The Puerto Rico Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk (PR-OUTLOOK) Study: Design and Methods.

The Puerto Rico (PR) Young Adults' Stress, Contextual, Behavioral & Cardiometabolic Risk Study (PR-OUTLOOK) is investigating overall and component-specific cardiovascular health (CVH) and cardiovascular disease (CVD) risk factors in a sample of young (age 18-29) Puerto Rican adults in PR (target n=3,000) and examining relationships between individual-, family/social- and neighborhood-level stress and resilience factors and CVH and CVD risk factors. The study is conducting standardized measurements of CVH and CVD risk factors and demographic, behavioral, psychosocial, neighborhood, and contextual variables and establishing a biorepository of blood, saliva, urine, stool, and hair samples. The assessment methods are aligned with other National Heart, Lung, and Blood Institute funded studies: the Puerto Rico Observational Study of Psychosocial, Environmental, and Chronic Disease Trends (PROSPECT) of adults 30-75 years, the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), the Boston Puerto Rican Health Study (BPRHS), and the Coronary Artery Risk Development in Young Adults (CARDIA). PR-OUTLOOK data and its biorepository will facilitate future longitudinal studies of the temporality of associations between stress and resilient factors and CVH and CVD risk factors among young Puerto Ricans, with remarkable potential for advancing the scientific understanding of these conditions in a high-risk but understudied young population.

Family adaptation in families of individuals with Down syndrome from 12 countries.

Our current understanding of adaptation in families of individuals with Down syndrome (DS) is based primarily on findings from studies focused on participants from a single country. Guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation, the purpose of this cross-country investigation, which is part of a larger, mixed methods study, was twofold: (1) to compare family adaptation in 12 countries, and (2) to examine the relationships between family variables and family adaptation. The focus of this study is data collected in the 12 countries where at least 30 parents completed the survey. Descriptive statistics were generated, and mean family adaptation was modeled in terms of each predictor independently, controlling for an effect on covariates. A parsimonious composite model for mean family adaptation was adaptively generated. While there were cross-country differences, standardized family adaptation mean scores fell within the average range for all 12 countries. Key components of the guiding framework (i.e., family demands, family appraisal, family resources, and family problem-solving communication) were important predictors of family adaptation. More cross-country studies, as well as longitudinal studies, are needed to fully understand how culture and social determinants of health influence family adaptation in families of individuals with DS.

Heterogeneity promotes resilience in restored prairie: Implications for the environmental heterogeneity hypothesis.

Enhancing resilience in formerly degraded ecosystems is an important goal of restoration ecology. However, evidence for the recovery of resilience and its underlying mechanisms require long-term experiments and comparison with reference ecosystems. We used data from an experimental prairie restoration that featured long-term soil heterogeneity manipulations and data from two long-term experiments located in a comparable remnant (reference) prairie to (1) quantify the recovery of ecosystem functioning (i.e., productivity) relative to remnant prairie, (2) compare the resilience of restored and remnant prairies to a natural drought, and (3) test whether soil heterogeneity enhances resilience of restored prairie. We compared sensitivity and legacy effects between prairie types (remnant and restored) and among four prairie sites that included two remnant prairie sites and prairie restored under homogeneous and heterogeneous soil conditions. We measured sensitivity and resilience as the proportional change in aboveground net primary productivity (ANPP) during and following drought (sensitivity and legacy effects, respectively) relative to average ANPP based on 4 pre-drought years (2014-2017). In nondrought years, total ANPP was similar between remnant and restored prairie, but remnant prairie had higher grass productivity and lower forb productivity compared with restored prairie. These ANPP patterns generally persisted during drought. The sensitivity of total ANPP to drought was similar between restored and remnant prairie, but grasses in the restored prairie were more sensitive to drought. Post-drought legacy effects were more positive in the restored prairie, and we attributed this to the more positive and less variable legacy response of forb ANPP in the restored prairie, especially in the heterogeneous soil treatment. Our results suggest that productivity recovers in restored prairie and exhibits similar sensitivity to drought as in remnant prairie. Furthermore, creating heterogeneity promotes forb productivity and enhances restored prairie resilience to drought.

