Impacts on electroconvulsive therapy (ECT) services, including patient relapse and death, during the COVID-19 pandemic: Mixed methods results from a multi-national survey

Objectives: Electroconvulsive therapy (ECT) is important in the management of major, life-threating, and treatment-resistant psychiatric illness. The COVID-19 pandemic has significantly disrupted ECT services. The need for new infection control measures, staff/resource redeployment and shortages, and the perception that ECT is as an 'elective' procedure have caused changes to, and reductions in, ECT delivery. The aim of this study was to explore the impacts of COVID-19 on ECT services, staff, and patients globally. Method(s): Data were collected using an electronic, mixed-methods, cross-sectional survey. The survey was open March to November 2021. Clinical directors in ECT services, their delegates, and anaesthetists were asked to participate. Quantitative findings are reported. Result(s): One hundred and twelve participants worldwide completed the survey. The study identified significant impacts on services, staff, and patients. Based on quantitative results, most participants (57.8%, n=63) reported their services made at least one change to ECT delivery. More than three-quarters (81.0%, n=73) reported their service had identified at least one patient who could not access ECT. More than two-thirds (71.4%, n=67) reported their service identified at patients who experienced a relapse in their psychiatric illness due to lack of ECT access. Six participants (7.6%) reported their service had identified at least one patient who died, by suicide or other means, due to lack of ECT access. Participants' qualitative responses were detailed, averaging 43 words. Three qualitative themes were identified: (1) Service provision, about the importance of ECT services continuing during the pandemic, (2) Preparedness, through guidelines and environmental design, and (3) Personal protection, about strategies to increase staff safety. Conclusion(s): This is the first multi-site, international survey to explore the impacts of COVID-19 on ECT services, staff, and patients. Its findings can be used to inform evidence-based ECT practice. This supports the ongoing safe, effective operation of ECT services. Research Category and Technology and Methods Clinical Research: 2. Electroconvulsive Therapy (ECT) Keywords: Survey, Mixed Methods, COVID, Service changes;Copyright © 2023

Being and becoming: Centering the morality of social responsibility through children's right to participate in society

Given the inconsistent support from adults and children for children's right to participate in society, this chapter focuses on issues relating to children's moral development by considering the morality of social responsibility in relation to participation. The civic behavior details how children's moral perceptions align with the concept of the common good by illustrating young people's awareness of the efficacy behind community action and moral consciousness for the common good-the ultimate exemplar of social responsibility. Given the global pandemic brought on by COVID-19, it is useful to highlight how children have responded to injustices related to this crisis, which by the conclusion of 2020 was led by the U.S. as the country with the most cases and deaths from COVID-19. The chapter conceptualizes social responsibility as a facet of moral development that functions as a link between the right to participate in society and moral development, which ultimately contributes to children's well-being and broader societal wellbeing. It provides an overview of children's active participation in society as illustrated by contemporary examples of children's involvement in social justice movements (e.g., environmental justice, racial justice). The chapter considers future research directions that intersect children's moral development with their agentic participation in society. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Mino Bimaadiziwin Homebuilder Program's Impact on Sustainable Livelihoods Among Youth in Garden Hill and Wasagamack First Nations: An Evaluative Study

The Mino Bimaadiziwin Homebuilders postsecondary education pilot project built Indigenous youth capacity and houses in two remote Anishinini reserves—Garden Hill and Wasagamack. To evaluate this community-led project, a sustainable livelihood assessment holistically measured the impact on 45 of the 70 (64%) Homebuilder students and the community. The community benefited by gaining three culturally appropriate houses built from local lumber and employment opportunities for Anishinini instructors. A longitudinal survey found five of the six livelihood assets improved sta-tistically and significantly, including satisfaction with social relationships, cultural awareness, in-come and ability to pay bills, housing safety, and human development. Students reported better relations with their families and neighbourhood. Most (85%) of the 70 Homebuilder students earned postsecondary certificates either in forestry, homebuilding, or both while obtaining a training sti-pend, which elevated their incomes. These positive outcomes occurred despite project underfunding, COVID-19 pandemic lockdown, climate change events, and inequitable housing policies under the Indian Act. Based on this project's success, we recommend investing in Indigenous-led postsecond-ary education in community homebuilding projects. However, to attain equitable housing and human rights, a plan is needed to overturn the Indian Act keeping Indigenous people "wards of the state” and their land in trust. © 2023 Canadian.

COVID-19 vaccination telephone outreach: an analysis of the medical student experience.

