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This engaging Research Handbook offers a comprehensive overview of research on social factors and mental health, examining how important it is to consider the social context in which mental health issues develop. It illustrates how social factors contribute to problems with mental health and how society, in turn, responds to people diagnosed with psychiatric disorders. Expert contributors provide an in-depth review of the history of social factors and mental health, and also discuss how boundaries between disorders such as bipolar and borderline personality disorder can be blurred and contested. Past and current social factors are thoroughly reviewed such as refugee mental health, stressors linked to discrimination based on race, gender or sexual orientation, exposure to police violence and the impact of the recent COVID-19 pandemic. The challenges and stigma faced by those diagnosed with disorders, alongside prejudices and discrimination in the health care system are also examined. The Research Handbook on Society and Mental Health will be an excellent resource for scholars studying social issues in relation to mental health or illness and researchers wishing to take an interdisciplinary approach by studying biopsychosocial factors. Mental health providers interested in well-rounded learning and those people experiencing and living with mental illness will find the alternative viewpoints to mainstream psychiatry and psychology informative and illuminating. © All rights reserved.
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This paper describes a redeployment programme developed by Kaiser Permanente Northern California (KP NCAL) to meet physician staffing needs during five COVID-19 surges in Northern California. By leveraging two existing programmes, creating a flexible system of redeployment levels, and supporting the system with a robust training programme, the physician redeployment programme effectively addressed physician staffing needs, maximised excellent patient care, and supported KP NCAL physicians during the pandemic. The programme delivered care to over 131,000 outpatients with COVID-19 infection and redeployed physicians into more than 800 inpatient shifts. © Henry Stewart Publications, 1749–9216.
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Background With the COVID-19 pandemic and referral from out-reach centers, there has been a change in practice of assessing left atrial appendage (LAA) via TEE on the day of LAA closure (LAAC). We present a challenging case of inadequate LAAC with WATCHMAN FLX due to suboptimal TEE images. Follow up TEE and CT revealed a much larger LAA ostium that was mostly uncovered. Case An 84 yo male with AF and recent hepatic hematoma, was referred for LAAC. LAA dimensions were measured using a technically difficult intraprocedural (IP) 2D TEE and a 24mm Watchman FLX was successfully implanted. Follow up 3D TEE at 45 days revealed incomplete LAAC with a large PDL. Retrospective review of fluoroscopic images revealed unrecognized filling of a posterior LAA lobe. Decision-making Anticoagulation (AC) was continued for 3 more months, and Cardiac CT was performed which showed persistent under-coverage of the LAA with large PDL of 16.5 x 11.3 mm (159mm2). A much larger ostium was measured on 45 days TEE (27 mm max 2 D dimension) and 145 days CT (18 X 25 mm) vs. 12.9 mm on IP-TEE. AC was continued with consideration of a 2nd adjacent device placement in future. Conclusion TEE on the day of LAAC although implemented in several centers, has its limitations. In the presence of sub-optimal image quality, it can lead to incorrect device sizing and incomplete LAAC as in our case. Cardiac CT with 3D evaluation or 3D TEE are crucial for pre-planning to achieve successful device implantation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Human subjects research protections have historically focused on mitigating risk of harm and promoting benefits for research participants. In many low-resource settings (LRS), complex and often severe challenges in daily living, poverty, geopolitical uprisings, sociopolitical, economic, and climate crises increase the burdens of even minimal risk research. While there has been important work to explore the scope of ethical responsibilities of researchers and research teams to respond to these wider challenges and hidden burdens in global health research, less attention has been given to the ethical dilemmas and risk experienced by frontline researcher staff as they perform research-related activities in LRS. Risks such as job insecurity, moral distress, infection, or physical harm can be exacerbated during public health crises, as recently highlighted by the COVID-19 pandemic. We highlight the layers of risk research staff face in LRS and present a conceptual model to characterize drivers of this risk, with particular attention to public health crises. A framework by which funders, institutions, principal investigators, and/or research team leaders can systematically consider these additional layers of risk to researchers and frontline staff is an important and needed addition to routine research proposals and protocol review.
