PROTOCOL: Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta‐analysis

Background Depressive symptoms and alcohol use in youth doubled in the first year of the COVID‐19 pandemic. The COVID‐19 pandemic has created sustained disruption in society, schools, and universities, including increasing poverty and discrimination. Public health restrictions have caused isolation and reduced social and emotional support. Together, these factors make depressive symptoms and alcohol use in youth a global public health emergency. Mobile applications (apps) have emerged as potentially scalable intervention to reduce depressive symptoms and alcohol use in youth that could meet increased demands for mental health resources. Mobile apps may potentially reduce psychological distress with accessible technology‐based mental health resources. Objectives This systematic review and meta‐analysis aims to assess the effect of mobile apps on depressive symptoms and alcohol use in youth. Search Methods We will develop a systematic search strategy in collaboration with an experienced librarian. We will search a series of databases (MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL) from January 2008 to July 2021. Selection Criteria Following the PRISMA reporting guidelines for systematic reviews, two independent reviewers will identify eligible studies: randomized controlled trials on mobile apps for the management of depressive disorders (depression and anxiety) and alcohol use in youth aged 15–24 years of age. Data Collection and Analysis Eligible studies will be assessed for risk of bias, and outcomes pooled, when appropriate, for meta‐analysis. Heterogeneity, if present, will be examined for gender. ethnicity, and socioeconomic status contributions. A narrative synthesis will highlight similarities and differences between the included studies. We will report GRADE summary of finding tables.

PROTOCOL: Mobile apps to reduce depressive symptoms and alcohol use in youth: A systematic review and meta-analysis.

Background: Depressive symptoms and alcohol use in youth doubled in the first year of the COVID-19 pandemic. The COVID-19 pandemic has created sustained disruption in society, schools, and universities, including increasing poverty and discrimination. Public health restrictions have caused isolation and reduced social and emotional support. Together, these factors make depressive symptoms and alcohol use in youth a global public health emergency. Mobile applications (apps) have emerged as potentially scalable intervention to reduce depressive symptoms and alcohol use in youth that could meet increased demands for mental health resources. Mobile apps may potentially reduce psychological distress with accessible technology-based mental health resources. Objectives: This systematic review and meta-analysis aims to assess the effect of mobile apps on depressive symptoms and alcohol use in youth. Search Methods: We will develop a systematic search strategy in collaboration with an experienced librarian. We will search a series of databases (MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL) from January 2008 to July 2021. Selection Criteria: Following the PRISMA reporting guidelines for systematic reviews, two independent reviewers will identify eligible studies: randomized controlled trials on mobile apps for the management of depressive disorders (depression and anxiety) and alcohol use in youth aged 15-24 years of age. Data Collection and Analysis: Eligible studies will be assessed for risk of bias, and outcomes pooled, when appropriate, for meta-analysis. Heterogeneity, if present, will be examined for gender. ethnicity, and socioeconomic status contributions. A narrative synthesis will highlight similarities and differences between the included studies. We will report GRADE summary of finding tables.

A multistakeholder development process to prioritize and translate COVID-19 health recommendations for patients, caregivers and the public. A case study of the COVID-19 recommendation map.

BACKGROUND AND OBJECTIVES: To develop a digital communication tool to improve the implementation of up-to-date COVID-19 recommendations. Specifically, to improve patient, caregiver and public understanding of healthcare recommendations on prevention, diagnoses and treatment. METHODS: Multi-stakeholder engagement design. In conjunction with the COVID-19 Recommendations and Gateway to Contextualization RecMap, we co-developed a stakeholder prioritization, drafting and editing process to enhance guideline communication and understanding. RESULTS: This paper presents the multi-stakeholder development process with three distinct plain language recommendation formats: formal recommendation, good practice statement, and additional guidance. Our case study of COVID-19 plain language recommendations PLRs addresses both public health interventions (e.g., vaccination, face masks) and clinical interventions (e.g., home pulse oximetry). CONCLUSION: This paper presents a novel approach to engaging stakeholders in improving the communication and understanding of published guidelines during the COVID-19 pandemic.

Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review.

Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.

Idiopathic inflammatory myopathy and axonal peripheral polyneuropathy in a poorly controlled coeliac disease patient

Background/Aims The current mainstay treatment of idiopathic inflammatory myopathies (IIM) includes steroid therapy with treatment escalation to steroids -sparing immunosuppressants to maintain remission. Nevertheless, some patients may not fully recover to their normal muscle strength, while exposing to potential side effects of these drugs. We report the first case of IIM and axonal peripheral polyneuropathy in a poorly controlled coeliac patient, who made complete recovery with adherence to gluten-free diet.Methods A 76-year-old white Caucasian lady, who was previously independent, presented with 6-weeks history of pain and weakness in both legs. She required the use of a wheelchair to get around as she was unable to weight bear as the result of the pain. She denied any change to regular medications, history of trauma, new rash, joint swelling, or B-symptoms. There was no history of smoking, alcohol, statins, or steroid use. She was previously diagnosed with coeliac disease 10 years ago but had opted not to adhere to a gluten-free diet due to personal preference.Results On examination, there was significant muscle tenderness on palpation of bilateral lower limbs. The rest of systemic examination was unremarkable. Duodenal biopsy revealed severe villous atrophy and chronic lymphocytic and plasma cell inflammation, which reinforced the diagnosis of coeliac disease. All immunology screen including ANA, ENA, ds-DNA, myositis and vasculitis screen were negative except anti-RO-52. This patient did not have any clinical feature of Sjogren’s or systemic lupus erythematosus. EMG revealed fibrillation potentials, positive sharp waves, and myotonic discharges in the paraspinal, upper and lower limbs muscles. It also demonstrated underlying axonal peripheral polyneuropathy. Muscle biopsy showed features consistent with the diagnosis of idiopathic inflammatory myopathy. This patient was started on a gluten-free diet during admission. Interestingly, we discovered that her creatinine kinase level had improved spontaneously along with the clinical improvement of her presenting symptoms. As her symptoms have completely resolved, she was discharged home. She was never started on steroid or immunosuppressant due to her significant clinical improvement. At three-month follow up, her creatinine kinase level had normalised, and she remained in remission while adhering to a gluten-free diet.Conclusion To the best of our knowledge, there is no reported case of complete clinical resolution of IIM with gluten withdrawal in coeliac disease patients, without the need of steroid or immunosuppressants. In addition, the concomitant of myopathy and polyneuropathy, as some described as neuromyositis, is extremely rare. The pathophysiology remains unclear;however, it is proposed that neuropathy could be an extra-muscular manifestation of IIM.The clinical remission of IIM in our patient with adherence to a gluten-free diet provide an alternative treatment option to the current recommended regimes of steroid and immunosuppressants. Such non-pharmacological approach is favourable, especially in the current SARS-CoV-2 pandemic.Disclosure Y. Tan: None. A. Mohamedalhadi: None. F. Wood: None.