Who is seeking help for psychological distress associated with the COVID-19 pandemic?

Background: The COVID-19 pandemic and accompanying restrictions are associated with substantial psychological distress. However, it is unclear how this increased strain translates into help-seeking behavior. Here, we aim to characterize those individuals who seek help for COVID-19 related psychological distress, and examine which factors are associated with their levels of distress in order to better characterize vulnerable groups. Methods: We report data from 1269 help-seeking participants subscribing to a stepped-care program targeted at mental health problems due to the COVID-19 pandemic. Sample characteristics were compared to population data, and linear regression analyses were used to examine which risk factors and stressors were associated with current symptom levels. Results: Seeking for help for COVID-19 related psychological distress was characterized by female gender, younger age, and better education compared to the general population. The majority reported mental health problems already before the pandemic. 74.5% of this help-seeking sample also exceeded clinical thresholds for depression, anxiety, or somatization. Higher individual symptom levels were associated with higher overall levels of pandemic stress, younger age, and pre-existing mental health problems, but were buffered by functional emotion regulation strategies. Conclusions: Results suggest a considerable increase in demand for mental-healthcare in the pandemic aftermath. Comparisons with the general population indicate diverging patterns in help-seeking behavior: while some individuals seek help themselves, others should be addressed directly. Individuals that are young, have pre-existing mental health problems and experience a high level of pandemic stress are particularly at-risk for considerable symptom load. Mental-healthcare providers should use these results to prepare for the significant increase in demand during the broader aftermath of the COVID-19 pandemic as well as allocate limited resources more effectively.Peer Reviewe

PRO B: evaluating the effect of an alarm-based patient-reported outcome monitoring compared with usual care in metastatic breast cancer patients—study protocol for a randomised controlled trial

Background: Despite the progress of research and treatment for breast cancer, still up to 30% of the patients afflicted will develop distant disease. Elongation of survival and maintaining the quality of life (QoL) become pivotal issues guiding the treatment decisions. One possible approach to optimise survival and QoL is the use of patient-reported outcomes (PROs) to timely identify acute disease-related burden. We present the protocol of a trial that investigates the effect of real-time PRO data captured with electronic mobile devices on QoL in female breast cancer patients with metastatic disease. Methods: This study is a randomised, controlled trial with 1:1 randomisation between two arms. A total of 1000 patients will be recruited in 40 selected breast cancer centres. Patients in the intervention arm receive a weekly request via an app to complete the PRO survey. Symptoms will be assessed by study-specific optimised short forms based on the EORTC QLQ-C30 domains using items from the EORTC CAT item banks. In case of deteriorating PRO scores, an alarm is sent to the treating study centre as well as to the PRO B study office. Following the alarm, the treating breast cancer centre is required to contact the patient to inquire about the reported symptoms and to intervene, if necessary. The intervention is not specified and depends on the clinical need determined by the treating physician. Patients in the control arm are prompted by the app every 3 months to participate in the PRO survey, but their response will not trigger an alarm. The primary outcome is the fatigue level 6 months after enrolment. Secondary endpoints include among others hospitalisations, use of rescue services and overall QoL. Discussion: Within the PRO B intervention group, we expect lower fatigue levels 6 months after intervention start, higher levels of QoL, less unplanned hospitalisations and less emergency room visits compared to controls. In case of positive results, our approach would allow a fast and easy transfer into clinical practice due to the use of the already nationwide existing IT infrastructure of the German Cancer Society and the independent certification institute OnkoZert

Who is seeking help for psychological distress associated with the COVID-19 pandemic? Characterization of risk factors in 1269 participants accessing low-threshold psychological help

Background The COVID-19 pandemic and accompanying restrictions are associated with substantial psychological distress. However, it is unclear how this increased strain translates into help-seeking behavior. Here, we aim to characterize those individuals who seek help for COVID-19 related psychological distress, and examine which factors are associated with their levels of distress in order to better characterize vulnerable groups. Methods We report data from 1269 help-seeking participants subscribing to a stepped-care program targeted at mental health problems due to the COVID-19 pandemic. Sample characteristics were compared to population data, and linear regression analyses were used to examine which risk factors and stressors were associated with current symptom levels. Results Seeking for help for COVID-19 related psychological distress was characterized by female gender, younger age, and better education compared to the general population. The majority reported mental health problems already before the pandemic. 74.5% of this help-seeking sample also exceeded clinical thresholds for depression, anxiety, or somatization. Higher individual symptom levels were associated with higher overall levels of pandemic stress, younger age, and pre-existing mental health problems, but were buffered by functional emotion regulation strategies. Conclusions Results suggest a considerable increase in demand for mental-healthcare in the pandemic aftermath. Comparisons with the general population indicate diverging patterns in help-seeking behavior: while some individuals seek help themselves, others should be addressed directly. Individuals that are young, have pre-existing mental health problems and experience a high level of pandemic stress are particularly at-risk for considerable symptom load. Mental-healthcare providers should use these results to prepare for the significant increase in demand during the broader aftermath of the COVID-19 pandemic as well as allocate limited resources more effectively

