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Introduction: Cognitive difficulties experienced in MS impact areas such as work, socialising, self-care and many activities of daily living. There is a high prevalence of cognitive difficulties in MS, but despite this there are few programmes targeting cognition that focus on the ability to function well in everyday life. The COB-MS programme, an occupation-focused cognitive intervention, was developed to address this. It focuses on both the functional difficulties and the wide-ranging symptoms that present in MS, including the ability to maintain employment, social activities, home management and self-care. Objective(s): Here we report on the results of feasibility and initial efficacy of the COB-MS as a cognitive intervention for people with MS. Method(s): Although initially designed for in-person delivery, the COB-MS was adapted for online delivery due to the COVID-19 pandemic. Data was collected from people with MS experiencing cognitive difficulties at baseline, post-intervention, 12-weeks, and 6-month follow-up. The primary outcome measure was the Goal Attainment Scaling at 12 weeks. Data was also collected in cognition, quality of life, and mood. Result(s): One hundred and twenty-five people with MS and cognitive difficulties were randomised to either usual care or COB-MS intervention. Ninety-four participants were retained at 6-month follow-up. Fidelity data was collected and analysed for occupational therapist conducting the intervention. A qualitative evaluation of the COB-MS from the perspective of participants also took place. All feasibility results will be presented- preliminary efficacy, participant experiences, intervention fidelity, and overall outcomes from the trial. Conclusion(s):The results provide recommendations for a future definitive trial of COB-MS, with respect to both feasibility and preliminary, clinical efficacy.
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We review the effects of the COVID-19 pandemic on inequalities in education, the labor market, household living standards, mental health, and wealth in the United Kingdom. The pandemic has pushed up inequalities on several dimensions. School closures, in particular, disrupted the learning of poorer children, leading to lower attainment. Mental health worsened for those groups (women and younger adults) who had poorer mental health pre-pandemic. Lockdowns and social distancing particularly reduced the ability of younger, lower-earning, and less educated people to work. However, job-support programs combined with the expanded welfare system meant that, if anything, disposable income inequality fell. Rising house prices have benefited people around the middle of the wealth distribution. In the longer term, lower work experience and training for the less educated and missed schoolingparticularly among children from more deprived familiescould push up human capital inequalities and reduce social mobility. © 2022 Annual Reviews Inc.. All rights reserved.
ABSTRACT
Approximately 43-70% of people living with multiple sclerosis (MS) experience cognitive impairment. This study-within-a-trial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS), a holistic therapy on the management of cognitive symptoms in MS. Reliable remote cognitive testing could provide safer and more convenient care for MS patients, during the COVID-19 pandemic and thereafter. The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people to 68 people with MS experiencing cognitive difficulties. Group 1 (N=34) were tested in-person pre-pandemic. Group 2 were tested remotely. No significant differences between virtual and in-person administrations of the CVLT-II and SDMT were detected. BVMT-R scores were significantly higher for virtual administrations, possibly indicating inter-rater differences. Strong positive correlations were found for in-person and virtual scores within Group 1 on the CVLT-II. The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS. Future research with larger samples could investigate performance on BVMT-R with regards to screen size of device used.
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The coronavirus disease 2019 (Covid-19), which caused respiratory problems in many patients worldwide, led to more than 5 million deaths by the end of 2021. Experienced symptoms vary from mild to severe illness. Understanding the infection severity to reach a better prognosis could be useful to the clinics, and one study area to fulfill one piece of this biological puzzle is metabolomics. The metabolite profile and/or levels being monitored can help predict phenotype properties. Therefore, this study evaluated plasma metabolomes of 110 individual samples, 57 from control patients and 53 from recent positive cases of Covid-19 (IgM 98% reagent), representing mild to severe symptoms, before any clinical intervention. Polar metabolites from plasma samples were analyzed by quantitative 1H NMR. Glycerol, 3-aminoisobutyrate, formate, and glucuronate levels showed alterations in Covid-19 patients compared to those in the control group (Tukey's HSD p-value cutoff = 0.05), affecting the lactate, phenylalanine, tyrosine, and tryptophan biosynthesis and d-glutamine, d-glutamate, and glycerolipid metabolisms. These metabolic alterations show that SARS-CoV-2 infection led to disturbance in the energetic system, supporting the viral replication and corroborating with the severe clinical conditions of patients. Six polar metabolites (glycerol, acetate, 3-aminoisobutyrate, formate, glucuronate, and lactate) were revealed by PLS-DA and predicted by ROC curves and ANOVA to be potential prognostic metabolite panels for Covid-19 and considered clinically relevant for predicting infection severity due to their straight roles in the lipid and energy metabolism. Thus, metabolomics from samples of Covid-19 patients is a powerful tool for a better understanding of the disease mechanism of action and metabolic consequences of the infection in the human body and may corroborate allowing clinicians to intervene quickly according to the needs of Covid-19 patients.
