Zoonotic diseases in animal agriculture and beyond: a one health perspective

This publication focuses on a group of vignettes to help understand zoonotic diseases, the anthropogenic factors accelerating their emergence, and the consequences of these events. While human activities and behavior are mostly responsible for creating this new era, the world struggles to prepare, change behavior, and rethink strategies to effectively address the inevitability of more frequent occurrences and severity of disease outbreaks and pandemics. Although we know and have experienced the cost of failure, past disease outbreaks seem to be quickly lost from our collective memories and new innovative interventions have not been imagined or adopted. This publication highlights examples that challenge our traditional actions and thinking and emphasize the need to adopt new approaches to prevent or ameliorate zoonotic diseases. The consensus of the experts contributing to this publication is that One Health should be embraced to achieve these results. The growing costs and societal disruptions of outbreaks and pandemics demand that zoonoses be part of our national security planning and deserve commensurate investments in preparedness, prevention, research, and resilience. This publication also highlights the necessity to fundamentally rethink and reestablish new relationships among institutions, organizations, and countries and especially between humanity and our natural systems worldwide.

Evusheld prophylaxis increases social interactions and improves anxiety, depression, agoraphobia and quality of life scores

Evusheld is a combination injection of tixagevimab/cilgavimab for pre-exposure COVID-19 prophylaxis and was made available to UK private clinics from October 2022. NICE review is ongoing. Whilst efficacy analysis of Evusheld has focused on the risk-reduction of contracting COVID-19, anecdotal reports suggest additional psychological benefits from Evusheld, although supportive objective data are lacking. In this study, we used 4 well-established psychological health questionnaires to assess different psychological parameters (EQ5D-3 L quality of life (QoL) score, DSM5 Agoraphobia score, Duke's Social Support Index (DSSI) and the hospital anxiety and depression score (HADS)) in blood cancer patients treated with Evusheld at the Genesis Care (GC) Clinic, Cambridge. Patient data (pre-and post-Evusheld) were compared with a control group of GC blood cancer patients who had not received Evusheld. The study was approved by GC and all patients had consented to email contact. Questionnaire replies were anonymised and free-text comments were invited. Questionnaires were completed by 29/40 Evusheld and 54/100 control patients. With EQ5D, Evusheld did not impact mobility, self-care and pain/discomfort scores and patient/ control groups scored at similar levels. EQ5D scores for 'usual activities' and 'anxiety/depression' improved post-Evusheld (patients reporting 'normal activities' increased from 52% to 76% (control = 78%);patients reporting 'no anxiety/ depression' increased from 45% to 66% (control = 65%)). The mean global EQ5D QoL score improved post-Evusheld [69.4% to 72.9% (control = 75.7%)]. With the DSM5 agoraphobia score, Evusheld treatment improved agoraphobia parameters, reducing the mean score from 15.7 to 5.1 (control = 3.7;max = 40) with certain striking changes;72% of pretreatment patients avoided crowded situations all of/most of the time, reducing to 14% post-Evusheld (control = 11%). The DSSI score assessed social/work interactions with external household contacts and post-Evusheld the mean number of interactions over 3 weeks increased from 1.48 to 3.37 (control = 3.77). Pre-Evusheld, 52% of patients had no interactions outside their household, dropping to 20% in the 3 weeks post-Evusheld (control = 17%). Using the HADS 14-point analysis of depression and anxiety revealed on average that each parameter was 25.3% 'significantly improved' and 25.4% 'a little improved' post-Evusheld. Accepting limitations of a small study and potential biases associated with a self-funding patient cohort, Evusheld treatment broadly improved all psychological scores assessed. Free-text comments clearly indicate that Evusheld had a major positive impact on QoL/social mobility for specific patients. The Evusheld patients had higher baseline scores for social isolation, anxiety, depression and agoraphobia compared with control patients, yet Evusheld treatment appeared to improve these parameters to a level similar to control patients.

Benefits and Challenges of Telehealth Use during COVID-19: Perspectives of Patients and Providers in the Rural South

Social workers and other health care researchers have examined benefits and challenges of telehealth in rural communities before the COVID-19 pandemic. Yet, experience with virtual platforms and other technologies have rapidly evolved during the pandemic. The research team interviewed 14 health care providers and 17 patients after the onset of the pandemic in a predominantly rural state to examine perceptions of telehealth. MaxQDA analytic software was used to identify benefits and challenges in the use of telehealth. Findings identified commonly discussed benefits of telehealth including convenience for patients, increasing patient access to care, improved patient experience of care, and ability of telehealth to attract/retain patients. Challenges identified in this study included concerns about quality of care being compromised, patients' comfort and access to technology, policy challenges for providers, and the impersonal nature of telehealth visits. Persistent issues warrant research, education, and policy advocacy to improve access for rural populations. Social workers should play a key role in educating the emerging and existing workforce around barriers such as quality of care and patient comfort with technology, convening professionals and patients to establish sustained and effective reimbursement models, and advocating for structural access via enhanced broadband and other resource allocations. © 2022 Authors.

