The mental health of staff working in UK prisons during the Covid-19 pandemic

This article presents the results of an opportunistic, cross-sectional, self-report survey of the well-being of staff working in prisons throughout the UK. The survey was completed by 594 participants in the early part of 2021 at the height of the Covid-19 pandemic. Self-report measures indicated concerning levels of burnout and 43.4% of participants were above the established cut-offs on the Generalised Anxiety Disorder (GAD-7) scale. Eighty-one per cent reported that their mental and physical health had deteriorated and many said emotional support was lacking. Further research is required to establish how typical and persistent these concerns are. © 2023 The Authors. The Howard Journal of Crime and Justice published by Howard League and John Wiley & Sons Ltd.

142. The Reach, Implementation, and Effectiveness of Virtual Sex Education for Youth in Foster Care

Purpose: Youth in foster care have high rates of adverse sexual health outcomes and are important targets for evidence-based sex education. With the COVID-19 pandemic, sexual health programming was moved to a virtual format. However, few data existed to guide this transition. While it lowers expenses and can potentially broaden geographic reach, it is unclear if virtual programming meets the needs of youth in foster care or other vulnerable populations. We conducted a mixed-methods analysis comparing the reach, implementation, and effectiveness of virtual vs in-person sex education for youth in foster care before and during the COVID-19 pandemic. Methods: Indiana Proud and Connected Teens (IN-PACT) provides evidenced-based sex education programs to system-involved youth. The data used in this study focused exclusively on foster-care programming and includes attendance records, facilitator session reviews (n=64) from 2020-2021 virtual programs, and youth surveys from 2018-2020 in-person (n=965) and virtual (n=50) programs. Reach was measured using youth baseline survey demographics and sexual behaviors;implementation by free responses from facilitators on challenges and adaptation for virtual teaching;and effectiveness by attendance records and youth behavior intention on follow-up surveys. Results: Reach: Youth demographic diversity was maintained for virtual programming in ethnicity, race, sex, and sexual orientation. However, youth in virtual programs had lower rates of self-reported risk behaviors including lower rates of involvement with juvenile justice (35.0% vs 59.4%, p<0.01) to have ever had sex (44.4% vs 78.8%, p<0.001) or contributed to a pregnancy (4.4% vs 23.4%, p<0.05). And though not statistically significant, virtual youth reported higher rates of condom use (44.4% vs 30.4%, p=0.371) and lower rates of substance use before sex in the past 3 months (15.6% vs 28.5%, p=0.114) as compared to in-person youth. Implementation: Technical challenges included connection difficulties and learning curves to using Zoom. Virtual facilitators incorporated more technology than they did in-person by playing videos on complicated topics such as conception and STIs. In terms of curriculum, hands-on condom demonstrations were changed to facilitator-run experiments such as having youth use socks at home to simulate condoms on their arms. Breakout rooms were utilized to maintain small group work but were cumbersome. Relational challenges included awkward silences, disengagement, and a decrease in group trust due to cameras being turned off during sensitive topics and less connection between youth and facilitators. Effectiveness: Attendance records show that fewer virtual youth completed 100% of programming, as compared to in-person youth (23% vs 54%). More virtual youth answered yes to the question "As a result of this program, will you abstain from sex for the next three months?” as compared to in-person youth (55% vs 45%, p=0.462). However, virtual youth were significantly less likely to have baseline sexual experience. Conclusions: In-person sexual health programming had a wider reach, experienced fewer implementation challenges, and was potentially more effective than virtual programming for youth in foster care. If virtual programming becomes necessary again, sex educators and researchers can use these data to redesign virtual programming that maximizes reach, implementation, and effectiveness. Sources of Support: HHS 90AK0041-02-00 to Health Care Education and Training Inc.

Youth at the Margins: Continuity of Services During the COVID- 19 Pandemic

The coronavirus disease 2019 (COVID-19) pandemic created an increased need for youth services in a system that was already strained and underfunded. The move to remote learning disrupted access to school-based mental health services and limited the exposure of youth to mandatory reporters. Youth receiving services from community-based programs associated with juvenile probation were also affected by the lack of service access. This research provides a synthesis and critical examination of the literature on the delivery of trauma-informed services during COVID-19. Trauma-informed care recognizes the range of traumas that youth experience, including the trauma associated with a global pandemic that exacerbated racial and economic issues for families that were already experiencing marginalization. This research provides recommendations at the institutional, organizational, and interactional levels for maintaining continuity of youth services during COVID-19 as well as lessons learned for future practice. © 2022 selection and editorial matter, Nazneen Khan;individual chapters, the contributors

Social distancing without emotional distancing?