INTRODUCTION: The COVID-19 pandemic diminished opportunities for medical students to gain clinical confidence and the ability to contribute to patient care. Our study sought out to understand the value of telephone outreach to schedule COVID-19 vaccines on medical student education. MATERIALS AND METHODS: Forty students engaged in telephone outreach targeting patients aged 65+ without active patient portals to schedule COVID-19 vaccines. Data consisted of a single administration retrospective pre/post survey inquiring about what students learned, expectations, other health-care processes that would benefit from outreach, and interest in a population health elective. Likert items were analyzed and open response analysis involved inductive coding and generation of thematic summaries by condensing codes into broader themes. Demographic data of patients called and subsequently received the vaccine were also collected. RESULTS: There were 33 survery respondents. There was a statistically significant increase in net comfortability for pre-clerkship students for documenting in Epic, providing telehealth care, counseling on common health-care myths, having challenging conversations, cold-calling patients, and developing an initial trusting relationship with patients. The majority called and who received the vaccine were non-Hispanic Black, within the high SVI category, and had Medicare and/or Medicaid. Qualitative data showed that students emphasized communication, the role of trusted messengers, the need to be open minded, and meeting patients where they are. DISCUSSION: Engaging students in telephone outreach early in the COVID-19 pandemic provided students the opportunity to develop their skills as physicians-in-training, contribute to combating the ongoing pandemic, and add value to the primary care team. This experience allowed students to practice patience, empathy, and vulnerability to understand why patients had not received the COVID-19 vaccine; this was an invaluable experience that helped students develop the skills to become empathetic and caring physicians, and supports the continued role of telehealth in future medical school curriculum.

Multiplex MinION sequencing suggests enteric adenovirus F41 genetic diversity comparable to pre-COVID-19 era.

Human adenovirus F41 causes acute gastroenteritis in children, and has recently been associated with an apparent increase in paediatric hepatitis of unknown aetiology in the UK, with further cases reported in multiple countries. Relatively little is known about the genetic diversity of adenovirus F41 in UK children; and it is unclear what, if any, impact the COVID-19 pandemic has had on viral diversity in the UK. Methods that allow F41 to be sequenced from clinical samples without the need for viral culture are required to provide the genomic data to address these questions. Therefore, we evaluated an overlapping-amplicon method of sequencing adenovirus genomes from clinical samples using Oxford Nanopore technology. We applied this method to a small sample of adenovirus-species-F-positive extracts collected as part of standard care in the East of England region in January-May 2022. This method produced genomes with >75 % coverage in 13/22 samples and >50 % coverage in 19/22 samples. We identified two F41 lineages present in paediatric patients in the East of England in 2022. Where F41 genomes from paediatric hepatitis cases were available (n=2), these genomes fell within the diversity of F41 from the UK and continental Europe sequenced before and after the 2020-2021 phase of the COVID-19 pandemic. Our analyses suggest that overlapping amplicon sequencing is an appropriate method for generating F41 genomic data from high-virus-load clinical samples, and currently circulating F41 viral lineages were present in the UK and Europe before the COVID-19 pandemic.

Nutritional appointments among children under 9 years of age in the Maule region, Chile, between 2017 to 2021, the effect of social mobilizations and the COVID-19 pandemic

Background: The nutritional appointments is the first line of care for children with malnutrition or overweight in public primary health, but its normal functioning was affected by social mobilizations and the COVID-19 pandemic. Objective(s): To evaluate trends in consultations among children under 9 years of age in the Maule region, Chile, between 2017 and 2021. Method(s): Descriptive longitudinal study based on data from the Monthly Statistical Records (REM) of the Maule Health Service, the trends were analyzed with coefficient of determination (R2) using Prais-Winsten regression. Result(s): 274,377 nutritional consultations were analyzed, of which 53.8% were overweight and 12.1% with malnutrition. A 56.8% decrease in nutritional consultations was recorded during social mobilizations and 92% at the beginning of the pandemic. A tendency to increase consultations due to malnutrition was observed, especially in children under 12 months of age (R2 0.633, beta=4.45, p<0.001). Conclusion(s): The social and epidemiological situations significantly affected nutritional care in public health. It is necessary to give nutrition professionals greater visibility and promote the development of innovative strategies to deal with this epidemiological scenario. Copyright © 2022, Sociedad Chilena de Nutricion Bromatologia y Toxilogica. All rights reserved.

