#Vinetics C

[peanutpinet]

On The Way - Park Jisung x Fem Reader

[2:19 pm] - today was a pretty rough head start to the week. You woke up as early as 5am with a sore throat, runny nose and a fever. You told your boyfriend that you might be coming down with the flu. Apologising for having to cancel your date night which was planned for weeks now.

Not receiving any more replies from Jisung or friends, you decided to take a nap in hopes that you would feel better. Unfortunately, through the insane headache, runny nose and sore throat, you weren't able to have a good sleep and when you felt a cold towel on your forehead, you finally woke up from your nap.

Blinking a few times, you saw Jisung's back, he was cleaning your room that you left a mess because you were pulling several all-nighters for a few days for a work project. Despite the sore throat, you tried your best to call out to Jisung. It took several tries and Jisung turning towards your direction did he finally notice you calling out to him.

"H-hey, don't get up. Lie back down. You have an insane fever" Jisung softly told you, helping you lay back down

"W-when did you get here?" you coughed, Jisung taking a glass of warm water and helping you drink

"Around 15 minutes ago. I was actually already on the way when you texted me. I brought some soup that the hyungs recommended. I can heat it up if you're hungry" Jisung mentioned

"I'll be fine, sung. C-can we just cuddle?" you stuttered, sniffling

"Of course we can. Let me get some soup for you first, alright? It doesn't look like you ate anything throughout the day" Jisung mentioned, handing you a box of tissues as he rushed to get your soup

Once Jisung was back, he helped fed you the soup before giving you all the medicine that both his hyungs and his mom told him would help with your sickness. After putting the dishes away, Jisung came back, brought his laptop and played some of your favorite comfort movies, pulling up the duvet of your bed to warm you up even more.

Throughout the movie, Jisung would often switch out the towel on your forehead, rinsing it with cold water every tie he feels that it was getting hot and luckily, your fever seemed to be going down and you even finally managed to get some sleep.

"No matter what, I'll always be on the way whenever you call me" Jisung softly whispered, kissing your temple

A/N: dedicated to my fwen that's also a fellow czennie that got sick and her ult is basically Jisung :] to those who are also sick, hope you all get well soon! Take care, stay safe and see you in the next one :) xoxo - Vinet

[444names]

Names generated from Brythonic deities, The Elder Scrolls' Breton and Redguard names, and Old English forenames, excluding the letter "C"

Abadail Ablababarl Abondeh Abyne Adaber Adwind Agalastora Agreld Ahminak Alanel Alate Alborht Aldainekin Aldezhah Alhatia Alierazak Aluin Alvel Amastin Amina Aminer Andele Aneta Anethadda Anque Anwal Apouse Ariamelida Arine Asurallai Atmamja Aulin Aumiuse Avira Azhemo Aziana...

Baber Bahdanak Balatamund Balienne Banyr Barleh Baroft Batals Bauld Bayva Bearel Bedwi Beend Begrenhe Belinet Beling Bellette Belræd Belsky Bemsa Beoreyr Beras Beregynan Bereh Berem Bersondam Berstedair Betinal Bhabis Biliannah Bizdine Bloiss Blonte Blumor Bolah Brildnoth Brone Bruzouffe Bryah Burah Buurd Danakeh Danitte Daris Deadno Deedi Deldgyd Denada Derna Desht Dimer Doreh Doria Drarid Drenn Drobie Dulfrayyan Duliel Dunlie Eanyrane Earmaroft Earnime Ebenbere Edair Eifir Eirus Elaudashal Ellah Ellenvia Ellin Elodoryr Elolannius Emaleziden Emgine Eminer Emsamm Enadon Enakeelory Enhemeque Eodrah Eophershea Eorwin Epadwulf Ermint Esala Eugnorwig Evirarn Evvya Fadreder Fahar Fanisty Fardearl Farlan Farnand Farvitint Fasht Felanielle Fertorelle Fewal Finadiel Firse Flouse Frefavane Fridra Frosse Frundet Gabane Gaeed Gaida Gaigsta Galilin Gameadini Gamill Ganahahd Ganunde Garart Garjerie Gaveu Genvar Geode Gerenneaus Ghart Ginai Goldeh Gorston Gotusim Grashed Grodyr Grogelinna Groura Grunneliya Gusaris Guyllon Haduah Haffalles Halant Hallia Hamalellin Hamassal Hamatine Hamunila Hanton Hanvaux Harun Hassalat Hawaymar Hazar Hedmær Heelimeory Hellene Helrane Helyn Henazdana Henis Herah Hervoa Hinel Hiquada Hiwar Hiwoodel Houild Hrannou Huuzinessa Ihale Illes Imausaynah Imrarie Imtinna Inebel Innan Iondre Irnawyna Isamor Isharian Jahilmingh Jamira Janin Jathodh Javzoua Jealana Jeanie Jefsiel Jegne Jelievenna Jeston Joemiel Juldilla Junvien Kadebaharz Kalianse Kalta Kamirine Kamlyris Karoen Karth Kavie Khakenne Khamet Kharand Kharrel Kheraymare Khisan Kimeardoks Kinedore Kinius Kippe Kouse Kriena Laand Labywyne Ladard Lahaston Laneh Lanet Lanyne Lardræd Larle Layeq Leelina Lenrya Lesold Ligmeena Llexanakey Loryan Lotte Lourjon Luisre Lyrik Lyses Madim Madon Maeenioure Maela Maerronia Magari Magni Magre Mahah Mahithel Mahygew Maine Mairane Majholine Manda Marel Mashamin Masht Mastynd Matiq Matte Mauzor Mavritle Mazhuys Mellet Metere Miber Mieng Mihdandard Mihidendra Mirholwila Mitte Modhele Mokslyze Morde Morgewar Moriann Moringsly Mosamar Moumennand Mourair Mylven Naboin Naelle Nahhous Nariya Naryvang Natrind Nebete Nehte Niare Ninerlig Noyna Nuron Nusseen Odynn Odyssah Ofmærie Ohswigend Olette Omese Orend Orvan Osannina Osbar Ounette Ourald Palahim Panielysse Parque Patmuan Paudelyr Pelwine Penneaurre Peray Perendt Pette Peyne Phinabinse Phine Pierhte Piert Pondsh Prieliya Proquben Punde Quettausah Quilasie Qymal Rainesad Ralimir Razhafinia Razhanyir Redundyn Reeshswena Relmellie Retais Rhamrineh Riont Rodrees Rodyvyr Rolde Rolyzarael Ronvel Rotiendbet Ruhta Sahmud Saizara Salierhtah Samerare Selan Sephealia Setten Shandivir Shashuyeh Shtant Shuqua Sille Sineh Skinah Sonen Sudinese Suhayvald Tavri Tayas Tayther Telibria Tenazzin Theon Thille Thyras Tlanasari Toine Tores Torle Troine Ulfran Urennel Uthalhih Uthmim Uthude Valandirg Vandazirah Vekwadr Velah Viene Vinet Virente Vyruuzabar Waldwear Waliya Warnavo Warof Wigneth Winettere Wingsladya Winlya Wisuq Wooded Wouling Wulaud Wulinadst Wyrand Xaisard Xannie Xheodyna Yadelar Yagang Yanie Ysafix Ysert Ysesayna Yvarieudh Zaberiele Zahrya Zarry Zianna Zidrad Zuzon

[computingpostcom]

This is a continuation of our list of Best Linux Distributions 2022. Here we’re looking at Arch Linux. The father of Arch Linux is no other than Judd Vinet, a Canadian programmer and occasional guitarist who began developing Arch Linux in early 2001. Arch Linux – Introduction and Early days The Inspiration behind its development was the elegant simplicity of Slackware, BSD, PLD Linux, and CRUX. But Judd Vinet was disappointed with their lack of package management at the time. He made a decision to built his own distribution on similar principles as those distros with a package management program called Pacman, to automatically handle package installation, removal, and upgrades. This was the birth of Arch Linux. There is so much that can be said about the rest of the other distributions provided for users to enjoy using and for the business world to utilize in their environments. When Arch Linux is mentioned in the forest of all of the other distributions, something strange yet amazing happens in the hearts of those who have had the chance of installing and using this Linux distribution. I’m a big fan of Arch Linux, so this review might look a little biased. Major Benefits of Arch Linux Smart Package Management – Pacman Arch Linux ships with package management tool called Pacman which was coded in C and uses tar to package applications. Pacman handles binary system package management and works seamlessly with the Arch Build System. It makes it easy to manage packages, both from Official Arch repositories and user’s own builds. The Arch Build System is a ports-like system for building and packaging software from source code into installable .pkg.tar.xz packages which Pacman can manage. Just to satisfy your thirst, Ports is a system used by *BSD to automate the process of building software from source code. This sets aside Arch Linux as a distribution with easy installation of binary packages and from source with the help of ABS. The command options for Pacman are easy to memorize, no long commands required. Like to update all packages on your system, you just run pacman -Syu. To install all group packages which ship with Gnome, you run pacman -S gnome.  We already have good article and cheatsheet on managing Arch Linux package with Pacman, available at the link Pacman and yaourt package manager mastery Cheat Sheet Rolling-release system Arch Linux uses a rolling-release system with a large array of binary package repositories. A rolling release is typically implemented using small and frequent updates, which means at no point are you required to re-install your Operating system, no major releases. All system updates are new packages are made available to the public through the server/client repositories. All you need is regular system update to get the latest Arch software. The packages are made available to the distribution a short time after they are released upstream. Note that all installation images released by the Arch team are simply up-to-date snapshots of the main system components. Having to re-install your system and reconfigure it from scratch is a painful endeavor that no one is interested in doing. Minimal System – Low resource usage A default complete installation of Arch is a simple, minimal system with low resource footprint. Trust me you can have a running system utilizing less than 200MB of RAM, especially if you’re a person interested in using a stacking or tiling window manager like Bspwm, i3, sway, awesome instead of a full desktop environment (DE) like Gnome, KDE, XFCE e.t.c. Arch installations only include a base system, making it very customizable. The fact that you make a decision on how your system should look like and the packages it should have installed, makes your system clean and not having useless applications eating your memory and CPU. You can only install what you need for your daily use. Just for the record, My Arch Linux boot up time is less than 5 seconds with Samsung SSD 850 EVO and i3 window manager. All my Arch dotfiles for i3 are on Github.

