Social support for the chronically ill during lockdown. Qualitative research in the COVID-19 pandemic.

Chronic illness requires a web of actors, both professional and familiar, who constitute the support network of the chronically ill. This article aims to analyse how the COVID-19 pandemic has impacted on the delicate balance of these supports. Qualitative research was conducted among people with four types of chronic diseases in France: cystic fibrosis, kidney disease, haemophilia and mental disorders. Data on social support was collected using an innovative methodology combining semi-directive interviews (n = 54) and drawings (n = 32). During the first French lockdown (March-May 2020), the chronically ill were mainly supported by the usual support actors of their primary network: spouse and/or family. However, the COVID-19 health crisis has led to several changes in their support network; health-care professionals diversified their support roles and new supporting actors emerged, especially non-human entities and patient organisations. The chronically ill have received an interweaving of emotional, instrumental and informational, formal and informal and human and non-human support. Our study highlights the multiple and dynamic ties between these types of support and argues in favour of a comprehensive approach to social support of the chronically ill, both in social science theory and in practice of care.

[Influence of health care crises on the treatment of cancer pain: a presentation using the example of the COVID-19 pandemic from the provider's perspective]. / Einfluss von Versorgungskrisen auf die Behandlung von Tumorschmerzen: eine Darstellung am Beispiel der COVID-19-Pandemie aus Versorgersicht.

BACKGROUND: The COVID-19 pandemic led to significantly restricted access to pain medicine services. Patients with cancer-related pain are considered a vulnerable group in terms of care deficits. A questionnaire among providers providing treatment to this group was used to assess limitations and solutions in this critical situation. MATERIALS AND METHODS: The online survey, developed by the 'Tumour Pain Working Group' of the German Pain Society using the Delphi method, included questions on site structure, pandemic-related care problems, and burdens experienced by those treating patients. It was distributed several times via the mailing lists of the German Pain Society and the 'Palliative Medicine Working Group' of the German Society of Anaesthesiology and Intensive Care Medicine. RESULTS: In all, 175 fully completed questionnaires were analysed. Over 75% of participants reported pandemic-related staff shortages and closures of pain medicine facilities, with 32% of facilities temporarily not treating elective pain patients and 13% not treating any emergencies. Care was hampered by numerous logistical problems such as very frequent pandemic-related cancellations by patients or in the transmission of prescriptions. Alternative forms of consultation by telephone or telemedicine, rarely used before the pandemic, were reported by 79 and 31% of respondents respectively, but deficiencies were noted. In addition, 52.1% of respondents complained of severe and 26.8% of moderate psychological stress due to the pandemic, and 74.1% evaluated working conditions as moderately to severely difficult. Medical training was still possible for 86% through format changes. CONCLUSION: The COVID-19 pandemic revealed numerous deficits in the care of patients with cancer-related pain, as well as burdens on healthcare providers. The development of new concepts could help to ensure better care in future crisis situations.

Management of COVID-19 in Ophthalmology.

From its outbreak in early 2020, the new SARS-CoV-2 infection has deeply affected the entire eye care system for several reasons. Since the beginning of the COVID-19 pandemic, ophthalmologists were among the "high-risk category" for contracting the SARS-CoV-2 infection based on the notion that the eye was suspected to be a site of inoculation, infection, and transmission. Clinical ophthalmologists have been required to learn and promptly recognize the ocular manifestations associated with the COVID-19 disease, with its treatments and vaccinations. Restriction measures, lockdown periods, guidelines to prevent SARS-CoV-2 infection transmission, and the use of telemedicine and artificial intelligence modalities have induced profound modifications. These changes, which are most likely to be irreversible, influence routine clinical practice, education, and research, thus giving rise to a "new ophthalmology in the COVID era". This book chapter aims to provide several notions regarding COVID-19 in ophthalmology, including the SARS-CoV-2 virus infection and transmission modalities; the ocular manifestation associated with the COVID-19 disease; the drugs and vaccines used for COVID-19; the precautions adopted in the ophthalmic practice to limit the spread of the virus; the consequences of the pandemic on the ophthalmic patients, clinicians, and the entire eye care system; and, the future of ophthalmology in the era of "COVID new normal".