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Sustainable development is central to the current societal functioning, whose complexity demands consideration on a regional scale. However, there are disparate methods to express sustainable development, many of which use qualitative analysis cumbersome for policy-makers. Previous studies focused on environmental, economic, and social impacts without fully considering the regulation mechanisms of the plethora of administrative bodies. To fill this research gap, this research establishes an integrated assessment framework involving four pillars: environment and ecology, society and culture, economics, and governance and policy. Further, indicator systems and quantitative analysis give comparable and objective results. The current study applied them to one of the most economically significant and developed Chinese regions, the Yangtze River Delta. The result shows a dynamic variation in regional sustainability from 2010 to 2019, indicating an annual increase. Although economic and societal development has been increasing steadily, environmental development has stagnated in the past two years, and the influencing policy has fluctuated dramatically. Our analysis was done in Shanghai, Jiangsu, Zhejiang, and Anhui. Even though all regions showed increasing sustainability, we observed an imbalance in regional sustainable development. Achieving a regional approach and enhanced regional coordination in the Yangtze River Delta is imperative and cannot be ignored by local, regional, and national policy-makers. More importantly, this study created a model capable of predicting the impact of the COVID-19 epidemic on regional sustainable development. The model showed that, compared with predicted values, a 6.65% decrease in the integrated sustainability index ensued, attributed to the pandemic in Zhejiang province. © 2022 Elsevier Ltd
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Introduction: Clinical research staff play a critical role in recruiting families for pediatric research, but their views are not well described. We aimed to describe how pediatric research staff build trusting research relationships with patients and their families. Methods: We interviewed research staff at one pediatric research institution and its affiliated academic medical center between November 2020 and February 2021. Staff were eligible if they conducted participant recruitment, consent, and/or enrollment for clinical research. We developed our semi-structured interview guide based on a framework for trusting researcher-community partnerships. Results: We interviewed 28 research staff, with a median age of 28 years (range 22-50) and a median of 5 years of experience (range 1-29). Interviewees identified factors relevant to relationship building across three levels: the individual staff member, the relational interaction with the family, and the institutional or other structural backdrop. Individual factors included how staff developed recruitment skills, their perceived roles, and their personal motivations. Relational factors spanned four stages of recruitment: before the approach, forming an initial connection with a family, building the connection, and following up. Structural factors were related to access and diversity, clinical interactions, and the COVID-19 pandemic. Conclusions: Research staff discussed tensions and supports with various actors, challenges with the integration of research and clinical care, the importance of voluntariness for building trust, and multiple contributors to inequities in research. These findings reveal the importance of ensuring research staff have a voice in institutional policies and are supported to advocate for patients and families.
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The ocean is facing multiple pressures from human activities, including the effects of climate change. Science has a prominent role in identifying problems and communicating these to society. However, scientists are also increasingly taking an active role in developing solutions, including strategies for adapting to and mitigating climate change, increasing food security, and reducing pollution. Transmitting these solutions to society changes our narrative about the ocean and motivates actions. The United Nations triple initiatives for this decade-the Sustainable Development Goals, the Decade on Ocean Science for Sustainable Development, and the Decade of Ecosystem Restoration-provide the momentum for this change in narrative and focus. Here, we reflect on the search for solutions and the need for better ways of communicating science in a positive way. We synthesize insights from a summer school held during the COVID-19 pandemic and present some examples of successes and failures and the lessons learned from these.
