ABSTRACT
The role of the renin-angiotensin system in human pain is a complicated and controversial field, partly due to the complexities of the system itself, but also because of the diverse ways in which pain functions. Here, we focus on what is known about the angiotensins in pathological pain and describe the ongoing attempts to identify candidate modulators of clinical significance. Systemic angiotensin agonists and antagonists have effects in a number of neuropathic ailments, including some of the most medically intractable conditions, such as endocrine disorders, cancer, myopathies, and viral infections (such as COVID-19), apart from direct damage to the nervous system. These arise due to multiple physiological processes involving both neural and nonneural pathways that could be overcome with future research. In summary, it is clear that the angiotensins acting through their different receptors exercise both algesic and analgesic effects, but less clear how this diversity of responses arises. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Pre-pandemic research has shown adverse consequences of having unmet care needs for older adults' mental health. Due to the broad psychological distress and increased caregiving challenges during COVID-19, older adults' vulnerabilities to unmet needs may be amplified by the pandemic, especially for those with functional limitations and intense care needs. This study aims to examine (1) the associations between unmet needs and depression among older adults before and during the COVID-19 and (2) whether the excess mental health consequences from unmet needs and COVID-19 vary by older adults' dementia status. We pool data from the 2018, 2019, and 2020 rounds of National Health and Aging Trends Study, a nationally representative sample of U.S. Medicare beneficiaries. We analyze N=6,273 older adults aged 70 years and older who had limitations with self-care, household activities, or mobility. Results show that older adults with functional limitations experienced increased risk of depression over time. Before and during the pandemic, older adults with unmet needs and older adults with probable dementia had higher risks of depression compared to their counterparts, respectively. The risk of depression was highest among older adults who had probable dementia and could not have their care needs met. For older adults without dementia, their risks of depression increased significantly from pre-pandemic to COVID-19 if they had unmet care needs. Findings demonstrate the disproportionate impacts of COVID-19 on mental health among older adults. Older adults who have cognitive impairments and unmet needs are in particular need of mental health support.
ABSTRACT
In this essay, Patterson continues the tradition of turning to analysis of family as a way to challenge asymmetrical power relations within academic discourse. Through an analysis of publications and performances from three members of the author's family-Phillip Patterson's The Serenity of Knowing, Michael Patterson's Humanist Solutions to American Problems: An Apolitical Approach to Governing, and Morgan Deane's "A Light in the Night: Reopening & Operating Nightlife Venues in the Time of Covid-19"-Patterson animates Tracie Morris's theory of grace as an African proverb performance rooted in Black family rhetoric to make visible rhetorical traditions and strategies used to create literacies for working across difference and surviving and thriving despite racist hegemonic structures of oppression. Additionally, Patterson extends their family rhetorical practices as useful techniques for decolonizing curriculum in form and content.
ABSTRACT
Background: There is currently no approved treatment for patients with COVID-19 who have not been hospitalized, a setting in which early intervention may curb progression to more severe disease requiring hospitalization. We report longitudinal biomarker sampling from a Phase III (PINETREE) clinical trial to evaluate prognostic biomarkers of COVID-19 and to better understand the early remdesivir (RDV) treatment response. Methods: A Phase III, randomized, double-blind, placebo controlled, multicenter study was conducted to evaluate the efficacy and safety of RDV for outpatients with early stage COVID-19 who are at higher risk of disease progression (NCT04501952). Inclusion criteria were ≥60 years of age or ≥12 years of age with at least one risk factor for severe COVID-19 disease. All individuals had ≤7 days of symptoms prior to randomization. A total of 562 participants were randomized 1:1 to RDV or placebo. Serum and plasma were collected for biomarker analyses in 312 patients at days 1, 3, and 14 post-treatment. All biomarker values were adjusted for baseline age and stratified by sex. Results: RDV demonstrated an 87% reduction in risk for the primary composite endpoint of COVID-19-related hospitalization or all-cause death by day 28 (0.7% [2/279]) compared with placebo (5.3% [15/283]) (p=0.008). RDV treatment was associated with improved clinical outcomes in participants with higher risk of hospitalization or death from COVID-19, including individuals ≥60 years of age, males, and/or those with diabetes, obesity, and hypertension. Furthermore, we found that biomarkers associated with inflammation and coagulation, including lactate dehydrogenase (p<0.001) and procalcitonin (p<0.001), were prognostic for COVID-19 related hospitalization or all-cause death by day 28. Finally, we found that RDV improved some biomarkers associated with COVID-19 severity by day 3 of treatment, including peripheral lymphopenia, monocyte count, and decreased neutrophil-to-lymphocyte ratio compared to placebo (pWilcox<0.05). Conclusion: Our findings suggest that RDV treatment improves COVID-19 outcomes in high-risk SARS-CoV-2 infected individuals, particularly in those ≥60 years of age, male, and/or with diabetes, obesity, and hypertension. Biomarkers of COVID-19 severity that were prognostic for poor outcomes were identified in early infection. Furthermore, our results suggest that RDV treatment leads to more rapid recovery in the lymphopenia that is commonly associated with more severe COVID-19.