Arch User Repository ( AUR) AUR is a community-driven repository for Arch users, different from ABS mentioned earlier. AUR was created with an intention of making the process of sharing community packages easier and organized. It contains package descriptions (PKGBUILDs) that allow you to compile a package from source with makepkg and then install it via pacman. Check: yay – Best AUR Helper for Arch Linux / Manjaro AUR has a very large collection of PKGBUILDs contributed by users. A good number of new packages that enter the official repositories start in the AUR. Packages on AUR are not officially supported by Arch, but most are trusted applications distributed by Arch community users. All you need to start using AUR is a helper tool like yaourt, pacaur, and many others. Take a look at AUR helpers documentation for more details. Systemd Init System The default init system since 2013 has been Systemd. Systemd is a suite of basic building blocks for a Linux system. It provides a system and service manager that runs as PID 1 and starts the rest of the system. Systemd systemd supports SysV and LSB init scripts and works as a replacement for sysvinit. Some good features of systemd include: Aggressive parallelization capabilities Offers on-demand starting of daemons Uses a socket and D-Bus activation for starting services Keeps track of processes using Linux control groups Maintains mount and automount points Implements an elaborate transactional dependency-based service control logic Ships with the utilities to control basic system configuration like the hostname, date, locale e.t.c. A chance to learn Linux Arch has been categorized as a do-it-yourself distribution for advanced and experienced Linux users. First, as it has been mentioned, they give a user the chance to explore everything from file systems, partitioning, X server and everything in general. The graphical installers hide most of the details that are important to know. Trust me its installation can be really daunting for newbies. In a nutshell, it will take a bit of your time to install the operating system but at the end of it, no one else will know how your computer is running better than yourself. That is a guarantee. So instead of settling for the distributions with installers, why not take the plunge and do it all by yourself? It will be one beautiful ride. You can test in on VirtualBox before doing it on a real system. An active and enthusiastic fan base The Arch Linux family is quite an interesting one. They have a way of lobbying and convincing people to join their community and that shows how they enjoy being there. The huge fan base and active repositories are a sure way of letting you know that you are covered. What is more, the documentation that Arch Linux developers made available is breathtaking due to its thoroughness?. You can never get lost when you get stuck. The community works pretty hard to ensure that applications are available and in the most stable way possible with complete documentation for installation, configurations, and troubleshooting. Arch Linux Stability From the experience of others and myself, what is amazing about Arch Linux is its stability and performance. It rarely hangs or throws system tantrums like most of the rest do. You can leverage on this if you are tired of crashes and hanging when you are doing your important things. The only thing you have to be keen on is the packages you install, avoid beta releases of applications, especially ones related to Xorg or Desktop Environments like Gnome and KDE. Documentation and support The team has managed to put together the Arch Wiki which is a very comprehensive and detailed repository of information. You will for sure get everything you would wish to know concerning installation and maintenance of every component and detail of a proper Linux system. This documentation can be a reference for general Linux administration. I’m sure if

you are new to Arch but have experience with other Linux distros, you have already read Arch documentations a couple times. Conclusion All I can say in this section is that Arch is a beautiful distribution for all Linux users. It will bring the good out of you if you give it the patience and time it highly demands. Once you are through with all of the pieces, you have the freedom to install whatever you want for your machine. This means a highly customized system to suit your tastes and preferences. Please note that Arch is only available for x86_64 CPU architecture. If you are a newbie from Windows environment, I recommend you start with user-friendly Linux distributions like Ubuntu before moving to Arch Linux.

[wichmann76cole-blog]

Take Care Of Your Your Skincare Complications With subsequent Tips

Vinetics C The first four tips are self-explanatory. They are found simple no-nos when it comes to finding affordable face cream. However, the last three tips might develop into a bit unfamiliar to you and you might not know what to do with them. Compare these with ingredients like avocado oil, phytessenece wakame, grapeseed oil, extrapone nutgrass as well as thus on. All these are serving a specific purpose and you are totally skin friendly. They can boost collagen,moisturize without clogging our pores, reinforce HA and above all contribute to the skin cell renewal procedures. This is a person can select right product near the market to-day. You simply exclude any doubtful ingredients and choose the natural organic people. Now that is meaningful Skincare for i. The most recent trend nowadays comes in the way of anti aging wrinkle creams that contain collagen. While collagen is really important for smooth, strong skin, it is useless when applied topically as it cannot penetrate the skin. Collagen is really a protein that supports pores and skin from beneath, it is of no use around the surface. Other skincare products are as effective for other skincare snags. Skin facial acne can be it really is problem but now younger age. These are individuals going through puberty with released hormones. Let's take a look now at the qualities of a typical good Skin cream. An effective anti aging cream always be able to handle all nyc airports problems that anyone had seen above. So, You're on the hunt for super-powerful skincare cosmetics? I understand how it is- I've spent months of my time researching exactly what skincare products work in order to my skin look youthful and normal. I tried so many kinds of items in the beginning- I probably have went on the week's trip to Hawaii along with the money I spent on crappy units! Age spots - The dermis is likely to produce melanin as the application of of counteracting UV spoil. While Youthful Skin can still regulate melanin production, this becomes tough to maintain anyone get people. As a result, brown spots and pigmentation problems crop up. Next, you have to prepare your luggage. Every person one very sound parts with the trip. You need to choose some necessary clothes and shoes. And then, you need to prepare some medicine just in case you may get a cold an additional disease. And then, you're able to choose some necessities since your cup, your tooth brush, your towel as well as other small load.

[farleyhaley11-blog]

Choosing extremely Best Skin Care Products - precisely What To Know

Vinetics C Face Cream Another alternative is alter the soap you use to wash our selves. For instance try using glycerine soap love the ones that is generated by Neutrogena. Another thing is regular exfoliation. Nano-Lipobelle H EQ10 - This substance is quite an strong antioxidant made up of Coenzyme Q10 and natural vitamin E. Because of its strong antioxidant properties, Nano-Lipobelle H EQ10 involves dramatic anti wrinkle effect. The cheapest night cream on business contains petrolatum, mineral oil and paraffin, all of which are derived from petroleum or crude oil. One of the reasons that crude oil became famous is that we could make so numerous from it, cheaply. Benzyl peroxide is selecting a used as antibacterial agent for Acne treatment, but unfortunately it might make skin color flaky and dry. I'd rather recommend natural acne solutions like Acnezine. The next ingredient is Argireline. Moment has come present using some of the top anti-aging formulas today. Acetyl Hexapeptide or Argireline relaxes the face muscles and works well for reducing wrinkles. There plenty of resources of good skin care products but no single best. Skin types vary so there isn't really best product for everyone. What works for very best friend won't do anything for the customer. Your mom's favorite Skin Serum may irritate your flesh. What enhances the models on that catwalk skin may not work in quantity of for you might. Finding a product that fits your expectations is merely a matter of testing up until you find your match. It's going to take some time to work which natual skin care line is the best you and you might have. For more information on finding your skincare match, read on the. So discover your skin type, vital calorie intake provide what your unique situation needs. You may need the cleanser plus a toner and moisturizer. Some are responsive to toners, and also their face breaks-out when they use one. Still others may discover using a moisturizer causes itchiness rrncluding a heaviness minor discomfort. Then you'll find some lucky folks nobody can get by with only using a quality cleanser. Unfortunately, so lack require the standard three skin care products or even just an extra for troublesome areas. If a good cleanser is used, but you have still got trouble with break-outs, surely try continuing with the cleanser too product for spot treatment at dusk.

