ABSTRACT
The Veterans Health Administration (VHA) Supported Employment (SE) program provides a highly individualized vocational rehabilitation service. To deliver SE, providers traditionally spend most of their time meeting in-person with veterans, employers, and clinicians. This article explores the impact of COVID-19 on the implementation of SE programs for veterans with a history of traumatic brain injury. In interviews with 29 SE providers and their nine Compensated Work Therapy managers across 10 VHA medical centers, we analyzed stakeholders' descriptions of how they adjusted their practices during the pandemic. These included switching from in-person to telephone or video communications, identifying new jobs created by COVID-19 conditions, focusing on work-from-home opportunities, and finding other modalities for collaborating with clinicians. Implications for rehabilitation practice are discussed.
ABSTRACT
The annual number of firearm injuries in Portland, Oregon has been higher in the years since 2020 than in any prior year in the city's history. This descriptive study analyzed data from Gun Violence Archives (GVA) from January 1, 2018, to December 31, 2021. All incidents in GVA of interpersonal firearm injury that occurred in Portland during this period were analyzed for location, number of people injured or killed, and demographic information for those injured or killed. Comparisons in firearm injury rates were made with Seattle and San Francisco. Interpersonal firearm injuries began to rise after the first COVID-19 case in Oregon; July 2020 had the most injuries in the four-year period. Black men suffered the highest rate of interpersonal fatalities, with more than 11-fold higher rate per 100,000 than White men in every year studied. Portland had a higher rate of total interpersonal firearm injuries and a higher rate of firearm fatalities from 2018 through 2021 compared to Seattle and San Francisco. Neighborhoods near Downtown and those on the Eastside of the city had the highest rates of interpersonal injuries and deaths from firearms, whereas those in the Southwest had the lowest. Defining the burden of disease from interpersonal firearm injuries is a fundamental step in designing future public health research and implementing interventions to curb the trauma brought by interpersonal firearm injury.
Subject(s)
COVID-19 , Firearms , Suicide , Wounds, Gunshot , Male , Humans , United States , Oregon/epidemiology , Wounds, Gunshot/epidemiology , Violence , Population SurveillanceABSTRACT
BACKGROUND: Patients hospitalized for COVID-19 may be at high risk of mental health (MH) disorders. This systematic review assesses MH outcomes among adults during and after hospitalization for COVID-19 and ascertains MH care utilization and resource needs. METHODS: We searched multiple medical literature databases for studies published December 2019 to March 2021. Studies of ≥ 200 participants were synthesized. One reviewer completed article selection, data abstraction and assessed study quality and strength of evidence, with verification by a second. RESULTS: Fifty articles met preliminary inclusion criteria; 19 articles that included ≥ 200 participants were synthesized. Evidence from these primarily fair-quality studies suggests many patients experience symptoms of depression (9-66%), anxiety (30-39%), and insomnia (24-40%) during and 3 months after hospitalization for COVID-19. However, patients infrequently receive a new MH disorder diagnosis 6 months after hospitalization (5% are diagnosed with a new mood disorder, 7% anxiety disorder, and 3% insomnia). Some hospitalized patients - including women and those with more severe COVID-19 - may be at higher risk of poor MH outcomes. Data on MH care utilization and resource needs are currently limited. LIMITATIONS: Most included studies were small, did not report the proportion of participants with preexisting MH disorders, and did not use comparison groups. CONCLUSIONS: While many patients experience MH symptoms after hospitalization for COVID-19, most do not go on to develop a new MH disorder. Future studies should report whether participants have preexisting MH disorders and compare patients hospitalized for COVID-19 to patients hospitalized for other causes.