Projeto Score: Survey on Covid-19 Resilience

Objetivos: O objetivo do Projeto SCORE - Survey on COVID-19 REsilience - foi avaliar as emocoes e comportamentos dos adultos brasileiros com hemofilia durante o 1degree ano da pandemia. Material e Metodos: Foi realizada uma pesquisa online, com 17 perguntas, de marco a abril de 2021. Os dados foram coletados por meio de 5 perguntas sobre caracteristicas demograficas e clinicas e 12 perguntas sobre as preocupacoes e medos um ano apos o inicio da pandemia de COVID-19. Resultados: 40 PCH responderam ao questionario. Faixa etaria: 35% de 18-30, 50% 31-50, 15% 51-70. Entre os que responderam, 34 tinham hemofilia A e 6 hemofilia B, com prevalencia de casos graves, 1 tinha inibidor;87,5% PCH faz tratamento de profilaxia enquanto 12,5% realizam tratamento sob demanda. 53,7% declararam nao ter sido afetados pela pandemia, enquanto 24,4% relataram que tanto rotina quanto emergencia foram alterados. Para 19,5% apesar da suspensao das consultas, os atendimentos de urgencia e planos de tratamento foram oferecidos regularmente. Discussao: No que diz respeito as emocoes e sentimentos, para 53,7% dos pacientes, as informacoes fornecidas pelo governo e pela midia nao tiveram o efeito de tranquilizar, pelo contrario, muitas vezes criaram confusao e sensacao de incerteza. Para 31,7% as noticias traziam ainda mais medo e para 19,5%, as informacoes geravam estado de tensao. Apenas 17,1% dos pacientes relatou se sentir tranquilo e confiante. Sobre o apoio psicologico, apesar da maioria reconhecer que esta pandemia teria repercussoes psicologicas, 60% afirmaram nao precisar de apoio na area da saude mental. Para 31% dos pacientes a informacao fornecida pelos Centros de Hemofilia (CTH) foi suficiente, enquanto 9% dos respondentes solicitaram apoio e ajuda psicologica. Quanto ao relacionamento com o CTH, 61% relatou que nada mudou enquanto 12,2% relatou melhora no relacionamento. Para 12,2% houve dificuldades no relacionamento em funcao do medo de possivel contagio. Com relacao ao gerenciamento do controle de sangramentos e das consultas programadas, 53,7% declararam nao terem sido afetados pela pandemia, enquanto 24,4% relataram que tanto rotina quanto emergencia foram alterados. Para 19,5% apesar da suspensao das consultas, os atendimentos de urgencia e planos de tratamento foram oferecidos regularmente. Conclusao: Nossa pesquisa destacou a adaptabilidade dos pacientes durante a pandemia e que mostrou que a disponibilidade da equipe do CTH. Neste momento, mesmo a distancia, garantiu a continuidade das relacoes e do tratamento. Copyright © 2022

Association between SARS-CoV-2 Vaccines and Myoand Pericarditis, a Large Observational Study Using Electronic Healthcare Data from Four European Countries

Introduction: Some COVID-19 vaccines (Moderna and Pfizer) have been associated with an elevated risk of myocarditis in younger adults. However, observational studies were unable to stratify by dose and had limited ability to evaluate the effect of adenovirus-based COVID-19 vaccines due to the limited distribution of these in their study populations [1-4]. Objective(s): Estimate the incidence rates (IR), rate differences (RD) and incidence rate ratios (IRR) of myocarditis and pericarditis before and after each dose of mRNA (Pfizer and Moderna) and adenovirusplatform (AstraZeneca and Janssen) COVID-19 vaccines. Method(s): We conducted a population-based cohort design with nested self-controlled risk interval (SCRI) study. Participants were followed from 1st January 2020 to 31st December 2021. Data were derived from healthcare data from five population-based data sources in four European countries: Italy, the Netherlands, the United Kingdom (UK), and Spain. The main outcome was first occurrence of myocarditis or pericarditis. RD and IR before COVID-19 disease and after each COVID-19 vaccine dose in those without COVID-19 were calculated. The SCRI calculated IRR with 60-day control period prior to vaccination and 28-day risk windows, with adjustment for seasonality. All analyses were stratified by age (<30 and >= 30 years) and in the cohorts refined age-bands for<30 were utilised. Result(s): The study cohort comprised 35,365,669 persons with median age between 39-49 years, 57.4% received at least one COVID-19 vaccine dose and 77.6% of these received two. Myocarditis background rates were highest in persons 18-29 years (IR 2.8, 95% CI [1.5-4.1] to 6.4 [3.8-9.0] across UK, the Netherlands and Spain, and for 12-17 years in Italy (IR = 9.9 [5.3-14.4]). Pericarditis rates were higher in persons>30 years (standardised IR from 11.6 [10.9-12.4] to 29.7 [19.8-22.1] across databases). RD of myocarditis were significantly elevated after Moderna dose 2 in persons between 18-29 years in Italy. Significantly reduced RD of pericarditis in the age group above 30 years was seen for Pfizer, Moderna and AstraZeneca. The SCRI showed significantly higher myocarditis IRR after dose 1 of Pfizer (IRR = 3.3 [1.2-9.4]), and also after dose 2 of Pfizer and Moderna in persons 12-29 years (IRR of 7.8 [2.6-23.5] and 6.1 [1.1-33.5], respectively). No association was observed between COVID-19 vaccination and pericarditis in the SCRI. In a sensitivity analysis, occasional significant association was seen for AstraZeneca dose 2 and myocarditis. Conclusion(s): Myocarditis is rare, but rates were increased significantly after both doses of Pfizer and the second dose of Moderna vaccines in persons below 30 years of age. This was not seen for pericarditis.

