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Later-life migrants, as older people living away from their home nations, occupy multiply-precarious positions in relation to national COVID-19 pandemic responses. Concern has particularly centred on this group's increased risk of social and linguistic exclusion. We explore the perspectives of later-life older Chinese and Koreans living in New Zealand during the nation's COVID-19 lockdown of 2020. This paper presents a sub-analysis of culturally-matched interviews conducted with 3 Korean and 5 Chinese later-life migrants. These participants are a sub-sample of a larger qualitative interview study comprising 44 interviews. A social capital approach has been used to aid conceptualisation of participants' experiences and a reflexive thematic approach guided analysis. Despite their underrepresentation in national response efforts, Chinese and Korean later-life migrants resourcefully participated in ethnically-specific pandemic initiatives. Three themes identified were: (1) taking it seriously (2) already digitally literate (3) challenges and difficulties. Older Asian migrants engaged in a range of creative strategies to stay connected during COVID-19 lockdowns which drew heavily on pre-existing social capital. Future pandemic responses should seek to improve connectedness between the national government COVID-19 response and older Korean and Chinese later-life migrants. © 2022 The Authors. Asia Pacific Viewpoint published by Victoria University of Wellington and John Wiley & Sons Australia, Ltd.
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Within the past decade, parents, scientists, and policy makers have sought to understand how digital technology engagement may exacerbate or ameliorate young people's mental health symptoms, a concern that has intensified amidst the COVID-19 pandemic. Previous research has been far from conclusive, and a lack of research consensus may stem in part from widely varying measurement strategies (including subjective and objective measurement) around digital technology engagement. In a cross-sectional study of 323 university students, the present study seeks to understand the ways in which youth engagement with digital technology - across subjective and objective measurements, weekday and weekend distinctions, and social and non-social uses - is associated with mental health (as measured by depression, loneliness, and multidimensional mood and anxiety). The present study also tested a differential susceptibility hypothesis to examine whether COVID-19 related social isolation might exacerbate the potential harms or helps of digital technology engagement. Results yielded few observed associations between digital technology engagement and mental health, with little evidence of detrimental effects of observed or perceived time spent on digital technology. Rather, those significant findings which did emerge underscore potential protections conferred by social connections with friends (both online and offline), and that the loneliest students may be the most likely to be reaching out for these types of connections. It is important that the field move beyond crude (largely self-reported) measures of screen time to instead understand how and to what effect youth are using digital technologies, especially during the social corridor of emerging adulthood.
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BackgroundPulmonary rehabilitation (PR) is a core component of COPD treatment. An alternative to traditional face-to-face PR is online PR, also known as tele-rehabilitation. Despite lack of delivery standardisation there has been recent progression towards an online platform with myCOPD (NICE, 2022)1. The British Thoracic Society advising face-to-face PR suspension and COVID-19 restrictions may have encouraged services to develop tele-rehabilitation.MethodsA questionnaire survey of PR services in England explored the availability and practice of tele-rehabilitation in England. Additional aims were the investigation of recent development of tele-rehabilitation including changes following the COVID-19 pandemic, and potential barriers to and predictors of success for tele-rehabilitation delivery. The questionnaire used closed and open-ended questions and free text-boxes. Data was collected between 30th March 2022 and 19th April 2022.Results61 responses (33%) were received. 11 PR services (18%) stated that they had used a form of tele-rehabilitation prior to the COVID-19 pandemic and 59 (97%) services described using a form of tele-rehabilitation during COVID-19 restrictions. Common remote methods during COVID-19 restrictions included telephone (27%), videoconferencing with patients in groups (23%) and individual patient videoconferencing (21%).15 (25%) PR services strongly agreed, and 23 (38%) agreed, that inability to use tele-rehabilitation due to unfamiliarity with digital equipment or lack of access to the internet prevented many service users from using remote PR. 31 (51%) PR services strongly agreed, and 14 (23%) agreed, that face-to-face PR was preferred by users.31 (51%) PR services disagreed, and 13 (21%) strongly disagreed that tele-rehabilitation would be too costly whilst 7 (11%) strongly agreed, and 45 (74%) agreed that tele-rehabilitation would be beneficial to users.ConclusionTele-rehabilitation became widespread following COVID-19 restrictions, most commonly through telephone and videoconferencing. Most service users were thought to be unable to access tele-rehabilitation due to inability to access the internet and prefer face-to-face PR. Most services reported that cost was not an obstacle to tele-rehabilitation and would be beneficial to users.ReferencesNICE. (2022). Recommendations ;myCOPD for managing chronic obstructive pulmonary disease. [online] Available at: <https://www.nice.org.uk/guidance/MTG68/chapter/1-Recommendations> [Accessed 30 June 2022].