[vinetics-c-skin-cream-blog]

This morning I am here to tell you we are on our third Vinetics C Skin Cream. You have to spend lots of quality time with your Vinetics C Cream however, this is helpful. Vinetics C Skin Cream Review Summary  If you are ready to take your skincare routine to the next level, then Vinetics C Skin Cream may be the right product for you. On the other hand, if you return it, there are no obligations involved. It was clever instruction. Even though the number of cell layers remains unchanged. As you can tell, there are many advantages to adding Vinetics C Skin Cream. How do poor people access fresh Vinetics C Cream tricks? With this formula, you'll be able to finally get rid of the pesky and unsightly fine lines, wrinkles, age spots, under-eye circles, and the other most common signs of aging. Continue reading  The ingredients! The collagen and elastin compounds boost, restructure, and improve your skin cells so that they can prove your skin with the support that it needs to appear smooth, ageless, and beautiful. Genial P. Should you be alarmed that you might want to find a largely overlooked Vinetics C is that it give you just enough Vinetics C Skin Cream. You will want to make sure that what you have matches whatever you like but despite everything, I got a late notice on my Vinetics C Cream payment. It will also give a lifting effect to the face skin. Tried many things but none worked. See, this age-defying remedy can REVITALIZE, RENEW, and REPLENISH the whole skin appearance by causing NULL side-effects. Below we have penned down a couple of steps that you are needed to consider when applying this cream. This solution substance is known for their abilities to lock in moisture and keep our skin looking younger. This approach to Vinetics C Skin Cream Review is to have as many opportunities as possible. For this, do use a high-quality face cleanser or a mild soap and for washing the face use only warm water. If you do end up choosing this product,  Vinetics C :- Following a day-to-day skin care routine includes more than just managing a regular regimen. That's how to end worrying and enjoy life where this is how to do it with optimum accuracy. Made in the United States Second, the formula is made in the United States in an FDA approved facility that follows strict manufacturing standards. As you work this product into your daily routine, you'll notice the fine lines and wrinkles smooth away with every single application. With this product, you can finally overcome your aging issues and attain an ageless, beautiful, and flawless appearance. How? First of all, this anti-aging solution functions significantly by Hydrating the Skin. When you add this product into your daily skin care routine, you'll be able to enjoy from the following benefits:  Eliminates Fine Lines and Wrinkles The main advantage to this formula is that it works wonders to eliminate fine lines and wrinkles.

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[xyzsmartcollagencream-blog]

Make Your Skin Look More Younger With Vinetics C Skin Cream

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It does matter which you choose. That is issued by the government. If you want Vinetics C Skin Cream then it seems as if you are going to want to attempt anything you can. Let me take a look at some of the potential conundrums to contemplate. For the best Vinetics C Skin Cream experience, you first need to understand Vinetics C Skin Cream. Fortunately, it is remarkable. If you would like to learn bordering on Vinetics C Skin Cream, stick around. This brings me to the last factor as that touches on Vinetics C Skin Cream. This installment provides you with tricks on how you can effectively maximize your Vinetics C Skin Cream. Keep their eyeballs locked here to read more. I may have to assume that few masters discover a VineticsC Skin Cream like that.

Fundamentally, where do I start? I don't see that much hope for Vinetics C Skin Cream in this area, however. They went into a frenzy in reference to Vinetics C Skin Cream.  >>> http://supplementsbook.org/vineticsc-skin-cream-review/

[merrillwhitney99-blog]

Did some Study Into Different Winter May Make Your Skin Dry?

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Skincare products to treat this condition are about the. Tea tree oil for acne with the of these effective products for auction. Tea tree oil for acne breakouts is very efficient at treating acne issues. The changes you make can be simple. As an example, one of the main changes you actually can make is to limit a lot of time you spend in the sunlight. It holds true that a smallish amount of sun could be good anyone health. It replenishes the Vitamin D in physical structure. And this, in turn, has all sorts of advantages to the body. However, on the flip side, if you remain in the sun for a long of a time, you skin can be damaged. The how to nourish pores and skin is to consume vitamin, mineral and antioxidant rich fantastic for a quick. Find delicious recipes made by vegatables and fruits to enjoy daily. A well balanced diet fights wrinkles better than most wrinkle creams. Many cosmetic products contain bad alcohols like isopropyl which is actually strip the skin of its natural humidness. Use an organic Skin cream that raises your levels of hyaluronic plaque created by sugar. This will help nutrients to achieve the skin, and heading to help pores and skin to retain moisture. It is more preferable to be secure than sorry when you are looking at your as well as. Since men's faces are much more apt with regard to red a new result of shaving on the daily basis, a moisturizer is a-must. The damage that is done is often caused by free radicals as to be honest. Blunder 3: For more Youthful Skin, I must wash my face frequently to remove grime and dead skin cells.Truth: Over cleansing will dry out your skin, thus causing it to age faster. Use a cleanser that will fit your skin best and cleanse each day. To remove old skin debris cells, use exfoliating facial wash or facial scrubs weekly. Here's one idea you might not have observed. Your moisturizing cream will soak for a skin better if epidermis is slightly moist and warm. Enjoyable to request skin creams is right after you get rid of the shower. thinly pat your face dry, but don't get it too dry.

[your-dietician]

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases

New Post has been published on https://depression-md.com/immediate-effect-of-the-covid-19-pandemic-on-patient-health-health-care-use-and-behaviours-results-from-an-international-survey-of-people-with-rheumatic-diseases/

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases

Summary

Background

The impact and consequences of the COVID-19 pandemic on people with rheumatic disease are unclear. We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effects of the COVID-19 pandemic on people with rheumatic disease worldwide.

Methods

Survey questions were developed by key stakeholder groups and disseminated worldwide through social media, websites, and patient support organisations. Questions included demographics, rheumatic disease diagnosis, COVID-19 diagnosis, adoption of protective behaviours to mitigate COVID-19 exposure, medication access and changes, health-care access and communication with rheumatologists, and changes in employment or schooling. Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible for inclusion. We included participants with and without a COVID-19 diagnosis. We excluded participants reporting only non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.

Findings

12 117 responses to the survey were received between April 3 and May 8, 2020, and of these, 10 407 respondents had included appropriate age data. We included complete responses from 9300 adults with rheumatic disease (mean age 46·1 years; 8375 [90·1%] women, 893 [9·6%] men, and 32 [0·3%] participants who identified as non-binary). 6273 (67·5%) of respondents identified as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, and 42 (0·5%) as Native American or Aboriginal or First Nation. The most common rheumatic disease diagnoses included rheumatoid arthritis (3636 [39·1%] of 9300), systemic lupus erythematosus (2882 [31·0%]), and Sjögren’s syndrome (1290 [13·9%]). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. Almost all (9266 [99·7%] of 9297) respondents adopted protective behaviours to limit SARS-CoV-2 exposure. A change in employment status occurred in 2524 (27·1%) of 9300) of respondents, with a 13·6% decrease in the number in full-time employment (from 4066 to 3514).

Interpretation

People with rheumatic disease maintained therapy and followed public health advice to mitigate the risks of COVID-19. Substantial employment status changes occurred, with potential implications for health-care access, medication affordability, mental health, and rheumatic disease activity.

Funding

American College of Rheumatology.

Introduction

People with rheumatic disease are at increased risk of infection due to immune dysregulation and the use of immunosuppressive medications.

1

Doran MF

Crowson CS

Pond GR

O’Fallon WM

Gabriel SE

Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study.

, 

2

Systemic lupus erythematosus and risk of infection.

Behavioural changes that could mitigate these risks are often discussed as part of the shared decision making that occurs during the management of rheumatic diseases.

3

Smolen JS

Landewé RBM

Bijlsma JWJ

et al.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update.

However, at the beginning of the COVID-19 pandemic, little was known to inform discussions about the risks of COVID-19 in people with these rheumatic diseases. As a result, people with rheumatic diseases faced substantial challenges in deciding how to modify their behaviour to reduce their risk of infection with the SARS-CoV-2 virus.

The pandemic also caused substantial disruptions in health-care delivery, including the delay or cancellation of clinic visits, infusions, and procedures

4

Dejaco C

Alunno A

Bijlsma JWJ

et al.

Influence of COVID-19 pandemic on decisions for the management of people with inflammatory rheumatic and musculoskeletal diseases: a survey among EULAR countries.

and impaired access to some antirheumatic medications because these were diverted to prevent or treat COVID-19.

5

Mendel A

Bernatsky S

Thorne JC

Lacaille D

Johnson SR

Vinet É

Hydroxychloroquine shortages during the COVID-19 pandemic.

These challenges also greatly affected employment and education, and consequently, access to health insurance and the ability to obtain health care.

6

Blumenthal D

Fowler EJ

Abrams M

Collins SR

Covid-19—implications for the health care system.

Understanding the effect of the pandemic on people with rheumatic disease might help rheumatologists better address their patients’ needs and inform policies to protect this potentially vulnerable population.

Research in context

Evidence before this study

We searched PubMed for articles published up to March 1, 2020, regarding the risks of infection in patients with rheumatic disease. We included the Medical Subject Headings “rheumatology” OR “rheumatic diseases” AND “infections” AND “risk.” We did not restrict our search by language or type of publication. We found multiple studies showing that people with rheumatic disease are at increased risk of infection due to immune dysregulation and the use of immunosuppression. We then did a Medical Subject Headings search with “rheumatology” OR “rheumatic diseases AND “COVID-19” AND “behavior” OR “patient reported outcome measures” to our search algorithm and no relevant articles were found. At the beginning of the COVID-19 pandemic, little was known about the risks of COVID-19 in people with rheumatic disease or how people with rheumatic disease changed their behaviours because of the pandemic. Among this population, the impact of the pandemic on health-care access, use of health-care systems, and employment had not been well-characterised.

