19. Pregnant mothers are at higher risk of COVID-19 viral infection, with great morbidity and mortality. Thus, the purpose of this research is to assess the level of COVID-19 vaccine acceptability, determinants, and hesitancy among pregnant mothers attending antenatal care at Debre Markos town, public health institutions, Debre Markos, Northwest Ethiopia.Methodsa mixed study was conducted among 350 pregnant mothers attending antenatal care at Debre Markos town health institutions and the participants were selected by consecutive sampling techniques. The collected data were entered into EPI Info version 7 and then exported to SPSS version 25 for data cleaning and analysis. The level of COVID-19 vaccine acceptability was determined through descriptive statistics, whereas its determinants were identified by binary logistic regression analyses. Variables with p-value < 0.05 in multivariable were considered as significantly associated factors. The qualitative data were collected by an unstructured interviewer guide using in-depth interview data collection methods. Study participants were selected purposively until the required data was saturated. The data was analysed under selected themes based on the guide and summarized manually.Resultssixty-five (18.5%) of the respondents accept the COVID-19 vaccine [95% CI: 13, 23]. Maternal age [AOR: 3.281 (95% CI: 1.184, 9.092)], chronic medical illness [AOR: 0.170 (95% CI: 0.051, .562)], information about COVID-19 vaccine [AOR: 4.063 (95% CI: 1.462, 11.293)], pregnancy-induced medical conditions [AOR: 4.131 (95% CI: 1.055, 16.183) were identified as significant determinants of COVID-19 vaccine acceptability. From the quantitative wing. The qualitative finding implied that misconception, fear of medical complications, lack of trust in its effectiveness, and religious constraints were the common reasons for vaccine hesitancy.ConclusionCOVID-19 vaccine acceptability by pregnant mothers attending ANC at Debre Markos town public health institutions is very low. The health care providers and health extension workers shall create information about the COVID-19 vaccine on its importance and side effects.

Management of Psychiatric Disorders in Patients with Hepatic and Gastrointestinal Diseases.

Management of Psychiatric Disorders in Patients with Hepatic and Gastrointestinal Diseases.

Voicing their choices: Advance care planning with adolescents and young adults with cancer and other serious conditions.

To determine whether engaging in advance care planning (ACP) using a formal tool, Voicing My CHOiCES (VMC), would alleviate adolescent and young adults (AYAs) anxiety surrounding ACP and increase social support and communication about end-of-life care preferences with family members and health care providers (HCPs). A total of 149 AYAs aged 18-39 years receiving cancer-directed therapy or treatment for another chronic medical illness were enrolled at seven US sites. Baseline data included prior ACP communication with family members and HCPs and measures of generalized anxiety, ACP anxiety, and social support. Participants critically reviewed each page of VMC and then completed three pages of the document. ACP anxiety was measured again immediately after the completion of VMC pages. One month later, participants repeated anxiety and social support measures and were asked if they shared what they had completed in VMC with a family member or HCP. At baseline, 50.3% of participants reported that they previously had a conversation about EoL preferences with a family member; 19.5% with an HCP. One month later, 65.1% had subsequently shared what they wrote in VMC with a family member; 8.9% shared with an HCP. Most (88.6%) reported they would not have had this conversation if not participating in the study. No significant changes occurred in social support. There was an immediate drop in anxiety about EoL planning after reviewing VMC which persisted at 1 month. Generalized anxiety was also significantly lower 1 month after reviewing VMC. Having a document specifically created for AYAs to guide ACP planning can decrease anxiety and increase communication with family members but not necessarily with HCPs. Future research should examine ways ACP can be introduced more consistently to this young population to allow their preferences for care to be heard, respected, and honored, particularly by their healthcare providers.

