Impaired Physical Health Research Articles

Assessment of the general condition and quality of life of women of post-reproductive age after asymptomatic COVID-19 and 12 months after moderate COVID-19

The aim. To assess the general condition, laboratory parameters, quality of life of women of post-reproductive age after asymptomatic COVID-19 and 12 months after moderate COVID-19. Material and methods. We examined 47 women (45–69 years old), divided into 3 groups: those who did not have COVID-19, not vaccinated (group 1 – control; n = 15); women 12 months after moderate COVID-19, accompanied by pneumonia (group 2; n = 19); women with IgG in their blood who deny any symptoms of COVID-19 (group 3; n = 13). Results and discussion. An assessment of the general condition of women in post-reproductive age was carried out. In women 12 months after COVID-19 we found a lower level of total bilirubin compared to the group with asymptomatic COVID-19 (p = 0.004). An increase in thrombin time was determined in the groups of patients with symptomatic (p = 0.014) and asymptomatic (p = 0.025) COVID-19 course compared with the control group. Patients with asymptomatic COVID-19 course had a higher level of high-density lipoprotein cholesterol compared with the control group (p = 0.016) and the group 2 (p = 0.006). Compared with the control group, the group 2 had lower scores for general health (p = 0.006), vital activity (p = 0.013), general physical well-being (p = 0.039), physical functioning (p = 0.046); and the group 3 had higher scores in role functioning due to physical condition (p = 0.049). When comparing groups 2 and 3, lower scores in the group of women who recovered from the moderate COVID-19 were found in physical functioning (p = 0.002), pain intensity (p = 0.034), role functioning due to physical condition (p = 0.049), general health (p = 0.003), vital activity (p = 0.018), general physical well-being (p = 0.001). Conclusion. 12 months after moderate COVID-19, there is a pronounced deterioration in physical and emotional health; and in asymptomatic patients, better protective functions of an organism can be assumed.

Scoping child mental health service capacity in South Africa disadvantaged communities: community provider perspectives

Purpose This study aims to establish the perspectives of community providers on challenges and enablers in developing child mental health capacity in disadvantaged communities in South Africa. Design/methodology/approach The authors involved 29 community providers operating in a large urban-deprived area in the Gauteng Province, east of Johannesburg. Community providers had educational, social and health care backgrounds. Their perspectives were captured through three focus groups, two participatory workshops and reflective diaries. Data were integrated and subjected to inductive thematic analysis. Findings Three interlinked themes were identified. Community mobilization was viewed as pre-requisite through mental health awareness and strategies to engage children, youth and parents. Service provision should take into consideration contextual factors, predominantly inequalities, lack of basic needs and gender-based issues (domestic violence, teenage pregnancy and single motherhood). Participants referred to severe mental health needs, and related to physical health conditions, disabilities and impairments, rather than to common mental health problems or wellbeing. They proposed that capacity building should tap into existing resources and integrate with support systems through collaborative working. Practical implications Child mental health policy and service design in Majority World Countries (MWCs), should involve all informal and structural support systems and stakeholders. Contextual factors require consideration, especially in disadvantaged communities and low-resource settings, and should be addressed through joined up working. Originality/value Children’s mental health needs are largely unmet in MWC-disadvantaged communities. These findings capture the experiences and perspectives of various community providers on how to enhance mental health provision by mobilizing communities and resources.

Assessment of Health-Related Quality of Life, Medication Adherence, and Prevalence of Depression in Kidney Failure Patients.