Exploring the connection between ego-resiliency and health behaviors: a cross-sectional study of Polish health sciences students.

BACKGROUND: The aim of this study was to examine the relationship between ego-resiliency and the intensity of health behaviors among Polish health sciences students. METHODS: The study involved 483 students from health-related faculties in southern Poland, consisting of 314 women (63.7%) and 179 men (36.3%). The average age of the participants was 21.7 ± 2.5 years. To assess resiliency (ER), the Ego-Resiliency Scale (ER89-R12) by Block and Kremen was used in its Polish adaptation. The intensity of health behaviors was examined using the Health Behavior Inventory (HBI) developed by Z. Juczynski. RESULTS: The results revealed a positive correlation between the intensity of health behaviors and ER (r = 0.43, p < 0.001), both for the general factor and its categories (positive mental attitude, proper eating habits, preventive actions, and prohealth activities). Students with a high level of health behaviors exhibited significantly higher ER (M = 38.95, SD = 5.15) compared to those with average (M = 35.93, SD = 5.03) and low (M = 32.97, SD = 5.12) HBI levels. Among the HBI categories, Positive Mental Attitude showed the strongest correlation with both general ER and its factors: optimal regulation (OR) and openness to life experiences (OL). Furthermore, the correlation was found to be stronger with the OR and weaker with OL. CONCLUSION: Higher ER in students is correlated with a greater frequency of health behaviors. Nurturing the development of ER may contribute to the maintenance of prohealth practices despite life difficulties and temporary loss of motivation. This, in turn, promotes the regularity of health behaviors, which is crucial for their positive impact on overall health.

The interplay between ego-resiliency, math anxiety and working memory in math achievement.

Previous research has suggested that math anxiety may contribute to poor math performance by interfering with working memory. However, only a limited number of studies investigated the mediating role of working memory in the math anxiety-math performance link in school-aged children. Unlike math anxiety, ego-resiliency is a personality resource that promotes the management of challenges and has been positively associated with math performance and negatively with anxiety. Nevertheless, there is still limited understanding regarding the specific role of ego-resiliency in math learning and how it relates to math anxiety. This study aimed to investigate conjunctly the interplay between primary school children's ego-resiliency, math anxiety, working memory, and performance on two different math tasks (i.e., arithmetic task and word problem-solving task), after controlling for general anxiety and age. The study involved 185 Italian children from grades 3 to 5. Serial multi-mediational analyses revealed that: (1) ego-resiliency has a positive indirect effect on math achievement through two paths - math anxiety, and math anxiety and working memory; (2) the study replicated previous findings showing that working memory partially mediated the relationship between math anxiety and math performance; (3) similar patterns of results were found for both math skills. The study identifies ego-resiliency as a possible protective factor in the development of math anxiety and suggests that ego-resiliency could be worth considering when designing interventions aimed at reducing negative emotions towards mathematics.

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation.

RESEARCH OBJECTIVES: 1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury. DESIGN: Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants. SETTING: Four focus group sessions were conducted online through a video calling platform. PARTICIPANTS: 22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database. RESULTS: Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development. CONCLUSIONS: This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.

Community resilience across Australia towards natural hazards: an application of the Conjoint Community Resiliency Assessment Measurement.

Natural hazards can turn into disasters when not managed well. An important part of disaster risk reduction is to understand how well communities are prepared for natural hazards and how well they can cope with and recover from shocks in the long term. This research assesses self-reported community resilience and asks what makes a community resilient, using Australia as a case study. It reports on an Australian-wide online survey which included questions related to the Conjoint Community Resiliency Assessment Measurement, a subjective indicator, as well as questions about risk perception, well-being, and self-efficacy. Community resilience was found to be moderately high but scores for community leadership and preparedness were low. Perceived community resilience was positively correlated with age and those with high scores for self-efficacy and well-being. There was, as expected, an inverse relationship between reliance on external support during natural hazards and self-efficacy. The results complement previous studies which used different measures of community resilience.

Integrating science-based and local ecological knowledge: a case study of mangrove restoration and rehabilitation projects in the Philippines.