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Background and aims: In trials conducted in India, recombinant granulocyte colony stimulating factor (GCSF) improved survival in alcohol-associated hepatitis (AH). The aim of this trial was to determine the safety and efficacy of pegfilgrastim, a long-acting recombinant GCSF, in patients with AH in the United States. Method: This prospective, open label trial randomized patients with a clinical diagnosis of AH and a Maddrey discriminant function score ≥32 to standard of care (SOC) or SOC+pegfilgrastim (0.6 mg subcutaneously) on Day 1 and Day 8. SOC was 28 days of either pentoxifylline or prednisolone, as determined by the patient’s primary physician. The second injection of pegfilgrastim was not administered if the white blood cell count exceeded 30, 000/mm3 on Day 8. Primary outcomewas survival at Day 90. Secondary outcomes included the incidence of acute kidney injury (AKI), hepatorenal syndrome (HRS), hepatic encephalopathy, or infections. Results: The study was terminated early due to COVID19 pandemic. Eighteen patients were randomized to SOC and 16 to SOC+pegfilgrastim. All patients received prednisolone as SOC. Nine patients failed to receive a second dose of pegfilgrastin due to WBC>30, 000/ mm3 on Day 8. Survival at 90 days was similar in both groups (SOC: 0.83 [95% confidence interval {CI}: 0.57–0.94] vs. pegfilgrastim: 0.73 [95% CI: 0.44–0.89];p > 0.05). The incidences of AKI, HRS, hepatic encephalopathy, and infections were similar in both treatment arms and therewere no serious adverse events attributed to pegfilgrastim. Conclusion: This phase II trial found no survival benefit at 90 days among subjects with AH who received pegfilgrastim+prednisolone compared with subjects receiving prednisolone alone.
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Background and Aims: The COVID-19 pandemic has resulted in profound disruptions in the delivery of health care. These disruptions have disproportionately impacted patients with complex diseases, such as cirrhosis. This study aimed to evaluate the impact of the COVID-19 pandemic on the implementation of high-value care among veterans with cirrhosis. Method: All US Veterans with cirrhosis who were enrolled in VA health care in the fiscal year 2019 were identified using ICD-10-CM codes. This cohort was then followed through the end of the fiscal year 2021. Quarterly outcomes measured included every 6- months HCC screening (HCC-6), endoscopic variceal surveillance or treatment with nonselective beta-blockers (EVST), and all-cause hospitalizations. Joinpoint trend analysis was used to identify the time point at which health care measures declined during the pandemic. Multivariate logistic regression was used to compare pre-and post-COVID care, using January 2020 (onset of COVID pandemic) as the cutpoint. Results: There were 71,552 veterans with cirrhosis in VA care in 2019. This cohort was 96% male, with a median age of 66 (IQR: 61-70), and predominantly alcohol- or hepatitis C-related cirrhosis (Table 1). Over the following 3 years, 22,043 were censored due to death, withdrawal from the VA, or liver transplantation. HCC-6, which was stable at an average of 38% before COVID-19, had a sharp decline in the early phase of COVID-19 to a nadir of 31% (p<0,01) and is now gradually recovering (Figure 1A). Although the rates of EVST were decreasing before COVID- 19 onset, they dropped precipitously starting in 2020-Q1 and have not yet recovered (Figure 1B), with the rate of 49% dropping to 43% (p<0.01). There was no clear point at which hospitalization changed in the joinpoint analysis, though this measure has decreased slowly during COVID-19 from a 7.6% quarterly admission rate to 5.8% during the pandemic (Figure 1C). Similarly, on multivariate analysis, the odds of HCC-6 (0.68[0.63-0.65]), EVST (0.58[0.56-0.61]) and hospitalization (0.85[0.83-0.87]) were all lower during the COVID- 19 period. Conclusion: Despite the ongoing COVID-19 pandemic, HCC surveillance is recovering in VA. However, EVST rates remain low. Further research is needed to understand the decrease in hospitalization for patients with cirrhosis and identify measures to improve cirrhosis care. (Table Presented) (Figure Presented)