Subject(s)
COVID-19 , Amino Acids , COVID-19/diagnosis , Formates , Glucuronates , Glycerol , Humans , Lactates , Metabolomics , SARS-CoV-2ABSTRACT
Background: There is little data available on vaccine hesitancy rates in Irish parents, particularly in relation to the influenza vaccine (InV). Evidence to date would suggest that the morbidity from COVID-19 is lower in paediatric populations than that from influenza. Vaccination strategies are likely to be required for both infections, and as such, understanding parental perception of both vaccines is essential. Aims: We hoped to identify vaccination hesitancy rates for routine childhood vaccines (RCV) and for the influenza vaccine (InV). We then sought to identify intended uptake rates of the InV and any potential paediatric COVID-19 vaccine and review this data to try to identify trends in vaccination perceptions. Methods: A 10 item anonymised questionnaire was distributed to parents of all patients admitted under the General Paediatric team in a large tertiary centre in Dublin for 4 weeks during November 2020. Results were compiled and analysed, with scoring averages used to determine perceived vaccine efficacy scores (PVES) from a minimum of 1 to a maximum of 5 amongst the population and its subgroups. Results: A total of 214 questionnaires were analysed. The average age was 59.45 months, with the median being 34 months. Of those due to have commenced their RCV schedule, 92.98% were up to date, with 2.7% having received no vaccinations. The average PVES for RCV and the InV was 4.67 and 4.31, respectively. Of those eligible to receive the InV this year (n=143), 37.8% were either very likely or likely to receive the vaccine, with 47.6% unsure, unlikely, or very unlikely. PVES decreased steadily with increasing hesitancy, to a nadir of 4.13 for RCH and 3 for the InV in the very unlikely subgroup. The average likelihood to receive a COVID-19 vaccination, if one were available, was 3.67. Only 23.83% were likely or very likely to vaccinate against influenza and COVID-19 simultaneously. With regards to preferable vaccination, 22.9% would prefer COVID-19 vaccination, 20.56% would prefer Influenza vaccination, 41.59% had equal preference, and 13.55% wanted neither. Discussion: Our study showed high PVES for both RCV and InV as well as high vaccination rates, but comparatively low intended rates of uptake of the Influenza vaccine and a potential COVID-19 vaccination. More research as to the reasoning behind this is needed in order to plan potential vaccination strategies.
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Background: The COVID-19 pandemic posed unique challenges in the delivery of patient care across all subspecialties, including the paediatric cystic fibrosis (CF) service. In our Irish tertiary centre we sought to utilise technology to deliver the same standard of care to our patients whilst minimising their COVID-19 exposure risk. Methods: We established virtual CF outpatient appointments consisting of a consultant phone-call and subsequent contact with the different members of the multi-disciplinary team (MDT). Our "Drop-In" review service continued, with COVID-19 precautions added. Patient experiences of these clinics were evaluated using a five-point online questionnaire issued to parents at the end of 2020. Results: We achieved a response rate of 82 out of 125 (65.6%). A total of 50/82 (61%) found it "easy" to maintain contact with the CF team, with 7/82 describing it as either "somewhat difficult" or "difficult". In terms of OPD satisfaction as an alternative to face-to-face medical review, 67/82 (81.7%) described themselves as either "satisfied" or "somewhat satisfied" with the clinics. Only 2/82 (2.4%) were "dissatisfied" with the OPDs. A total of 66/82 (80.5%) felt it would be helpful to retain an element of the clinics going forward. The majority of respondents, 53/82 (64.6%), said that the pandemic had "no real effect" on their likelihood of attending for an in-person medical review, with 14/82 (17.1%) saying they were "much less likely" to attend. Only 3/82 were "more likely" to attend. Individualised comments were varied, with the increased use of technology, anxiety regarding COVID-19 exposure, and a desire to avoid the hospital, all frequent themes. Conclusion: Our results and feedback indicated a consistent parental desire to avoid the hospital and the perceived infection risk during the pandemic. However, our clinic arrangements did not increase parental feelings of isolation. The potential use of these clinics in conjunction with face-to-face visits should be considered as a viable option in paediatric CF outpatient management.