Added value of this study

Our study is the largest international survey of people with rheumatic disease during the COVID-19 pandemic. We found that people with rheumatic disease adhered to risk-mitigating behaviours such as physical distancing and mask-wearing and avoided potential high-risk exposures; the proportion of participants reporting a diagnosis of COVID-19 during this time period was low. Respondents largely continued their use of antirheumatic and immunosuppressive drugs. More than a quarter of respondents had changes in employment status, with decreases in the number of full-time employees while the number of those unemployed increased. Our study complements and contextualises data gathered from other sources, such as medical records, claims databases, and physician-entered registries.

Implications of all the available evidence

Understanding the behaviours and access to care among people with rheumatic disease during the early phase of the pandemic is essential to inform clinical decision making and structural changes required within health-care systems. Given the substantial changes to employment in people with rheumatic disease, policies that promote remote working might help them to continue working while avoiding potentially high-risk exposures. Future studies should investigate the long-term effects of the COVID-19 pandemic on patients, including COVID-19 vaccination, behavioral modifications, and effect on rheumatic disease activity.

We developed the COVID-19 Global Rheumatology Alliance Patient Experience Survey to assess the effect of the COVID-19 pandemic on patient-reported outcomes and health-related behaviours in people with rheumatic diseases.

7

Sirotich E

Dillingham S

Grainger R

et al.

capturing patient-reported outcomes during the covid-19 pandemic: development of the COVID-19 Global Rheumatology Alliance Patient Experience Survey.

The survey was disseminated through social media, websites, and patient support organisations. It complemented a physician-entered registry of people with rheumatic disease and COVID-19 that focused on clinical outcomes.

8

Gianfrancesco MA

Hyrich KL

Gossec L

et al.

Rheumatic disease and COVID-19: initial data from the COVID-19 Global Rheumatology Alliance provider registries.

Using real-world data from this survey, we aimed to describe the effect of the COVID-19 pandemic on health-care access, protective health behaviours, employment, and educational opportunities in adults with rheumatic disease.

Methods

 Survey development and dissemination and study participants

The COVID-19 Global Rheumatology Alliance Patient Experience Survey was developed by the COVID-19 Global Rheumatology Alliance Steering Committee, patient partners, patient organisation representatives, physicians, and researchers in March 2020.

7

Sirotich E

Dillingham S

Grainger R

et al.

capturing patient-reported outcomes during the covid-19 pandemic: development of the COVID-19 Global Rheumatology Alliance Patient Experience Survey.

The purpose of the survey was to understand the effect of the COVID-19 pandemic on individuals with inflammatory or autoimmune rheumatic diseases globally.

The patient and public involvement in this study prioritised patient-valued questions and allowed perspectives of patient partners and patient organisations to direct survey development, dissemination, and interpretation to improve the quality and relevance of our research.

9

Hamilton CB

Leese JC

Hoens AM

Li LC

Framework for advancing the reporting of patient engagement in rheumatology research projects.

, 

10

Staniszewska S

Brett J

Simera I

et al.

GRIPP2 reporting checklists: tools to improve reporting of patient and public involvement in research.

Patient partners were involved in the generation of the survey questions, study design, selection and development of measurement instruments, recruitment of participants to the study, contribution to manuscripts, and participation in the COVID-19 Global Rheumatology Alliance Steering Committee.

7

Sirotich E

Dillingham S

Grainger R

et al.

capturing patient-reported outcomes during the covid-19 pandemic: development of the COVID-19 Global Rheumatology Alliance Patient Experience Survey.

, 

11

Putting patients at the centre of COVID-19 research.

Patients and care-partners were viewed as primary stakeholders and therefore most knowledgeable about the essential themes and questions about COVID-19 for those living with rheumatic disease. A full list of all the contributors can be found in the appendix (pp 44–45).

Physicians, patients, researchers, and patient organisation representatives reviewed initial survey items to ensure the inclusion of meaningful questions and use of appropriate language sensitive to diverse cultures and belief systems. This methodology enabled rapid iteration of the survey questions to ensure focus on outcomes most relevant to the patient community and issues of importance to the rheumatologists caring for these patients.

The survey was translated by physician and patient volunteers into nine languages (English, Spanish, Arabic, Chinese (simplified and traditional), French, German, Hebrew, Italian, and Portuguese) and hosted on a Qualtrics server. Patient partners led survey dissemination.

11

Putting patients at the centre of COVID-19 research.

International patient organisations received a social media kit, including images, text, and survey links designed to explain the survey’s purpose and invite participants to the study. Patient organisations disseminated the survey to their members and through social media channels. Additionally, the survey was publicly accessible from the COVID-19 Global Rheumatology Alliance website. A copy of the survey is provided in appendix (pp 1–39).

Adults age 18 years and older with inflammatory or autoimmune rheumatic diseases were eligible to participate. We included all adult respondents who completed the survey between April 3 and May 8, 2020, and provided their age, gender, country of residence, race or ethnicity (or both), rheumatic disease diagnosis, and reported their use of antirheumatic medications. Participants with and without a COVID-19 diagnosis were included. We excluded participants reporting non-inflammatory rheumatic diseases such as fibromyalgia or osteoarthritis.

The project was deemed exempt from requiring ethics review by the Boston Children’s Hospital Institutional Review Board. The survey was anonymous and consent was implied by survey completion.

 Survey data collection

As part of the survey, participants were required to provide information on demographics and clinical characteristics. Participants self-reported demographics, including age, gender (female, male, non-binary, prefer not to answer), country of residence, and race or ethnicity. Country of residence was grouped by WHO region.

12

WHO Definition of regional groupings.

Race or ethnicity was grouped into mutually exclusive categories: Black, Asian (including East Asian, South Asian, and West Asian), Latin American, White, Native American or Aboriginal or First Nations, Arab, Pacific Islander, and multiple identities (participants with more than one race or ethnicity).

Participants reported tobacco smoking status (current, past, never) and selected from 22 common comorbidities, including those that had been associated with poorer outcomes from COVID-19 (appendix p 40). Individual comorbidity burden was defined by the number of comorbid conditions reported, and categorised as: none, one, two, and three or more comorbidities.

Participants were also required to report their COVID-19 status, and if believed to have the SARS-CoV-2 virus, how it was diagnosed (self-diagnosed on the basis of symptoms, diagnosed by a health-care provider on the basis of symptoms, or via laboratory testing).

The survey additionally included questions on rheumatic disease diagnoses and rheumatic disease activity. Respondents could indicate multiple rheumatic diseases. Rheumatic diseases were categorised as: rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, psoriatic arthritis, antiphospholipid syndrome, spondyloarthritis, vasculitis, other connective tissue disease, autoinflammatory disease, other arthritis, and other rheumatic disease (appendix p 40). Rheumatic disease activity was adapted from a patient global assessment of disease activity on a visual analogue scale.

13

Anderson JK

Zimmerman L

Caplan L

Michaud K

Measures of rheumatoid arthritis disease activity: Patient (PtGA) and Provider (PrGA) Global Assessment of Disease Activity, Disease Activity Score (DAS) and Disease Activity Score with 28-Joint Counts (DAS28), Simplified Disease Activity Index (SDAI), Cl.

Participants were asked “considering all the ways your rheumatic disease affects you, rate how well you are doing today on the following scale,” in which 0 indicated “very well” and 10 indicated “very poor”.

Participants were required to answer questions regarding medication use and availability. Participants identified all antirheumatic medications they took within 3 months of completing the survey from a list of 23 classes of medications, with an option to report medications not listed (appendix p 40). Respondents indicated whether there were any changes to their medication use specifying: “yes, I continue to take this drug”; “no, pharmacy did not have supply”; “no, it was not effective”; or “no, I want to avoid immunosuppression.”

The survey also included questions on adaptive behaviours during the pandemic. Participants were asked whether they contacted their rheumatologist, adopted protective behaviours, and engaged in activities that could increase their risk of COVID-19. Modes of communicating with their rheumatologist included phone call, email or patient portal, telemedicine or video conference, in person visit, unable to communicate, and unnecessary to communicate. The protective behaviours included physical distancing (avoiding crowds and large groups of people), quarantining (staying home and avoiding others as much as possible), using gloves or masks, or both during social interactions, or none. Those reporting quarantining also specified whether it was self-imposed or imposed by their government. We also asked about travel to an area with many COVID-19 cases, close contact with a person with confirmed or probable COVID-19, and presence in a health-care facility where COVID-19 is managed.

Finally, the survey included questions about employment and educational status. Participants indicated their employment or student status as of Jan 1, 2020 (employed full-time, part-time, not employed looking for work, not employed not looking for work, retired, disabled, or full-time student) and whether this had changed at the time of survey completion. Full-time students specified how they were participating in classes at the time of survey completion (in the classroom, virtually on a computer, classes were cancelled, or other).

 Statistical analysis

Descriptive statistics, including means and SDs, proportions and 95% CIs, were summarised. Missing data for each question were omitted. A sensitivity analysis was done to determine the effect of including respondents with missing demographics information.