Kidney failure is a global health problem with a worldwide mean prevalence rate of 13.4%. Kidney failure remains symptomless during most of the early stages until symptoms appear in the advanced stages. Kidney failure is associated with a decrease in health-related quality of life (HRQOL), deterioration in physical and mental health, and an increased risk of cardiovascular morbidity and mortality. This study aimed to evaluate the factors associated with decreased HRQOL and other factors affecting the overall health of patients. Another objective was to measure how medication adherence and depression could affect the overall HRQOL in patients with kidney failure. The study used a prospective follow-up mix methodology approach with six-month follow-ups of patients. The participants included in the study population were those with chronic kidney disease grade 4 and kidney failure. Pre-validated and translated questionnaires (Kidney Disease Quality of Life-Short Form, Hamilton Depression Rating Scale Urdu Version, and Morisky Lewis Greens Adherence Scale) and assessment tools were used to collect data. This study recruited 314 patients after an initial assessment based on inclusion criteria. The mean age of the study population was 54.64 ± 15.33 years. There was a 47.6% male and a 52.4% female population. Hypertension and diabetes mellitus remained the most predominant comorbid condition, affecting 64.2% and 74.6% of the population, respectively. The study suggested a significant (p < 0.05) deterioration in the mental health composite score with worsening laboratory variables, particularly hematological and iron studies. Demographic variables significantly impact medication adherence. HRQOL was found to be deteriorating with a significant impact on mental health compared to physical health. Patients on maintenance dialysis for kidney failure have a significant burden of physical and mental symptoms, depression, and low HRQOL. Given the substantial and well-known declines in physical and psychological well-being among kidney failure patients receiving hemodialysis, the findings of this research imply that these areas related to health should receive special attention in the growing and expanding population of kidney failure patients.

CHILDREN AND THEIR PARENTS IN THE STRESS SITUATION OF THE COVID-19 PANDEMIC (RESULTS OF A COHORT STUDY IN THE VOLOGDA REGION)

Early in the COVID-19 pandemic, UNICEF warned that the mental well-being of children and adolescents could be severely affected. And their parents are also, according to scientists, a group of increased risk of adverse outcomes of the outbreak of a new coronavirus infection. This study presents selective results of the cohort monitoring “Studying the conditions for the formation of a healthy generation in the Vologda Oblast”, conducted by the Vologda Scientific Center of the Russian Academy of Sciences. The information base is the results of a survey of 364 mothers of children from three cohorts born in 2004, 2014 and 2020. (aged 1, 7 and 17). The problems and experiences faced by the families of children and adolescents during the pandemic are considered. Results: children, according to parents, most easily endured the situation of the spread of a new coronavirus infection. However, schoolchildren's mothers note in their children an increase in the level of fear for the health of loved ones, the emergence of problems with distance learning, a decrease in physical activity, excessive passion for gadgets, an increase in body weight, and a deterioration in physical and mental health. Parents of first-graders became the group at increased risk of developing adverse psychological outcomes of the pandemic. They were more likely than other parents to face economic problems, experienced anxiety and depressive symptoms, feelings of guilt towards children due to insufficient time and attention, their family members began to quarrel more often. Despite the severity of the condition, their behavior was dominated by constructive coping actions in a difficult life situation. The most protected in psycho-emotional and economic terms were the parents of children of the first year of life. Health, education and social policy professionals, governmental and non-governmental organizations have an important role to play in mitigating the psychosocial negative impacts of COVID-19 on children and adolescents and their parents.

Anxiety Disorders in Children.

Anxiety disorders are the most common mental health disorders in children with clearly defined and empirically based treatment. However, assessment and treatment pose several obstacles for pediatric providers. A child who may have age-appropriate communication skills will still struggle to accurately report the presence, timing, and severity of symptoms. Reports from parents, caregivers, and teachers are often subjective and can focus on 1 aspect of the child's behavior. Untreated, anxiety disorders have an adverse effect on a child's functioning, and impairments in physical health, academic performance, and social competence can lead to lifelong consequences. Well-validated and rapidly administered screening tools can be used to gather data from schools and other resources to inform the diagnosis, guide treatment recommendations, and track improvements. Limited training on behavioral health diagnosis and fear of "black box warnings" have left many pediatric clinicians reluctant to prescribe medications. There are readily available practice guidelines for these medications, and data documenting the efficacy of these medications for children should encourage their use.

What is the patient acceptance when only scapulectomy is possible in case of malignant tumor? A case series.