English

BACKGROUND Exclusive breastfeeding is recommended up to 6 months of age with all its beneficial effects on child survival. Several studies have shown that adequate intake of vitamin D cannot be met with human milk as the sole source of vitamin D, although risk factors for developing vitamin D deficiency may be low maternal levels of vitamin D, indoor confinement during the day, living at higher altitudes, living in urban areas with tall buildings, air pollution, darker skin pigmentation, use of sunscreen and covering much over the body when outside. An infant who is entirely on breastfeeding and has minimal to no exposure to sunlight is more prone to the development of hypovitaminosis-D. The main purpose of the study was to identify the prevalence &amp; high-risk groups of hypovitaminosis D in exclusively breastfed babies. METHODS It was a cross-sectional observational study consisting of 30 entirely breastfed healthy full-term babies with a birth weight &gt; 2.5 kg. Babies born to mothers with a history of pre-eclampsia, gestational diabetes, antepartum haemorrhage, tuberculosis, and other chronic medical illnesses were excluded from the study. The period of study was from 1st August 2019 to 30th September 2019. Their serum vitamin D3, serum calcium, serum phosphate, and alkaline phosphatase levels were measured using appropriate methods. RESULTS In our study, 25 infants out of 30 came out as vitamin D deficient. The prevalence of vitamin D3 was found to be 83 %. CONCLUSIONS Breastfeeding is of utmost importance but the nutritional status of the mother, proper exposure to the sun, and vitamin D supplementation are the factors that should be taken care of for the prevention of hypovitaminosis D. KEY WORDS Vitamin D3, Hypovitaminosis D, Exclusive Breast Feeding, term babies, infants, Sun Exposure, Rickets

Gut Microbiota Diversity and Composition Are Altered during Therapy in Pediatric Acute Lymphoblastic Leukemia Patients

BackgroundChildhood acute lymphoblastic leukemia (ALL) has a very high cure rate, however, long-term survivors are at increased risk of chronic medical illnesses that are likely in part microbiome mediated. Previous studies comparing microbiota of pediatric ALL survivors to healthy siblings showed altered composition in survivors. Longitudinal microbiome changes through treatment leading to these alterations are unknown.MethodsChildren with ALL were enrolled and stool samples were collected at diagnosis and at the end of induction, consolidation, interim maintenance I, delayed intensification, interim maintenance II, as well as approximately 3 months and 6 months into maintenance. Stool samples from healthy siblings were used as controls. Clinical data were collected. DNA was extracted from stool samples and 16S rRNA was sequenced for analysis of hypervariable region V4. Differences in alpha and beta diversities and relative abundance of taxa were calculated between phases and with sibling controls.Results35 ALL patients age 3 months-19 years were included. The diagnoses were 14 standard risk pre-B ALL, 14 high risk pre-B ALL, 6 T-ALL, and 1 relapsed pre-B ALL. Stool samples were sequenced from 19 healthy siblings.Statistically significant differences in alpha diversity (Shannon) were found between healthy siblings and ALL patients during the more intense chemotherapy phases before low dose maintenance (Figure 1A). Beta diversity (Bray-Curtis), was significantly different between microbiota of ALL patients at diagnosis and their siblings, as well as between ALL patients at diagnosis and at each of the subsequent treatment phases (Figure 1B). Longitudinal comparison using multivariate analysis showed that leukemia risk group (high risk vs standard risk) and antibiotic treatment were significant factors in beta diversity changes. The relative abundance of microbes showed that with treatment, ALL patients exhibit a significant decrease in the phylum Verrucomicrobiota, driven by the genus Akkermansia, which is beneficial to health and is associated with protection against obesity and other chronic inflammatory diseases (Figure 2). Proteobacteria and Fusobacteria, which include proinflammatory species, were increased.ConclusionPediatric ALL patients have decreased diversity of gut microbes at diagnosis and during treatment. The types of gut microbes harbored in ALL patients are already different than their siblings at diagnosis and continue to change during treatment, but may begin to recover in low dose maintenance therapy. Taxa considered to be beneficial are depleted, while more pathogenic microbes become prominent. Microbiota changes are likely influenced by intensity of chemotherapy and antibiotic exposure. Continued longitudinal follow up is needed to determine whether these changes correlate with adverse long term health outcomes. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Inexpensive Portable Infrared Device to Detect and Quantify Alcohols in Hand Sanitizers for Public Health and Safety.

The onset of Covid-19 pandemic has resulted in the exponential growth of alcohol-based hand rub (ABHR)/hand sanitizer use. Reports have emerged of ABHR products containing methanol, a highly toxic compound to humans, exposing users to acute and chronic medical illnesses. While gas chromatography-mass spectrometry (GC-MS) remains the gold-standard method for the detection and identification of impurities in ABHRs, there exist limitations at widespread volume testing. This paper demonstrates the capability of an inexpensive portable pyroelectric linear array infrared spectrometer to rapidly test ABHR and compare the performance with a benchtop Fourier transform infrared spectrometer and HS-GC-MS. Multicomponent partial least square quantification models were built with performance found to be comparable between the two spectrometers and with the HS-GC-MS. Furthermore, the portable spectrometer was field-tested with real-world samples in Malaysia on both retail products (Group A) and freely deployed public dispensers (Group B) between May and November 2020. A total of 386 samples were tested. Only 75.2% of Group A met the criteria of safe and effective ABHR [no detectable methanol and alcohol concentration above 60% (v/v)], while <50% of Group B did. In addition, 7.4 and 18.8% of Group A and Group B, respectively, were found to contain methanol above permissible limits. The high percentage of sub-standard and methanol-containing samples combined with the frequent use of ABHR by the public highlights the need for and importance of a portable and rapid testing device for widespread screening of ABHR against falsified products and protects the general public.