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A third survey of the practice of licensed psychologists during the pandemic conducted in June 2021 revealed that the rapid adoption of telepsychological service provision has continued approximately 15 months after a national public health emergency was declared. Most respondents intend to make telepsychology a permanent component of their practice going forward. Other notable findings from our survey revealed that after an initial decline in caseload reported in the early days of the pandemic, the majority of psychologists surveyed now report an increase in caseload, often necessitating the establishment of a waitlist. Respondents reported that their patients/clients are more accepting of telepsychology than in our previous survey. That said, a significant minority of psychologists expressed concerns that this technology will negatively affect their future practice. Results also indicated that psychologists are encountering greater symptom acuity among their patients associated with the pandemic, including an increase in reports of suicidal thinking or behavior. Supplementary Information: The online version contains supplementary material available at 10.1007/s42843-021-00044-3.
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BACKGROUND AND OBJECTIVES: We conducted a multisite, pragmatic replication trial at 4 New England epilepsy centers to determine the effectiveness of Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) in a real-world setting and to assess feasibility of a virtual intervention. METHODS: HOBSCOTCH is an 8-session intervention addressing cognitive impairment and quality of life (QoL) for people with epilepsy (PWE). Participants were recruited from epilepsy centers in 4 states and block-randomized into the following groups: in-person HOBSCOTCH (H-IP), virtual HOBSCOTCH (H-V), and waitlist control. Outcome measures were assessed for all groups at baseline, 3 months, and 6 months; intervention groups received long-term follow-up at 9 and 12 months. RESULTS: A total of 108 participants were recruited, of whom 85 were included in this analysis (age at baseline 47.5 ± 11.5 years; 68% female). Participants completing the in-person intervention (H-IP) had a 12.4-point improvement in QoL score compared with controls (p < 0.001). Pairwise comparisons found a 6.2-point treatment effect for subjective cognition in the H-IP group (p < 0.001). There were no meaningful group differences in objective cognition or health care utilization at any time points and the treatment effect for QoL diminished by 6 months. The virtual intervention demonstrated feasibility but did not significantly improve outcomes compared with controls. Within-group analysis found improvements in QoL for both H-V and H-IP. DISCUSSION: This study replicated the effectiveness of the HOBSCOTCH program in improving QoL for PWE. The study was conducted prior to the COVID-19 pandemic, but the distance-delivered intervention may be particularly well-suited for the current environment. Future research will explore modifications designed to improve the efficacy of H-V and the sustainability of HOBSCOTCH's treatment effect. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov (NCT02394509). CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that in-person HOBSCOTCH delivery improved subjective measures of cognition in persons with epilepsy.