ABSTRACT
Introduction: Community pharmacy is one of the most accessible sectors in the health service and played a key role in responding to COVID-19 (1). Efforts to tackle COVID-19 have required an immediate response from the community pharmacy workforce. Aim: To examine views and experiences of community pharmacists regarding changes in practice/processes in preparation for and response to the COVID-19 pandemic. Methods: A telephone questionnaire was conducted across a geographically stratified sample of community pharmacists in Northern Ireland (NI). Based on the total number of pharmacies (N=528) and an anticipated response rate of 30%, up to 433 pharmacies were to be contacted to achieve a target sample size of n=130 (sampling fraction 24%). The questionnaire sections comprised: (1) measures taken to prevent COVID-19 infection;(2) response to the pandemic, i.e. immediate actions taken, effect on service provision and new/innovative ways of working;(3) pandemic preparedness;(4) communication with GPs and patients;(5) professional knowledge;(6) recovery and future outlook. Data were coded, entered into SPSS v27, and analysed descriptively. Free-text comments were summarised using thematic analysis. Results: One hundred and thirty community pharmacists (175 approached) completed the questionnaire (74% response rate). Pharmacists responded comprehensively to implementing infection control measures, e.g. management of social distancing in the shop (n=125, 96.2%), making adjustments to premises, e.g. barriers/screens (n=124, 95.4%), while maintaining medicines supply (n=130, 100.0%) and advice to patients (n=121, 93.1%). Patient-facing services such as minor ailments and smoking cessation were initially stopped by 115 (88.5%) and 93 (71.5%) pharmacies respectively during the first wave of the pandemic (March-May 2020);by the second wave (Sep-Dec 2020), modified services had resumed in 121 (93.1%) and 104 (79.9%) pharmacies respectively. Newly commissioned services were provided, e.g. emergency supply service (n=121, 93.1%), flu vaccination for healthcare workers (n=101, 77.7%) and volunteer deliveries to vulnerable people (n=71, 54.6%);new initiatives were developed, e.g. measures to flag/assist patients with sensitive issues (n=73, 56.2%). Pharmacies with a business continuity plan increased from 85 (65.4%) pre-pandemic to 101 (77.7%) during the second wave. Free-text responses indicated how pharmacists adapted practice in the front line to reassure and advise the public and maintain essential medicines supply. Pharmacists were least prepared for the increased workload and patients' challenging behaviour, but 126 (96.9%) reported that they felt better prepared during the second wave. Telephone was the main method of communication with patients (n=107, 82.3%) and GPs (n=114, 87.7%). Pharmacists felt they had sufficient training resources available (n=113, 86.9%) to maintain professional knowledge. Pharmacists agreed/strongly agreed that they would be able to re-establish normal services (n=114, 87.7%), were willing to administer COVID-19 vaccines (n=105, 80.7%) and provide COVID-19 testing (n=79, 60.8%) in the future. Conclusion: The high response rate is a strength of the study, but the impact is limited by not including patients or service commissioners. The pharmacy workforce remained accessible and maintained supply of essential medicines and advice to patients throughout the pandemic. Provision of modified and additional services such as vaccination reinforced the clinical and public health role of pharmacy.
ABSTRACT
Introduction: Community pharmacy has played a frontline role during the COVID-19 pandemic (1,2). Governments and professional organisations in the United Kingdom and Republic of Ireland (RoI) have acknowledged the need to support and maximise community pharmacy to maintain delivery of patient care. However, the pandemic's impact on day-to-day changes to community pharmacy practice has not been comprehensively examined across the island of Ireland. Aim: To identify changes as communicated by policy and professional bodies to community pharmacy practice across the island of Ireland in preparation for and/or response to the COVID-19 pandemic, and to compare identified changes in Northern Ireland (NI) and RoI. Methods: Government, health service, regulatory and professional organisation websites in both NI and RoI were searched using relevant search terms (e.g. pharmacist, COVID- 19). Any document (e.g. official publications/reports, website pages, circulars) containing information relating to changes to community pharmacy-related infrastructure, funding/resourcing, legislation, guidelines or policies in preparation for, and/ or response to, COVID-19, published between 1st January and 31st October 2020 was included. Guidelines on clinical use of medicines were excluded as this was considered a separate topic. Initial screening of each website was undertaken by one reviewer. Brief details of potentially relevant documents were collated in a spreadsheet. Following removal of duplicates, full-texts of identified documents were assessed for inclusion by two reviewers independently, with discrepancies resolved through discussion. A content analysis was undertaken. Results: In total, 253 documents were identified. Following removal of duplicates and screening, 98 documents were included in the analysis. Most documents were published in the first three months of the pandemic (March-May 2020). A key theme related to medication prescribing and supply, with changes implemented to ensure continued access to medicines. In both NI and RoI, significant changes were made to emergency supply arrangements (e.g. increase in allowable duration of supply at the request of patients). In RoI, legislative changes were made to recognise Healthmail as the national electronic prescription transfer system and to temporarily extend prescription validity. In NI, many community pharmacy services (e.g. Minor Ailments Service, Medicines Use Review) were 'stood down' during initial months of the pandemic. Much of the communication in NI and RoI related to operational changes to ensure business continuity. In both jurisdictions a temporary register of pharmacists was introduced to allow previously registered pharmacists to contribute to the health service response. Additionally, in NI, General Dental Practitioners were redeployed to assist with community pharmacy response. Other areas of focus across both jurisdictions included infection control within a workplace setting, dealing with situations where staff were affected by COVID-19, and the use of personal protective equipment during pharmacy service provision. Conclusion: This study examined changes in community pharmacy practice across two jurisdictions during the COVID-19 pandemic. Whilst our searches were limited to publicly accessible documents only, the overlap in identified changes reflects the similarities in challenges faced by community pharmacists in adapting and responding to COVID-19. The cross-country comparison may help pharmacists and policy-makers to identify optimal approaches for responding to any future public health crises.