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Introduction Clinician burnout and distress are pervasive and exacerbated by the COVID-19 pandemic, but the drivers may vary by provider discipline and care setting. We surveyed the wellbeing of nurses and physicians in oncology and cardiovascular programs at a Canadian hospital network. Methods Nurses (n=261) and physicians (n=167) completed measures of the WellBeing Index to assess distress levels and rated perceived workplace fairness, staffing levels, professional satisfaction and impact of COVID-19 on work and personal life. Associations between high distress and outcomes of interest were explored using chi-squared tests and in multivariable models. Results Of 428 participating clinicians, 82% of nurses and 62% of physicians reported high distress with no significant differences between programs. High distress in nurses was linked to impact of COVID-19 on personal life [OR=4.4 (1.8-10.6), p=0.001], and in physicians, insufficient staffing [OR=3.7 (1.6-8.7), p=0.003], professional dissatisfaction [OR=5.4 (1.4- 21.8), p=0.017], and impact of COVID-19 on work [OR=3.9 (1.5-10.3), p=0.006]. High distress in oncology and cardiovascular nurses was linked to unfair treatment [OR=4.9 (1.1-23.0), p=0.042], and impact of COVID19 on work [OR=4.0 (1.1-14.2, p=0.035], respectively. Conclusions High distress is common in nurses and physicians in oncology and cardiovascular programs but drivers vary by clinician discipline and care setting. Multifaceted approaches to mitigate burnout and distress may improve clinician wellbeing.
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Background: Head and neck cancer (HNC) treatment has been significantly affected worldwide by the SARS-Cov-2 pandemic due to high viral loads in the upper aerodigestive tract. We present a single-institution experience of successful continued management of HNC patients during the pandemic. Methods: A retrospective audit was conducted comparing operative time, anaesthetic time, case volume and type (aerosol generating vs. non aerosol generating) between equivalent time periods from 2019 and 2020 during the peak of the pandemic in Australia, from a single high-volume, tertiary, academic head and neck centre. Furthermore, we document the multi-level changes instituted for each department involved in the patient cancer journey. Results: The average operative time for aerosol generating procedures (AGPs) was 85 minutes (IQR 455) in March 2019 compared with 180 minutes in March 2020 (IQR 366). Case volume and case type was similar between the two years. With appropriate patient screening, perioperative planning and judicious use of personal protective equipment (PPE), higher-risk AGPs were able to continue essentially as normal. Conclusions: HNC requires timely investigation and treatment, even in the midst of a pandemic, which can be achieved at a dedicated, COVID-free oncology centre utilising clear, rapid communication and a multidisciplinary approach. © Australian Journal of Otolaryngology. All rights reserved.
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Understanding the molecular evolution of the SARS-CoV-2 virus as it continues to spread in communities around the globe is important for mitigation and future pandemic preparedness. Three-dimensional structures of SARS-CoV-2 proteins and those of other coronavirusess archived in the Protein Data Bank were used to analyze viral proteome evolution during the first 6 months of the COVID-19 pandemic. Analyses of spatial locations, chemical properties, and structural and energetic impacts of the observed amino acid changes in >48 000 viral isolates revealed how each one of 29 viral proteins have undergone amino acid changes. Catalytic residues in active sites and binding residues in protein-protein interfaces showed modest, but significant, numbers of substitutions, highlighting the mutational robustness of the viral proteome. Energetics calculations showed that the impact of substitutions on the thermodynamic stability of the proteome follows a universal bi-Gaussian distribution. Detailed results are presented for potential drug discovery targets and the four structural proteins that comprise the virion, highlighting substitutions with the potential to impact protein structure, enzyme activity, and protein-protein and protein-nucleic acid interfaces. Characterizing the evolution of the virus in three dimensions provides testable insights into viral protein function and should aid in structure-based drug discovery efforts as well as the prospective identification of amino acid substitutions with potential for drug resistance.
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COVID-19 , Pandemics , Amino Acids , Humans , Prospective Studies , Proteome , SARS-CoV-2 , Viral Proteins/genetics , Viral Proteins/metabolismABSTRACT
This article will provide an example of how the 'Mobile Arts for Peace (MAP): Online psychosocial support through the arts in Rwanda' project used digital art-based workshops to facilitate social and community cohesion and mental health provision. During the COVID-19 pandemic, there was an increased need for psychosocial support due to the economic and social pressures of lockdown and yet many individuals had less access to mental health provision. While many mental health services around the world went online, there was still a gap between the Global South and Global North in terms of digital literacy, access to smart phones and computers, and the variation between psychosocial support through individual vs. collective healing alongside Indigenous and traditional vs. western psychosocial approaches. Implications for the use of art-based digital methods as a tool for mental health provision during and after the wake of the pandemic are explored.