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COVID-19 , Epilepsy , Self-Management , Cognition , Epilepsy/psychology , Epilepsy/therapy , Female , Humans , Male , Pandemics , Quality of Life/psychologyABSTRACT
We are interested in determining whether ambient air pollutants impact the development of Parkinson's disease (PD) by increasing -synuclein pathology via inflammation. After completing Specific Aim 2, wherein we found no differences between experimental groups in spread of -syn, nor the expected nPM-induced neuroinflammatory changes. We repeated Specific Aim 2 mouse experiments with a new batch of nPM that showed in vitro activity. We collected tissues during the first week of SARS-CoV-2 quarantine. After restrictions were relaxed, we began analyzing tissues for neuroinflammation. This on-going analysis has yet to show strong inflammatory effects of the in vivo nPM exposure. Due to continued pandemic quarantine and travel restrictions we are discussing option with our collaborators. We will plan and execute novel experiments to explore the effects of LPS-induced olfactory inflammation on spread of -syn by histological (VAI) and biochemical (USC) analyses. We are interested in determining whether ambient air pollutants impact the development of Parkinson's disease (PD) by increasing -synuclein pathology via inflammation. After completing Specific Aim 2, wherein we found no differences between experimental groups in spread of -syn, nor the expected nPM-induced neuroinflammatory changes. We repeated Specific Aim 2 mouse experiments with a new batch of nPM that showed in vitro activity. We collected tissues during the first week of SARS-CoV-2 quarantine. After restrictions were relaxed, we began analyzing tissues for neuroinflammation. This on-going analysis has yet to show strong inflammatory effects of the in vivo nPM exposure. Due to continued pandemic quarantine and travel restrictions we are discussing option with our collaborators. We will plan and execute novel experiments to explore the effects of LPS-induced olfactory inflammation on spread of -syn by histological (VAI) and biochemical (USC) analyses.
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BACKGROUND: People with psychogenic nonepileptic seizures (PNES) are at elevated risk of multiple psychiatric comorbidities. Current treatment gaps highlight the need for time-limited, distance-delivered interventions that can be cost-effectively delivered to patients with PNES. Project UPLIFT is a self-management program addressing mood problems in epilepsy that has not previously been adapted for PNES. The purpose of this study was to assess the feasibility and acceptability of UPLIFT for patients with PNES. METHODS: Project UPLIFT was minimally adapted by a multidisciplinary research group at Dartmouth-Hitchcock Medical Center. Participants were recruited into a nonrandomized pilot study and were assessed at baseline, after completing the intervention, and at 1-month follow-up. RESULTS: The intervention was adapted and delivered without additional modification. A total of eight participants enrolled in the trial, and six participated in the first session. All six participants who started UPLIFT completed the intervention, with a 98% attendance record across the eight sessions. At follow-up, 100% reported that UPLIFT provided useful tools for daily life. All participants continued using UPLIFT after completing the program, and 83% felt it helped with seizure management. Preliminary results provide proof-of-concept for future efficacy trials. CONCLUSION: This study provides initial support for the feasibility and acceptability of Project UPLIFT, minimally adapted for patients with PNES. As a time-limited program that can be distance-delivered to groups of patients, UPLIFT may be well-suited for the healthcare environment brought on by the COVID-19 pandemic.
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COVID-19 , Psychogenic Nonepileptic Seizures , Electroencephalography , Feasibility Studies , Humans , Pandemics , Pilot Projects , SARS-CoV-2 , Treatment OutcomeABSTRACT
An introduction to design for first year engineering students contains many facets. Students are expected to learn and demonstrate their knowledge of design processes, drawing, and computer-aided-design. In a new interdisciplinary design unit, students were given an ongoing individual design project which assessed their understanding of design, as well as competencies and skills in using their drawing, computer-aided design (CAD) and programming skills - they were also introduced to design through a design challenge that enhanced their individual and collective learning run in partnership with Engineers without Borders. This paper discusses the challenges of not only delivering such an ambitious model to first year engineering students from multiple disciplines-but the online and face-to-face teaching delivery that had to be implemented under Covid-19 restrictions. This paper documents a challenging year for all design educators, with significant uncertainty and rapidly changing circumstances. The conclusions of the paper are that Problem-Based Learning alone may not be suitable for engineering teaching in the first year of study, and with students who are getting to grips with blended learning and self-directed study. A hybrid model of problem and project-based learning may be more adaptable to different learning styles. If Problem-Based Learning is solely to be used it should place more emphasis on team work rather than individual competencies. Further work is to be explored in hybrid or hyflex online and in-class teaching to make the most out of activities linked with Project and Problem-Based Learning. © PDE 2021.