Association between SARS-CoV-2 Vaccines and Myoand Pericarditis;a Large Observational Study Using Electronic Healthcare Data from Four European Countries: An International Journal of Medical Toxicology and Drug Experience

Introduction: Some COVID-19 vaccines (Moderna and Pfizer) have been associated with an elevated risk of myocarditis in younger adults. However, observational studies were unable to stratify by dose and had limited ability to evaluate the effect of adenovirus-based COVID-19 vaccines due to the limited distribution of these in their study populations [1-4]. Objective: Estimate the incidence rates (IR), rate differences (RD) and incidence rate ratios (IRR) of myocarditis and pericarditis before and after each dose of mRNA (Pfizer and Moderna) and adenovirusplatform (AstraZeneca and Janssen) COVID-19 vaccines. Methods: We conducted a population-based cohort design with nested self-controlled risk interval (SCRI) study. Participants were followed from 1st January 2020 to 31st December 2021. Data were derived from healthcare data from five population-based data sources in four European countries: Italy, the Netherlands, the United Kingdom (UK), and Spain. The main outcome was first occurrence of myocarditis or pericarditis. RD and IR before COVID-19 disease and after each COVID-19 vaccine dose in those without COVID-19 were calculated. The SCRI calculated IRR with 60-day control period prior to vaccination and 28-day risk windows, with adjustment for seasonality. All analyses were stratified by age (< 30 and > 30 years) and in the cohorts refined age-bands for < 30 were utilised. Results: The study cohort comprised 35,365,669 persons with median age between 39-49 years, 57.4% received at least one COVID-19 vaccine dose and 77.6% of these received two. Myocarditis background rates were highest in persons 18-29 years (IR 2.8, 95% CI [1.5-4.1] to 6.4 [3.8-9.0] across UK, the Netherlands and Spain, and for 12-17 years in Italy (IR = 9.9 [5.3-14.4]). Pericarditis rates were higher in persons > 30 years (standardised IR from 11.6 [10.9-12.4] to 29.7 [19.8-22.1] across databases). RD of myocarditis were significantly elevated after Moderna dose 2 in persons between 18-29 years in Italy. Significantly reduced RD of pericarditis in the age group above 30 years was seen for Pfizer, Moderna and AstraZeneca. The SCRI showed significantly higher myocarditis IRR after dose 1 of Pfizer (IRR = 3.3 [1.2-9.4]), and also after dose 2 of Pfizer and Moderna in persons 12-29 years (IRR of 7.8 [2.6-23.5] and 6.1 [1.1-33.5], respectively). No association was observed between COVID-19 vaccination and pericarditis in the SCRI. In a sensitivity analysis, occasional significant association was seen for AstraZeneca dose 2 and myocarditis. Conclusion: Myocarditis is rare, but rates were increased significantly after both doses of Pfizer and the second dose of Moderna vaccines in persons below 30 years of age. This was not seen for pericarditis.

Optimizing Mental Health Referrals in a University Based Primary Care Clinic

Background/Significance: Primary care settings are often the first point of contact for psychiatric diagnosis, treatment, and referral – and primary care clinicians manage many psychiatric illnesses in the community. Integrated and collaborative care models have grown in response to the recognized need for psychiatric services in the primary care setting. Despite increased psychiatric presence, access to mental health services remains a challenge for patients and primary care providers. This challenge is particularly notable in racially diverse and socioeconomically disadvantaged patient populations and is further exacerbated by the COVID-19 pandemic, which disproportionately affects these groups. We describe an initiative to improve equity and access to mental health services among racially diverse and socioeconomically disadvantaged patients in a primary care clinic affiliated with an academic teaching hospital. Methods: We convened a meeting of internal medicine, psychiatry, social work, and administrative stakeholders affiliated with our university-based primary care clinic. This clinic primarily serves low income, racially diverse, and/or immigrant populations. We reviewed provider needs related to mental health referrals and compiled a comprehensive list of local outpatient, partial hospital, inpatient, addiction, and emergency resources. We then created an algorithm to direct providers to the appropriate resources based on the presenting mental health concern. This algorithm has been integrated into the electronic medical record (EMR) for easier access and use. Clinicians were surveyed pre-training and deployment of the algorithm and will be surveyed in follow up to measure its benefits. Results: The majority of primary care providers did not feel confident with psychiatric referral options. The most frequently described reason for psychiatric intervention was for depression and anxiety. Among mental health questions, a majority could be addressed with the assistance of a referral. Discussion: Despite increasing psychiatry presence in primary care, challenges remain in accessing mental health services. The COVID-19 pandemic has exacerbated existing challenges with increased demand for services. Our project builds on an existing integrated care model and introduces a resource that further streamlines mental health referrals. By having this resource available both physically in the clinic and embedded within the EMR, we hope to enhance the ease and efficiency of referral. Conclusion/Implications: A streamlined referral process can further aid in improving access to mental health services within a clinic already using an integrated care model. This is particularly important given the increased need for mental health services in low income, diverse, and immigrant populations hit hard by the COVID-19 pandemic. References: 1. Rothman S, Gunturu S, Korenis P. The mental health impact of the COVID-19 epidemic on immigrants and racial and ethnic minorities. QJM. 2020;113(11):779-782. 2. Jackson-Triche ME, Unützer J, Wells KB. Achieving Mental Health Equity: Collaborative Care. Psychiatr Clin North Am. 2020;43(3):501-510. 3. Lee-Tauler SY, Eun J, Corbett D, Collins PY. A Systematic Review of Interventions to Improve Initiation of Mental Health Care Among Racial-Ethnic Minority Groups. Psychiatr Serv. 2018;69(6):628-647.