Technology and Specialist Care for Older Patients in the Post Covid-19 Era.

The COVID-19 pandemic poses a major challenge to delivering multi-disciplinary complex care for older patients. Modern technology can assist in providing such care. This article highlights efforts to bridge the "digital divide" between generations and addresses the beneficial impact telemedicine has on older people's lifestyles. Novel triage models for accessing emergency care which were successful for patients of all age groups including those over 65 years are described. Moreover, innovative successful approaches to the outpatient assessment of older patients with complex chronic health conditions using telemedicine are highlighted. Furthermore, innovative solutions piloted in remote areas of Australia offer promise for telemedicine-lead remote assessment of older patients, and the results are encouraging compared to in-person consultations. The experience with a General Practitioner (GP)/specialist online real-time interaction model for remote management of HF in mainly older people has also been encouraging. The use of telemedicine in falls prevention has produced impressive results in high-risk older patients albeit with some ambivalence from older participants. Virtual reality rehabilitation programmes have produced better physical outcomes than traditional rehabilitation programmes. Furthermore, telerehabilitation for chronic obstructive pulmonary disease (COPD) and HF have shown to be both feasible and effective. To maximise their benefits in the difficult post-COVID-19 period, technologies must be embraced by both physicians and older patients. Online community care platforms discussed have demonstrated a positive, tangible impact on the lifestyle of the older generation. Furthermore, educational guidelines can assist in implementing the fundamentals of telemedicine, but for the widespread successful and safe integration of these services, adoption of regulatory frameworks with a focus on ethical issues of telehealth is imperative.

Prevalence of mental health disorders in children and adolescents in the Republic of Ireland: a systematic review.

Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services. AIM: To establish prevalence of MH disorders among youth (under 18) in Ireland. METHOD: A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Empirical studies conducted in Ireland, in youth and focusing on MH disorders were included. RESULTS: From a total of 830 papers identified, 38 papers met inclusion criteria. Significant variation in rates of MH disorders was evident based on study methodology. Screening questionnaires for general psychopathology reported rates of 4.8-17.8% scoring above clinical cut-offs, with higher rates for ADHD (7.3%). Studies examining depression ranged from 4% to 20.8%, while rates for 'current' MH disorder, determined by semi-structured interview, were 15.5%, while 'lifetime' rates varied from 19.9% to 31.2%. Fewer than half (44%) of those identified as 'in need' of specialist MH services were accessing CAMHS. CONCLUSION: Data on MH disorders among Irish youth is limited, and studies showed significant variance in rates, making service planning difficult. There is an urgent need for serial epidemiological surveys, with clear operational criteria for clinically impairing MH difficulties. Such studies are essential to understand potential demand and service planning. This is most urgent given the expected increased demand post Covid-19.

Funny thyroid function tests - TSHoma and post-COVID 19 thyroiditis leading to confusing thyroid function tests dynamics, a case report

Background: We present the case of a male patient with a diagnosis of TSH-secreting pituitary adenoma (TSHoma) who became infected with SARS-CoV-2 and developed a post-COVID-19 thyroiditis with resultant confusing changes in his thyroid function tests (TFTs). Case Presentation: The patient presented with an incidental finding of elevated Free T4 and inappropriately normal TSH, confirmed on multiple analytical platforms. A TRH test showed a flat TSH response, and an MRI pituitary showed a 2.4 cm macroadenoma. Somatostatin analogue treatment was commenced pending surgery, with rapid normalization of TFTs. The patient then became symptomatic of headache, pyrexia, dysgeusia and anosmia lasting two weeks, at a time when the first wave of the COVID-19 pandemic was affecting Ireland. The patient had been a close contact of two confirmed COVID-19 cases. He did not have a SARS-CoV2 PCR test at the time but later tested positive for COVID-19 spike and nucleocapsid antigen IgG antibodies (vaccine naïve), indicating previous exposure to SARS-CoV-2. Two months after this illness, the patient’s TFTs showed a pattern typical of primary hyperthyroidism with grossly elevated FT4 and fully suppressed TSH (with co-existent thyrotoxicosis symptoms), followed by a pattern of primary hypothyroidism with a low FT4 and high TSH – a pattern consistent with subacute thyroiditis post-viral illness. TRAb was negative. The patient’s TFTs later showed high normal TSH and normal FT4 while continuing lanreotide therapy. He is currently euthyroid and awaiting pituitary surgery which was delayed due to the COVID-19 emergency. Conclusion: To our knowledge, this is the first case of post-COVID-19 thyroiditis in a patient with underlying TSHoma. The case highlights the importance of considering an alternative or new diagnosis in the setting of rapidly changing patterns in thyroid function tests, and for close clinical and biochemical follow-up in these situations. The patient gave written consent to this publication. SARS-CoV-2 = Severe Acute Respiratory Syndrome Coronavirus 2 TFT = Thyroid Function Test FT4 = Free Thyroxine TSH = Thyroid-Stimulating Hormone TRH = Thyrotropin-Releasing Hormone MRI = Magnetic Resonance Imaging TRAB = TSH Receptor Antibodies Anti-TPO Ab = Anti-Thyroid Peroxidase Antibodies