Increased rate of injuries to the anterior cruciate ligament in amateur soccer players after the COVID-19 pandemic lockdown.

The COVID-19 pandemic led to the discontinuation of soccer activities at all levels of play. Injuries to the anterior cruciate ligament (ACL) are still one of the most severe injuries in soccer. The aim of this investigation was to analyze the changes in the incidence and mechanism of ACL injuries in professional and amateur soccer before and after the lockdown period. Injury data were prospectively collected using the database 'ACL registry in German soccer'. Between 2019 and 2021, 10 matches in professional, semi-professional, and amateur leagues before and after the lockdown were analyzed for the incidence and mechanism of ACL injuries. Data were collected using standardized and recently published study methods. Mean incidence of the 84 ACL injuries recorded during the study period was 0.083 injuries per 1000 h of exposure before and 0.079 injuries per 1000 h of exposure after the lockdown period (p = 0.699). In amateur soccer, the incidence of ACL injuries increased significantly from 0.058 injuries per 1000 h of exposure before to 0.128 injuries per 1000 h of exposure after the lockdown period (p = 0.026), in contrast to professional (p = 0.436) and semi-professional (p = 0.802) soccer. The predominant mechanisms of ACL injuries were non-contact injuries (pre-COVID: 59.1%; post-COVID: 57.7%) and indirect contact injuries (pre-COVID: 31.8%; post-COVID: 30.8%). The absence from training and match practice in German soccer during the COVID-19 lockdown led to a significantly increased ACL injury rate in amateur leagues, while in professional and semi-professional soccer no differences were reported. The mechanism of ACL injuries did not change after the lockdown period.Level of evidence: II.

Social and Health-related Changes in Hispanic Cancer Patients during the COVID-19 Lockdown.

OBJECTIVE: The current study aimed to explore changes in health-related behaviors and social practices in Hispanic cancer patients during a government-mandated lockdown and their relationship to sociodemographic and clinical characteristics. METHODS: Secondary analyses were conducted on data gathered by a longitudinal cohort study to describe the unmet needs of Hispanic cancer patients living in Puerto Rico exposed to Hurricane Maria in 2017, earthquakes in 2020, and COVID-19. However, our study solely focuses on the data from the COVID-19 pandemic period. RESULTS: Most participants were women (n = 72) with breast cancer (81.2%). Participants exhibited changes in religious practices (60%), physical activity (58.4%), and sedentary behavior (50%); 31.4% experienced changes in eating habits and sleeping patterns. Responses to the study questionnaire involved staying connected with family (85.5%) through phone calls (78.2%); 69.9% of the participants reported observing shifts in the family dynamics. A strong majority endorsed the government-imposed isolation measures (95.6%). Patients not undergoing treatment were likelier (r = -0.324; P = .010) to support the measures. Finally, younger patients experienced more work-related changes (r = -0.288; P = .017) and were less inclined (r = -0.293; P = .011) to find the isolation measures appropriate. CONCLUSION: This paper describes the lockdown related changes in health and social behaviors sustained by cancer patients, changes which could potentially impact their overall health and health-related quality of life. Our results fill an existing gap in our findings and contribute to understanding the experiences of cancer patients (in particular, Hispanic patients) during the COVID-19 pandemic.

Impact of the COVID-19 Lockdown on Primary Bariatric Surgery: A Comparative Study of Weight Loss Trajectories and Perioperative Outcomes.

