COVID-19 in the Community: Changes to Women's Mental Health, Financial Security, and Physical Activity

Introduction

This study describes changes in the mental health, financial security, and physical activity levels of women in North Carolina during the COVID-19 pandemic.

Methods

Data were collected from women aged 20-40 years receiving primary care at 2 health centers in North Carolina during 2020-2022. Surveys (N=127) evaluated changes in mental health, financial security, and physical activity during the COVID-19 pandemic. These outcomes were analyzed both descriptively and for association with sociodemographic factors using logistic regression. A subset of participants (n=46) participated in semistructured interviews. Interview transcripts were reviewed and evaluated for recurring themes by primary and secondary coders using a rapid-coding technique. Analysis was conducted in 2022.

Results

Women surveyed were 28.4% non-Hispanic White, 38.6% non-Hispanic Black, and 33.1% Hispanic/Latina. Compared with reports before the pandemic, participants reported increased frustration or boredom (69.1%), loneliness (51.6%), anxiety (64.3%), depression (52.4%), and changed sleep patterns (68.3%). Increased alcohol and other recreational substance use were associated with race and ethnicity (p<0.05) after adjustment for other sociodemographic factors. Participants reported difficulty in paying for basic expenses (44.0%). Financial difficulties during COVID-19 were associated with non-Hispanic Black race and ethnicity, less education, and lower prepandemic household income. Data showed pandemic-associated reductions in mild (32.8%), moderate (39.5%), and strenuous (43.3%) exercise, with a correlation between increased depression and reduced mild exercise. Interviews identified themes including reduced activity while working remotely, lack of gym access, and reduced motivation for exercise.

Conclusions

This mixed-methods study is one of the first to evaluate the mental health, financial security, and physical activity challenges women aged between 20 and 40 years in the southern U.S. faced during the COVID-19 pandemic.

[Progressive myoclonic epilepsy as a sign of a late form of Alpers syndrome]

INTRODUCTION

Progressive cerebral polidystrophy or Alpers syndrome is a clinico-pathological picture, with no specific biological marker, characterized by involvement mainly of the cerebral grey matter and which shows clinically as a rapidly progressive encephalopathy with intractable seizures, usually myoclonic. The typical picture starts, after a normal neonatal period, during the first two years of life.

CLINICAL CASE

A boy who after some previous difficulty with school-work presented with epilepsy at the age of 10 years and when he was 11 years old had a sudden illness with intractable seizures and severe neurological deterioration with spastic-dystonic tetraparesia, absence of visual function and minimal social contact to vocal or tactile stimuli. He had had a previously normal brother who died at the age of seven years during status epilepticus. Skin and muscle biopsies showed increase in the number and size of the mitochondria. Study of the respiratory chain in muscle showed a partial deficit in the activity of cytochrome C oxidase. CAT scanning showed marked generalized atrophy after four years.

CONCLUSIONS

This case fulfils the criteria for Alpers syndrome established by Adams and Lyon in 1996. We consider that in the context of Alpers syndrome ultrastructural changes in the mitochondria of skin and muscle and partial deficit of enzyme activity of the IV complex of the respiratory chain should be evaluated. We emphasize the late presentation of Alpers syndrome, which has rarely been reported in the literature.

[Episodes of unilateral sympathetic hyperfunction, changes in consciousness status and respiratory dysfunction in a girl with type II Chiari malformation]

INTRODUCTION

The Chiari type II malformation, often associated with a myelomeningocele, is characterized by a small posterior fossa and downward displacement of the cerebellum, IV ventricle and brainstem, with elongation and dysgenesis of other structures. It is usually linked to hydrocephaly, anomalies of the corpus callosum and hydrosyringomyelia. In symptomatic cases, the age and form of presentation are very variable and partly dependent on associated anomalies. Respiratory symptoms, the main cause of death in children with myelomeningocele, are frequent. There may be dysfunction of other cranial nerves with dysphagia, bradycardia and weakness of the cervical muscles together with motor and sensory disorders of the arms, signs of involvement of the long pathways and cerebellar dysfunction.

CLINICAL CASE

A four year old girl with a myelomeningocele and type II Chiari syndrome causing episodes of congestion, excessive sweating, left mydriasis, impaired consciousness and respiratory alterations with pauses of apnea. Between episodes there was left myosis and ptosis. Surgical decompression was done but the episodes persisted and the girl died eight months after the operation.

CONCLUSIONS

We consider that the patient had alternately, on the same side, Horner's syndrome and paroxystic episodes of sympathetic hyperstimulation. However, there are only a few, brief references in the literature to involvement of the sympathetic pathway (both of deficit and of hyperfunction) in patients with Chiari II malformation. We emphasize the evolutionary character of spinal and intracranial anomalies usually present in myelomeningocele, and that treatment is purely palliative.