 Role of the funding source

The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Results

Between April 3 and May 8, 2020, 12 117 responses were received. Of these, 1710 were missing age data, and 10 407 respondents had included adequate age data. 623 responses were excluded on the basis of age, which showed that 9784 responses were received from adults. 484 responses were further excluded and 9300 responses were included in survey data analysis (figure 1). A sensitivity analysis showed no effect when including respondents with missing demographics information. Demographics and clinical characteristics of adult participants are outlined in the table. Additional characteristics, stratified by gender, are presented in the appendix (pp 41–42).

Figure 1Survey respondent inclusion and exclusion criteria

Show full caption

*We used these criteria as a consequence of limitations to survey design in which participants were not required to enter values for all questions, which led to questions being easily missed; after analysing the missing data pattern and the importance of patient characteristics when describing the sample, we decided to exclude for missing demographics.

TableDemographics and clinical characteristics of COVID-19 Global Rheumatology Alliance Patient Experience Survey respondents

Data are n (%) or n/N (%), unless otherwise specified. DMARDs=disease-modifying antirheumatic drugs.

Responses were collected from more than 90 countries, with most respondents from the Americas (6113 [65·7%] of 9300) or Europe (2697 [29·0%]). 8375 (90·1%) respondents were women, 893 (9·6%) were men, and 32 (0·3%) identified as non-binary. The mean age of respondents was 46·1 years (SD 12·8). 6273 (67·5%) respondents identified themselves as White, 1565 (16·8%) as Latin American, 198 (2·1%) as Black, 190 (2·0%) as Asian, 42 (0·5%) as Native American or Aboriginal or First Nations. The remaining 1032 (11·1%) respondents indicated that they identified as other races or ethnicities (table). The most common rheumatic disease diagnoses were rheumatoid arthritis (3636 [39·1%]), systemic lupus erythematosus (2882 [31·0%]), and Sjögren’s syndrome (1290 [13·9%]). The mean score of the patient global assessment of disease activity was 4·5 (SD 2·5). The most commonly reported antirheumatic medications taken within the previous 3 months were conventional synthetic disease modifying antirheumatic drugs (DMARDs; 6637 [71·4%]), systemic glucocorticoids (3248 [34·9%]), and biologic DMARDs (2888 [31·1%]).

At least one comorbidity was reported by 5665 (63·5%) of 8923 respondents (table). Two or more comorbidities were reported by 2833 (31·7%) respondents. The most common comorbidities were cardiovascular disease (2241 [25·1%]), pain syndromes (1901 [21·3%]), and pulmonary disease (1819 [20·4%]; appendix p 41). Current smoking was reported by 943 (10·1%) of 9300 respondents and past tobacco smoking was reported by 2875 (30·9%) respondents (table). Additionally, 348 (3·8%) of 9266 respondents reported current use of vaping or e-cigarettes, whereas 512 (5·5%) reported past use (appendix p 41).

Of the 9300 participants, 510 (5·5%) reported a COVID-19 diagnosis. Of these, 223 (43·7%) were self-diagnosed on the basis of symptoms, 179 (35·1%) were diagnosed by a health-care provider on the basis of symptoms, and 91 (17·8%) were confirmed by laboratory testing. The remaining 17 (3·3%) respondents indicated that they were unsure of how they were diagnosed or did not complete the question (table).

Communication with a rheumatologist most commonly occurred by telephone (2252 [24·3%] of 9270), followed by email or patient portal (1611 [17·4%]), office visit (ie, in person appointment; 919 [9·9%]), and telemedicine (552 [6·0%]). Other communication methods, including social media and texting, were used by 773 (8·3%) of respondents. More than a third (3291 [35·5%]) of respondents reported that they did not have any reason to contact their rheumatologist, and 1043 (11·3%) could not communicate with their rheumatologist by any method (appendix p 41).

Nearly all respondents (9266 [99·7%] of 9297) adopted at least one protective behaviour (appendix p 41). Protective measures included quarantining (staying home as much as possible; 7952 [85·5%]), physical distancing (7206 [77·5%]), and using gloves or masks, or both (4631 [49·8%]). All the listed protective measures were used by 3620 (38·9%) participants. More than half of those who quarantined were instructed to do so by their local or national governments (4056 [51·1%] of 7935). Most respondents (6921 [82·0%] of 8441) continued their antirheumatic medications as prescribed. The remaining 1520 (18·0%) participants treated with antirheumatic medications discontinued at least one of their medications for reasons including lack of efficacy, concern for immunosuppression, or diminished pharmacy supply (appendix p 42).

About a fifth of respondents (2104 [22·9%] of 9179) engaged in activities that could increase their risk of SARS-CoV-2 exposure (appendix pp 41–42). Of 9179 respondents, 1228 (13·4%) visited a health-care facility where COVID-19 had been managed, 394 (4·3%) had close contact with a confirmed or probable case of COVID-19, and 365 (4·0%) travelled to an area with a high prevalence of COVID-19. Other potential exposures were reported by 477 (5·2%) participants, including close interactions in the workplace, shopping, taking public transport, and secondary transmission from their children attending school or relatives and friends travelling. Of 2104 respondents who engaged in activities that might have increased SARS-CoV-2 exposure, 1781 (84·6%) reported one activity, while 290 (13·8%) reported two activities, and 33 (1·6%) reported three or more activities that could increase their risk of exposure.

As of Jan 1, 2020, almost half of the respondents reported that they were employed full-time (4066 [43·7%] of 9300), 1434 (15·4%) were employed part-time, while 1058 (11·4%) were not employed (including those not looking and those looking for work). 1321 (14·2%) were disabled and unable to work, 301 (3·2%) were full-time students, and 1120 (12·0%) were retired (appendix p 43).

A change in employment status was reported by 27·1% (2524 of 9300) of respondents, and these transitions are depicted in figure 2. The most common transition was from full-time employment to another category, experienced by 21·9% (552 of 2524) of respondents reporting a change in employment. The proportion of individuals who classified under the employed full-time status decreased by 13·6% (from 4066 to 3514) at the time of the survey.

Figure 2Employment changes reported by patients with rheumatic disease in the early stages of the COVID-19 pandemic

Show full caption

The spheres indicate the percentage of change noted in each employment status between Jan 1, 2020, (grey spheres) and at the time of the survey response (blue spheres). Arrow directions depict migration between the different categories. Detailed data are provided in the appendix (p 43).

Full-time students also experienced changes, with 207 (68·8%) of 301 transitioning to virtual classes, 52 (17·3%) having classes cancelled, 5 (1·7%) continuing to attend classes in person, and 35 (11·6%) reporting other changes such as having finished classes at the time of the survey (appendix p 42).

Discussion

Our study shows that almost all respondents with rheumatic disease adopted protective behaviours during the early phase of the pandemic, with most practicing physical distancing or self-isolation strategies, using masks and gloves, and avoiding activities that could increase their risk of SARS-CoV-2 exposure. Most respondents also continued their antirheumatic medications. Moreover, the pandemic had severe effects on participants’ employment and education, with an increase in unemployment and most students transitioning to virtual classes.

The COVID-19 Global Rheumatology Alliance Patient Experience Survey was unique due to the international involvement of multiple stakeholders in developing questions to ensure patient-important outcomes were collected. This survey fills a gap and complements results from physician-reported registries, medical records, and claims databases by collecting data regarding patient perceptions and behavioural adaptations. Dissemination of the survey through social media and patient organisations enabled participation from people who did not access health care and would not have been captured in medical records-based studies.

In our study, most participants continued their antirheumatic medications, including immunosuppressants. This practice conforms to current recommendations for people with rheumatic conditions during the pandemic,

14

Landewé RBM

Machado PM

Kroon F

et al.

EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2.

, 

15

Mikuls TR

Johnson SR

Fraenkel L

et al.

American College of Rheumatology guidance for the management of rheumatic disease in adult patients during the COVID-19 pandemic: version 2.

, 

16

Gelfand JM

Armstrong AW

Bell S

et al.

National Psoriasis Foundation COVID-19 Task force guidance for management of psoriatic disease during the pandemic: version 1.

which were not yet available at the time of the survey. The presence of rheumatic disease and the decision to continue immunosuppression might have created an increased perceived risk of infection, which perhaps explains the frequent use of protective behaviours and avoidance of potential exposures to COVID-19 in this population. Other studies have found that those with rheumatic disease are more likely to isolate than are matched friends or family controls,

17

Hooijberg F

Boekel L

Vogelzang EH

et al.

Patients with rheumatic diseases adhere to COVID-19 isolation measures more strictly than the general population.

and that people taking biologic drugs are more likely to practice shielding (ie, to quarantine) than are those not taking biologics.

18

Mahil SK

Yates M

Langan SM

et al.

Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

Whether or not people with rheumatic disease are at increased risk of infection or complications than the general population remains unclear.

19

D’Silva KM

Serling-Boyd N

Wallwork R

et al.

Clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and rheumatic disease: a comparative cohort study from a US ‘hot spot’.

, 

20

Akiyama S

Hamdeh S

Micic D

Sakuraba A

Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis.

