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Mental health issues are fast becoming one of society's greatest health challenges with evidence of higher levels of illness and strain on psychiatric services. The reasons for this trend of increasing mental health problems across the population are complex and there is an urgent need to research and deliver effective public mental health strategies. In this perspective piece we argue that psychiatrists and public health physicians have unique knowledge and perspectives on population mental health. The development of interdisciplinary initiatives and training posts would result in clinicians with expertise to drive forward public mental health strategies. Focused and sustained advocacy and collaboration are necessary for prioritisation of public mental health on policymakers' agendas.
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Emerging evidence suggests that the consequences of childhood adversity impact later psychopathology by increasing individuals' risk of experiencing difficulties in adjusting to stressful situations later in life. The goals of this study were to: (a) identify sociodemographic factors associated with subgroups of psychological adjustment prior to and after the onset of the COVID-19 pandemic and (b) examine whether and to what extent types of childhood adversity predict transition probabilities. Participants were recruited via multiple social media platforms and listservs. Data were collected via an internet-based survey. Our analyses reflect 1942 adults (M = 39.68 years);39.8% reported experiencing at least one form of childhood adversity. Latent profile analyses (LPAs) and latent transition analyses (LTAs) were conducted to determine patterns of psychological adjustment and the effects of childhood adversity on transition probabilities over time. We identified five subgroups of psychological adjustment characterized by symptom severity level. Participants who were younger in age and those who endorsed marginalized identities exhibited poorer psychological adjustment during the pandemic. Childhood exposure to family and community violence and having basic needs met as a child (e.g., food, shelter) significantly moderated the relation between latent profile membership over time. Clinical and research implications are discussed. © 2023 by the authors.
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The psychological impact of COVID-19 on Health Care Workers (HCWs) has been widely reported. Few studies have sought to examine HCWs personal models of COVID-19 utilising an established theoretical framework. We undertook a mixed methods study of beliefs about COVID-19 held by HCWs in the Mid-West and South of Ireland during the first and third waves of COVID-19. Template analysis was undertaken on the free text responses of 408 HCWs about their perceptions of the Cause of COVID-19 as assessed by the Brief Illness Perception Questionnaire (B-IPQ). Responses were re-examined in the same cohort for stability at 3 months follow-up (n = 100). This analytic template was subsequently examined in a new cohort (n = 253) of HCWs in the third wave. Female HCWs perceived greater emotional impact of COVID-19 than men (t = -4.31, df405, p < 0.01). Differences between occupational groups were evident in relation to Timeline (F4,401 = 3.47, p < 0.01), Treatment Control (F4,401 = 5.64, p < 0.001) and Concerns about COVID-19 (F4,401 = 3.68, p < 0.01). Administration staff believed that treatment would be significantly more helpful and that COVID-19 would last a shorter amount of time than medical/nursing staff and HSCP. However, administration staff were significantly more concerned than HSCP about COVID-19. Template analysis on 1059 responses to the Cause items of the B-IPQ identified ten higher order categories of perceived Cause of COVID-19. The top two Causes identified at both Waves were 'individual behavioural factors' and 'overseas travel'. This study has progressed our understanding of the models HCWs hold about COVID-19 over time, and has highlighted the utility of the template analysis approach in analysing free-text questionnaire data. We suggest that group and individual occupational identities of HCWs may be of importance in shaping HCWs responses to working through COVID-19.
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In the last three decades, early intervention for psychosis (EIP) services have been established worldwide and have resulted in superior symptomatic and functional outcomes for people affected by psychotic disorders. These improved outcomes are a result of reducing delays to treatment and the provision of specialised, holistic interventions. The COVID-19 pandemic poses significant challenges to the delivery of these services, such as undetected cases or long delays to treatment. Furthermore, the COVID-19 pandemic will likely increase the mental health needs of communities, including the incidence of psychotic disorders. In this perspective piece, we provide suggestions as to how EIP services can adapt within this environment, such as utilising novel technologies. Finally, we argue that despite the economic consequences of the pandemic, the funding for mental health services, including EI services, should be increased in line with the need for these services during and beyond the pandemic.
