MODELLING THE IMPACT OF COVID-19 AND ROUTINE MENACWY VACCINATION ON MENINGOCOCCAL CARRIAGE AND DISEASE IN THE UK

Intro Enforced country-wide social distancing and suspension of most non- emergency medical care due to the COVID-19 pandemic will undoubtedly affect public health in multiple ways. While non-pharmaceutical interventions are expected to reduce transmission of several infectious diseases, severe disruptions to healthcare systems have hampered diagnosis, treatment, and routine vaccination. We examine the pre-pandemic community carriage prevalence together with the effect of this disruption on meningococcal disease and vaccination in the UK. Methods By adapting an existing mathematical model for meningococcal carriage and disease, we address the following questions:a) What is the predicted impact of the adolescent MenACWY vaccination on meningococcal transmission pre-pandemic? b) What is the predicted impact of social distancing on current infection rates? c) What effect might reductions in vaccine uptake have on future infection rates? d) Will catch-up vaccination campaigns be necessary for the MenACWY vaccine? Findings Model findings indicate that the MenACWY vaccine programme was already generating indirect protection and supressing transmission. Even without pandemic modelling assumptions, we observe that carriage prevalence could approach near-elimination in around 30 years due to the new lower community carriage prevalence observed by UKMenCar4 and effects of the 2015 MenACWY catch-up campaign. Moreover, COVID-19 social distancing is expected to have accelerated the decline, causing significant long-lasting reductions in the carriage prevalence of meningococcal strains A, C, W, and Y leading to near- elimination in under 20 years. Conclusion In all scenarios modelled, pandemic social mixing effects outweighed potential reductions in vaccine uptake (of up to 50%) causing an overall decline in carriage prevalence.

Feasibility of an Automated Assessment to Measure Cognition and Mood in the Acute Stroke Setting

Introduction Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current pen-and-paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Methods Patients are approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have preexisting condition i.e dementia, severe aphasia Participants could speak to the digital doctor on the ward or at home via a web-version. Results Recruitment started on 8th December 2020;We have screened 614 people assessed for suspected acute stroke/TIA at Sheffield Teaching Hospitals. Of those we have recruited 71 participants (13 with TIA) Mean NIHSS of 4.5 and mean MoCA of 24.6. We will present initial results of factors affecting participant recruitment. We will also compare the mood and anxiety screening scores used in this study to those collected via the SNAPP database. Discussion Screening was adapted due to Covid pandemic and utilising remote consent and participa- tion allowed the project to continue.

Alcohol use trends in Dallas County during the COVID-19 pandemic

Alcohol (ethanol) is the most widely detected drug in forensic toxicology casework and an increase in consumption of alcohol was reported during the COVID-19 pandemic. The increase in consumption could be attributed to rising stress levels and social isolation. To determine whether the pandemic had an impact on ethanol positivity and concentrations in cases analyzed by the Dallas County Southwestern Institute of Forensic Sciences, blood ethanol results were evaluated from January 1, 2019, through December 31, 2021. This time frame captured ethanol prevalence and concentrations before, during, and immediately following the pandemic for comparison. The average ethanol concentration in postmortem casework over the three years for each quarter ranged from 0.116 g/100 mL to 0.142 g/100 mL while the average concentration in driving while intoxicated (DWI) was higher, ranging from 0.173 g/100 mL to 0.188 g/100 mL. The ethanol positivity rate for postmortem casework remained relatively the same at approximately 20% during the time frame, while there was a decrease in ethanol positivity rate for DWI casework during the pandemic in April - June (Q2) 2020. However, the positivity rate returned to pre-pandemic levels by the end of 2020. Despite the self-reported surveys of increased alcohol consumption during the pandemic, a corresponding increase in average ethanol concentrations was not observed in Dallas County and the surrounding area.Copyright © 2023

Feasibility of automated longitudinal cognitive and mood assessment in the stroke pathway

Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.

Psychiatric Admissions, Referrals, and Suicidal Behavior Before and During the COVID-19 Pandemic in Denmark: A Time-Trend Study

Introduction: The COVID-19 pandemic has affected mental health globally, but the impact on referrals and admissions to mental health services remains understudied. Objective(s): To assess patterns in psychiatric admissions, referrals, and suicidal behavior before and during the COVID-19 pandemic in Denmark. Method(s): Utilizing hospital and Emergency Medical Services (EMS) health records covering 46% of the Danish population, we compared psychiatric in-patients, referrals to mental health services and suicidal behavior in years prior to the COVID-19 pandemic to levels during the first lockdown (March 11 - May 17, 2020), inter-lockdown period (May 18 - December 15, 2020), and second lockdown (December 16, 2020 - February 28, 2021) using negative binomial models. Result(s): The rate of psychiatric in-patients declined compared to pre-pandemic levels (RR = 0.95, 95% CI = 0.94 - 0.96, p < 0.01). Referrals were not significantly different (RR = 1.01, 95% CI = 0.92 - 1.10, p=0.91) during the pandemic;neither was suicidal behavior among hospital contacts (RR =1.04, 95% CI= 0.94 - 1.14, p=0.48) nor EMS contacts (RR=1.08, 95% CI=1.00 - 1.18, p=0.06). In the age group <18, an increase in the rate of psychiatric in-patients (RR = 1.11, 95% CI = 1.07 - 1.15, p < 0.01) was observed during the pandemic;however, this did not exceed the pre-pandemic, upwards trend in psychiatric hospitalizations in the age group <18 (p=0.78). Conclusion(s): The pandemic was associated with a decrease in psychiatric hospitalizations. No significant change was observed in referrals and suicidal behavior.