People with rheumatic diseases might be more likely to be tested for COVID-19 because of their underlying diagnoses, thus creating biases in the outcomes of many studies.

21

Ferri C

Giuggioli D

Raimondo V

et al.

COVID-19 and rheumatic autoimmune systemic diseases: report of a large Italian patients series.

Additionally, those with rheumatic disease might have increased prevalence of comorbidities such as chronic lung disease, a known risk factor for poor COVID-19 outcomes, which has been associated with increased risk of death among this patient population.

22

Strangfeld A

Schäfer M

Gianfrancesco MA

et al.

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Health-care systems adapted quickly to the COVID-19 pandemic, even during the early stages, with participants engaging in telemedicine as early as April, 2020. Concerningly, a portion of respondents indicated that they could not communicate with their rheumatologist, perhaps because of the closures of many clinics and delays in adapting to new types of health-care delivery. How this could magnify existing disparities in rheumatology care related to access to technology and the ability to use telemedicine remains to be elucidated.

We found a shift in employment in nearly a third of respondents, with a rise in unemployment and a decrease in full-time employment. Increases in unemployment and underemployment occurred in the USA and UK during the early months of the pandemic.

23

US and UK labour markets before and during the COVID-19 crash.

The impact of the COVID-19 pandemic on employment in people with rheumatic disease is further complicated by work limitations and lower workforce participation already present in this population, including for younger people.

24

Berkovic D

Briggs AM

Ayton D

Parker C

Ackerman I

Arthritis-related work outcomes experienced by younger to middle-aged adults: a systematic review.

The loss of employer-sponsored health insurance could be particularly catastrophic for those living in countries without universal health care, who might not be able to afford out-of-pocket medical costs.

6

Blumenthal D

Fowler EJ

Abrams M

Collins SR

Covid-19—implications for the health care system.

Policies that promote remote working might help people with rheumatic diseases continue working while avoiding potentially high-risk exposures.

Strengths of our study include the strong engagement of stakeholders through all phases of the research, international scope and reach, and responses from more than 9000 people with rheumatic disease. Several limitations must be acknowledged. Given the online nature of our survey, there could be limited generalisability to the general rheumatic disease patient population, although our study probably gives voice to groups that would not be included in more traditional medical studies. Individuals who had severe symptoms from COVID-19 are probably underrepresented because they were not able to take the survey. Few patients with reports of COVID-19 had confirmatory laboratory tests, and the accuracy of self-reported COVID-19 is unknown. Although these details might have increased the risk of misclassification in this study, they might also reflect the limited availability of testing early in the pandemic. There was limited male and racial and ethnic diversity within the cohort, which has been shown to affect the risk and severity of COVID-19,

25

COVID-19 and the impact of social determinants of health.

, 

26

Gianfrancesco MA

Leykina LA

Izadi Z

et al.

Association of race and ethnicity with COVID-19 outcomes in rheumatic disease: data from the COVID-19 Global Rheumatology Alliance Physician Registry.

although challenges to minority recruitment for research are not limited to this study. Barriers to enrollment of non-white participants in research studies include structural racism and distrust of research given the history of mistreatment of vulnerable individuals.

27

Removing barriers and disparities in health: lessons from the COVID-19 pandemic.

The female predominance in this study probably reflects the increased prevalence of rheumatic diseases in women, as well as the increased participation of women in online studies.

28

Thornton L

Batterham PJ

Fassnacht DB

Kay-Lambkin F

Calear AL

Hunt S

Recruiting for health, medical or psychosocial research using Facebook: Systematic review.

Relying on self-reported data, we cannot rule out misclassification of diagnosis or other relevant clinical or demographic data. Finally, we lacked a control population of people without rheumatic disease, so some of the findings of this study might not necessarily be attributable to the presence of rheumatic disease, but rather might reflect changes that occurred in the general population.

In summary, we describe adaptations employed by people with rheumatic disease early in the pandemic, including those aimed to reduce their perceived risk of COVID-19, as well as the disruptions in health care that occurred. The results of this international survey complement and provide a context for data gathered from other sources, such as medical records, claims databases, and physician-entered registries. The engagement of patients, physicians, and researchers to develop, disseminate, and analyse the results of this survey provides a model of collaboration among the rheumatology community. Understanding the early behaviours of people with inflammatory and autoimmune conditions is necessary to assess the effects of the pandemic on this population, and not only those who became infected with SARS-CoV-2. A far-reaching consequence of the pandemic at the time of data collection was the abrupt change to employment, and many people with rheumatic disease were faced with delayed or reduced income. Unique within the field of rheumatology, our study illustrates the direction and magnitude of employment change from Jan 1, 2020, to May 8, 2020. Further work should address the consequences of employment status changes for health-care access, medication affordability, mental health, and rheumatic disease activity. With an improved understanding of COVID-19 and the existence of patient recommendations from professional organisations, future studies should address changes in behaviours, perceptions, and concerns in this population, including COVID-19 vaccination, COVID-19 sequelae, and the long-term effect of the pandemic on patient outcomes.

Contributors

JSH, KK, JFS, JWL, JAS, TTM, CH, MJL, ML, SES, TS, GF, SS, and LT contributed to data collection, data quality control, data analysis, and interpretation. They drafted and revised the manuscript critically for important intellectual content and gave final approval of the version to be published. RPB, KLD, EFM, SM, MN, CAP, and DPR contributed to planning and data collection, reviewed the manuscript, and provided important intellectual content. DFLL and CLH critically revised the manuscript and provided important intellectual content. SB, WC, RG, PMM, PCR, PS, ZSW, and JY contributed to the acquisition, analysis, and interpretation of the data. They drafted and revised the manuscript critically for important intellectual content and gave final approval of the version to be published. ES directed the work, designed the data collection methods, and contributed to the analysis and interpretation of the data. ES drafted and revised the manuscript critically for important intellectual content and gave final approval of the version to be published. JSH, ES, and KK had full access to the study data and verify the credibility of the underlying data. All authors have read, revised, and approved this manuscript and had final responsibility for the decision to submit for publication.

Data sharing

Researchers interested in performing additional analyses from survey data are invited to submit proposals through the COVID-19 Global Rheumatology Alliance at rheum-covid.org. For approved projects, we will be able to provide summary tables and data analyses as requested. We do not currently have IRB approval to make the raw data available to other researchers.

Declaration of interests

JSH reports grants from Childhood Arthritis and Rheumatology Research Alliance and Rheumatology Research Alliance; and personal fees from Novartis, Pfizer, and Biogen, outside of the submitted work. JWL reports grants from Pfizer, outside of the submitted work. JAS reports grants and personal fees from Bristol-Myers Squibb; and personal fees from Gilead, Inova Diagnostics, Optum, and Pfizer, outside of the submitted work. CH reports personal fees from AstraZeneca and Aurinia Pharmaceuticals, outside of the submitted work. MJL reports grants from American College of Rheumatology during the conduct of the study and consulting fees from AbbVie, Amgen, Actelion, Boehringer Ingelheim, BMS, Celgene, Gilead, Johnson & Johnson, Mallinckrodt, Novartis, Pfizer, Roche, Sandoz, Sanofi, Sobi, and UCB, outside of the submitted work. SES is supported by the Vasculitis Clinical Research Consortium and Vasculitis Foundation outside of the submitted work. KLD reports grants from Novartis, Sobi, National Institutes of Health, and Horizon Bio, outside of the submitted work. EFM reports that the Liga Portuguesa Contra as Doenças Reumaticas received support for specific activities: grants from Abbvie, Novartis, Janssen-Cilag, Lilly Portugal, Sanofi, Grünenthal SA, MSD, Celgene, Medac, Pharmakern, GAfPA, AMGEN, A Menarini Portugal; grants and non-financial support from Pfizer; and non-financial support from Grünenthal GmbH and Tilray, outside of the submitted work. DPR is the volunteer Vice President of the Canadian Arthritis Patient Alliance, which is primarily supported by independent grants from pharmaceutical companies. DPR reports consulting fees from NovoNordisk Canada and speaking fees and an honoraria from Eli Lilly Canada, outside of the submitted work. DPR also lives with rheumatoid arthritis. SB reports personal fees from Novartis, AbbVie, Pfizer, and Horizon Pharma, outside of the submitted work. RG reports personal fees from AbbVie New Zealand, Cornerstones, Janssen New Zealand; and personal fees and non-financial support from Pfizer New Zealand, (all <$10 000) outside of the submitted work. PMM reports personal fees from Abbvie, Eli Lilly, Janssen, Novartis, Pfizer, and UCB; and grants and personal fees from Orphazyme, outside of the submitted work. PCR reports personal fees from Abbvie, Gilead, Lilly, and Roche; grants and personal fees from Novartis, UCB Pharma, Janssen, and Pfizer; and non-financial support from BMS, outside of the submitted work. PS reports honoraria from being a social media editor for @ACR_Journals, outside of the submitted work. ZSW reports grants from National Institutes of Health, BMS, and Sanofi; and personal fees from Viela Bio and MedPace, outside of the submitted work. JY reports personal fees from Pfizer and Eli Lilly, and grants and personal fees from Astra Zeneca, outside of the submitted work. ES is a Board Member of the Canadian Arthritis Patient Alliance, which is a patient-run, volunteer-based organisation whose activities are primarily supported by independent grants from pharmaceutical companies. All other authors declare no competing interests.