REIMAGINING ADRD IN CONTEXT

This symposium embraces diversity and discovery to address contextual issues in aging, specifically issues of race and ethnicity in the study of cognitive health and Alzheimer's Disease and Related Dementia (ADRD). Rooks and colleagues compare dementia risk among African American and White men and women in the context of work using the longitudinal Health, Aging, and Body Composition data. They consider the effects of productive activities on dementia risk in gender stratified models, adjusting for socio-demographic and genetic factors. Siddiq and colleagues consider the contexts of migration. Using a multi-method approach, they establish priorities for interventions addressing ADRD risk among older adult immigrants and refugees from Afghanistan and the Middle-East and North Africa (MENA) in California. Sayed also investigates the context of migration, and uses qualitative data (N=31) to identify the psychosocial impact of COVID-19 on cognitive aging in Middle Eastern/Arab Americans immigrants and refugees in Michigan. Finally, Meier and colleagues consider contexts of metal exposure for cognitive decline among Latinos aged 65 and older using the Sacramento Area Latino Study on Aging. In total, this symposium highlights the benefits of reimagining contextual factors that influence ADRD to improve our understanding and the potential to reduce health disparities research in underrepresented racial and ethnic populations.

INNOVATIONS IN AGING: CREATING A TRANSDISCIPLINARY RESEARCH COLLABORATIVE GRADUATE FELLOWSHIP PROGRAM

Social isolation impacts nearly one-quarter of community dwelling adults aged 65+ in the United States. It is associated with poor physical and mental health, cognitive decline, higher healthcare costs, and early mortality. Older adults are at greater risk because they are more likely to live alone, experience a shrinking social network from loss of family and friends, and encounter limitations with driving and mobility resulting from chronic health conditions and sensory impairments. Social isolation in later life is not new;however, the COVID-19 pandemic brought to light the increased risk for negative outcomes. Reducing social isolation is a priority area for our state's Department of Aging (DoA), and the updated State Plan on Aging highlights the need for innovative approaches to develop and strengthen initiatives addressing social isolation among older adults. The DoA is advancing multiple projects, including a partnership with our public university to create a transdisciplinary graduate fellowship program. The program brought together professional students from medicine, nursing, pharmacy, and social work and resulted in a community of practice in which fellows engaged with DoA and university faculty to share best practices and receive training in transdisciplinary research. In this session, the first presentation will focus on development of the fellowship program and highlight the success of the inaugural year;the second session will focus on the future goals of the fellowship program, and the third presentation will share how we plan to expand the partnership between our public university and our state's Department of Aging.

Temporal Trends in Substance Use Among Child/Adolescent Inpatients

Objectives: Substance use (SU) in minors has become an increasing public concern over the past decade. We hypothesized that SU would increase over time, particularly affecting minors with a history of trauma, suicide attempt, or violence. Method(s): Variables (such as sociodemographics, psychiatric treatment, urine toxicology report, and self-report of substance use) were extracted from the charts of all unique child and adolescent patients admitted to a 17-bed metropolitan inpatient psychiatry unit between June 2018 and November 2021. Statistical analyses included descriptive statistics, chi2 tests, independent t tests, Pearson correlations, and logistic regression. Result(s): Of the 1101 patients admitted, 30% (n = 330) were found to have SU by positive urine toxicology (n = 147) or self-report. Patients with SU were older than those without use (mean age 15.4 vs 13.4 years;p <.001). Significant racial differences were found, with White participants making up 21.8% of the SU population but only 14.1% of the non-SU group (p <.01), and Asian participants making up only 1.2% of the SU group (vs 4.2% without;p <.01). SU patients were more likely to have a history of self-harm (nonsuicidal self-injurious behavior [NSSIB]) or suicide attempt (NSSIB: 64.8% vs 52.%, p <.001;suicide attempt: 41.5% vs 25.7%, p <.001). Patients with SU were less likely to be admitted for aggression (14.5% vs 22.8%;p <.01) and more likely to be admitted for mania (2.4% vs 0.8%;p =.03). Positive predictors of SU were older age (OR = 1.41;95% CI, 1.15-1.72;p <.001), White race (OR = 1.98;95% CI, 1.19-3.29;p <.01), history of an impulsive/behavioral disorder (OR = 1.69;95% CI, 1.03-2.79;p <.04), history of suicide attempt (OR = 1.44;95% CI, 1.04-2.00;p =.03), history of violence (OR = 1.86;95% CI, 1.26-2.75;p <.01), and history of Administration of Children's Services (ACS)/Child Protective Services (CPS) involvement (OR = 1.45;95% CI, 1.03-2.03;p =.03). Gender, other races, history of other diagnoses, trauma history, or history of NSSIB were not found to be significant predictors. Conclusion(s): Our findings are consistent with emerging literature that SU in minors has had a slow increase in the COVID-19 era, particularly seen among White patients, patients of older age, and patients with a history of NSSIB or suicide attempt. While some of our analyses did control for potential confounding factors (logistic regression), further analyses are required to formulate a preventative plan for SU in youth. SUD, ICP, ALC Copyright © 2022