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Objective: To characterize adherence patterns to antiretroviral therapy (ART) and identify factors affecting optimal adherence among adolescents living with HIV (ALHIV) in Kingston, Jamaica during the COVID-19 pandemic Methods: During August-October 2021, we conducted a cross-sectional study on adherence (no missed doses in preceding four days) among adolescents 10-18 years attending three outpatient departments in the Kingston Metropolitan Area. Adherence factors were evaluated using a selfadministered, interviewer-assisted structured questionnaire. Biochemical and clinicopathological information were retrieved from patients' medical records. Multivariate logistic regression was used to determine likelihood of adherence for given adherence factors. Result(s): Of 65 participating clients, 92.3 % were perinatally infected, mean (SD) age 15.4 (2.0) years and 61.5% were female. Overall self-reported adherence was 66.1% (43/65) and higher among adolescents in residential care versus family care (p = 0.002). Median (IQR) viral load 19 copies/ml/103 (IQR 19-51) was lower (p = 0.010) and median (IQR) CD4+ count 701 cells per muL (IQR 501-1052) higher (p = 0.016) among adolescents in residential care compared to family care. Adherence was 4X more likely among adolescents at UHWI (OR = 4.53, 95% CI (1.25, 16.43), knowledgeable about ARVs (OR = 4.31, (1.09,17.04), and with reduced appointments due to COVID-19 pandemic (OR = 5.36, (1.09, 26.41) and 4X less likely if cared for by relatives, experiencing side effects, higher pill burden or hospitalized with complications. Conclusion(s): Medication, caregiver-related and health system management factors are both enablers and barriers of adherence for ALHIV, and the importance of caregivers' support, treatment literacy and simplified treatment regimens are highlighted.
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Considerable literature has reported the COVID-19 pandemic's negative mental health sequelae. This surge in mental health problems will likely present to primary care in the coming months. The development of interventions to support GPs in the care of patients with mental health problems is a priority. The aim of this review was to examine interventions which could be implemented in general practice to enhance care of mental health disorders post COVID-19. PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO Global Research on COVID-19 databases were searched following Arksey and O'Malley's scoping review process(1). Initial searches identified 148 articles. Twenty-nine studies were included in the review, mostly randomised control trials, qualitative interviews and surveys. Outcome measures to test feasibility of interventions included the 'Seven-item Generalised Anxiety Disorder Scale' and 'Nine-item Patient Health Questionnaire'. Results were divided into themes: Interventions to improve identification of mental health disorders;Interventions to support GPs;Therapeutic interventions;Telemedicine interventions, and barriers and facilitators to intervention implementation. Interventions requiring active involvement of patients in their own care may be effective. GPs should encourage participation in physical activity andmeditation, implement digitalmental health interventions and incorporate telemedicine into their practice. Our findings suggest a broad range of interventions may be implemented in primary care to tackle the mental health sequelae of COVID-19. Practitioners worldwide must stay informed of relevant research, and actively implement studied interventions to improve the mental health care they offer. Priority areas for future research include biological treatments for mental health sequelae of COVID-19.
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Introduction: Limited data on SARS-CoV-2 vaccine reactogenicity in persons with multiple sclerosis (PwMS) exists and it is of interest due to the novel vaccine strategies deployed and the uncertain impact of disease modifying therapies (DMTs). Objective: To report real-world data on SARS-CoV-2 vaccine reactions in PwMS in the context of DMTs. Aim: To identify sociodemographic and clinical attributes associated with SARS-CoV-2 vaccine reactogenicity in PwMS. Methods: PwMS participating in iConquerMS (an online research network) completed detailed online surveys between 3/2021- 6/2021, and reported their SARS-CoV-2 vaccines, experiences of local (itch, pain, redness, swelling, or warmth at injection site) and systemic (fever, chills, fatigue, headache, joint pain, malaise, muscle ache, nausea, allergic, or other) reactions within 24 hours (reported as none, mild, moderate, or severe), and other attributes, including DMT use. Multivariable models characterized associations between predictors and reactogenicity after the 1st and 2nd vaccination. Results: In 719 PwMS, 64% reported a reaction and 17% reported a severe reaction after the 1st vaccine, which were primarily experiences of pain at injection site, fatigue, headache, and malaise. Younger age, being female, a prior SARS-CoV-2 infection, and receiving the ChAdOx1 nCoV-19 versus the BNT162b2 vaccine were independently associated with experiencing a reaction. Similar relationships were observed for experiencing a severe reaction, including higher reactogenicity for PwMS with greater physical impairment and lower reactogenicity for PwMS treated with an alpha4-integrin blocker or sphingosine-1-phosphate receptor modulator (SIPR). In 441 PwMS who received two vaccinations, 74% reported a reaction and 22% reported a severe reaction after the 2nd vaccine. Younger PwMS and those who received the mRNA-1273 versus the BNT162b2 vaccine reported higher reactogenicity, while those on a S1PR or fumarate reported fewer reactions. Similar relationships for age, vaccine type, and S1PR treatment were observed for experiencing a severe reaction after the 2nd vaccine. There were no differences in reactogenicity by MS subtype, disease duration, or for B-cell depleting DMTs across models. Conclusions: Factors associated with SARS-CoV-2 vaccine reactogenicity in the general population were similarly associated in PwMS. Intriguingly, PwMS on specific DMTs were significantly less likely to report vaccine reactions.