Mangrove forest is an ecosystem-based solution for disaster risk reduction in the Philippines, but its historical deforestation has hampered its capacity to protect coastal communities. With the increasing occurrence of storm surge in the Philippines, mangrove reforestation projects have received renewed attention, but many have failed. Community participation was deemed to be essential in those projects that did well. Hence, this paper examines successful mangrove restoration and rehabilitation projects in the Philippines to find out how community participation contributed to the accomplishments. The study found that while the transfer of science-based ecological knowledge from project managers to the community is an important factor in ensuring successful initial planning and implementation, its integration into existing local ecological knowledge-'localisation' of science-based ecological knowledge or hybrid ecological knowledge formation-helped to facilitate long-term community-based mangrove management beyond project duration by empowering community members and enabling project acceptance and ownership. Still, continuous local institutional support is a necessary anchor for community resilience.

The mental and behavioral health crisis in youth: Strategic solutions post COVID-19 pandemic: An American Academy of Nuring consensus paper.

The COVID-19 pandemic wrought significant negative impacts on youth well-being, particularly among Black, Hispanic, American Indian, Alaska Native, and LGBTQ+ (Lesbian, gay, bisexual, transgender, queer or questioning) youth. The pandemic disrupted connections to family, school, and community, which are essential supports for youth mental health. Lessons learned from the pandemic suggest the role of stress and windows of opportunity to build resiliency. Drawing from a policy dialog on the youth mental health crisis conducted by 4 American Academy of Nursing Expert Panels, we present approaches to the current increase in youth mental health problems. Included is emerging literature on building youth resilience, particularly via re-establishing school and community connections. The role of families, schools, and community support is emphasized, particularly by creating a healing school environment and the pivotal role of school nurses. Recommendations include increased support for families, engaging the school nurse role, and developing school-based innovative programs to build connections and youth wellness.

Telehealth Coverage for a Pediatric Gastroenterology Consult Service at a Regional Hospital: An Accepted, Useful, and Sustainable Model of Care.

OBJECTIVE: To evaluate a novel telehealth inpatient pediatric gastroenterology (GI) consult service at a regional children's hospital in regard to acceptance, utility, quality, sustainability, and provider resiliency. STUDY DESIGN: Patients requiring GI care at a regional children's hospital between July 2020 and June 2021 were treated by an in-person or telehealth physician with physician assistant support, randomly assigned based on a weekly preset staffing schedule. A retrospective, multidomain program evaluation was performed based on the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) and STEM (SPROUT Telehealth Evaluation and Management) frameworks, using statistical analysis to compare the patient cohorts and anonymous surveys to assess provider perceptions. RESULTS: In total, 1051 patient-days of GI care were provided for 348 patients, 17% by telehealth and 83% in-person. There were no significant differences in diagnosis, transfer, or readmission rates between the cohorts. No transfers occurred for reasons other than need to access specialized services not available at the regional hospital. Daily consult workload was slightly greater for telehealth physicians. Primary and consult team providers accepted the practice. The model continued beyond the first year. In total, 75% of local GI physicians reported greater Brief Resilience Scores in the context of shifting 20% of their inpatient call weeks to another campus's physicians. CONCLUSION: Episodic pediatric GI consult service coverage via telehealth at a regional hospital was well accepted, useful, and sustainable, with improved physician resilience and no adverse outcomes seen. Telehealth holds promise for leveraging pediatric subspecialty physicians across hospitals, allowing complex patients to be admitted closer to home while reducing inpatient coverage requirements for smaller physician groups.

Ecosystem resilience to invasion and drought: Insights after 24 years in a rare never-grazed grassland.