DEMOCRATIZATION OF KNOWLEDGE IN TIMES OF PANDEMIC AMONG TEACHERS

Information and Communication Technologies (ICT) have gained great relevance as a result of the health situation produced by Covid-19, so new dynamics in teacher training are proposed. The study is a descriptive qualitative study using case studies, content and discourse analysis. The teachers explain the adaptation of the technopedagogical design, motivating them to the proactive self-learning of their students. The pedagogical sense of the use of ICT provided a learning scenario to favor the enrichment of teachers' practices, where the democratization of knowledge is achieved. © GKA Ediciones, authors.

Prevalence and correlates of stocking up on drugs during the COVID-19 pandemic: Data from the C3PNO Consortium.

BACKGROUND: Data from the COVID-19 pandemic describes increases in drug use and related harms, especially fatal overdose. However, evidence is needed to better understand the pathways from pandemic-related factors to substance use behaviours. Thus, we investigated stockpiling drugs among people who use drugs (PWUD) in five cities in the United States and Canada. METHODS: We used data from two waves of interviews among participants in nine prospective cohorts to estimate the prevalence and correlates of stockpiling drugs in the previous month. Longitudinal correlates were identified using bivariate and multivariate generalized linear mixed-effects modeling analyses. RESULTS: From May 2020 to February 2021, we recruited 1873 individuals who completed 2242 interviews, of whom 217 (11.6%) reported stockpiling drugs in the last month at baseline. In the multivariate model, stockpiling drugs was significantly and positively associated with reporting being greatly impacted by COVID-19 (Adjusted Odds Ratio [AOR]= 1.21, 95% CI: 1.09-1.45), and at least daily use of methamphetamine (AOR = 4.67, 95% CI: 2.75-7.94) in the past month. CONCLUSIONS: We observed that approximately one-in-ten participants reported stocking up on drugs during the COVID-19 pandemic. This behaviour was associated with important drug-related risk factors including high-intensity methamphetamine use. While these correlations need further inquiry, it is possible that addressing the impact of COVID-19 on vulnerable PWUD could help limit drug stockpiling, which may lower rates of high-intensity stimulant use.

Sugar taxation for climate and sustainability goals

Recovering from the impacts of the coronavirus pandemic while achieving environmental goals requires creative policy measures. This study analyses the sustainability co-benefits of reducing sugar consumption through redirecting existing sugar cropland to alternative uses via sugar taxation. Meeting environmental sustainability goals while simultaneously recovering from the health and economic crises arising from the coronavirus pandemic requires creative policy solutions. Sugar taxation presents one such policy as sugar crops are arguably the least efficient to consume from a health perspective but the most efficient for biofuel production. Here we analyse the sustainability co-benefits of reducing sugar consumption through redirecting existing sugar cropland to alternative uses. Emissions could fall 20.9-54.3 Mt CO(2)e yr(-1) if the EU were to reduce its sugar consumption in line with health guidelines and the excess Brazilian sugar cane redirected to ethanol. These savings would be around four times higher than an alternative strategy of afforesting existing EU sugar beet cropland and double those from producing sugar beet ethanol in the European Union. Achieving this through policies aimed at behavioural change, with a serious role for sugar taxation, would not only reduce the environmental impacts of biofuels but also provide health and economic benefits.

Evaluating the effectiveness of an online group programme to manage Multiple Sclerosis-related fatigue

Background and aim: A group-based fatigue management programme called FACETS has typically been delivered face-to-face to people living with MS within a neuropsychology service. In response to Covid-19 government guidelines, this service adapted to online delivery of their fatigue management group intervention. This study aims to evaluate two FACETS group interventions which were delivered online consecutively within this service. Methods: Group 1 was delivered face-to-face for the first three sessions before being adapted for virtual delivery for the final three sessions. Group 2 was delivered virtually for all six sessions. Quantitative data was collected from outcome measures collected pre-and post-group. Qualitative feedback was gathered to explore participants’ experience of the group as well as the adapted virtual delivery. A thematic analysis was undertaken to identify key themes. Results: Participants in both groups felt they had more control over managing their fatigue and it was having less of an impact on their quality of life. Five themes were identified from participants’ qualitative feedback (knowledgeable content, awareness and learning, validating experience, accessible amendments, patient choice). Discussion: Feedback was largely positive from both groups following the adaptation to online delivery as it offered a cost-and time-effective solution. Participants reflected on the value of a mixed delivery option for future group interventions to facilitate rapport with other participants and empower self-management of their fatigue. © 2022, British Psychological Society. All rights reserved.