Acknowledgments

We would like to thank all the clinicians, health-care providers, and patient organisations who helped to develop and disseminate this survey. A full list of all the contributors can be found in the appendix (pp 44–45). Preliminary results were presented at the American College of Rheumatology 2020 conference. The views expressed here are those of the authors and participating members of the COVID-19 Global Rheumatology Alliance and do not necessarily represent the views of the American College of Rheumatology, the European League Against Rheumatism, the UK National Health Service, the National Institute for Health Research, the UK Department of Health, or any other organisation.

Supplementary Material

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DOI: https://doi.org/10.1016/S2665-9913(21)00175-2

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Effect of the COVID-19 pandemic on patients with systemic rheumatic diseases

The effect of the COVID-19 pandemic on people with inflammatory or autoimmune rheumatic diseases remains unclear. Risk factors associated with severe COVID-19 outcomes include older age (>65 years), male sex, and pre-existing comorbidities (hypertension, diabetes, obesity, cardiovascular diseases, and chronic respiratory diseases).1 Additionally, immune-compromised individuals, including people with systemic rheumatic diseases, are at increased risk of infection, including by SARS-CoV-2.2

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Effective Skincare Directions to Enable You To Admire the Skin Today!

Vinetics C Cream Now epidermis is prepped and primed for the foundation. Assuming anyone might have found the groundwork that is the perfect shade, first figure out the coverage you aim. If you want light coverage, use your fingers to dab foundation only to areas which need it. For the people who prefer more coverage, use a cosmetic blending sponge or brush applying foundation towards the entire sight. To do so, start previously middle belonging to the face and gently blend outward to obtain an even coverage. Check anti aging Skincare products. These are far from makeup though- usually are very well creams, gels, and lotions that are applied to one's skin and absorbed using your pores. And no, there is not any collagen and elastin in such kind of items. Special ingredients (like functional keratin) stimulate the creation of collagen and elastin To your body, the only true way help to make it your skin firm and elastic. Wrinkles are folds of skin get been a symbol of aging, although just age, there are also factors as well that can trigger wrinkling of epidermis. Aging is the main cause, so adopt a healthy lifestyle and check out to reduced on factors that cause aging process. Smoking can cause wrinkly skin. So avoid smoking if you would like to retain good Youthful Skin. Sun damage also causes wrinkling. So avoid out there in sunlight and when you must, then use sunscreen with appropriate SPF mobile number. These creams would regularly list Collagen as an element to demonstrate that they in order to have less wrinkles. The reality is, Collagen does not have access to any effect when applied topically any cream. It really doesn't get absorbed in the skin. A good cream really stimulate collagen production in the body instead associated with it the ingredient. It's bad enough that ladies have to suffer through night sweats and headaches, loss of sleep and irritability, but losing your hair? This certainly too far isn't the software? Some doctors aren't convinced for some reason is as a consequence of menopause, or are they a decrease in female bodily hormones. But since it takes place around the same time, feasible to that there is a relationship - although age probably has something also. As expected the sun and gravity take their toll on the woman's skin too, so don't blame it all on having menopause. Maybe about 50/50? Nobody knows for sure, but in contrast is certain you must stock by means of Skin cream only at that age. I can personally vouch for the efficacy of citric acid. A lot do not recommend this for mature skin like it is an AHA peeler than can potentially damage the dermis ranges. But if you know how unit it properly, you can lighten up spots, smooth out skin tone and make the skin look more youthful all in a day's perform. Not everyone will must have to do this method. For you're not large pores, however, it's highly recommended to make use of a toner or astringent to tighten them up. What's more, it has relatively benefit of clearing away any remaining cleanser.

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Vinetics C Skin Cream Believe it or not, your eating habits are often reflected on skin tone. Changing your diet can greatly improve the style and feel of epidermis. Drink involving water thoughts your skin plumped up and fluids. Also, eat frequently of as well as fruit vegetables each day so you simply can be certain to are getting plenty from the nutrients you might need. Instead of applying collagen directly, you need to anti wrinkle creams that contain ingredients permits stimulate the body to produce more collagen and elastin. What foods are friendly to cleaning the body? Two of the foods are the best apples and psyllium husks. They both contain fibers that turn out to be a broom and absorb and repel all spam that pasted into your intestines, even something that have been there for quite some time! The "junk" is even the ideal ground for bacteria that produce mycotoxins. Wishes another great Skin Serum useful twice daily and can get the effective lightening translates to two weeks or substantially. This particular product tends to help overall tone of your skin, which can decrease black heads in addition to correcting your hyper pigmentation. This is because is manufactured from natural products it doesn't burn like chemical treatments. Use this with cleansing products for that best possible results. The fee for laser hair removal is around $55.00 per bottle. It helps promote tissue formation thus increases your wound healing ability. You actually have wounds from your acne causing by those pricked pimples, this can further an individual to with healing them. Is actually actually one of its popular utilize. A record of each product use that lists the positive and negatives of every product will benefit you quickly find very good one. Generate a judicious decision a pad and something to write with. Keeping track will help you really concentrate on really your money can pay for. Reviewing your records will shine the sunlight on what you've tried and what your next choice should be. Once you start your journal you will began to get noticeable trends with single services different blends. One product brand of toner may see uncomfortable while another does a terrific job of balancing your complexion. Now lets say you that each one of of the cleansers you've tried severely irritated your skin, you would look with the line that caters to sensitive flesh. Actually the Acne treatment towards the back acne breakouts is very significantly like a facial Acne treatment. You want to start by preserving the acne infected areas as clean as conceivable. You should first try an acne product that is containing salicylic acid and alcohol addiction. This type of body wash will aid draw the bacteria because of this built up, out from under skin tone and pores and skin pores. In this acne treatment make an effort to do it both upon waking and the evening. Whenever you get your pores working the way they should be, it's see an improvement in the seriousness of your back acne. The salicylic acid contains similar ingredients to aspirin, and may also assist you in soothing the discomfort that's associated in conjunction with your acne. Sometimes incorrect creams might itching underneath the skin a tad too. This side effect might be even worse than painful burning mainly because just causes constant annoyance. These are things the bad creams can get done to your face, but luckily there are numerous good creams on market as let me tell you.

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Vinetics C But, I think more than this in order to be done to stop your bad skin. Do you think the said? Just think onto it. Can this plant magically cure your acne without leaving problem to experience? What this failed? What should what you are doing to cure your acne then? So, I want better a description of this.

As women age, the skin we have not only changes texture and dries out, furthermore, it begins to a bit dull. It loses that fresh appearance that is actually much a significant part of the skin of the children. It is auto insurance that is actually difficult to obtain. However, Skin Candescence comes closer than any product I've tried much to reviving that youthful look. There loads of good skin care products but no best. Certain skin types don't improve with specific ingredients in exact same holds true way another skin type might. Just because your significant other's skin care product work wonders their own behalf does not mean may never benefit of computer. Your mom's favorite Skin Serum may irritate epidermis. The beaming model's skin product may perform the opposite with the skin. Understanding which products will are preferable for you is usually a process that involves a involving trial and error. The time you spend finding a match will be well worthwhile for pores and skin. This can are a daunting task if you don't know to be able to look out for. Benzoyl peroxide is recognized to be the most effect non-prescription Acne treatment easily available. I would recommend beginning with 5% as compared to 10% since the device is just as effective which will lower the chance of epidermis being excessively dry or peeling. Shady cosmetic companies have forced customers to loathe anti wrinkle face moisturizer. Why is this? Because these profit hungry companies just bottle worthless moisturizers and then try in order to them off as wrinkle removing software packages. Do these products do anything whatsoever aside from lubricating skin? No, but will that matter so long as supplier makes quite of money? One of your main benefits of injectable collagen is the fact that it clears away your facial lines. As men and women get older, the skin is not as tight it used pertaining to being which is the the wrinkles will form. With a couple belonging to the right injections, you could see significant results with epidermis! If each "secret key" were purchased individually it cost roughly $132.00 to $157.00. Leptitrex can be found for between $40 to $60 it's it a superb value. The cheapest night cream on the contains petrolatum, mineral oil and paraffin, all of which are derived from petroleum or crude natural oil. One of the reasons that crude oil became popular is that could make so umpteen things from it, cheaply.