Understanding the resilience of ecosystems globally is hampered by the complex and interacting drivers of change characteristic of the Anthropocene. This is true for drylands of the western US, where widespread alteration of disturbance regimes and spread of invasive non-native species occurred with westward expansion during the 1800s, including the introduction of domestic livestock and spread of Bromus tectorum, an invasive non-native annual grass. In addition, this region has experienced a multi-decadal drought not seen for at least 1200 years with potentially large and interacting impacts on native plant communities. Here, we present 24 years of twice-annual plant cover monitoring (1997-2021) from a semiarid grassland never grazed by domestic livestock but subject to a patchy invasion of B. tectorum beginning in ~1994, compare our findings to surveys done in 1967, and examine potential climate drivers of plant community changes. We found a significant warming trend in the study area, with more than 75% of study year temperatures being warmer than average (1966-2021). We observed a native perennial grass community with high resilience to climate forcings with cover values like those in 1967. In invaded patches, B. tectorum cover was greatest in the early years of this study (1997-2001; ~20%-40%) but was subsequently constrained by climate and subtle variation in soils, with limited evidence of long-term impacts to native vegetation, contradicting earlier studies. Our ability to predict year-to-year variation in functional group and species cover with climate metrics varied, with a 12-month integrated index and fall and winter patterns appearing most important. However, declines to near zero live cover in recent years in response to regional drought intensification leave questions regarding the resiliency of intact grasslands to ongoing aridification and whether the vegetation observations reported here may be a leading indicator of impending change in this protected ecosystem.

How Central Ugandan HIV Clinics Adapted During COVID-19 Lockdown Restrictions to Promote Continuous Access to Care: A Qualitative Analysis.

We used qualitative data from the Partners PrEP Program (PPP) to address the question: How did Central Ugandan HIV clinics adapt to COVID-19 lockdown restrictions to promote continuous access to HIV care? PPP was a stepped-wedge cluster randomized trial of integrated PrEP and ART delivery for HIV serodifferent couples at Central Ugandan HIV clinics (NCT03586128). Individual interviews with purposefully selected PPP couples (N = 42) and clinicians, coordinators, and counselors providing HIV care (N = 36) were carried out. Sixty-four interviews were completed after lockdown and included questions about accessing and providing ART/PrEP refills during lockdown restrictions. We used an inductive, content-focused approach to analyze these interview data. Barriers to continuous access identified by interviewees included loss of income with increased cost of transport, reduced staff at clinics, and physical distancing at clinics. Interviewees pointed to multi-month refills, visits to clinics "close to home," transport to clinics for providers, and delivery of refills in neighborhoods as factors promoting continuous access to antiretroviral medications. Access barriers appeared somewhat different for ART and PrEP. Fewer resources for community delivery and pre-refill HIV testing requirements were identified as PrEP-specific access challenges. Participants emphasized their success in continuing ART/PrEP adherence during the lockdown, while providers emphasized missed refill visits. These results highlight the contributions of providers and ART/PrEP users to adaptation of HIV services during COVID-19 lockdown restrictions in Uganda. The roles of direct care providers and service users as drivers of adaptation should be recognized in future efforts to conceptualize and investigate health system resiliency.

Rural resilience during COVID-19: the lived experience of North Carolinian rural-dwelling cancer caregivers.

PURPOSE: To illuminate the lived experience of resilience in rural-dwelling North Carolinian cancer caregivers at the intersection of cancer and the COVID-19 pandemic. METHODS: In spring, 2020, we recruited self-identified primary caregivers (CGs) for a relative/friend with cancer living in a rural area. We conducted cross-sectional semi-structured interviews and then thematically analyzed transcripts to identify and categorize instances of stressors and benefit-finding. RESULTS: Of the 24 participants, 29% were < 50 years old, 42% identified as non-Hispanic Black, 75% were women, and 58% were spousal CGs. Most care recipients (CRs) had stage IV cancer (n = 20) and cancer types varied. Participants played a variety of roles in caregiving and experienced stressors related to caregiving demands (e.g., conflicts with other responsibilities), rurality (e.g., transportation), and the COVID-19 pandemic (e.g., new visitor policy at hospital). Despite stressful experiences, participants also identified many positive aspects of their caregiving. Five domains of benefit-finding were identified: appreciation (e.g., gratitude toward their ability to care for CRs), CG-CR dyad relationship dynamics (e.g., increased closeness), interpersonal relationship dynamics (e.g., perceived peer support), faith (e.g., ability to cope through praying), and personal growth (e.g., new skills learned from caregiving). CONCLUSION: Rural-dwelling cancer caregivers from mixed sociodemographic backgrounds identified a diverse range of benefits from caregiving, despite experiencing multiple stressors, including emergent stressors from the COVID-19 pandemic. Healthcare delivery serving rural communities may consider expanding transportation assistance and boosting benefit-finding to ameliorate stress in cancer caregivers.