Sensory Integration Balance Deficits in Complex mTBI: Can Early Initiation of Rehabilitation With Wearable Sensor Technology Improve Outcomes?

Objectives: 1) To determine the role of timing in rehabilitation of balance deficits in people with mTBI 2) To determine if home monitoring improves outcomes 3) To develop a novel feedback system using wearable sensors to provide physical therapists with real-time information about quality of head and trunk movement during exercise. Plan: This is an interventional study on people with mTBI. Aim I examines whether initiating interventional physical therapy earlier rather than later improves outcomes. Aim II, nested within Aim I, examines whether home monitoring of vestibular rehabilitation improves outcomes. Aim III develops a system capable of delivering real-time feedback on quality to improve outcomes.

142 Improving Functional Outcomes During Covid-19 for Both COVID-19 and Non COVID-19 Positive Older Adults Through the Introduction

Purpose To improve the functional outcomes of older adults presenting to the Health and Ageing wards during the COVID-19 pandemic through a focussed rehabilitation list. The intended benefits to the older adult and service were for: 1. Daily rehabilitation input for older adults. 2. Older adults to spend less time immobile. 3. Ongoing rehabilitation intervention while awaiting medical clearance for discharge. 4. Increased staff satisfaction 5. Better outcomes on discharge. 6. Rehabilitation ethos on the Health and Ageing wards. Methods The quality improvement project was carried out using the Plan, Do, Study, Act (PDSA) cycle. Three iterative PDSA cycles were carried out over the course of the project to deliver proactive interventions as a result of analysis of baseline data and stakeholder involvement. These interventions were aimed at developing communication around the rehabilitation list within the team and sustainability of this list. Results The project resulted in better functional outcomes for older adults and increased staff morale. Between May 2020–June 2020, a total of 56 patients were seen on the rehabilitation list, with 84% of these patients seeing improvements in their Elderly Mobility Scores (EMS). 27% of patients on the rehabilitation list saw a change to their initial discharge plan, either needing reduced packages of care or reduced need for ongoing rehabilitation in an external setting. Conclusions The quality improvement project found that with focussed rehabilitation older adult inpatients with or without COVID-19 can make significant functional gains. These gains have wider effects on their outcomes on discharge and also for the service through increased morale and job satisfaction. Due to demand and capacity issues in the acute setting, older adults who would often benefit from ongoing input are not always reviewed regularly. This project demonstrates that with focussed rehabilitation older adults can improve and achieve better functional outcomes.

Reflections on running an International Public Health Film Competition during the COVID-19 pandemic and implications for future film festivals

The COVID-19 pandemic has had a substantial impact on the film industry in 2020. Films that tell the story of the pandemic by giving independent commentaries are important to our understanding of life during these rare public health events. However, it is unclear what effects the pandemic would have on the production of these films. In this Letter we describe a unique global collaboration that saw the launch of an International Public Health Film Competition during the first wave of the pandemic in early 2020 to collect the ‘best health-related’ stories told through film. We reflect on the process followed for this competition and provide insights for future film competitions/ festivals. © 2021 Informa UK Limited, trading as Taylor & Francis Group.

Emergency Department Management of the Covid-19 Pandemic.

BACKGROUND: Emergency departments (EDs) need to be prepared to manage crises and disasters in both the short term and the long term. The coronavirus disease 2019 (COVID-19) pandemic has necessitated a rapid overhaul of several aspects of ED operations in preparation for a sustained response. OBJECTIVE: We present the management of the COVID-19 crisis in 3 EDs (1 large academic site and 2 community sites) within the same health care system. DISCUSSION: Aspects of ED throughput, including patient screening, patient room placement, and disposition are reviewed, along with departmental communication procedures and staffing models. Visitor policies are also discussed. Special considerations are given to airway management and the care of psychiatric patients. Brief guidance around the use of personal protective equipment is also included. CONCLUSIONS: A crisis like the COVID-19 pandemic requires careful planning to facilitate urgent restructuring of many aspects of an ED. By sharing our departments' responses to the COVID-19 pandemic, we hope other departments can better prepare for this crisis and the next.