Scapulectomy is one of the surgical options in the case of malignant lesions in the scapula with an indication of surgical removal. Very few series in the literature have looked at postoperative quality of life and emotional acceptance, particularly in the case of scapulectomy without reconstruction. The objective is to assess the midterm results of scapulectomies in terms of function, quality of life, and acceptance for the patient. With a mean follow-up of 85 months (range 42 months-180 months), 11 scapulectomies for malignant tumors were performed with a mean age of 50 years: 5 partial scapulectomies, 4 total scapulectomies, and 2 subtotal scapulectomies. There were 6 chondrosarcomas, 2 high-grade osteosarcomas, 1 malignant peripheral nerve sheath tumor, and 1 low-grade atypical epithelioid sarcoma. The radio-clinical analysis was focused on functional results and mental health evaluation. The mean Musculoskeletal Tumor Society score of 11 scapulectomies was 20 ± 5 at 66% of normal, with the Disabilities of the Arm, Shoulder and Hand (DASH) score of 35 ± 26, and the Toronto Extremity Salvage Score of 76%. Patients had controlled pain (mean visual analog scale 1/10). Mobilities of the 11 scapulectomies were correct: average active anterior elevation of 89.5 ± 43 degrees, average abduction of 81 ± 42 degrees, average external rotation of 30 ± 25 degrees, and average internal rotation was at L5. Scapulectomy results in impaired physical and mental health compared with the general population (PCS-12=-9; MCS-12=-7). Partial scapulectomy, compared to total scapulectomy, gave better results: Musculoskeletal Tumor Society score (14±1 vs. 24±1 P=.0175), acceptance (45±9 vs. 92±16, P=.0184), mental health (MCS-12: 29±1 vs. 55±4, P=.0175), and Toronto Extremity Salvage Score (84±5 vs. 68±7, P=.0195). Partial and subtotal scapulectomies were better accepted (45±9 vs. 86±23, P=.0323) and tolerated (MCS-12: 29±1 vs. 52±6, P=.0099) by the patient compared to total scapulectomy. Total or partial scapulectomies without scapula reconstruction remain a disabling procedure performed with consequences on the physical and mental health of the patients. Partial or subtotal scapulectomy should be performed whenever possible because it seems to be associated with a better functional prognosis as well as less poor mental health and emotional acceptance of the patients, even though total scapulectomy may be necessary to obtain a complete curative tumor resection, which is the main goal.

Relationship between Participation in Physical Activity and Subjective Well-Being: Evidence from Korea during the Pandemic.

The lack of physical activity because of restrictions from the pandemic has increased interest in the deterioration of mental and physical health. This is the first study in Korea to investigate how participation in physical activity is correlated with subjective well-being among Koreans in the early stages of the COVID-19 pandemic. The survey was conducted among those aged >13 years, from August 24 to September 7, 2020. The process included self-reported surveys, telephone surveys, and face-to-face household interviews; 11,604 people (men=7,758 and women=3,846) participated. Frequency, correlation, and one-way analysis of variance were performed to identify differences between age and sex groups according to the physical activity level, while post-hoc Scheffe tests to examine between-group differences when significant results were observed. Statistically significant correlations were observed between life satisfaction, living environment satisfaction, and levels of happiness and anxiety based on sex and age (P<0.05). There were significant differences between frequency and time spent on physical activity and subjective well-being according to sex and age (P<0.05). The study results are highly generalizable considering the analysis of a large-scale sample within a big area in Korea. The findings emphasize that subjective well-being is influenced by sex, age, frequency, and time spent engaged in physical activity. Such basic data can be helpful for establishing policies related to physical activity.

Prevalence and Functional Impact of Vertigo among Long Term Survivors of Head and Neck Cancer