How to design and implement a university-based COVID-19 testing programme? An evaluation of a novel RT-LAMP COVID-19 testing programme in a UK university.

BACKGROUND: Little is known about how asymptomatic testing as a method to control transmission of COVID-19 can be implemented, and the prevalence of asymptomatic infection within university populations. The objective of this study was to investigate how to effectively set-up and implement a COVID-19 testing programme using novel reverse transcriptase loop-mediated isothermal amplification (RT-LAMP) technology and to quantify the scale of asymptomatic infection on a university campus. METHODS: An observational study to describe the set-up and implementation of a novel COVID-19 testing programme on a UK university campus between September and December 2020. RT-LAMP testing was used to identify asymptomatic cases. RESULTS: A total of 1,673 tests were performed using RT-LAMP during the study period, of which 9 were positive for COVID-19, giving an overall positivity rate of 0.54%, equivalent to a rate in the tested population of 538 cases per 100,000 over the duration of testing. All positive tests were found to be positive on RT-PCR testing, giving a false positive rate of 0%. CONCLUSIONS: This study shows that it is possible to rapidly setup a universal university testing programme for COVID-19 in collaboration with local healthcare providers using RT-LAMP testing. Positive results were comparable to those in the local population, though with a different peak of infection. Further research to inform the design of the testing programme includes focus groups of those who underwent testing and further interrogation of the demographics of those opting to be tested to identify potential access problems or inequalities.

Biomarkers in COVID-19: Association with disease severity and outcomes

Background: In coronavirus disease 2019 (COVID-19) the need for intervention increases with disease severity and a risk prediction model that incorporates biomarkers would be beneficial for identifying patients for treatment escalation. Aim(s): To investigate biomarkers changes associated with disease severity and outcomes (mortality, thrombosis). Method(s): COVID-19 patients were sampled between April 15 and May 31 2020. Disease severity was assessed by World Health Organization (WHO) ordinal scale. 132 systemic biomarkers were investigated by routine and multiplex assays and statistical analysis performed to characterise the biomarker profile of COVID-19 patients associated with disease severity, duration, survival and thrombosis. Result(s): The study enrolled 150 COVID-19 positive adults and 16 healthy volunteers. The average age was 64 years, 59% were male, 85% had co-morbidities, 33% had a thrombotic event, and 13% died. A cross comparative analysis of biomarkers identified 13 biomarkers common to severity, mortality and thrombosis with significant correlation;including endothelial dysfunction (VWF, tPA, TFPI), hypercatabolism (low albumin, Hb, FXIII) and inflammatory response (IL-8, Osteopontin). Similarly, 14 biomarkers associated with severity and mortality included pro-inflammatory cytokines and their receptors (sTNFRII, STNFRI, sIL2a, IL6, MIP1a), neutrophils (elevated WBC, Neutrophils, TIMP1) and tissue remodelling (SCGF, EG3A). Nine biomarkers common across severity and thrombosis were angiogenesis (VEGF, LYVE1, Follistatin), acute phase response (SAP, AGP) and clot formation (Fibrinogen and PAPs). Conclusion(s): The biomarker profile associated with poorer outcomes indicates an inflammatory response, endothelial cell disruption, hypercoagulability and hypercatabolism. This study has identified several biomarkers that may be useful indicators of disease severity and progression. Further work is needed to determine how these may be used to direct clinical management. (Figure Presented).