The mental health of officials who regularly examine child sexual abuse material: strategies for harm mitigation.

BACKGROUND: The current study aims to better understand the mental health and subjective well-being of investigators and forensic examiners exposed to child sexual abuse material (CSAM) by examining which components of this work are associated with elevated mental health conditions and decreased well-being, as well as the intra-personal and organizational variables that may mitigate harm and improve well-being. METHODS: Police investigators, forensic examiners, and others connected with the criminal justice system from across the United States who were exposed to CSAM as part of their professions (N = 500) completed an anonymous online survey. Participants were recruited through connections with the National Criminal Justice Training Center. RESULTS: Duration, frequency, amount, and content of CSAM exposure was not related to poorer mental health with the exception of exposure to violent CSAM which was related to elevated post-traumatic stress symptoms. Several agency-level practices and policies, such as the availability of an Officer Wellness Program and more frequently knowing the final case resolution, were related to better mental health and well-being. Harm mitigation strategies, such as talking to other officers investigating the case and taking breaks from the material being viewed, were also related to better mental health. CONCLUSIONS: Findings indicate that police agencies have options for implementing agency-level procedures and practices that have the potential to reduce the negative impact of CSAM investigations. Additionally, many investigators use strategies that are correlated with greater well-being, suggesting opportunities for improving training programs.

Interrogating multisystem intended pathways to youth thriving and resilience: Benefits of inclusive human development theoretical framing.

Moving more deeply into the 21st century and acknowledging the ongoing patterned needs of children, there continues to be broadly voiced sentiments about the importance of all children's thriving, adaptive coping, and resiliency. This paper notes that social science more broadly and developmental science specifically is a major resource determinative of the nature of remedies conceptualized, designed, and implemented. Evident is that the harms experienced by children and the solutions implemented by delivery systems are frequently unaligned. Efficacy and impact do not appear to be improved by multisystem integration delivery. This paper explores the benefits of incorporating inclusive and shared human development theory. As well, it examines the need to question the character virtue of the multisystem integration efforts intended to afford supportive solutions required for youths' thriving and resiliency. Specifically, it addresses whether democratic and equity relevant character values are integrated into public and privately funded intended supportive systems. The position taken is that whether considered under conditions of trauma illustrated by the global COVID pandemic or the efficacy of systems intended to aid the most vulnerable youngsters, the character of the content of support and its delivery matter and can benefit from inclusive human development interrogation and theorizing.

The Ecological Resilience Framework: The Justice Ambassadors Youth Council as a model for community-based resilience.

We present an 'Ecological Resilience Framework' (ERF) to demonstrate how resilience is created through the Justice Ambassadors Youth Council (JAYC) program. JAYC is a platform in which New York government representatives collaboratively learn and develop policy solutions alongside emerging adults who are criminal legal system impacted and reside in predominantly Black and Hispanic communities characterized by chronically high levels of poverty, violence, and incarceration. We focus our work on the process of developing resilience in the context of structural social inequity and injustice. We argue that resilience can best be understood in the context of the adversity to which it is a response, not as an isolated individual quality. Therefore, resilience science is at its best when it incorporates a multi-disciplinary scientific perspective, one that addresses a continuum from individual- to community- to society-level physical, cognitive, relationship, and mental health variables. To demonstrate how our ERF incorporates this approach, we outline how JAYC not only supports young adult participants in understanding their individual life trajectories and narrative identity, but also actively connects them within a diverse social network of mentors and to various opportunities that support a healthy transition to adult resilience.

Steroid Hormones as Modulators of Emotional Regulation in Male Urogenital Cancers.