Pneumothorax in COVID-19 – A New Challenge

Background: Coronavirus disease 2019 mainly affect the lungs which can complicate into pneumothorax and require hospitalization. We aimed to discuss the presence of pneumothorax and its possible risk factors in vulnerable patients of COVID-19 to establish an effective preventive and therapeutic strategy for this fatal complication.&#x0D; Methods: This retrospective observational study included 30 admitted patients of COVID-19 associated pneumothorax. The patient’s data concerning demography, clinical manifestation, associated medical illness, point of onset of pneumothorax, mode of oxygenation with FiO2 and PEEP, radiological imaging, and outcome were extracted from their medical records. All collected data were tabulated, compiled, and analyzed to establish possible causality of pneumothorax.&#x0D; Results: All patients of the study group exhibited symptomatic presentations, 73% of patients had severe clinical conditions and 24 patients also had associated chronic medical illness. In our study pneumothorax developed 3rd week onwards after symptoms onset with a mean time of pneumothorax was found to be 23.96 days (23.96±8.06). At the point of diagnosis of pneumothorax, 22 patients were on non-invasive ventilation, 6 on high flow mask, and 2 patients on invasive ventilation, these patients required higher FiO2 (77.66%) and higher PEEP (10.83 cmH2O) to maintain PaO2 within normal range. All patients had raised COVID-related inflammatory markers viz. NLR, D-dimer, CRP, IL-6, and these markers showed a positive correlation with the duration of hospital stay in patients of pneumothorax.&#x0D; Conclusion: Pneumothorax can be suspected in COVID-19 infected patients having severe COVID-19 pneumonia of longer duration with assistant ventilation and raised inflammatory markers going to rapid worsening of symptoms.

Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up.

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. Frøjd LA, Papageorgiou C, Munkhaugen J, etal. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study.

BackgroundBehavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden.ObjectiveIn this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020.MethodsThe ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively.ResultsBy October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001).ConclusionsCommunities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics.

Redefining Primum Non Nocere to Include Reproductive Autonomy: A New Paradigm in Subspecialty Medicine.

People with chronic medical illnesses are at particularly high risk for adverse pregnancy outcomes, yet current clinical approaches largely fail to identify and support their individualized reproductive and pregnancy goals. Instead, the predominant approach to pregnancy in subspecialty medicine is disease centered rather than patient centered. To better meet the individual needs and preferences of people with childbearing potential who have chronic medical conditions, we advocate in this article for a paradigm shift in subspecialty care that honors individuals' reproductive autonomy and human right of reproduction.

Atypical Presentations of Acute Infections in Hospitalized Older Adults: The Prevalence, Predictors, and Outcomes

Background/ purpose: Atypical presentation of acute infections, is a well-known phenomenon in older people. It is extensively recognized in the literature but lacks sufficient attention in recent clinical research. Reaching a disease - specific diagnosis in those with subtle, nonspecific , or atypical presentations is a major challenge. The aim of this study was to report the prevalence of different presentations of acute infections among hospitalized elderly patients, and the factors associated with atypical presentation. Methods: a retrospective medical records review of 220 patients diagnosed with acute infection. The presenting symptoms for each type of infection were reported. Data regarding medical comorbidities, cognition, frailty, and functional status were obtained. Factors associa ted with the atypical presentation were evaluated. Results: Urinary tract infections and community -acquired pneumonia accounted for 44.5% and 25.5% infections, respectively. The patients presented with atypical symptoms in absence of classical symptoms rep resented 35.5% of the cases. 64.5% of the participants had an absent febrile response. Decreased oral intake was the most prevalent atypical complaint followed by unexplained new-onset functional decline. Dementia and frailty were independent predictors for atypical presentations. Conclusions: Older adults present acute infections differently. Many common infections present as delirium, new functional decline, new or worsened incontinence [urine, fecal], anorexia, or falls, especially in patients with dementia and frailty. Fever is usually absent in the elderly with acute infections. Moreover, infections in the elderly may present as an exacerbation of chronic stable medical illness e.g. congestive heart failure or diabetes. The in - hospital mortality is higher among those having atypical presentation