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Importance: Identifying which patients with COVID-19 are likely to benefit from COVID-19 convalescent plasma (CCP) treatment may have a large public health impact. Objective: To develop an index for predicting the expected relative treatment benefit from CCP compared with treatment without CCP for patients hospitalized for COVID-19 using patients' baseline characteristics. Design, Setting, and Participants: This prognostic study used data from the COMPILE study, ie, a meta-analysis of pooled individual patient data from 8 randomized clinical trials (RCTs) evaluating CCP vs control in adults hospitalized for COVID-19 who were not receiving mechanical ventilation at randomization. A combination of baseline characteristics, termed the treatment benefit index (TBI), was developed based on 2287 patients in COMPILE using a proportional odds model, with baseline characteristics selected via cross-validation. The TBI was externally validated on 4 external data sets: the Expanded Access Program (1896 participants), a study conducted under Emergency Use Authorization (210 participants), and 2 RCTs (with 80 and 309 participants). Exposure: Receipt of CCP. Main Outcomes and Measures: World Health Organization (WHO) 11-point ordinal COVID-19 clinical status scale and 2 derivatives of it (ie, WHO score of 7-10, indicating mechanical ventilation to death, and WHO score of 10, indicating death) at day 14 and day 28 after randomization. Day 14 WHO 11-point ordinal scale was used as the primary outcome to develop the TBI. Results: A total of 2287 patients were included in the derivation cohort, with a mean (SD) age of 60.3 (15.2) years and 815 (35.6%) women. The TBI provided a continuous gradation of benefit, and, for clinical utility, it was operationalized into groups of expected large clinical benefit (B1; 629 participants in the derivation cohort [27.5%]), moderate benefit (B2; 953 [41.7%]), and potential harm or no benefit (B3; 705 [30.8%]). Patients with preexisting conditions (diabetes, cardiovascular and pulmonary diseases), with blood type A or AB, and at an early COVID-19 stage (low baseline WHO scores) were expected to benefit most, while those without preexisting conditions and at more advanced stages of COVID-19 could potentially be harmed. In the derivation cohort, odds ratios for worse outcome, where smaller odds ratios indicate larger benefit from CCP, were 0.69 (95% credible interval [CrI], 0.48-1.06) for B1, 0.82 (95% CrI, 0.61-1.11) for B2, and 1.58 (95% CrI, 1.14-2.17) for B3. Testing on 4 external datasets supported the validation of the derived TBIs. Conclusions and Relevance: The findings of this study suggest that the CCP TBI is a simple tool that can quantify the relative benefit from CCP treatment for an individual patient hospitalized with COVID-19 that can be used to guide treatment recommendations. The TBI precision medicine approach could be especially helpful in a pandemic.