<h3>Purpose/Objective(s)</h3> To determine the prevalence of vertigo as a late effect of radiation therapy (RT) for head and neck cancer (HNC) and assess for a dose-volume relationship between radiation exposure to the vestibulocochlear apparatus and vertigo. We also sought to determine the impact of vertigo on functional outcomes. <h3>Materials/Methods</h3> This cross-sectional study enrolled participants treated with RT for HNC who survived at least 2 years and were free from disease at the time of enrollment. Participants completed the Short Form 36 as well as a detailed health survey with questions regarding medical history, medications, physical and mental symptoms, and socioeconomic status. Vertigo was assessed by the question "Has a doctor or other health care professional told you that you have or have had persistent dizziness or vertigo?" Mean radiation doses to the bilateral vestibulocochlear apparatuses were obtained by review of treatment plans. Differences in frequencies between groups were assessed with the chi-square test. Multiple logistic regression was used to assess the association between vertigo and physical health impairment as well as the association between vestibulocochlear dose and vertigo in models that also controlled for age and sex. <h3>Results</h3> A total of 123 HNC survivors met the inclusion criteria and had complete survey results for review. The median age of the cohort was 63.8y (range: 28.6y – 86.4y) and the median time from RT to survey completion was 4.0y (range: 2y – 28.9y); 31 (25.2%) were female and 92 (74.8%) were male. Vertigo was reported by 22 (17.9%) participants, hearing loss by 23 (18.7%), and tinnitus by 19 (15.4%). Hearing loss was present in 5 (22.7%) of patients who reported vertigo and 18 (17.8%) who did not report vertigo (p=0.593). The mean dose in Gy to the cochlea receiving the greater radiation dose was statistically associated with patient-reported vertigo (OR=1.031 95% CI: 1.001 – 1.061). Patients who reported vertigo were more likely to indicate that their physical health interfered with work activities on the SF36 (OR=4.224 95% CI: 1.567 – 11.384) whereas hearing loss was not statistically associated with interference due to physical health (OR=1.902 95% CI: 0.701 – 5.162). <h3>Conclusion</h3> Vertigo is a relatively common late adverse effect of RT for HNC that was associated with the presence of tinnitus but not hearing loss in this cohort. Radiation exposure to the vestibulocochlear apparatus was associated with the development of vertigo, and patients who developed vertigo were more likely to report that their physical health interfered with work activities. The results of this study highlight an ongoing need to study the late effects among HNC survivors. Future work is needed to characterize associations between vertigo and chemotherapy and other modifiable treatment factors.

Long COVID and NCDs: the Elephant in the Room

Abstract Issue/problem COVID-19 has now emerged as a public health concern that not only disrupted healthcare services of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs. Description of the problem Before the pandemic, SDG target 3.4, which calls for a reduction in premature mortality from NCDs by one third by 2030, was expected to be achieved by 17.5% of countries, and a further of 23% could achieve the target with a slight acceleration in decline. Currently, most countries are off track due to disruption of healthcare services for people with NCDs, overstretched health systems, and fewer resources than before the pandemic. In addition, only around one in four people who had COVID-19 reported feeling fully recovered within a year of being discharged from hospital. The adverse health effects from long COVID range from ‘invisible symptoms’ such as fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease. Results The COVID-19 pandemic has shown that siloed programmes are increasingly unfit, and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Cost-effective, feasible, and relevant interventions that target both physical and mental health impairments are urgently required. Lessons By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Protecting current investments and scaling up cost-effective public health interventions is especially crucial in the context of long haul COVID and NCDs. Policy makers and planners will need concrete guidance for making progress on SDG target 3.4, often with overburdened health systems and scarcer resources.

An Empirical Analysis of Health-Dependent Utility on SHARE and ELSA Data

This paper investigates the presence of health-dependent utility on a panel of European countries. We follow the strategy of Finkelstein et al. (J Eur Econ Assoc 11:221–258, 2013) and extend their analysis focusing on different health measures. The results show that utility exhibits an increase in the marginal utility to consume when physical health deterioration occurs. For cognitive decline, we find a decrease in the marginal utility for low memory skills and an increase in the marginal utility for low verbal fluency. However, both are not statistically significant, thus the evidence is limited. We show that individuals living in low-spending countries for long-term care services experience the greatest drop in marginal utility compared to the others. Overall, these results suggest the presence of heterogeneity in the direction of the marginal utility when the sick state occurs, and this evidence goes in the opposite direction compared to the recent empirical findings for US. A potential explanation might be found in different welfare systems.

Personality functioning and physical health

Objectives: Considering direct and indirect evidence of associations between deficits in personality functioning and high somatic morbidity, our exploratory study determined whether and, if so, which physical illnesses may be associated with impairments in personality functioning. Method: A large sample of diagnostically heterogeneous psychotherapy inpatients (N = 5401) was assessed with the short version of the Structural Questionnaire of the Operationalized Psychodynamic Diagnosis (OPD-SQS) and the Work Ability Index (WAI). In addition, discharge diagnoses were recorded. For a subsample (N = 2582), levels of personality functioning were assessed by their therapists according to the OPD system. Results: While consistent associations were found between personality functioning and neurological, urogenital, dermatological, and musculoskeletal disorders, findings on possible associations with other disorders revealed inconsistencies. The number of diseases as surrogate marker for disease burden was significantly associated with several indicators of personality functioning. Conclusions: Our results suggest associations between impairments in personality functioning and poor physical health. We discuss potential mechanisms as well as clinical implications.