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Background: The COVID-19 pandemic has presented tremendous hurdles to the continuation of preventative services worldwide, including surveillance for HCC for patients with cirrhosis. The Veterans Health Administration (VA) Hepatic Innovation Team Learning Collaborative (HIT) aims to improve care for Veterans with cirrhosis nationally. This evaluation aimed to assess 1) the approaches that sites used to providing cirrhosis care (implementation strategies) during the pandemic and 2) the implementation strategies associated with improved HCC surveillance rates during the pandemic. Methods: VA hepatology clinicians were surveyed about the use of 73 implementation strategies used to improve cirrhosis care in fiscal year (FY) 2020 and whether strategy use was affected by COVID-19. Descriptive and bivariate statistics defined frequencies and associations with HCC surveillance in the year. Results: Survey responses were received from 72 (55%) VA sites caring for over 42,000 Veterans with cirrhosis. Over the course of the pandemic in FY20, the HCC surveillance rate nationally declined from 51% to a nadir of 39%, with an overall rate of 40% at the end of FY20. Sites reported using a median of 10 (IQR 4-20) of 73 implementation strategies to improve cirrhosis care in FY20. Implementation strategy use shifted during the pandemic such that, relative to pre-COVID, sites engaged in more academic collaborations, local technical assistance, and networking to problem solve and less outreach to patients, clinical performance data, site visits, and external facilitation. Implementation strategy selection was associated with HCC surveillance;sites using more implementation strategies had significantly higher HCC surveillance rates (p=.046). Six of 73 individual implementation strategies were significantly associated with increased HCC surveillance: 1) use clinical reminders or note templates, 2) create new clinical teams, 3) use data experts, 4) tailor care to meet local needs, 5) learn from experts in cirrhosis care, and 6) use interdisciplinary workgroups to provide input into cirrhosis policies and practices. Conclusion: While VA experienced an expected national decline in HCC surveillance during FY20, sites used a variety of shifting strategies to adapt to the changing environment. A subset of implementation strategies, including interdisciplinary team formation and using medical record tools and data, was associated with higher surveillance rates during the pandemic.
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Objective: In early 2020, our research teams at Northwestern University, NorthShore University HealthSystem, University of Michigan, and Fox Chase Cancer Center prepared to launch the final year of interventions for an NCI-funded RCT titled REASSURE ME (R01 CA193331). This study examines the extent to which training in mindfulness helps men diagnosed with prostate cancer on active surveillance and their partners be able to cope with the uncertainties of this treatment approach. Challenges associated with COVID-19 and shelter-in-place orders abruptly halted in-person study activities, prompting our team to quickly pivot and rethink how best to proceed. Methods: Our strategy consisted of four primary components:( 1) examining COVID-19's impact on the research (what affect, if any, it had on the study's purpose, design, procedures, findings);(2) re-evaluating plans underway before COVID-19 struck (including recruitment, interventions, data collection, multisite communications);(3) determining if video-conferencing would be a viable delivery solution, and if so, how to adapt content for that platform;and (4) identifying best resources/practices for the virtual environment. Results: Preparations for an additional year of the study included: (1) holding site meetings to determine funding needs, (2) requesting an NIH no-cost extension, and (3) submitting modifications to each site's Institutional Review Board. Procedural changes/additions included: (a) online intervention trainings and creation of tutorial aids for the research team;(b) video-conferencing training sessions, tutorial aids, and ongoing technical assistance for research participants;(c) development of online versions of the treatment and control interventions;(d) postal delivery of paper-based intervention materials/supplies to research participants;(e) electronic/postal qualitative data collection;and (f) establishing a coordinating assistant to be on call for intervention facilitators during sessions. Conclusion: The unprecedented constraints of COVID-19 presented our team with the opportunity to re-envision and develop a new approach for online delivery of mindfulness that can be used by future researchers.