The COVID-19 pandemic has impacted every aspect of society and no more so than in educational applications of theatre for children in schools. This article explores the complexities of what applied theatre/drama offer the young to think critically and develop empathetic human relationships crucial to sound mental health. The article’s authors reaffirm ways in which applied theatre/drama and TIE have contributed to healthy social development through contributions to the Personal, Social and Health Education curriculum. Cited are recent projects with compromised praxis in the face of the pandemic. Identified is a shift in educational priorities that are returning to traditional approaches in place of wider heuristic social education. Consequent moves to online teaching and imposition of social distancing has led to concerning levels of social distancing potentially impacting negatively on mental health of the young. However, applied theatre/drama disciplines play a particular role in facilitating emotional maturity through critical thinking. © 2021, Intellect Ltd.. All rights reserved.

The efficacy of telephone consultations in ear, nose, and throat (ENT)

Background: Telephone consultations have been shown previously to be effective and safe in general practice and in specialties for specific conditions such as human immunodeficiency virus (HIV), inflammatory bowel disease (IBD) and epilepsy. They include certain advantages such as gain of time, but these must be balanced against potential disadvantages in terms of efficacy and patient satisfaction. Until recently, there was no information available on the adequacy of telephone consultations in ear, nose, and throat (ENT). Methods: The study design was a cross-sectional observational study in the context of a service improvement project in a single ENT department during the COVID-19 pandemic. Telephone consultations by three ENT doctors were studied over a 3-week period. Total consultation time, including administrative tasks, and telephone call time were calculated and compared to pre-COVID consultation times. Clinician-assessed adequacy of the consultation was determined. Results: Ninety-six consultations were included;65 were deemed adequate whereas 31 were inadequate due to the lack of examination. Telephone consultations took an average of 16 minutes, of which 9 minutes were spent on the telephone call, compared to an average of 20 minutes for face to face consultations. Conclusions: Telephone consultations were quicker than face to face consultations by 20% and were an appropriate alternative in two-thirds of cases. This suggests that routine practice would benefit from the addition of telephone consultation with selected patients, based on clinical presentation and patient preference. © Journal of Hospital Management and Health Policy. All rights reserved.

Did hand washing and use of personal protective equipment (PPE) reduce transmission of surgical site infections during the SARS-CoV-2 pandemic?

Aim: A retrospective case-control study comparing Surgical Site Infections (SSIs) following primary hip and knee arthroplasty before and during the SARS-CoV-2 pandemic across East Sussex NHS Trust (ESHT). The aim of this study was to evaluate whether the government advice relating to increased vigilance surrounding hand hygiene and use of personal protective equipment (PPE) reduced SSIs following elective arthroplasty. Method: Data was obtained from Public Health England website relating to SSIs following primary hip and knee arthroplasty between April 2019 and March 2020 (pre-pandemic) performed at ESHT and compared to April 2020 to March 2021 (pandemic). Results: A total of 454 patients underwent a total hip replacement (THR) during the pre-pandemic period with 12 patients developing an SSI (2.6%). Comparatively, during the pandemic period, 146 patients underwent a THR with 4 reporting an SSI (2.7%). A total of 449 patients underwent a total knee replacement (TKR) during the pre-pandemic period with 11 reporting an SSI (2.5%). In contrast, 9 of the 138 patients undergoing a TKR during the pandemic group developed an SSI (6.5%). Conclusions: As the data shows, there was no significant difference observed between SSIs following THR performed at ESHT prior to and during the pandemic. Surprisingly, there was a 2.6-fold increase in SSI following TKR during the pandemic period compared with prepandemic. Both of these findings seemingly reject the null hypothesis that increased vigilance to hand hygiene and use of PPE mandated by the government and echoed by healthcare trusts during this time would reduce transmission of infections.

Social distancing without emotional distancing? (Special Issue: Art-based research in health and well-being during the pandemic.)

The COVID-19 pandemic has impacted every aspect of society and no more so than in educational applications of theatre for children in schools. This article explores the complexities of what applied theatre/drama offer the young to think critically and develop empathetic human relationships crucial to sound mental health. The article's authors reaffirm ways in which applied theatre/drama and TIE have contributed to healthy social development through contributions to the Personal, Social and Health Education curriculum. Cited are recent projects with compromised praxis in the face of the pandemic. Identified is a shift in educational priorities that are returning to traditional approaches in place of wider heuristic social education. Consequent moves to online teaching and imposition of social distancing has led to concerning levels of social distancing potentially impacting negatively on mental health of the young. However, applied theatre/drama disciplines play a particular role in facilitating emotional maturity through critical thinking.

A change in clinical practice for aural foreign bodies - what we learnt from the coronavirus disease 2019 pandemic.