Network pharmacology and pharmacological evaluation for deciphering novel indication of Sishen Wan in insomnia treatment

BackgroundInsomnia is the most frequent sleep disorder worldwide and is a prominent risk factor for mental and physical health deterioration. The clinical application of common pharmacological treatments for insomnia is far from satisfactory due to their various adverse effects. In recent years, drugs developed from natural herbs have become potential alternative therapies for insomnia. Sishen Wan (SSW), a traditional Chinese medicine (TCM) used for centuries to treat diarrheal disease, consists of multiple neurologically active herbs with sleep-regulating potential that may have therapeutic effects on insomnia. However, its hypnotic and sleep-regulating effects have not been evaluated in clinical practice or laboratory experiments. PurposeTo investigate the anti-insomnia effects of SSW and explore its possible mechanisms using preclinical models. Study design and methodsThe sedative effect of the SSW formula was investigated using network pharmacology analysis that was validated using various pharmacological approaches, including the evaluation of locomotor activity (LMA), pentobarbital-induced sleep time, and electroencephalography/electromyogram (EEG/EMG)-based sleep profiling in normal rats. Several animal models of insomnia, including sleep deprivation, serotonin depletion, and cage-changing models, have been used to further assess the anti-insomnia effects of SSW. Furthermore, the potential underlying mechanisms of action of SSW were predicted using bioinformatics methods and verified using in vivo and in silico experiments. ResultsThe results showed that SSW reduced LMA and prolonged pentobarbital-induced sleep time in a dose-dependent manner, which was consistent with the increase in non-rapid eye movement (NREM) sleep in normal rats, indicating a solid sedative effect. In animal models of insomnia, SSW alleviated sleep disturbance by increasing NREM sleep time, shortening NREM sleep latency, and inhibiting sleep fragmentation, suggesting a possible curative effect of SSW on insomnia. Finally, through functional enrichment analysis and in vivo and in silico experiments, 5-HT1A was identified as the key target of the anti-insomnia effect of SSW. Moreover, (S)-propranolol, nuciferine, zizyphusine, and N,N-dimethyl-5-methoxytryptamine may be the active compounds of SSW responsible for its anti-insomnia effect. ConclusionThis study extended the possible indication scope for SSW, which provides a potential therapeutic TCM that may be used for insomnia treatment, as well as a reference scheme for the discovery of novel indications of TCM.

Metakognitiv kunnskap om hukommelse og arbeidsevne: En replikasjon og stringent test

Work ability is a prospective predictor of sick leave and is defined as the balance between human resources and work demands. Since work ability is not equivalent to health status, identifying modifiable factors that contribute to it has the potential to reduce sick leave and related problems. The metacognitive model suggests that metacognition may be related to work ability and status, and a previous study reported an association between memory confidence and work ability. We aimed to replicate this finding and to test its robustness. In a cross-sectional study, 502 eligible participants responded to self-reporting measures. Confidence in memory significantly correlated with work ability, and this association held even when controlling for gender, age, physical health impairments, symptoms of anxiety and depression, negative automatic thoughts related to anxiety, fear of bodily sensations, and intolerance of uncertainty. Memory confidence may be a target for treatment with an aim to improve work ability. Keywords: work ability, metacognition, S-REF model, cognitive confidence, metacognitive therapy

Association of Chronic Pancreatitis Pain Features With Physical, Mental, and Social Health

Pain is a cardinal symptom of chronic pancreatitis (CP). Using Patient-Reported Outcomes Measurement Information System (PROMIS) measures, we characterized physical and mental health and symptom profiles of a well-defined cohort of individuals with CP and compared them with control subjects. Among patients with CP, we also examined associations between pain (intensity, temporal nature) and PROMIS symptom profiles and the prevalence of clinically significant psychological comorbidities. We analyzed baseline data in 488 CP patients and 254 control subjects enrolled in PROCEED (Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies), an ongoing longitudinal cohort study. Participants completed the PROMIS-Global Health, which captures global physical and mental health, and the PROMIS-29 profile, which captures 7 symptom domains. Self-reported pain was categorized by severity (none, mild-moderate, severe) and temporal nature (none, intermittent, constant). Demographic and clinical data were obtained from the PROCEED database. Pain was significantly associated with impairments in physical and mental health. Compared with participants with no pain, CP participants with severe pain (but not mild-moderate pain) had more decrements in each PROMIS domain in multivariable models (effect sizes, 2.54-7.03) and had a higher prevalence of clinically significant depression, anxiety, sleep disturbance, and physical disability (odds ratios, 2.11-4.74). Similar results were noted for constant pain (but not intermittent pain) for PROMIS domains (effect sizes, 4.08-10.37) and clinically significant depression, anxiety, sleep disturbance and physical disability (odds ratios, 2.80-5.38). Severe and constant pain are major drivers for poor psychological and physical health in CP. Systematic evaluation and management of psychiatric comorbidities and sleep disturbance should be incorporated into routine management of patients with CP. (ClinicalTrials.gov, Number: NCT03099850).