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OBJECTIVES: We report on the key clinical predictors of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and present a clinical decision rule that can risk stratify patients for COVID-19. DESIGN, PARTICIPANTS AND SETTING: A prospective cohort of patients assessed for COVID-19 at a screening clinic in Melbourne, Australia. The primary outcome was a positive COVID-19 test from nasopharyngeal swab. A backwards stepwise logistic regression was used to derive a model of clinical variables predictive of a positive COVID-19 test. Internal validation of the final model was performed using bootstrapped samples and the model scoring derived from the coefficients, with modelling performed for increasing prevalence. RESULTS: Of 4226 patients with suspected COVID-19 who were assessed, 2976 patients underwent SARS-CoV-2 testing (n = 108 SARS-CoV-2 positive) and were used to determine factors associated with a positive COVID-19 test. The 7 features associated with a positive COVID-19 test on multivariable analysis were: COVID-19 patient exposure or international travel, Myalgia/malaise, Anosmia or ageusia, Temperature, Coryza/sore throat, Hypoxia-oxygen saturation < 97%, 65 years or older-summarized in the mnemonic COVID-MATCH65. Internal validation showed an AUC of 0.836. A cut-off of ≥ 1.5 points was associated with a 92.6% sensitivity and 99.5% negative predictive value (NPV) for COVID-19. CONCLUSIONS: From the largest prospective outpatient cohort of suspected COVID-19 we define the clinical factors predictive of a positive SARS-CoV-2 test. The subsequent clinical decision rule, COVID-MATCH65, has a high sensitivity and NPV for SARS-CoV-2 and can be employed in the pandemic, adjusted for disease prevalence, to aid COVID-19 risk-assessment and vital testing resource allocation.
Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19 , Clinical Decision-Making , Models, Biological , SARS-CoV-2 , Adult , Aged , Australia/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
We conducted a survey of licensed psychologists at two weeks and again at six months after the declaration of a national emergency related to the COVID-19 pandemic. This article describes the results of the second survey conducted approximately six months after the crisis began. The rapid shift to telepsychological services seen in the first survey in the pandemic has solidified in the second survey. More providers reported delivering a larger percentage of services via telepsychology than early in the pandemic. The majority of respondents do not anticipate resuming in-person services until after a vaccine is made available, although a consistent minority reports ongoing in-person service provision. A majority reported their patients had appropriate access to internet and telepsychological service platforms, although one-fifth of respondents reported their patients had difficulty accessing such services. Early concerns about technological or regulatory problems involved in telepsychology are no longer evident. Most respondents indicated they will continue to use telepsychological services for the delivery of some of their psychological services after the pandemic ends. Forty-five percent knew of individuals who contracted the disease, 13% knew someone who died of the disease, and 2% reported contracted the disease themselves.
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In the siege for a drug for covid-19, early signals of drugs' effectiveness were magnified and the need to prove a drug as effective and safe in the frame of randomized clinical trials (RCT) was neglected. Herein the most prominent covid-19 treatments, remdesivir, loponavir/ritonavir, favipiravir and (hydroxy)chloroquine, are presented. Remdesivir, accessible in Slovenia within a compassionate use program, is highlighted as proved effective in shortening the time to clinical improvement in a large RCT with 1059 covid-19 patients, with no important safety signals. On the other hand, the broad use of (hydroxy)chloroquine despite the lacking evidence of effectiveness is discussed in the light of its possible detrimental effects as suggested by recent large observational studies. A further proof of the need for clinical trials, also in Slovenia, to upgrade from»thinking« to»knowing« drugs that are effective and safe in treating patients with covid-19.
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Healthcare workers are at the frontline managing COVID-19 patients with transmission of the COVID-19 virus to healthcare workers evident in many Australian states. Minimisation of this spread is vital to protecting the healthcare workforce with individual organisations detailing best practice for infection and control. However, interpretation and implementation of infection control guidelines is varied across Australian Radiation Therapy Departments, highlighting inconsistencies. Strong leadership, quality communication and clear direction is required during this crisis to ensure that radiation therapists receive all necessary support and resources required to maintain safety and well-being during the COVID-19 pandemic.
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Due to the ongoing COVID-19 pandemic and increased pressure on testing resources, understanding the clinical and epidemiological features closely associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is vital at point of care to enable risk stratification. We demonstrate that an internally derived and validated clinical decision rule, COVID-MATCH65, has a high sensitivity (92.6%) and NPV (99.5%) for SARS-CoV-2 and could be used to aid COVID-19 risk-assessment and resource allocation for SARS-CoV-2 diagnostics.