PSYCHOTHERAPY WITH MEDICALLY ILL CHILDREN: EARLY CHILDHOOD TO TRANSITIONAL-AGE YOUTH IN 2021

This session aims to equip attendees with selected psychotherapeutic tools for the mental health assessment and treatment of medically ill children and adolescents situated in a developmental framework. Participants will have an opportunity to discuss the effects of medical illness on development from early childhood through adolescent and young adult (AYA) age groups. They will learn about therapeutic interventions with young medically ill children aged 0-6 years and their families. Presenters will share experiences on establishing remote services on the pediatric unit and emergency service with medically ill children during the pandemic and discuss bedside psychotherapy strategies. Participants will also have an opportunity to learn about psychotherapeutic strategies regarding chronic illness themes in the AYA age group, leading up to and including end-of-life care. Participants will gain a new understanding of the effects of medical illness on development from early childhood through AYA age groups. Methods of psychotherapeutic engagement are evolving, whether due to forced adaptations during the COVID-19 pandemic or through recently developed psychotherapeutic tools from parent-child interaction, dignity, and meaning-centered psychotherapies for patients and families. Effective psychotherapeutic applications across the pediatric continuum of care are essential for optimal implementation and outcomes. Children and adolescents remain subject to chronic and terminal medical illnesses with comorbid mental health conditions and considerations. Even as medical advances have extended life expectancies, the need for relevant, practical, and effective delivery of psychotherapeutic interventions—both in person and virtual—has also increased. Child and adolescent psychiatrists are advised to be current with helpful treatment modalities in their roles as psychotherapists and multidisciplinary treatment team leaders working in settings with medically ill youth.

Stress effect of COVID-19 pandemic among Egyptian children and adolescents with malignancy

Background Thoughts and feelings of stress and worry are common for any person facing the challenges of a serious illness. Aim The aim was to assess the effect of COVID-19 on the psychological well-being of patients with malignancy compared with age-matched and sex-matched controls and to compare the psychological effect of COVID-19 with the psychological effect of malignancy among the patient group. Patients and methods This case–control study included 46 participants diagnosed with malignancy who were compared with 45 healthy age-matched and sex-matched individuals serving as a control group. Their ages were more than 8 years. All patients and controls were subjected to history taking with an emphasis on age, sex, educational level, history of chronic medical illness in the family, disease status, physical symptoms during the last 14 days, and data about COVID-19 infection. The psychological effect was measured using the Children's Revised Impact of Event Scale Crises-13. Results Mean age of the patient group was 11.76±3.31 years. There were 30 male and 16 female in the case group, who were compared with 45 age-matched and sex-matched healthy children and adolescents. There was a significantly higher prevalence of psychological stressful effect among the healthy children group than the oncological pediatric patients. The psychological effect related to malignancy diagnosis was significantly higher than the psychological effect related to COVID-19. Conclusion COVID-19 pandemic is a stressful event; however, the psychological effect related to cancer diagnosis among the oncological patients showed a higher stressful effect.

Knowledge of school teachers regarding Asthma in Aseer region of Saudi Arabia

Background: Asthma is a leading cause of impairment, high health-care costs and poor quality of life for those who suffer from it. Asthma is the most prevalent chronic medical illness that schoolteachers must deal with in their students, impacting more than 10% of them. Teachers may be required to supervise inhaler administration and determine the necessity for additional treatment in acute attacks. Asthma prevalence varies greatly over the world, ranging from 1 to 20% for both children and adults. Methods: The data for this cross-sectional study was acquired using a specially designed questionnaire. The questionnaire includes demographic questions as well as questions about asthma awareness and knowledge. After collection of data, it was coded and entered in the SPSS ver.20 software for analyses descriptive statistics (mean standard deviation, frequencies and percentages were computed), to measure the significance differences t test and chi-square test was used at 5% level of significance. Data was collected from the teachers of Aseer region of KSA. Ethical approval was obtained from King Khalid University, Saudi Arabia. The study duration was from January-2021 to April-2021. Results: Out of a total 759 respondents, the mean (S.D.) of the respondents were 31.6(12.8). 14.2% were male while 85.8% were females. The Cronbach alpha of the questionnaire was 0.79. We have observed that age and education have a significant impact over the prevalence of Asthma awareness. Conclusion: We should train our teachers by conducting series of seminars, webinars and workshops. We will also incorporate training the trainer sessions for teaching staff to enhance their skills to deal with asthma. Key words: Asthma, diseases, teacher, knowledge, awareness