Patient-reported long-term outcome following allogeneic hematopoietic stem cell transplantation in pediatric chronic myeloid leukemia.

BackgroundPediatric CML is very rare. Before the introduction of tyrosine kinase inhibitors (TKIs), allogeneic hematopoietic stem cell transplantation (HSCT) from a donor -if available- was the standard cure attempt. Data on the long-term outcome and health-related quality of life (HRQOL) in former pediatric CML patients undergoing HSCT are lacking.Study questionWe investigated long-term survivors’ self-reporting to a questionnaire sent out to patients formerly enrolled in pediatric CML-HSCT trials.MethodsIndividuals with CML transplanted at age <18 years were identified from the German Childhood Cancer Registry database. Long-term survivors received a questionnaire based on the SF-36 and FACT-BMT asking them to self-report HRQOL issues. (Ethical vote #541_20 B, Medical Faculty, University of Erlangen-Nürnberg).Results111/171 (64.9%) individuals survived HSCT long-term and 86/111 (77.5%) fulfilled all inclusion criteria and received the questionnaire. 37/86 (43%) participants (24 female, 13 male, median age at HSCT 12 years [range 2-18], median age at the time of the survey 29 years [range 18-43]) responded after a median follow-up period of 19 years (range 4-27) after HSCT. 10/37 (27%) participants underwent no regular medical follow-up examinations. Self-reported symptoms like chronic graft-versus-host disease (cGvHD)-associated organ impairments and conditioning regimen consequences could causatively not sharply be separated in each case. Complains comprised hypothyroidism (N=11, 30%), infertility (N=9, 24%), lung problems, dry eyes (each N=7, 19%), skin alterations (N=6, 17%), hair problems (N=4, 11%), and sexual dysfunction (N=3, 9%). 10 (27%) participants experienced 13 CML relapses after a median interval from HSCT of 31 months (range 2-93). Only one patient underwent 2nd SCT after failure of relapse treatment with TKIs. Six secondary malignancies (dysplastic melanocytic nevus and ALL, basal cell carcinoma (N=2), rhabdomyosarcoma, and thyroid carcinoma developed in 5 (13%) participants. As assessed by the SF-36 questionnaire, impaired physical health was mainly associated with cGvHD. The mental component summary score showed that also participants without cGvHD scored significantly lower than the general population. When assessed by the FACT-BMT, participants with cGvHD scored significantly lower while participants without cGvHD scored even 5 points higher than the data from controls. 18 (49%) participants considered the sequelae of HSCT an obstacle to education. Out of the total cohort, N=20 (54%), N=7 (19%), N=5 (14%), and N=4 (11%) participants worked full time, part-time, were unemployed, or had not yet finalized their education, respectively. 20 (54%) participants lived as singles, 8 (22%) lived in a partnership, 6 (16%) were married, and 3 (8%) had been divorced. Four (11%) participants reported a total number of 7 children.ConclusionThis first assessment of HRQOL in former pediatric patients with CML surviving HSCT for more than two decades demonstrates self-reported satisfactory well-being only in the absence of cGvHD. Research-based on self-reported outcomes sheds light on former patients’ perspectives and provides an additional layer of valuable knowledge for pediatric and adult hematologists. Regular follow-up examinations are mandatory helping to avoid that late secondary neoplasias, CML-relapse, and disorders forming the broad range of possible long-term consequences of HSCT are not detected too late.

Challenges and coping mechanisms among women living with unrepaired obstetric fistula in Ethiopia: A phenomenological study.