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Objectives: This study was designed to test the feasibility of running a trial to compare the effectiveness of a combined weight management and physical function programme for patients with knee osteoarthritis ARMED (Arthritis Rehabilitation through the Management of Exercise and Diet) with usual care ESCAPE pain (Enabling Self-management and Coping with Arthritic Pain using Exercise). The COVID-19 pandemic interruption allowed additional measurement of the qualitative 'lived in' experiences of this patient group during the pandemic and also their appetite for virtual health. Participants: Thirty-two patients with knee osteoarthritis were recruited from a combined primary/secondary care waiting list and were allocated to either a six-week intervention group (ARMED) or to the six-week usual care ESCAPE pain group (Enabling Self-management and Coping with Arthritic Pain using Exercise) group. Results: The intervention programme was interrupted after three weeks by COVID-19. Fifteen patients were reassessed after the first stage. The average attendance was 92% with 6 patients attending all sessions, 5 attending 5/6, 1 attending 4/6 and 2 attending 3/6. One subject dropped out and 15/16 patients completed all outcome measurements. All patients completed the KOOS knee score and the Short Warwick-Edinburgh Mental Well Being Scale to evaluate anxiety and depression. There was a statistically significant improvement in pain, activities of daily living, quality of life and mental health and well-being scores from time one to time 2. The mean weight, BMI and waist measurements were reduced also from time one to time 2, but these failed to reach significance. The semi-structured interviews provided rich information on enablers and barriers to coping in lockdown, benefits of the ARMED programme to increasing physical activity and weight management and enablers and barriers to redesigning the programme for online delivery. Conclusions: Evaluation of preliminary data from this feasibility study supports the three-week intervention combining education, exercise and weight management in this patient group even during a pandemic. Based on the results of the qualitative interviews, we have now redesigned our programme to present it virtually. We hope to present the results of our virtual feasibility study later in 2021. ©
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Aim To examine the characteristics and outcomes of hospitalised older adults with COVID-19. Methods Retrospective, multi-centre, cohort observational study. Data from sixty-nine hospitalised patients aged over 70 years with reverse transcriptase polymerase chain reaction-confirmed COVID-19 at three Irish hospitals were collected from health records. Symptom profile, COVID-19 severity level based on Irish Thoracic Society guidelines, Clinical Frailty Scale (CFS), Cumulative Illness Rating Scale-Geriatric (CIRS-G) scores, laboratory and radiological data were reviewed. Results Patient mortality rate was 23.2% (n=16). Median survivor age was 81.5 years (IQR 76.5-86.5). Mean CFS and CIRS-G scores were 5;(SD1.6) and 8.19;(SD4.4). Most patients (n=56, 81.1%) were categorised as mild COVID-19 cases. Five patients (n=5, 7%) were asymptomatic. Atypical symptom presentation was 7%(n=5). Delirium was noted in almost one-third of patients (n=21, 30.4%). Seven patients (n=7,10.1%) required intubation and intensive care unit admission. Over 1/3 of delirious patients died (n=8, 38%). Frail patients were older (P= 0.005), more likely to have dementia (P=0.04) and required less ventilatory support than non-frail patients (P=0.001) but were categorised as mild COVID-19 on admission (P=0.004). Conclusion Despite mild COVID-19 symptoms, mortality and delirium rates remained high. Low co-morbidity burden & atypical symptom rates were recorded despite high frailty rates.