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Background: Whilst the Irish Health Service Executive (HSE) currently recommends COVID-19 screening for all adult hospital admissions, current guidelines state that the screening of asymptomatic paediatric admissions is not necessarily required. However, clinically determining who requires testing can be difficult and subject to inter-carer variability. We sought to audit our acute admissions and swab results to determine rates of testing, characteristics of those being tested, and rates of positivity in a busy Irish tertiary paediatric unit. Methods: We reviewed the charts of 122 patients admitted acutely to our unit over the course of July 2021 to determine whether or not they had undergone COVID-19 screening using a nasopharyngeal PCR test and the clinical indication for testing. The clinical presentation of these admissions was analysed to try to determine positive predictive factors for COVID-19 screening and better streamline surveillance criteria. Results: A total of 122 admissions were analysed, with 74 (60.7%) having had a COVID-19 PCR test performed at the point of admission. Of these, 1 patient was found to be COVID-19 positive, giving an overall positivity rate of 0.8% amongst admissions analysed and 1.4% for admissions screened. The patient who returned a positive result was febrile at presentation but did not have any respiratory symptoms. Respiratory symptoms were documented for 45 of the 122 admissions (36.9%), and 42 of these underwent COVID-19 screening (93.3%). All swabs were negative. A total of 59 out of 122 were febrile at presentation, 55 (93.2%) of whom underwent screening. As above, 1 case tested positive. Of the afebrile patients, 19 out of 64 underwent COVID-19 screening. COVID-19 screening was performed in 12 patients who did not have a fever or respiratory symptoms at the time of presentation. In terms of non-respiratory presentations, screening was performed in 12 out of 14 (85.7%) presenting with gastritis/gastroenteritis, and 9 out of 12 (75%) presenting with a history and examination consistent with a UTI/pyelonephritis. Of 18 patients who were admitted with primarily psychiatric presentations, none had either a fever or respiratory symptoms at presentation, and none underwent COVID-19 screening. Conclusion: Our results reflect the existing data that COVID-19 appears to be less pathogenic in paediatric populations than in adult ones. Our low positivity rate compared to a high swab rate has repercussions in terms of bed allocation and isolation status. There is variation in terms of clinical criteria being viewed as sufficient to justify screening. Further study is required to determine consensus guidelines for COVID-19 surveillance in acute paediatric hospital admissions.
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Introduction: The COVID-19 pandemic has had a significant impact on research and health care in MS. This study-within-atrial (SWAT) takes place within a host trial investigating the feasibility of the Cognitive-Occupation-Based programme for people with MS (COB-MS) that was originally designed to be delivered in-person but was amended to an online environment. As such, reliable remote cognitive testing could provide safer and more convenient care for MS patients. Aims: The SWAT examines the reliability of delivering the Brief International Cognitive Assessment for MS (BICAMS) and the Trail-Making Test (TMT) remotely to people with MS. Objectives: Performance on BICAMS measures and the TMT administered remotely are compared with performance on tests administered in-person. BICAMS measures include the California Verbal Learning Test, Second Edition (CVLT-II), the Symbol Digit Modality Test (SDMT) and the Brief Visuospatial Memory Test-Revised (BVMT-R). Method: Independent samples t-tests were conducted on a sample of 68 participants to investigate differences in performance between Group 1 (11 males, 23 females), who were visited by a research assistant in their homes before the pandemic and Group 2 (10 males, 24 females) who received online testing only via teleconference platform Zoom. Within-group differences for Group 1 who also received virtual testing after a six-month interval were also examined. Results: The analysis revealed no significant differences in scores between virtual and in-person administrations of the CVLT-II, TMT and SDMT. Strong positive correlations were found for inperson and virtual tests within Group 1 after a six-month interval on the CVLT-II, SDMT, TMT-A and TMT-B. BVMT-R scores were significantly higher for virtual testing (M = 20.59, SD = 6.65) compared to in-person testing (M = 16.35, SD = 6.05). However, this discrepancy may be attributed to inter-rater differences, rather than enhanced performance for online testing. In-person and virtual assessments within Group 1 were also strongly correlated (r = .72). Conclusions: The findings support the reliability of remote administration of BICAMS and the TMT in people living with MS.
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Introduction: Traditionally, public and patient involvement (PPI) in research has included people with MS in consultation roles rather than deeper levels of 'involvement'. There has also been limited evidence regarding the impact that such involvement has on the person living with MS or on trials which employ people living with MS, as part of the research team. Here we report on the experiences of a person living with MS who is embedded in a clinical trial throughout the lifetime of the project- an embedded patient researcher (EPR). Aims & Objectives: The aim of this research is to explore and present an embedded patient researcher's (EPR) perspective on PPI integration within a feasibility trial of a Cognitive Occupation- Based programme for people living with MS (COB-MS), with respect to the PPI impact on trial feasibility and potential success. Methods: This presentation is focused on three specific examples of EPR impact, participant recruitment, trial materials and adapting to the impact of the SARS-Cov-2 pandemic on the trial. Due to the high level of PPI integration within COB-MS, significant amendments were made. Results: As a result of a high level of PPI integration, the research team identified the recruitment of between 34% - 62% of participants as a result EPR involvement, which also influenced the decision to extend the role of the EPR to include Patient Advocacy. The EPR's involvement facilitated the development of more accessible trial materials for participants with MS and the development of online protocols for the treatment and assessment of participants. Conclusion: When fully integrated into a trial, PPI - along with the inclusion of an EPR - has the potential to improve participant recruitment, trial material development and adaptability as a result of external factors impacting the trial (with respect to being more suitable for participants with MS.) It has also encouraged the EPR to develop further as a Patient Advocate, by sharing their experience with patients wanting to become more involved in research as well as researchers and educators who want to incorporate PPI in their research or training.