Background: The COVID-19 pandemic and subsequent lockdowns led to substantial changes in health-related behaviors and deferred elective surgeries. This study aimed to evaluate the impact of the COVID-19 lockdown on weight loss trajectories (WLT) and perioperative outcomes in primary bariatric surgery at a single tertiary referral center. Methods: Patients who underwent primary bariatric surgery immediately prior to the enforced lockdown (During-Lockdown Group, DLG) were compared with historical controls who underwent surgery before the lockdown (Before-Lockdown Group, BLG). WLT were estimated using a random intercept mixed-effects model with repeated measures. Cross-sectional group differences at 3- and 6-months post-surgery were examined. Perioperative outcomes were also analyzed. Results: A total of 273 patients were included (133 BLG, 140 DLG). The adjusted average weight decreased in both groups over time at different levels. The expected difference in weight between BLG and DLG at 3-months was 1.06 kg (P = .013) and at 6-months was .04 kg (P = .920), respectively. There were no statistically significant differences in postoperative complications, emergency department visits, re-admission rates, re-operation rates, or mortality. Conclusions: This study suggests that bariatric procedures performed before the COVID-19 lockdown were effective and safe. Despite a statistically significant difference in weight between groups at 3- and 6-months post-surgery, the difference was small and unlikely to be clinically significant. Short-term outcomes were comparable between the two groups. Further investigation is warranted to assess the impact of lifestyle changes during the lockdown on long-term bariatric surgery outcomes.

Source apportionment of particle-bound polycyclic aromatic hydrocarbons (PAHs), oxygenated PAHs (OPAHs), and their associated long-term health risks in a major European city.

Many studies have drawn attention to the associations of oxygenated polycyclic aromatic hydrocarbons (OPAHs) with harmful health effects, advocating for their systematic monitoring alongside simple PAHs to better understand the aerosol carcinogenic potential in urban areas. To address this need, this study conducted an extensive PM2.5 sampling campaign in Athens, Greece, at the Thissio Supersite of the National Observatory of Athens, from December 2018 to July 2021, aiming to characterize the levels and variability of polycyclic aromatic compounds (PACs), perform source apportionment, and assess health risk. Cumulative OPAH concentrations (Σ-OPAHs) were in the same range as Σ-PAHs (annual average 4.2 and 5.6 ng m-3, respectively). They exhibited a common seasonal profile with enhanced levels during the heating seasons, primarily attributed to residential wood burning (RWB). The episodic impact of biomass burning was also observed during a peri-urban wildfire event in May 2021, when PAH and OPAH concentrations increased by a factor of three compared to the monthly average. The study period also included the winter 2020-2021 COVID-19 lockdown, during which PAH and OPAH levels decreased by >50 % compared to past winters. Positive matrix factorization (PMF) source apportionment, based on a carbonaceous aerosol speciation dataset, identified PAC sources related to RWB, local traffic (gasoline vehicles) and urban traffic (including diesel emissions), as well as an impact of regional organic aerosol. Despite its seasonal character, RWB accounted for nearly half of Σ-PAH and over two-thirds of Σ-OPAH concentrations. Using the estimated source profiles and contributions, the source-specific carcinogenic potency of the studied PACs was calculated, revealing that almost 50 % was related to RWB. These findings underscore the urgent need to regulate domestic biomass burning at a European level, which can provide concrete benefits for improving urban air quality, towards the new stricter EU standards, and reducing long-term health effects.

Anthropogenic impacts on polycyclic aromatic hydrocarbons in surface water: Evidence from the COVID-19 lockdown.