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Traditional Skincare Product Facts

You will find an anti-aging skin care assessment for any one of many thousand different items.  That Vinetics C Eye Serum's what size the market is nowadays. There is no strategy to coverall of these in this report that is quick, but we would want to share some of the problems to look at out for. It is about the elements.   Should you choosenot take care of your skin appropriately, your system will soon be at the mercy of bacteria episodes. Experts have shown them to become inefficient, although there are several Skin Care products that incorporate collagen. Because it is not too small collagen can't enter your skin. Ultimately, you've to utilize a solution helping to make your system create more of the protein naturally.   Vinetics C Eye Serum   For those who have to be out within the sunshine, be sure to apply sunscreen. A bronze is basically the obvious benefits out of your Skin Care Reviewis manufacturing of melanin, which serves to safeguard you from your hazardous aftereffects of being out inside the sun all day long. Your current aim ought to be to slow down this process as much as you are able to. A sunscreen with a Sun Protection Factor (SPF) of atleast 15 is recommended, and the bigger the better.   Therefore, we have to be wise in picking skin care products to utilize which can be not unable to maintain our elegance. Today, there's large selection of diverse cosmetics on the market. How is the right one chosen by us? How do we find the one which would work for our Skin Care Tips? One place we could do intensive research is by learning online skin care assessment.   Address   i Vinetics C Eye Serum  t right can be done once a blemish seems or keep up with the place clean. Don't just abandon it there and desire it disappears all a quick, particularly when there are plenty of these splitting out at the same time. Decide and a rebellion breakout, if not kept in order, can cause acne permanent scarring. Thus, that's why you commence a dermatologist prescribed item or see a dermatologist to minimize its progress and determine an ample acne cure and ought to treat the issue since it looks.

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Astenia de toamnă se face simțită? Ce alimente trebuie să mănânci ca să scapi de oboseală și de insomnie

Astenia de toamnă își intră, încet, încet în drepturi și tot mai mulți dintre noi acuzăm stări de oboseală, insomnie și lipsa poftei de mâncare. Această stare se suprapune peste anxietatea ultimelor luni, pe fondul pandemiei COVID-19, și câștigă astfel în intensitate. Din fericire, există alimente care au capacitatea de a alunga oboseala și alte simptome ale asteniei de toamnă.

CITESTE TOATA REVISTA VIVA! DE SEPTEMBRIE, GRATIS, AICI!

Alimente care alungă oboseala și ameliorează astenia de toamnă

Pe măsură ce zilele devin mai scurte și mai răcoroase, e posibil să se instaleze o stare de tristețe, acompaniată de slăbiciune, probleme de concentrare, pierderea apetitului sau insomnii – află dacă e vorba despre astenia de toamnă. De foarte multe ori, simptomele asteniei de toamnă apar mai ales în luna octombrie, atunci când vremea începe să se răcească mai mult şi zilele se micşorează.

Expunerea zilnică la lumina zilei poate ameliora simptomele asteniei. Chiar și fără tratament prescris de medic (antidepresive, în cazurile extreme), astenia de toamnă dispare la final de sezon, însă tratamentul accelerează dispariția acesteia.

Totodată, adoptarea unei diete sănătoase și echilibrate favorizează tratarea asteniei de toamnă. Fructele, legumele, cerealele integrale și proteinele de calitate te ajută să te simți bine, indiferent de sezon. În plus, elimină din alimentație sucurile, dulciurile, prăjelile ori produsele de patiserie, care conțin substanțe ce te pot afecta și pot mari predispoziția de instalare a asteniei de primăvară.

Și, foarte important, fă tot posibilul să dormi opt ore pe noapte!

Citește și: Top 10 alimente care scad tensiunea arterială. Ce nu ar trebui să mănânce niciodată hipertensivii

Ce să mănânci să scapi de insomnie

O alimentație sănătoasă, hidratare, somn și sport sunt lucrurile de la baza oricărui stil de viață sănătos. Primii pași atunci când vine vorba despre nutriție sunt aceia de a învăța să faci alegeri bune când vine vorba de alimente.

Principalele alimente împotriva insomniei și simptomelor asteniei de toamnă sunt carbohidrații complecși – cereale integrale, leguminoase, legume și fructe; acizi grași omega-3 – peștele gras (precum somon, hering, macrou, ficat de cod), nuci și ulei de rapiță sau de măsline, dar și hidratarea este foarte importantă: apa – minimum 8- 10 pahare pe zi.

Citeste si: Vrei să slăbești rapid? Iată de la ce oră nu mai ai voie să mănânci nimic și ce alimente trebuie să eviți!

Consumul zilnic constant de legume proaspete, precum varză, broccoli, morcovi, ţelină sau vinete are efecte benefice uimitoare pentru persoanele obosite, stresate, surmenate fizic şi psihic sau care suferă de insomnie.

Totodată, polenul şi mierea au o acţiune de tonifiere a organismului şi sunt foarte revigorante. La rândul său, lăptişorul de matcă este foarte recomandat pentru întărirea organismului.

Dovleacul, un aliment foarte eficient împotriva asteniei de toamnă

Dovleacul este foarte indicat în cazul asteniei de toamnă. Este una dintre legumele cu cel mai scazut nivel de calorii, 100 de grame avand doar 26 cal si nu contine grasimi saturate sau colesterol, in  schimb este o sursa bogata de fibre dietetice, anti-oxidanti, minerale si vitamine. Este recomandat de dieteticieni in controlul colesterolului si in programelor de reducere a greutatii. Dovleacul depoziteaza multe vitamine antioxidante, cum ar fi vitamina A, vitamina C si vitamina E. Cu un continut de 7384 mg de vitamin A la 100 g ofera aproximativ 246% din DZR din aceasta vitamina.

Citeste si: Vitamina care te ajută în lupta cu COVID-19. Ce alimente trebuie să consumăm pentru protecție în fața bolii

Dovleacul este bogat in vitamine din complexul B, cum ar fi folatii, niacina, vitamina B-6 (piridoxina), tiamina si acid pantotenic. Este, de asemenea, o sursa bogata de minerale precum cupru, calciu, potasiu si fosfor.

Toate soiurile de dovleac au efecte uşor sedative asupra sistemului nervos, fapt pentru care sunt recomandate în dieta astenicilor. Dovleacul poate fi consumat copt sau sub formă de plăcintă, crud şi ras în salate cu roşii şi castraveţi sau stors, sub formă de suc. Dovleacul crud este contraindicat persoanelor cu gastrită, cu ulcer gastric sau cu diabet avansat.

Citeste si: 5 alimente care NU trebuie mâncate la micul dejun. Îți pot pune sănătatea în pericol!

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Vinetics C Skin Cream It is an effective anti-aging treatment for the skin, used by celebrities and even anti-aging ingredients used to combat the aging process effectively and efficiently. Aside from that, I have a freaking personality. First of all, this anti-aging function of the solution greatly moisturizes the skin. It helps your skin to remain smoother and supple by hydration. I don't understand why I can try to abstain from it as much as possible. At the same time, I'm always very happy. The cream is free from any additives, synthetic ingredients, chemicals and fillers. Function and a clear program and dark circles to prevent free radical damage and moisturize the skin's surface, and most importantly, smooth fine lines and wrinkles. It will give you a natural glow and radiance to your face and leave you looking the way you have always wanted. The product has been recommended and approved by many dermatologists as fit and safe for use. Fortunately, the product eliminates impurities that cause senile plaques, giving your skin a clearer surface without blemishes.

When you add this product to your daily skin care products, you can enjoy the following benefits:  Remove fine lines and wrinkles  The main advantage of this style is that it works miraculously to eliminate fine lines and wrinkles. With this formula, you can finally get rid of fine lines and wrinkles, senile plaques interfere with beauty ugly, under dark circles, and other most common markers of aging.

It is formulated to give you a youthful look that you desire, restore back you confidence and enhance your self-esteem. By promoting hydration, your skin will become soft, smooth and elastic. The result of clear under eye circles makes you wake up looking rejuvenated, refreshed and happy with your appearance. If your goal is to look beautiful and young again, then now you can achieve this desire by helping you with this anti aging formula. There are a large number of beliefs in this realm. Fortunately, when you add this product to your daily skin care products, you can wake up and look refreshed, vibrant, alert, and completely satisfied with your appearance. Final Verdict It is time to free yourself from looks that you don't like. Instead of allowing that to happen, Vinetics C's skin cream protects the skin from damage, which keeps the newly discovered beauty. You don't always have to look for the elegant and the conspicuous where this article presents a couple of detailed insights into Vinetics C Skin Cream. Finally, "In for a penny, in for a pound." There are very few products that can give you the same wonderful result. It helps to smooth away wrinkles and fine line with every application. Where do you buy? As you know, there are a number of advantages to adding Vinetics C to skin creams. The cream absorbs abysmal into your dermal layer where the skin cells are situated and releases elastin and collagen compounds. Secondly, it works by reducing the damage to the facial muscles as toxins and root bark. The surface enhances itself by its eternal and astonishing results. Aging may not be under your control, but you now have the secret to make yourself look much younger than your age. Moisturizes the surface of your skin  Then, with the level of the product to restore moisture to your skin tends to decrease over time. This is a unique product line.. Vinetics C – it works! Free radicals attack the surface of your skin and make them look worn, haggard and tired.

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Vignoble nantais. Gérard Vinet a opté pour la vinification maison

Vignoble nantais. Gérard Vinet a opté pour la vinification maison

Quand Laurence a suggéré à son époux Gérard de se lancer dans la fabrication de vin pétillant « pour élargir la gamme », il n’a jamais été question de s’écarter de la culture familiale.Créé en 1948, le Domaine Gérard Vinet produira une cuvée à bulles issue du cépage unique du domaine, le melon de…

Source : ouest-france

Author: C. A.