BACKGROUND: Tumors develop within an organism operating in a specific social and physical environment. Cortisol and dehydroepiandrosterone (DHEA), two of the most abundant steroid hormones in humans, are involved in both emotional regulation and the tumor progression. Several studies reported preclinical findings that DHEA can have preventive and therapeutic efficacy in treating major age-associated diseases, including cancer, although the mechanisms of action are not yet defined. The main aim of current study was to investigate the relationship between psychological and physiological emotional regulation and cancer development. METHOD: This study assessed the quality of life of urogenital cancer male patients using several validated tools, including the Functional Assessment of Cancer Therapy-General and the Profile of Mood States. Saliva samples were collected to monitor peripheral activity of both cortisol and DHEA. It was hypothesized that patients with a better quality of life would have higher levels of the DHEA/cortisol ratios. RESULTS: We found that the quality of life was positively related to DHEA, but not cortisol levels. Negative mood increases were related to lower levels of DHEA. Logistic regression of the predictors of metastases indicated three main independent factors involved: DHEA, age, and cortisol. In other words, the higher the DHEA levels in comparison to cortisol levels, controlling for age, the lower the probability of metastases. CONCLUSION: Our results appear to support the hypothesis that emotional dysregulation mediated by DHEA/cortisol activity is a key factor in the probability of metastasis in urogenital cancers.

Functions of Resiliency Traits and Processes in Differential Effects of CBSM on Quality of Life in Breast Cancer Survivors: A Moderated Mediation Model.

BACKGROUND: Although there is evidence that cognitive behavioral therapy (CBT)-based group interventions can improve quality of life (QoL) in women undergoing treatment for breast cancer (BC) little is known about factors that mediate and moderate these effects. We examined a) the mediating role of benefit finding on QoL changes after a Cognitive Behavioral Stress Management (CBSM) intervention, and b) whether this mediation effect differed based on baseline optimism in the first year following surgery for BC. METHODS: We used data from a prior CBSM trial in 240 women with stage 0-3 BC who completed measures of benefit finding (Benefit Finding Scale, BFS), QoL (Functional Assessment of Cancer Treatment, FACT-G), and optimism (Life Orientation Test-Revised) at baseline (2 - 10 weeks post-surgery), 6-months and 12-months after randomization. CBSM-related changes and mediation and moderation effects were assessed using latent growth curve models. RESULTS: We found CBSM increased benefit finding (b = 2.65, p < 0.01), emotional (b = 0.53, p < 0.01), and functional QoL (b = 0.71, p < 0.05) over time. CBSM-related changes in emotional QoL were mediated by increased benefit finding (indirect effect = 0.68, 95% bootstrapped CI: 0.17, 1.56) but only among participants with low to moderate optimism at baseline. CONCLUSION: CBSM intervention improved emotional QoL over the first year of breast cancer treatment by increasing benefit finding among women who reported low trait optimism suggesting those who will most likely benefit from improving benefit finding during this stressful period.

Implementing a resilience coach program to support first year housestaff during the COVID-19 pandemic: early pilot results and comparison with non-housestaff sessions.

BACKGROUND: In response to the COVID-19 pandemic, we launched the Penn Medicine Coping First Aid program to provide psychosocial supports to our health system community. Our approach leveraged lay health worker volunteers trained in principles of Psychological First Aid to deliver coaching services through a centralized virtual platform. METHODS: We emailed all (n = 408) first year housestaff (i.e., residents and fellows) with an invitation to schedule a session with a resilience coach. We compared the mental health concerns, symptoms, and Psychological First Aid techniques recorded in (n = 67) first year housestaff sessions with (n = 91) sessions of other employees in the health system. RESULTS: Between June and November 2020, forty-six first year housestaff attended at least one resilience coaching session. First year housestaff most commonly presented with feelings of anxiety and sadness and shared concerns related to the availability of social support. Resilience coaches most frequently provided practical assistance and ensured safety and comfort to first year housestaff. First year housestaff reported fewer physical or mental health symptoms and held shorter sessions with resilience coaches than non-housestaff. CONCLUSIONS: This work offers insights on how to address psychosocial functioning through low-intensity interventions delivered by lay personnel. More research is needed to understand the efficacy of this program and how best to engage housestaff in wellness and resilience programs throughout training, both during and beyond COVID-19.

The resiliency of noncommunicable diseases services during the public health crisis: a lesson from Bangkok, Thailand.

BACKGROUND: The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. METHODS: Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. RESULTS: The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. CONCLUSION: During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.