THE EFFECTS OF THE COVID-19 PANDEMIC ON PRESENTATIONS AND DIAGNOSIS OF UPPER GI AND HEPATOPANCREATICOBILIARY MALIGNANCIES

Introduction: In March 2020, Coronavirus Disease 2019 (COVID-19) was declared a pandemic. Elective healthcare services were reorganised worldwide. This study addresses the impact of measures taken in the early stages of the pandemic on diagnosing Upper Gastrointestinal (UGI) and Hepatopancreaticobiliary (HPB) malignancies in a university teaching hospital. Aims: To ascertain whether fewer cases of UGI/HPB cancers were detected, the differences in inpatient and outpatient diagnosis and whether there was an increased detection of later stage disease during the pandemic than in the preceding year. Methods: This was a retrospective cohort study conducted in Tallaght University Hospital in Ireland. All new diagnoses of UGI/HPB cancers, excluding hepatocellular carcinomas, are managed at a weekly Multidisciplinary Team (MDT) meeting. Data was retrieved from the MDT database and medical records and analysed using IBM SPSS Statistics V20. Results: 111 cases were detected. There was no significant difference in the proportion of cases detected in the overall post-COVID period (n=53, 47.7%) compared to the Pre-COVID period (n=58, 52.3%) (p=0.7884). When COVID-19 cases were at their highest levels in Ireland, we observed a significant drop in new UGI/HPB cases detected compared to the pre-COVID period. This was mitigated in the third quarter of 2020, when transmission was depressed and a sharp increase in detection of UGI/HPB cases was observed. The variance of distribution of cases per quarter in the two periods was statistically significant with a P-value of 0.0001. There was a non-significant trend towards fewer diagnoses of early cancer (stage ≤2) in the Post- COVID period (21% v 26%) (p=0.6416). The proportion of patients diagnosed as an inpatient did not differ between the two periods, p=.739. Discussion: As fears about aerosolization abated, endoscopy services quickly increased the number of scopes performed after the initial reduction at the start of the pandemic. There are several limitations to this study, however it does lead us to conclude that our fears regarding cancer diagnosis in the postpandemic period did not materialise. It also offers solace that when transmission of COVID- 19 is depressed, as it was in Ireland in Q3 2020 before the peak of the second wave in Q4 2020, that outpatient services can quickly escalate their level of activity and detect cancers that were missed with no significant change in stage. A further observation is that when lockdown measures in Ireland were reintroduced in winter 2020/2021 but outpatient services were kept open, a similar reduction in detections was observed compared to when they were closed. Therefore, the question may be posed if the primary driver of reduced detection of UGI/HPB cancers is primary care services being overwhelmed with pandemic work rather than a reduction in outpatient services . (Table Presented) (Figure Presented)

A Randomized Controlled Trial of Internet-Based Self-Help for Stress During the COVID-19 Pandemic.

PURPOSE: The COVID-19 pandemic has heightened the need for mental healthcare that can be delivered remotely and at scale to college students. This study evaluated the efficacy of online self-help for stress among students during the pandemic. METHOD: College students with moderate or higher stress (N = 585) were recruited between November 2020 and February 2021, when COVID-19 had a major impact on colleges. Participants were randomly assigned to receive either online self-help using cognitive-behavioral therapy and positive psychology principles to support resilience and coping with pandemic-related stressors (n = 301) or referral to usual care (n = 284). Stress (primary outcome), depression, and anxiety (secondary outcomes) were assessed at pretreatment, one-month post-treatment, and three-month follow-up. RESULTS: Participants in the online self-help condition experienced significantly larger reductions in stress (d = -0.18, p = .035) and depression (d = -0.20, p = .018) from pretreatment to post-treatment than participants in the referral group. Reductions in stress from pretreatment to follow-up were also larger in the treatment versus referral group (d = -0.23, p = .005). Groups did not differ in change in anxiety. More time using the self-help program predicted greater improvement in depression at post-treatment (d = -0.41, p = .001) and follow-up (d = -0.32, p = .007), although usage was unrelated to change in stress or anxiety. CONCLUSION: Online self-help targeting resilience and coping during the pandemic appears efficacious for long-term alleviation of stress and short-term alleviation of depression symptoms among the college students. REGISTRATION: ClinicalTrials.gov (NCT04762173).

College Mental Health Before and During the COVID-19 Pandemic: Results From a Nationwide Survey.

Background: The COVID-19 pandemic could affect college students' mental health. We examined screening rates for psychological disorders before and during the pandemic. Methods: Undergraduates were surveyed before (n = 3643) or during the pandemic (n = 4970). Logistic regression adjusting for participant demographics was conducted. Results: Frequencies of depression [OR 1.32, 95% CI (1.17, 1.48)], alcohol use disorder [OR 1.70, 95% CI (1.50, 1.93)], bulimia nervosa/binge-eating disorder [OR 1.54, 95% CI (1.28, 1.85)], and comorbidity [OR 1.19, 95% CI (1.04, 1.35)] were greater during (vs. before) the pandemic. Frequencies of posttraumatic stress disorder were lower during the pandemic [OR 0.86, 95% CI (0.75, 0.98)]. The upward trend in alcohol use disorder was stronger among women than men [OR 1.47, 95% CI (1.18, 1.83)]. The upward trend in depression was stronger among Black students than White students [OR 1.72, 95% CI (1.19, 2.49)]. Anxiety disorders, insomnia, anorexia nervosa, and suicidality showed no significant trends. Conclusions: Depression, alcohol use disorder, bulimia nervosa/binge-eating disorder, and comorbidity were higher, whereas posttraumatic stress disorder was lower during the pandemic. Women and Black students could face especially heightened risk for alcohol use disorder and depression, respectively, during the pandemic.