Reactive surveillance of suicides during the COVID-19 epidemic in France, 2020- March 2022 : Anne Fouillet

Background Mitigation actions during the COVID-19 pandemic, in particular lockdowns and curfews, may impact mental health and suicide in general populations. We aimed to analyse the evolution in suicide deaths from January 2020 to March 2022 in France. Methods Using free-text medical causes in death certificates, we built an algorithm, which aimed to identify suicide deaths. We measured its retrospective performances by comparing suicide deaths identified using the algorithm with deaths which had either an ICD10 code for ‘intentional self-harm’ or for ‘external cause of undetermined intent’ as underlying cause. The number of suicide deaths from January 2020 to November 2021 was then compared with the expected number estimated using a generalized additive model. The analysis was stratified by age group and gender. Analysis from December 2021 to March 2022 was conducted using electronic death certificates only. Results The free-text algorithm demonstrated high performances. From January 2020 to November 2021, suicide mortality declined during France's three lockdowns, particularly in men, and remained quite comparable with expected values between and after both of the country's lockdowns. Provisional results based on electronic death certificates suggest that suicide mortality remained stable until March 2022. Conclusions Monitoring suicide mortality is possible in France with a 4-month delay;this will be reduced to two days when electronic death certification is fully deployed. This study highlighted the absence of an increase in suicide mortality during France's COVID-19 pandemic, and a substantial decline during lockdowns periods, something already observed in other countries. Further studies are required to explain the factors for this decline. Key messages • In the absence of reactive coding of medical causes of deaths, the study proposed an approach to reactively identify suicide based on free-text medical causes from death certificates. • Our findings provide reassurance that the COVID-19 pandemic has not had a negative impact on the general population in terms of suicide in France from March 2020 to September 2021.

Themes of recovery from a child and adolescent eating disorder unit: Staff experiences

Background: We looked at how our staff from a tier 4 child and adolescent eating disorder unit have been impacted by the Covid-19 pandemic. We hope to encourage a period of self-reflection with our staff to think of ways their work has changed and how far they have come. Method(s): We created a questionnaire with three questions: (1) How much has your work of looking after young people with eating disorders been impacted by the Covid-19 pandemic? (2) How much do you think the experience of being treated in a child and adolescent eating disorder unit has changed since the Covid-19 pandemic? (3) How much do you feel like you have adapted the way you work as a result of the Covid-19 pandemic? We used a Likert scale with free-text boxes for expansion of answers. Result(s): We are in the process of collecting data but the following themes are emerging: Question 1: emotional distress and social isolation, lockdown triggered illness and worsening of symptoms, and short staffing. Question 2: new protocols for patients, feelings of claustrophobia from reduced visits and outings. Question 3: personal protective equipment, staff testing and 'the new normal.' Discussions/Conclusions: Further data are needed to draw more solid conclusions however it seems staff have seen first-hand signs of lockdown induced mental distress and the triggering of eating disorders. Staff struggled to express ways they have adapted their working as they have accepted that Covid- 19 is a permanent part of their job role.

Virtually-delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans with PTSD: A study protocol for a nation-wide effectiveness and implementation evaluation.

BACKGROUND: Post-traumatic stress disorder (PTSD) remains a significant treatment challenge among Canadian veterans. Currently accessible pharmacological and non-pharmacological interventions for PTSD often do not lead to resolution of PTSD as a categorical diagnosis and have significant non-response rates. Sudarshan Kriya Yoga (SKY), a complementary and integrative health (CIH) intervention, can improve symptoms of PTSD. In response to the COVID-19 pandemic, this intervention has pivoted to virtual delivery and may be reaching new sets of participants who face multiple barriers to care. OBJECTIVE: To evaluate the implementation and effectiveness of virtually delivered Sudarshan Kriya Yoga (SKY) on decreasing PTSD symptom severity, symptoms of depression, anxiety, and pain, and improving quality of life in Canadian veterans affected by PTSD. METHODS AND ANALYSIS: Using a mixed-methods approach guided by the RE-AIM framework, we will conduct a hybrid type II effectiveness and implementation study of virtually delivered Sudarshan Kriya Yoga (SKY) for Canadian veterans. Effectiveness will be evaluated by comparing virtually delivered SKY to a waitlist control in a single-blinded (investigator and data analyst) randomized controlled trial (RCT). Change in PTSD symptoms (PCL-5) is the primary outcome and quality of life (SF-36), symptoms of depression (PHQ-9), anxiety (GAD-7), and pain (BPI) are secondary outcomes. The SKY intervention will be conducted over a 6-week period with assessments at baseline, 6-weeks, 12-weeks, and 30 weeks. The reach, effectiveness, adoption, implementation, and maintenance of the intervention will be evaluated through one-on-one semi-structured interviews with RCT participants, SKY instructors, health professionals, and administrators that work with veterans. DISCUSSION: This is the first investigation of the virtual delivery of SKY for PTSD in veterans and aims to determine if the intervention is effective and implementable at scale.