THE ESSENTIAL NETWORK (TEN): A BLENDED MENTAL HEALTH SERVICE FOR AUSTRALIAN HEALTHCARE WORKERS DURING THE COVID-19 PANDEMIC

Background: Healthcare workers (HCWs) are at significant risk of poor mental health (MH) because of the COVID-19 pandemic. MH services are available, but many are not sensitive to the needs and workplace culture of HCWs. 'Blended care', which integrates digital and person-to-person care, may leverage the scalability and anonymity of digital health while offering a choice of care options. Objectives: To outline the design and evaluation of The Essential Network (TEN), a blended mental health service created for Australian HCWs during the COVID-19 pandemic. Methods: We outline the development of TEN and service design methodologies, including stakeholder and user consultation, and strategies for adaptive service delivery. TEN was evaluated through an audit of service analytics (website analytics and clinical service analytics). A total of 105 HCWs also participated in an observational study to use TEN for 1 month. Participants completed MH and service acceptability measures at baseline and followup. Findings: TEN has serviced more than 57,000 HCWs. More than 7000 HCWs completed a digital MH assessment and received personalised referral to services. Engagement was highest for self-assessments and self-help resources. Preliminary results from the observational study indicate high service acceptability. Conclusion: TEN united peak professional bodies and service providers to create a digital hub offering HCWs a range of MH resources and help-seeking options. With more than 800,000 HCWs in Australia, uptake of the service has been relatively low. To leverage the potential of blended care, such services must be implemented in a way that ensures that HCWs feel safe to use them.

Return to work after COVID-19 infection - A Danish nationwide registry study.

OBJECTIVES: This study aimed to explore return to work after COVID-19 and how disease severity affects this. STUDY DESIGN: This is a Nationwide Danish registry-based cohort study using a retrospective follow-up design. METHODS: Patients with a first-time positive SARS-CoV-2 polymerase chain reaction test between 1 January 2020 and 30 May 2020, including 18-64 years old, 30-day survivors, and available to the workforce at the time of the first positive test were included. Admission types (i.e. no admission, admission to non-intensive care unit [ICU] department and admission to ICU) and return to work was investigated using Cox regression standardised to the age, sex, comorbidity and education-level distribution of all included subjects with estimates at 3 months from positive test displayed. RESULTS: Among the 7466 patients included in the study, 81.9% (6119/7466) and 98.4% (7344/7466) returned to work within 4 weeks and 6 months, respectively, with 1.5% (109/7466) not returning. Of the patients admitted, 72.1% (627/870) and 92.6% (805/870) returned 1 month and 6 months after admission to the hospital, with 6.6% (58/870) not returning within 6 months. Of patients admitted to the ICU, 36% (9/25) did not return within 6 months. Patients with an admission had a lower chance of return to work 3 months from positive test (relative risk [RR] 0.95, 95% confidence interval [CI] 0.94-0.96), with the lowest chance in patients admitted to an ICU department (RR 0.54, 95% CI 0.35-0.72). Female sex, older age, and comorbidity were associated with a lower chance of returning to work. CONCLUSION: Hospitalised patients with COVID-19 infection have a lower chance of returning to work with potential implications for postinfection follow-up and rehabilitation.

Global impact of the COVID-19 pandemic on stroke care and intravenous thrombolysis

Objective: The objectives of this study were to measure the global impact of the pandemic on the volumes for intravenous thrombolysis (IVT), IVT transfers, and stroke hospitalizations over 4 months at the height of the pandemic (March 1 to June 30, 2020) compared with two control 4-month periods. Background: The COVID-19 pandemic led to widespread repercussions on the delivery of health care worldwide. Design/Methods: We conducted a cross-sectional, observational, retrospective study across 6 continents, 70 countries, and 457 stroke centers. Diagnoses were identified by ICD-10 codes and/or classifications in stroke center databases. Results: There were 91,373 stroke admissions in the 4 months immediately before compared to 80,894 admissions during the pandemic months, representing an 11.5% (95%CI,-11.7 to-11.3, p<0.0001) decline. There were 13,334 IVT therapies in the 4 months preceding compared to 11,570 procedures during the pandemic, representing a 13.2% (95%CI,-13.8 to-12.7, p<0.0001) drop. Interfacility IVT transfers decreased from 1,337 to 1,178, or an 11.9% decrease (95%CI,-13.7 to-10.3, p=0.001). There were greater declines in primary compared to comprehensive stroke centers (CSC) for stroke hospitalizations (-17.3% vs-10.3%, p<0.0001) and IVT (-15.5% vs-12.6%, p=0.0001). Recovery of stroke hospitalization volume (9.5%, 95%CI 9.2-9.8, p<0.0001) was noted over the two later (May, June) versus the two earlier (March, April) months of the pandemic, with greater recovery in hospitals with lower COVID-19 hospitalization volume, high volume stroke center, and CSC. There was a 1.48% stroke rate across 119,967 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.3% (1,722/52,026) of all stroke admissions. Conclusions: The COVID-19 pandemic was associated with a global decline in the volume of stroke hospitalizations, IVT, and interfacility IVT transfers. Primary stroke centers and centers with higher COVID19 inpatient volumes experienced steeper declines. Recovery of stroke hospitalization was noted in the later pandemic months, with greater recovery in hospitals with lower COVID-19 hospitalizations, high volume stroke centers, and CSCs.