Endoglin Haplo-Insufficiency Modifies the Inflammatory Response in Irradiated Mouse Hearts without Affecting Structural and Mircovascular Changes

<div><p>Background</p><p>It is now widely recognized that radiotherapy of thoracic and chest wall tumors increases the long-term risk of cardiovascular damage although the underlying mechanisms are not fully elucidated. There is increasing evidence that microvascular damage is involved. Endoglin, an accessory receptor for TGF-β1, is highly expressed in damaged endothelial cells and may play a crucial role in cell proliferation and revascularization of damaged heart tissue. We have therefore specifically examined the role of endoglin in microvascular damage and repair in the irradiated heart.</p><p>Materials & Methods</p><p>A single dose of 16 Gy was delivered to the heart of adult Eng^+/+ or Eng^+/− mice and damage was evaluated at 4, 20 and 40 weeks, relative to age-matched controls. Gated single photon emission computed tomography (gSPECT) was used to measure cardiac geometry and function, and related to histo-morphology, microvascular damage (detected using immuno- and enzyme-histochemistry) and gene expression (detected by microarray and real time PCR).</p><p>Results</p><p>Genes categorized according to known inflammatory and immunological related disease were less prominently regulated in irradiated Eng^+/− mice compared to Eng^+/+ littermates. Fibrosis related genes, TGF-β1, ALK 5 and PDGF, were only upregulated in Eng^+/+ mice during the early phase of radiation-induced cardiac damage (4 weeks). In addition, only the Eng^+/+ mice showed significant upregulation of collagen deposition in the early fibrotic phase (20 weeks) after irradiation. Despite these differences in gene expression, there was no reduction in inflammatory invasion (CD45+cells) of irradiated Eng^+/− hearts. Microvascular damage (microvascular density, alkaline phosphatase and von-Willebrand-Factor expression) was also similar in both strains.</p><p>Conclusion</p><p>Eng^+/− mice displayed impaired early inflammatory and fibrotic responses to high dose irradiation compared to Eng^+/+ littermates. This did not result in significant differences in microvascular damage or cardiac function between the strains.</p></div

Graphical representation of the top network of differentially regulated genes (40 weeks).

<p>Each network symbolizes the biological functions and/or diseases that were most significantly regulated 40 weeks after cardiac irradiation of Eng ^+/+ mice (n = 4–5) (A) and Eng ^+/− mice (n = 4–7) (B). The genes marked in red represent the upregulated genes and in green the downregulated genes. The solid arrows represent direct interactions and the dotted arrows indirect interactions. Genes circled in dark blue represents central molecules and the light blue lines direct interaction with other genes.</p

EDV, ESV, EF and SV measured by gated SPECT at 20 weeks or 40 weeks after irradiation or sham treatment.

<p>Values represent mean ± SEM (7–14 mice in each irradiated group), *p<0.05 compared to age-matched, unirradiated controls.</p

Representation of the top network and functional pathways using IPA approach.

<p>Top networks for 4, 20 and 40 weeks after 16 Gy irradiation of Eng^+/+ and Eng^+/− mice. Numbers in brackets represent the network score, which is explained in material and methods. The first two functional pathways for 4, 20 and 40 weeks after 16 Gy irradiation of Eng^+/+ and Eng^+/− mice are also shown. Nerv.system devlp. & funct. : Nervous system development and function; Lipid metabl, Molecl. Transp.: Lipid metabolism, Molecular transport; Hematl. system devlp.& funct.: Hematological system development and function; Cell-to-cell signlg.& inter.: Cell-to-cell signaling and interaction; Cardio.system devlp.& funct.: Cardiovascular system development and function.</p

Pericyte coverage altered at 40 weeks after irradiation.

<p>Confocal imaging showing the effects of radiation on pericyte coverage (marked in red) on endothelial cells of the cardiac microvasculature (marked in blue). Graph displaying NG2/CD31 ratio as % of each individual treatment group and genotype. Values represents mean ± SEM with 4–5 mice in the 4 and 20 weeks group and 4–7 mice in the 40 weeks group,*p<0.05 compared to age-matched, unirradiated controls.</p

Representation of differently regulated genes after 16 Gy irradiation using IPA approach.

<p>The top 5 upregulated and downregulated genes per genotype are shown after 16 Gy at 4 weeks, 20 weeks and 40 weeks. Numbers in brackets show log₂ ratio of sham treated mice versus 16 Gy irradiated mice.</p

Graphical representation of the top network of differentially regulated genes (20 weeks).

<p>Each network symbolizes the biological functions and/or diseases that were most significantly regulated 20 weeks after cardiac irradiation of Eng ^+/+ mice (n = 4–5) (A) and Eng ^+/− mice (n = 5) (B). The genes marked in red represent the upregulated genes and in green the downregulated genes. The solid arrows represent direct interactions and the dotted arrows indirect interactions. Genes circled in dark blue represents central molecules and the light blue lines direct interaction with other genes.</p