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COVID-19/therapy , Hospitalization , Patient Selection , Plasma , Therapeutic Index , Aged , Blood Grouping and Crossmatching , Comorbidity , Female , Humans , Immunization, Passive , Male , Middle Aged , Odds Ratio , Pandemics , Respiration, Artificial , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , World Health Organization , COVID-19 SerotherapyABSTRACT
Importance: COVID-19 convalescent plasma (CCP) is a potentially beneficial treatment for COVID-19 that requires rigorous testing. Objective: To compile individual patient data from randomized clinical trials of CCP and to monitor the data until completion or until accumulated evidence enables reliable conclusions regarding the clinical outcomes associated with CCP. Data Sources: From May to August 2020, a systematic search was performed for trials of CCP in the literature, clinical trial registry sites, and medRxiv. Domain experts at local, national, and international organizations were consulted regularly. Study Selection: Eligible trials enrolled hospitalized patients with confirmed COVID-19, not receiving mechanical ventilation, and randomized them to CCP or control. The administered CCP was required to have measurable antibodies assessed locally. Data Extraction and Synthesis: A minimal data set was submitted regularly via a secure portal, analyzed using a prespecified bayesian statistical plan, and reviewed frequently by a collective data and safety monitoring board. Main Outcomes and Measures: Prespecified coprimary end points-the World Health Organization (WHO) 11-point ordinal scale analyzed using a proportional odds model and a binary indicator of WHO score of 7 or higher capturing the most severe outcomes including mechanical ventilation through death and analyzed using a logistic model-were assessed clinically at 14 days after randomization. Results: Eight international trials collectively enrolled 2369 participants (1138 randomized to control and 1231 randomized to CCP). A total of 2341 participants (median [IQR] age, 60 [50-72] years; 845 women [35.7%]) had primary outcome data as of April 2021. The median (IQR) of the ordinal WHO scale was 3 (3-6); the cumulative OR was 0.94 (95% credible interval [CrI], 0.74-1.19; posterior probability of OR <1 of 71%). A total of 352 patients (15%) had WHO score greater than or equal to 7; the OR was 0.94 (95% CrI, 0.69-1.30; posterior probability of OR <1 of 65%). Adjusted for baseline covariates, the ORs for mortality were 0.88 at day 14 (95% CrI, 0.61-1.26; posterior probability of OR <1 of 77%) and 0.85 at day 28 (95% CrI, 0.62-1.18; posterior probability of OR <1 of 84%). Heterogeneity of treatment effect sizes was observed across an array of baseline characteristics. Conclusions and Relevance: This meta-analysis found no association of CCP with better clinical outcomes for the typical patient. These findings suggest that real-time individual patient data pooling and meta-analysis during a pandemic are feasible, offering a model for future research and providing a rich data resource.
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COVID-19/therapy , Hospitalization , Pandemics , Patient Selection , Plasma , Aged , Bayes Theorem , Female , Humans , Immunization, Passive , Male , Middle Aged , Respiration, Artificial , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , World Health Organization , COVID-19 SerotherapyABSTRACT
Background: People with kidney failure who are on facility-based hemodialysis (FBHD) are at high risk for COVID-19 infection due to inherent alterations in their immune system as well as the requirement to travel to a health care facility multiple times per week. In Alberta Kidney Care South, AKCS, public health measures and standardized screening of all patients entering clinics and HD units was initiated in March 2020 with COVID-19 testing of all patients who presented with a temperature, COVID related symptoms or a history of exposure to COVID-19. Methods: All COVID-19 test results performed for AKCS patients are tracked in the electronic kidney database. We performed a 14-month prospective observational study (March 2020 to May 2021) to determine the incidence of confirmed COVID-19 infections, the prevalence of symptoms amongst COVID + patients and outcomes of hospitalization and death for FBHD, home hemodialysis (HHD) and peritoneal dialysis (PD) patients within the Alberta Kidney Care South program. Results: We report on our preliminary results up to December 31, 2020. From a population of 1 329 patients, (931 FBHD, 102 HHD and 296 PD) 46(3.5%) patients were COVID positive. COVID-19 prevalence was 3.5% in FBHD (33/931), 4.4% in PD (13/296) and no HHD patients. The mean age of the cohort was 61 ± 16.5 years with 14(30%) female and comorbidities of hypertension 43(93%), diabetes 35(76%), coronary artery disease 16(35%) and heart failure 10(22%). COVID-19 testing was done for the following reasons: contact with a known COVID-19 person in 4(8.7%), resident of a long-term care facility in 3(6.5%) and for symptoms in 31(67%). The most common symptoms were fever (defined as T> 37.3C) with 20(43%), cough 10(22%) and sore throat 6(13%). Overall, 14 patients (30%) were admitted to hospital, 4 of whom went to the ICU and 5(11%) died. There were no differences in hospitalization between FBHD and PD (30% vs 31% respectively p = 0.971), ICU admissions (12% vs 0%, p=0.189) or death (12% vs 8 %, p=0.664). Conclusions: The prevalence of COVID-19 amongst FBHD and PD patients was similar to the general population but with higher rates of hospitalization, ICU admissions and death. People on HHD appear to have very low rates of COVID-19 as compared to either PD or FBHD.