PREVALENCE OF MENTAL ILLNESS IN CHILDREN AND ADOLESCENTS IN THE REPUBLIC OF IRELAND

Mental illness in young people is a growing concern, with an estimated 10-20% of adolescents suffering from mental illness worldwide.1 In Ireland, referrals to CAMHS (Child and Adolescent Mental Health Services) have increased by 26% in recent years.2 These services are already under-resourced leading to long waiting lists. The adverse psychological impact of Covid-19 has disproportionately affected youth and is likely to result in increased demand for CAMHS. Given these circumstances, an understanding of pre-Covid-19 prevalence of mental illness among youth in Ireland is imperative to help inform & plan services. The aim of this research is to report on prevalence of mental illness in youth (aged 0-18) in Ireland. A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Studies included youth population health empirical studies conducted in Ireland, focusing on mental illness. From a total of 624 papers identified, 43 papers were selected by Title/ selection, and 38 following full paper review. 2 nationally representative studies (Growing Up in Ireland & My World Survey) identified 10-15% to be 'at risk' by one-stage screening. A two-stage study (Challenging Times) reported rates of 'any' mental health disorder in 15% of adolescents, with other studies reporting on specific disorders. Although data on mental illness among Irish youth is limited, available data of illness and risk suggest rates similar to international levels. Attention needs to be given post Covid-19 to regular reliable data collection, and dedicated CAMHS funding to allow best use of a scarce resource.

Paediatric hospital admissions for psychiatric and psychosocial reasons during the first year of the COVID-19 pandemic.

Increases in youth psychiatric presentations to out-patient and emergency department settings during COVID-19 have been reported. This study, using data from five hospitals in Ireland, examines changes in the number and type of paediatric admissions during COVID-19 (March 2020 - February 2021) compared to the previous two years. ICD-10 classification was used to establish admissions with mental, behavioural, neuro-developmental disorders and psychosocial reasons (MBN-PS). Overall hospital admissions fell by 25.3%, while MBN-PS fell by only 2.6%, mostly during an initial lockdown. Admissions for MBN-PS increased in July-August (9.2%), increased further in September-December (28.3%), returning to pre-COVID-19 levels in January-February 2021. Significant increases were observed among youths with anorexia nervosa (47.8%), other eating disorders (42.9%), and admissions for anxiety (29.6%), with these effects relating to females only. Although admissions for self-harm increased (3%) and rates of ASD admissions reduced (17%), these were not statistically significant. The disproportionate increase in admissions for MBN-PS compared to medical admissions suggests an adverse effect of COVID-19 on youth mental health, for females in particular, and supports previous reports of a pandemic specific increase in eating psychopathology. Combined community and acute service delivery and capacity planning are urgently needed given the prior underfunding of services pre-pandemic.

Increased mental health presentations by children aged 5-15 at emergency departments during the first 12 months of covid-19

Aims To determine changes in mental health (MH) attendance at Emergency Departments (ED) by children aged five to 15 during the COVID-19 pandemic. Methods Analysis of MH presentations during the first year of the pandemic compared with prior year for three public paediatric EDs serving the greater Dublin area with a paediatric population of 430,000. Results Overall, ED attendance during the 12 months to 28th February 2021 was 34.3% below prior year, while MH presentations were 8.9% above prior year. MH attendances initially decreased by 26.8% (2020: 303;2019: 414) during the first four months of the pandemic (March to June), lower than the corresponding decrease of 47.9% for presentations for any reason (2020: 11,530;2019: 22,128). However, MH presentations increased by 52.4% in July and August (2020: 218;2019: 143), and by 45.6% in September to December (2020: 552;2019: 379), dropping 28.1% below prior year in January (2021: 87;2020: 121) before returning to prior year levels in February 2021 (2021: 107;2020: 106). Conclusion Following the initial COVID-19 lockdown, ED presentations by children for acute MH care increased significantly over prior year, with this increase sustained throughout 2020. Long-term stressors linked to the pandemic may be leading to chronic MH problems, warranting increased funding of MH services as part of the response to COVID-19.