The lockdown restrictions against coronavirus disease 2019 (COVID-19) have led to unprecedented reductions in global anthropogenic activities. Polycyclic aromatic hydrocarbons (PAHs) are carcinogenic combustion-induced pollutants, but the influence of anthropogenic responses to COVID-19 on PAH contamination remains largely unknown. Here we quantified the impacts of lockdown restrictions on 16PAH pollution based on the data in concentrations dissolved in the water phase and absorbed on the suspended particulate matter (SPM) in the Elbe River from 2015 to 2021 and determined the changes in source contributions classified by individual years and stations. Results show that the annual average PAH concentrations in water and SPM were determined as 0.055 µg·L-1 and 3.77 mg·kg-1 from 2015 to 2021, respectively. Pronounced declines in PAH on SPM (up to -18 %) were observed during the three lockdowns in Germany from 2020 to 2021. However, dramatic rebounds of anthropogenic activities during the removal of the lockdown led to increases (up to 29 %) in ∑16PAH concentrations compared to the same period in previous years. Through the source apportionment method, vehicle and coal emissions were the two most predominant sources of PAHs in the river. Vehicle contribution decreased during the lockdown, while coal emissions increased by 5 %. Health risks for three age groups were assessed as potential low risk and decreased by 18 % from 1.54 × 10-4 in 2015 to 1.27 × 10-4 in 2019, and rebounded to 1.40 × 10-4 in 2020-2021. The findings of this study highlight the strong consistency between PAH concentrations and anthropogenic intensity, implying that source control from improved cleaner production is an effective pathway for mitigating PAH contamination in the aquatic environment.

Long-term effects of the COVID-19 lockdown on weight status, eating habits, and lifestyle changes related to school-aged children in Bandar Abbas, Iran.

BACKGROUND: Despite the end of the COVID-19 lockdown and reopening of schools, the long-term effects of quarantine on the weight status, eating habits, and lifestyle of children and adolescents remain unknown. This study aimed to determine the long-term effects of the lockdown on the weight status, eating habits, and lifestyle changes of children and adolescents in Iran. METHOD: This descriptive cross-sectional study was conducted from April to May 2022. The target population comprised one hundred students aged between 10 and 16 years old. Our study obtained students' weight and height data from records maintained by school principals or physical education instructors before and after the quarantine period. The BMI z-score (zBMI) was calculated for each time point. The researchers also provided a questionnaire to collect the students' demographic and lifestyle status changes during school closures. RESULTS: We found that the zBMI increased significantly from - 0.02 ± 1.64 to 0.36 ± 1.12, and the number of individuals with overweight and obesity increased by 3% during quarantine (P ≤ 0.05). These changes were more pronounced in males and students aged 14-16 years old. We also found that eating habits, sleeping time, sleeping patterns, screen time (time spent on social media per day), and physical activity had significant negative changes during quarantine, and a significant increase in zBMI was observed among students who experienced negative eating behaviors, altered sleeping patterns, and decreased physical activity during school closures. CONCLUSION: As prolonged school closures due to the COVID-19 lockdown aggravated students' health and lifestyle status, our findings can aid in proper planning to establish an appropriate framework for the diet, physical activity, and sleeping quality of students during extended school closures.

Influence of the COVID-19 Pandemic on Patients with Rectal Cancer.

Objectives: The COVID-19 pandemic and its associated restrictions have resulted in delayed diagnoses across various tumor entities, including rectal cancer. Our hypothesis was based on the expectation of a reduced number of primary operations due to higher tumor stages compared to the control group. Methods: In a single-center retrospective study conducted from 1 March 2018 to 1 March 2022, we analyzed 120 patients with an initial diagnosis of rectal cancer. Among them, 65 patients were part of the control group (pre-COVID-19), while 55 patients were included in the study group (during the COVID-19 pandemic). We compared tumor stages, treatment methods, and complications, presenting data as absolute numbers or mean values. Results: Fewer primary tumor resections during the COVID-19 pandemic (p = 0.010), as well as a significantly lower overall number of tumor resections (p = 0.025) were seen compared to the control group. Twenty percent of patients in the COVID-19 group received their diagnosis during lockdown periods. These patients presented significantly higher tumor stages (T4b: 27.3% vs. 6.2%, p = 0.025) compared to the control group prior to the pandemic. In addition, more patients with angiolymphatic invasion (ALI) were identified in the COVID-19 group following neoadjuvant treatment compared to the control group (p = 0.027). No differences were noted between the groups regarding complications, stoma placement, or conversion rates. Conclusions: The COVID-19 pandemic, particularly during lockdown, appears to have contributed to delayed diagnoses, resulting in higher tumor stages and a decreased number of surgeries. The quality of rectal cancer treatment can be maintained under pandemic conditions.