Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey

BACKGROUND: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and nonadherence to immune-modifying therapy during the pandemic. OBJECTIVES: To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence. METHODS: Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and nonadherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity) and country of residence. RESULTS: Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07-1.76]. Specifically, anxiety was associated with nonadherence to targeted therapy (OR 1.41, 95% CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95% CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with nonadherence to overall systemic (OR 1.20, 95% CI 0.92-1.56) or targeted (OR 1.33, 95% CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with nonadherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49). CONCLUSIONS: These data indicate substantial nonadherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment nonadherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimize adherence and disease outcomes

A Questionnaire on Materialisms

Recent philosophical tendencies of “Actor-Network Theory,” “Object-Oriented Ontology,” and “Speculative Realism” have profoundly challenged the centrality of subjectivity in the humanities, and many artists and curators, particularly in the UK, Germany, and the United States, appear deeply influenced by this shift from epistemology to ontology. October editors asked artists, historians, and philosophers invested in these projects—from Graham Harman and Alexander R. Galloway to Armen Avanessian and Patricia Falguières to Ed Atkins and Amie Siegel—to explore what the rewards and risks of assigning agency to objects may be, and how, or if, such new materialisms can be productive for making and thinking about art today

An exploration of the experiences of endurance athletes with atrial fibrillation

Growing evidence indicates that chronic high-intensity endurance exercise predisposes male, middle-aged athletes to an increased risk of atrial fibrillation (AF). The etiology of AF in endurance athletes is multi-factorial and remains incompletely understood. AF care in athletes remains largely based on evidence derived from the general population. However, athletes have training demands that make them a unique group of patients with AF which may complicate their care. Understanding the experiences of athletes with AF provides a necessary foundation for addressing their challenges in living and managing their condition and identifying any gaps in their arrhythmia management. The purpose of this qualitative descriptive study was to describe the experiences and perspectives of endurance athletes living with AF. Masters’ athletes with AF between the ages of 35-60 years were recruited internationally through cardiology practices and social media. Ten middle aged, male endurance athletes with AF and more than 1500 lifetime training hours participated in individual, semi-structured interviews. Data were analyzed using inductive thematic analysis to construct four main themes: (1) athletic identity (2) training with AF (3) psychological and psychosocial impacts (4) athletes' experiences with healthcare providers. Participants’ identities as athletes were core to their experiences with AF. Having AF constantly threatened their athletic identity and influenced their decision making. Athletes' description of their AF revolved around how it affected their training which remained a priority for them despite experiencing significant limitations. Athletes gauged their responses to treatments (e.g., pharmacologic, cardioversion, ablation) according to the impacts on their exercise capacity. Participants additionally highlighted the negative impact of AF on work, relationships, and general psychological well-being. Athletes felt largely misunderstood by healthcare providers, who rarely considered their training as an aspect of care and found a lack of treatment recommendations tailored towards continuation of sport practice. In particular, athletes highlighted the need for practitioners to consider their training goals and to provide them with specific exercise parameters. Findings from this study emphasized the uniqueness of this male athletic AF population and highlighted a need for tailored ‘athlete-specific' management. Specialized sport AF care should be considered to ensure efficacious treatment and maintain quality of life in athletes.Health and Social Development, Faculty of (Okanagan)Nursing, School of (Okanagan)Graduat

Atrial fibrillation care in rural communities: a mixed methods study of physician and patient perspectives

Background: Atrial fibrillation (AF) is a serious heart arrhythmia associated with devastating outcomes such as stroke. Inequitable rural AF care may put patients at risk. Virtually delivered specialty AF care offers a viable option, but stakeholder perceptions of this option within the context of rural AF care is unknown. The study purpose was to obtain patient and primary care physician perspectives of rural AF care and virtually delivered AF care as a potential option. Methods: Using a mixed methods design, AF patients (n = 101) and physicians (n = 15) from three rural communities participated in focus groups and/or surveys. Focus group data were thematically analyzed, survey data were descriptively analyzed, and data were triangulated. Results: Findings captured patients’ and physicians’ perceptions of prioritized, needs, concerns and problems in AF management, available/unavailable services, and their ideas about virtual AF care. Patients and physicians identified eclectic problems in managing AF. Overall, patients felt ill informed about managing their AF and their most salient problems related to fatigue, exercise intolerance, weight maintenance, sleep apnea, and worry about stroke and bleeding. Physicians found treating patients with co-morbidities and cognitive decline problematic and balancing risks related to anticoagulation challenging. Patients and physicians identified education as a pressing need, which physicians lacked time and resources to meet. Despite available rural services, access to primary and cardiology care was a recurring challenge, and emergency department (ED) use highly contentious but often the only option for accessing care. Physicians’ managed AF care and varied in the referrals they made, often reserving them for complex situations to avoid patient travel. Patients and providers supported a broad approach to virtual AF care, tailored to an inclusive rural patient demographic. Conclusions: The study offered valuable physician and patient perspectives on AF care in rural communities including diverse management challenges, gaps in access to primary and specialty services that made ED an often used but contentious option. Findings point to the potential value of virtual care designed to reach patients with AF across the spectrum and geared to local contexts that preserve the vital role of primary care physicians in AF care in their communities.Health and Social Development, Faculty of (Okanagan)Arts and Sciences, Irving K. Barber School of (Okanagan)Non UBCNursing, School of (Okanagan)Psychology, Department of (Okanagan)ReviewedFacult