IntroductionObstetric fistula remains a debilitating complication of childbirth and maternal morbidity in developing countries. Few studies document the challenges and coping mechanisms among women living with obstetric fistula in Ethiopia. Therefore, this study aimed to explore the challenges and coping mechanisms among women with obstetric fistula in Ethiopia.MethodsA phenomenological study was employed among purposively selected eleven women with obstetric fistula and three key informants at five fistula treatment centers in Ethiopia. An in-depth interview was conducted, audio-recorded, and transcribed into a Microsoft Word document. The transcripts were imported into Atlas. ti version 8.4 for thematic analyses.ResultsPainful social life, consequences of fistula, and coping mechanisms with fistula problems were the main themes in this study. Difficult social life, stigma, discrimination, impaired marital status; psychological, physical, sexual, and reproductive health problems were the major challenges for women with obstetric fistulas. Women with fistulas used coping mechanisms such as—going to spiritual sites and drinking alcohol to cope with their fistula disease; separating themselves from community participation and living alone in the forest to cope with a painful social life; restricting the amount of drinking water and wearing many clothes at a time to cope with wetness and odors, and allowing their husband to marry a new wife to cope with the impaired marital responsibilities.ConclusionWomen with obstetric fistulas encountered challenges such as a painful social life, impaired marital status, psychological, physical, sexual, and reproductive health problems; and used coping mechanisms with their fistula condition, difficult social life, and impaired marital responsibility that may have an added negative effect on their overall health. Therefore, policymakers need to prioritize the availability and early utilization of obstetric fistula surgery in all settings for all women living with obstetric fistulas to restore their holistic health.

Virtual Learning during COVID-19: Exploring Challenges and Identifying Highly Vulnerable Groups Based on Location.

Amid the outbreak of the COVID-19 pandemic in the year 2020, educational platforms have been forced to change and adapt from conventional physical learning to virtual learning. Nearly all higher learning institutions worldwide are forced to follow the new educational setting through virtual platforms. Sabah is one of the poorest states in Malaysia with the poorest infrastructure, with the technology and communication facilities in the state remaining inept. With the changes in virtual platforms in all higher education institutions in Malaysia, higher learning institutions in Sabah are expected to follow the lead, despite the state lagging in its development. This has certainly impacted the overall productivity and performance of students in Sabah. Therefore, this study aims to explore the challenges of the implementation of virtual learning among students in Sabah. More specifically, this study seeks to identify vulnerable groups among students based on their geographical location. To achieve the objective of this study, a survey has been conducted on a total of 1,371 students in both private and public higher learning institutions in Sabah. The sample selection for this study was determined using a purposive sampling technique. Based on Principal Component Analysis (PCA), it was found that there are five challenges in virtual learning faced by students in higher learning institutions in Sabah. These are the unconducive learning environment (var(X) = 20.12%), the deterioration of physical health (var(X) = 13.40%), the decline of mental health (var(X) = 12.10%), the limited educational facilities (var(X) = 10.14%) and social isolation (var(X) = 7.47%). The K-Means Clustering analysis found that there are six student clusters in Sabah (Cluster A, B, C, D, E & F), each of which faces different challenges in participating in virtual learning. Based on the assessment of location, almost half of the total number of districts in Sabah are dominated by students from Cluster A (9 districts) and Cluster B (4 districts). More worryingly, both Cluster A and Cluster B are classified as highly vulnerable groups in relation to the implementation of virtual learning. The results of this study can be used by the local authorities and policymakers in Malaysia to improve the implementation of virtual learning in Sabah so that the education system can be more effective and systematic. Additionally, the improvement and empowerment of the learning environment are crucial to ensuring education is accessible and inclusive for all societies, in line with the fourth of the Sustainable Development Goals (SDG-4).

Psychophysiological effects of residential options on older people living in long-term nursing house

Background: Nursing home is critical for the elderly.&#x0D; Methods: To investigate the effects of decision-making process in terms of choosing room type and roommates on cognitive and psychosocial conditions of the elderly, 174 eligible participants were randomly assigned into three groups. In the first two groups, participants were randomly assigned to single-person rooms (Group SPR, n = 58) and multi-person rooms (2–4 persons per room, Group MPR, n = 58), and the third group of participants were allowed to voluntarily choose to live in single-person room or with preferred roommates (Group VPR, n = 58).&#x0D; Results: Participants who voluntarily choose room type and roommates (Group VPR) showed the least deterioration of cognitive function, psychosocial, and physical health, with Group MPR showing less deterioration than Group SPR. Allowing elderly people to voluntarily choose room type and roommate is better for preserving their cognitive, psychological, and physical health.&#x0D; Conclusions: Voluntary choice of room type and roommates is beneficial to the cognitive, psychological, and physical health of elderly people.