ABSTRACT
The COVID-19 pandemic has upended every aspect of American life. State governments responded quickly to protect public health and stabilize overwhelmed hospital systems. The most restrictive policy, the stay-at-home order, was seen by public health officials as a cornerstone of successful state mitigation strategies. But like many aspects of contemporary politics, support for these efforts took on a distinctly partisan hue. In this paper, I argue that party politics significantly affected state policy responses to COVID-19, which in turn limited mitigation efforts. To this point, I first demonstrate that Democratic governors were faster and more likely to adopt stay-at-home orders than Republicans. Next, using a synthetic control approach, I show that these orders caused residents to practice greater social distancing. Finally, I find that greater social distancing worked to "flattened the curve" by limiting the growth of COVID-19 cases. Together these findings show how party politics affected state pandemic responses and have important long-term implications as states begin lifting restrictions.
ABSTRACT
Objective: To assess frequency of utilization of advanced diagnostic testing in COVID-19 patients with encephalopathy, incidence of serious complication, and outcomes. Background: Extensive literature and clinical experience suggest a high rate of neurologic complications for COVID-19, especially encephalopathy, but also complications associated with significant morbidity such as ischemic stroke and encephalitis. However, not much literature has yet examined the utility of advanced diagnostic testing resources in COVID-19 associated encephalopathy in identifying such complications. We present a retrospective case series of patients with encephalopathy during COVID-19 infection, diagnostic test results and associated outcomes. Design/Methods: Cases were reviewed from inpatient neurologic consultations at two associated hospital sites from 2019-2020. In total, 47 COVID-19 cases of encephalopathy from March through May of 2020 were retrospectively reviewed. A control group of 20 cases was retrospectively randomly selected from QI records from 2019-2020. All cases were reviewed for utilization of diagnostic testing including CT, MRI, EEG, lumbar puncture (LP), as well as outcome at discharge. Results: The incidence of serious neurologic complication was found in a much higher frequency on MRI and EEG diagnostic testing in patients with encephalopathy and COVID-19, compared with controls (24% and 11% respectively, vs 9% and 0%). CSF results were obtained in 6 COVID- 19 cases and 0 had diagnostic results or markers of illness. We conclude that MRI and EEG are of significant utility in the evaluation of COVID-19 encephalopathy in spite of logistical challenges in obtaining the studies. More research is needed for COVID-19 associated encephalopathy, including advancing reliability of COVID-19 detection in CSF. Conclusions: In conclusion, MRI and EEG are of significant utility in the evaluation of COVID-19 encephalopathy in spite of logistical challenges in obtaining the studies during the height of pandemic. More research is needed for COVID-19 associated encephalopathy, including advancing reliability of COVID-19 detection in CSF.
ABSTRACT
Public health and safety concerns around the SARS-CoV-2 novel coronavirus and the COVID-19 pandemic have greatly changed human behaviour. Such shifts in behaviours, including travel patterns, consumerism, and energy use, are variously impacting biodiversity during the human-dominated geological epoch known as the Anthropocene. Indeed, the dramatic reduction in human mobility and activity has been termed the “Anthropause”. COVID-19 has highlighted the current environmental and biodiversity crisis and has provided an opportunity to redefine our relationship with nature. Here we share 10 considerations for conservation policy makers to support and rethink the development of impactful and effective policies in light of the COVID-19 pandemic. There are opportunities to leverage societal changes as a result of COVID-19, focus on the need for collaboration and engagement, and address lessons learned through the development of policies (including those related to public health) during the pandemic. The pandemic has had devastating impacts on humanity that should not be understated, but it is also a warning that we need to redefine our relationship with nature and restore biodiversity. The considerations presented here will support the development of robust, evidence-based, and transformative policies for biodiversity conservation in a post-COVID-19 world. © 2021, Canadian Science Publishing. All rights reserved.