Chronic disease patients’ experience with telehealth interventions and self-care strategies during the first wave of the COVID-19 pandemic

Purpose. During COVID-19 pandemic, Québec (Canada) Public Health Agency asked Family Medicine Group (FMG) to change their practice such as recommending the use of telehealth interventions. However, it is unknown if telehealth meets patients' needs in terms of self-care, especially those suffered from physical and mental chronic condition (PCDs). This study aimed to explore, from a PCD's perspective, the response of FMG about their self-care needs during COVID-19 pandemic. Methods. We conducted an exploratory qualitative descriptive study using semi-structured interviews to reach 40 PCDs from three regions of Québec. We explored FMGs' responses, PCDs needs, coping strategies regarding the COVID-19 and the changes in primary care services. We used the transactional theory of stress and coping to inform the data collection and analysis and the COREQ appraisal grid to report this study. Results. PCDs appreciated telehealth and perceived that the accessibility was increased. Moreover, family physicians from FMG conducted the majority of the follow-ups although interdisciplinary teams were available. The coping strategies raised by the PCDs were primarily aimed at maintaining their health status, while some of them aimed to reduce stress levels. Conclusions. PCDs seem to appreciate telehealth but believe it requires improvements, and it is not adequate for all types of follow-ups. PCDs adopt coping strategies to face the pandemic that were not always optimal for their health. We call for a better understanding of PCDs' needs in times of a pandemic in order to offer them the appropriate services an interdisciplinary team can provide.http://deepblue.lib.umich.edu/bitstream/2027.42/167663/1/Article patients-covid copingVF_PP.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167663/3/Article patients-covid coping VF_V2.pdfDescription of Article patients-covid copingVF_PP.pdf : Main ArticleSEL

Large-scale genomic analyses link reproductive aging to hypothalamic signaling, breast cancer susceptibility and BRCA1-mediated DNA repair

Copyright © 2015, Rights Managed by Nature Publishing GroupThis is the author's version of an article subsequently published in definitive form at: Nature Genetics (2015) doi:10.1038/ng.3412See supplementary documents for full affiliations and acknowledgmentsMenopause timing has a substantial impact on infertility and risk of disease, including breast cancer, but the underlying mechanisms are poorly understood. We report a dual strategy in ∼70,000 women to identify common and low-frequency protein-coding variation associated with age at natural menopause (ANM). We identified 44 regions with common variants, including two regions harboring additional rare missense alleles of large effect. We found enrichment of signals in or near genes involved in delayed puberty, highlighting the first molecular links between the onset and end of reproductive lifespan. Pathway analyses identified major association with DNA damage response (DDR) genes, including the first common coding variant in BRCA1 associated with any complex trait. Mendelian randomization analyses supported a causal effect of later ANM on breast cancer risk (∼6% increase in risk per year; P = 3 × 10(-14)), likely mediated by prolonged sex hormone exposure rather than DDR mechanisms