818P Phase II confirmatory study of cemiplimab (350mg IV Q3W) in patients with locally advanced or metastatic cutaneous squamous cell carcinoma (CSCC): Study 1540 Group 6

While most patients (pts) diagnosed with CSCC are cured with local therapies, for the small percentage developing advanced CSCC the disease is life threatening with dismal prognosis. In a phase 1 (NCT02383212) and a pivotal phase 2 (NCT02760498) clinical trials, cemiplimab, an anti–programmed cell death receptor-1 [anti–PD-1], was the first systemic therapy to demonstrate significant antitumor activity in pts with advanced CSCC. Here, we report results from group 6 of the pivotal phase 2 trial, providing additional efficacy and safety data for cemiplimab monotherapy, 350 mg every 3 weeks (Q3W) up to 104 weeks, in patients with advanced CSCC. Patients with advanced CSCC (metastatic [nodal or distant] or locally advanced) were treated with cemiplimab 350 mg intravenous (IV) Q3W for up to 108 weeks. The primary endpoint was objective response rate (ORR; complete response + partial response) per independent central review (ICR). Secondary endpoints included duration of response (DOR), progression-free survival (PFS), and overall survival (OS) by central and investigator review as well as safety and tolerability of cemiplimab. At data cut-off date of Oct 25 2021, 167 pts were enrolled, of which 165 pts received at least one dose of cemiplimab and were followed-up for a median of 8.71 months (range: 0.0 - 19.5). 5 of 167 pts received prior systemic therapies. Per ICR, ORR was 44.3% (74/167, 95% CI: 36.6%, 52.2%) with complete response in 5.4% (9/167), partial response in 38.9% (65/167), and DOR was not reached (95% CI: 13.0 months, not evaluable [NE]). Among treated patients, median PFS was 14.7 months (95% CI: 10.4, NE) and median OS was not reached (95% CI: 17.6 months, NE). The most common treatment-emergent adverse events (TEAEs) by any grade were fatigue (26.1%), diarrhoea and pruritus (each 21.2%), and nausea (17.0%). The most common grade ≥3 TEAEs were hypertension and pneumonia (each 3.6%), and general physical health deterioration (3.0%). The group 6 primary analysis demonstrates a safety and efficacy profile that is consistent with that of the earlier groups of the study.

"Effects of the COVID-19 pandemic on university students' physical health, mental health and learning, a cross-sectional study including 917 students from eight universities in Germany".

The COVID-19 pandemic has severely affected physical and mental health. Since its commencement in 2020, social distancing has become the “new normal”. Temporary lockdowns and distance learning have disproportionately affected young adults, including university students. To identify effects of the pandemic on university students’ physical and mental health and learning, this empirical study included eight universities in Heidelberg, Mannheim and Ludwigshafen. Data was collected in May and June 2020. The self-administered survey was filled by 1,246 university students. 917 students completed the survey in full. 80.6% were bachelor students (n = 738), the mean semester was 3.8 and mean age was 23.1 years. 51.8% (n = 472) were female students and 47.4% (n = 432) male students. 38.5% (n = 352) stated a deterioration in physical health and 53.1% (n = 485) in mental health. From 0 to 10, students rated mean levels of stress highest due to social distancing (5.6), spending most time at home (5.0) and e-learning (4.5). Compared to male students, female students’ mental health worsened significantly (58.7% vs. 46.8%). A logistic regression analysis identified gender having a significant effect on university students’ stress levels: males seemed to have a lower risk of moderate to high levels of stress compared to females (odds ratio = 0.698; 95% CI = 0.515 to 0.945). Age, city of university and semester did not show a significant effect. The results are important to both regional and international audiences as university students face similar physical and mental health challenges due to the pandemic and its public health measures. Low-threshold initiatives are needed to mitigate the effects of the pandemic. These may include measures to reinforce students’ locus of control, sense of belonging, relaxation and mindfulness as well as (online) counselling services. Gender-specific differences must be taken into account.