OBJECTIVE: This case series, conducted during the coronavirus disease 2019 pandemic, investigates the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications and success rates of subsequent removal attempts. METHOD: A retrospective study of aural foreign body referrals over a six-month period was carried out. RESULTS: Thirty-four patients with 35 foreign bodies were identified (6 organic and 29 inorganic). The duration of foreign bodies left in situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts. First attempts made by non-ENT specialists (68.8 per cent) all failed and were associated with a high risk of trauma (36.4 per cent). CONCLUSION: Because of the coronavirus disease 2019 pandemic, this is the first case series to specifically investigate the relationship between the duration of aural foreign bodies left in situ and the risk of complications. Our data suggest that prolonged duration does not increase the incidence of complications.

Facemasks: Perceptions and Use in an Emergency Department Population During COVID-19

Study Objectives: During the COVID-19 pandemic, the use of facemasks by the general population has become a significant issue despite evidence that shows that facemask use is associated with reduced transmission of SARS-CoV-2, the causative organism of COVID-19. We assessed beliefs, access, and practices of mask wearing across an ED population. Methods: This was a cross sectional survey of ED patients conducted from 12/14/20 - 2/22/21 at 15 geographically diverse safety net EDs. The survey asked questions regarding COVID-19 vaccine and the use of facemasks. In this analysis, the primary outcome was reporting the responses to survey questions regarding mask wearing practice and patient access to masks. Results: Of 2513 patients approached, 2239 (89.1%) agreed to participate. The median age of respondents was 48 years (IQR 34 - 62). The race and ethnicity reported for participants were: 40% White, 29% Black, 24% Latinx and 5% Asian. All other categories each accounted for 1% or less of the respondents. 14.8% reported that they had previously been diagnosed with COVID-19. Most respondents (81%) had primary care doctors or clinics. Of those without primary care, 64% used the ED as their usual source of health care. 78% of respondents reported wearing masks “all of the time” and 17% reported wearing masks >50% of the time. Subjects with primary care providers (PCPs) were more likely to report wearing masks at least most of the time as compared to subjects without primary care (97% vs 92%) Those with no PCP reported more difficulties obtaining masks compared to those who have a PCP (13% vs 6%, p < 0.001). The primary reasons respondents cited for not wearing masks were that they do not believe that masks work, masks are uncomfortable, and masks make it hard to breathe. Subjects with a PCP and those without a PCP both reported that the most common source of masks was through purchasing at a store or pharmacy. Subjects without a PCP were more likely to get masks from a shelter or food bank as compared to those without a PCP (6.5% vs 2.1%). Surveys were administered exclusively in urban EDs, and there may be response bias towards mask wearing in the hospital setting. Conclusion: Overall, respondents in the study reported a high rate of facemask wearing. Having a PCP was associated with higher proportion of respondents who reported wearing a mask at least 50% of the time. Respondents without a PCP also reported greater barriers in obtaining masks than those with a PCP. The results of this study inform on the acceptance rate of facemask usage in a large population of ED patients primarily in an urban setting. Having a PCP provides opportunities for education and distribution of facemasks. There is an opportunity to increase facemask usage through increased education and availability.

Appointment attendance and patient perception of drive-up INR testing in a rural anticoagulation clinic during the COVID-19 pandemic

Introduction: The Anticoagulation Forum and the CDC recommend drive-up INR testing in response to the COVID-19 pandemic. Patient perceptions and impact on patient attendance have not been studied. Research Question or Hypothesis: Does drive-up INR testing impact patient attendance during the COVID-19 pandemic? How is it perceived? How long should drive-up INR testing continue? Study Design: Cross-sectional cohort study surveying pharmacistmanaged anticoagulation clinic patients, with retrospective medical record analysis of appointment volume. Methods: Patients attending the anticoagulation clinic via drive-up or in-office visits were surveyed from May 27 - July 2, 2020. Patients tested off-site were excluded. Study endpoints included monthly patient volume, and visit type preference, INR testing barriers, desired drive-up INR testing duration, and overall clinic satisfaction from the survey. Clinic appointment volume from October 2019 - June 2020 was collected retrospectively through schedule review. SPSS 24 (Chicago: IBM Corporation) was used for analysis. Results: Sixty-four (80%) of 80 surveys offered were completed. Twenty-eight (47%) of patients preferred drive-up testing, sixteen (26%) indifferent, and sixteen (26%) preferred in-office visits. Fortysix and twenty-seven percent of respondents identified reduced COVID-19 transmission risk and ease of transportation as benefits of drive up INR testing, respectively. Thirty-five (59%) wanted drive-up testing to continue indefinitely. Patient satisfaction before and after drive up testing remained high at 2.75 on a scale of 0-3. March and April clinic volumes were 19% and 22% below average, respectively, returning to baseline after drive-up testing was implemented. Conclusion: Drive-up INR testing improves patient attendance during the COVID-19 pandemic. Patient perception of drive-up testing is positive. The large percentage of patients who want drive-up testing to continue indefinitely suggest this as a potential method to allay barriers to routine monitoring beyond the scope of the pandemic.