Appendiks Metoder og opmærksomhedspunkter

First and foremost, the appendix explains the operationalization of the approach of the COVID-19 survey. As background for the articles, which presenting and interpret the analytical results, it also documents specific methodological approaches such as scales of religiosity and wellbeing, and factor-analysis of some of the survey responses. Approaches to content analysis are also delineated. Finally, we acknowledge and discuss the challenges associated with comparing surveys collected at different times and with different sampling approach. © 2021 Aarhus Universitet. All rights reserved.

Tillid under COVID-19

In the article, we examine Danes' trust in the authorities during the crisis, the relationship between the high degree of trust in the authorities and compliance with the authorities' advice to avoid the spread of infection, and how a growing distrust of society can have consequences for the cohesion in the society, including increasing polarization. The general trust in other people is high in Denmark, and our study shows that trust in the authorities has grown during the pandemic. However, the study shows incipient signs of polarized trust in the population. Religion does not seem to play a role in this development, which instead seems to be associated with material and social insecurity. Research in trust generally indicates that the basis for the strong cohesion that Danish society has shown for decades is precisely trust. If the material and social consequences of the pandemic create fertile ground for change in the level of trust, it can help to create a value setback for the norms that create cohesion in society. © 2021 Aarhus Universitet. All rights reserved.

COVID-19 og religion

Personal and societal crises often generate existential or religious questions. The article examines differences between how religiously oriented Danes think about the causes of the coronavirus and how the pandemic should be handled, compared with less religious' Danes. Unsurprisingly, the least-religious Danes are less disturbed by the extended lockdown of faith communities. Further, the article demonstrates that while a minority of Danes is very religious, those who are have a clear sense of social and religious deprivation as a result of COVID restrictions. Many in this group have participated in online community activities, but few consider these to be satisfactory alternatives to physical services. Generally, there is widespread support for the rational and scientific explanation of the virus and how it should be handled, but a minority of the most religious think the virus has divine origin and should be handled by following God's plan. © 2021 Aarhus Universitet. All rights reserved.

Befolkningens reaktion på COVID-19 set i lyset af aviser og andre medier

The population of Denmark had no former expericence with pandemics, meaning that its evaluation of risk and the necessary measures against contagnation were dependent on the dissemination of information through the media. This article uses a media-centric prism to discuss the themes found throughout this special issue, arguing that the Government's use of the media as well as the media's support of rapidly evolving government policies had a decisive impact on the population's response. This argument is supported by a thematically organized discussion of events between 11 March until the early part of October 2020. The themes are the horror raised by the pandemic, the ethical considerations regarding easy and equal access to the health services, unemployment, global warming and, not the least, religion as seen in relation to COVID-19. This last theme is considered in relation to whether the pandemic could be a punishment decided by God or perhaps a personified Nature's revenge due to humans' ill-tratment. The meaning of the prohibition on public rituals and the application of private rituals are considered at last. © 2021 Aarhus Universitet. All rights reserved.

COVID-19-krisen: Forløb og bekymringer

This article offers an overview over the political steps and containment proceedures during the first months of the COVID-19 pandemic in Denmark 2020. © 2021 Aarhus Universitet. All rights reserved.

A comparison of acoustic and linguistics methodologies for Alzheimer's dementia recognition

In the light of the current COVID-19 pandemic, the need for remote digital health assessment tools is greater than ever. This statement is especially pertinent for elderly and vulnerable populations. In this regard, the INTERSPEECH 2020 Alzheimer's Dementia Recognition through Spontaneous Speech (ADReSS) Challenge offers competitors the opportunity to develop speech and language-based systems for the task of Alzheimer's Dementia (AD) recognition. The challenge data consists of speech recordings and their transcripts, the work presented herein is an assessment of different contemporary approaches on these modalities. Specifically, we compared a hierarchical neural network with an attention mechanism trained on linguistic features with three acoustic-based systems: (i) Bag-of-Audio-Words (BoAW) quantising different low-level descriptors, (ii) a Siamese Network trained on log-Mel spectrograms, and (iii) a Convolutional Neural Network (CNN) end-to-end system trained on raw waveforms. Key results indicate the strength of the linguistic approach over the acoustics systems. Our strongest test-set result was achieved using a late fusion combination of BoAW, End-to-End CNN, and hierarchical-attention networks, which outperformed the challenge baseline in both the classification and regression tasks. Copyright © 2020 ISCA