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Aims Peri-operative SARS-CoV-2 infection is of particular concern for surgeons and their patients due to the high morbidity and mortality. In this study, we investigate the effectiveness of pre-operative SARS-CoV-2 screening in preventing peri-operative infections in a region with a low incidence of infection. Methods Data was collected prospectively on all patients who underwent urological surgery after the exponential phase of the pandemic. The primary outcome was the development of SARS-CoV-2 infection in patients. The secondary outcome was SARS-CoV-2 infections in healthcare workers. Results During the 6-week period following the exponential phase of the pandemic 136 procedures were performed. Ninety-nine (73%) patients had pre-operative SARS-CoV-2 swabs. Forty (29%) had a pre-operative CT Thorax. No patient was found to have SARS-CoV-2 infection pre-operatively. Five (3.6%) of patients developed symptoms that required a second SARS-CoV-2 swab in the post-operative period, all 5 (100%) were negative. No patient developed SARS-CoV-2 infection in the follow-up period, and no member of the urology team developed SARS-CoV-2 infection. Conclusion Our findings demonstrate that elective urological surgery can be safely performed in a region with a low incidence of SARS-CoV-2 with pre-operative screening. We report no cases of symptomatic SARS-CoV-2 infection or deaths among 136 patients undergoing urological surgery.
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Aim COVID-19 has posed an unprecedented challenge to healthcare systems. We aimed to observe the impact on urological care delivery in an Irish university hospital. Methods Data on urological activity was prospectively collected for 3 months from March 2020. A retrospective review of the same period in 2019 was performed for control data. Results Over the 2020 study period, 356 urological admissions were recorded;a 23.1% decrease from the 2019 corresponding period(n=463). A 21.7% decrease in flexible cystoscopies was seen (162 versus 207). 125 theatre cases (36 off-site) were performed in the 2020 period, versus 151 in 2019. Emergency case load remained stable, with 69 cases in the 2020 period. The percentage of trainee-performed cases was preserved. COVID-era outpatient activity increased, to involve 559 clinic consultations compared to 439 the preceding year;a reflection of annual growth in service demand and facilitated by virtual clinic application (n=403). There were 490 instances of patients cancelling/failing to attend outpatient appointments, compared to 335 in 2019. Conclusion The Irish COVID-19 outbreak has created obstacles for urological care. Nonetheless, urgent/emergent urological cases persist. Our unit has managed this to-date with flexible adaptation of service delivery. The global challenge posed by COVID-19 will demand ongoing resourcefulness to minimise impact on patients with time-sensitive urological conditions.
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Background: Patients with COVID are more likely to have systemic thrombotic events. Although it has been theorized that those on CRRT also have an increased rate of filter loss due to clotting. If COVID-positive patients are more likely to clot their filter than other patients on CRRT, a more aggressive anticoagulation strategy may be worthwhile. This could result in longer filter lifespan, less circuit down time, which would result in improved clearance, lower costs, less risk of iatrogenic blood loss, and less wasted nursing time. If there is no difference in filter lifespan between COVID positive and negative patients, then more aggressive anticoagulation would result only in added risk without a clear benefit. Methods: We analyzed COVID data on patients in a related unblinded prospective randomized trial, in which patients are assigned to either pre-filter CVVH or CVVHD. The standard treatment protocol at the University of Iowa is to use citrate anticoagulation with a blood flow rate of 200 mL/min and a dose of 25 mL/kg/hr. The primary outcome is average filter life, and secondary outcomes are mortality, intensive care unit LOS, hospital LOS, and renal recovery. Results: A total 30 patients using a total of 90 filters from March 25 to May 20, 2020 were evaluated (Table 1). The average filter life in COVID-positive patients was 37.4 +/- 35.8 compared to 33.1 +/- 26.7 in COVID-negative patients (p = 0.55). However, COVID-19 patients were more likely to receive heparin anticoagulation in addition to citrate. Conclusions: Contrary to other reports, in this retrospective, unadjusted analysis of CRRT patients, the presence of COVID-19 did not decrease average filter life. Further research is needed regarding the appropriate anticoagulation strategy in COVID-19 positive patients.