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Background: The COVID-19 pandemic has led to significant disruptions across all levels of medical training. International fellows in subspecialty training programs are essential members of the frontline physician workforce, who may be facing additional and unique challenges being far away from their home country. We aimed to understand the impact of the pandemic on the wellbeing of current international fellows in the Hematology/Oncology training program. Methods: We conducted an online survey of 52 international fellows at the PMCC from July 6-August 10, 2020. There were 60 questions divided into 4 sections: demographics, wellbeing assessment using the validated Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), fellowship specific questions (personal and professional) and coping strategies using the validated brief COPE scale. Results: Response rate was 46% (n = 24). Relevant demographics include: married (65%), male (54%), age between 31-35 years (48%), have children (48%), and home country from Asia (48%). Mean SWEMWBS score was 21, indicating lower overall wellbeing than the general population (23.6). Compared to pre-COVID-19, many reported a decline in their wellbeing (63%), sense of guilt for not being with their family (45%) or helping their country (41%), stress in personal relationships (26%), fatigue (50%), sleep disorders (38%) and loss of interest in daily activities (38%). Personal events were altered by almost 80% and 20% plans to extend their fellowship. According to the Brief- COPE scale, most fellows used more adaptive coping mechanisms (mean score 39.2) as opposed to maladaptive ones (mean score 21.8). Conclusions: The ongoing COVID-19 pandemic has negatively affected the overall wellbeing of international fellows. Understanding the specific challenges and coping mechanisms of international fellows may help Institutions develop better targeted strategies to promote their overall wellbeing, professional development and highquality patient care during these unprecedented times.
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Background: The COVID19 pandemic stopped most face to face (F2F) interventions like CPAP & NIV as they were deemed aerosol generating (AGP) and only telephone consultations continued. Prior to this we were performing 30 CPAP trials/week. We realised that without an alternative our patients will have to wait a long time for treatment. Methods: We sent CPAP machines by post with MirageFX nasal mask, a sizing gauge for full face mask along with a link to a Youtube video that we created simulating F2F trial. Patients received a phone call prior to sending the kit explaining what to expect & address any concerns. A pre-setup Airsense 10 machine with our standard CPAP booklet was sent and remote monitoring was enabled for a 4 week virtual review. We assessed patients' experience with this system and whether this could become the new normal. A survey questionnaire was sent to all patients. Most responses were on a 5 point Likert scale, 0 being very poor & 5 excellent. Results: We sent 171 CPAPs(ESS 12±5,ODI 32±22) between 27th April & 17th July 2020. 85(50%) responded to the (Table presented) survey. 95% felt able to set up the device successfully. 80% felt better or much better. Overall satisfaction score was 9/10 on a 10 point scale. 75% accessed the video. Table 1 shows the results. Conclusion: 95% patients could setup their devices through remote instructions without any F2F interaction. Initial phone call from the clinical team helped to address queries reducing future interactions. This new way of CPAP trial shows excellent patient satisfaction & less than half needed additional support. Most patients felt symptomatically better, suggesting good response to CPAP. Moving routine trials from F2F to postal had a significant impact in reducing waiting list, room utilizations, AGPs, PPE & man power usage. This reduced hospital visits during pandemic & allowed us to focus on more vulnerable patients. Currently we are sending 30 postal CPAPs/wk. If we have a second spike all F2F interactions might stop again hence we propose this as the standard practice limiting F2F CPAPs only in situations when this is not possible.