Differential occupational risks to healthcare workers from SARS-CoV-2 observed during a prospective observational study.

We conducted voluntary Covid-19 testing programmes for symptomatic and asymptomatic staff at a UK teaching hospital using naso-/oro-pharyngeal PCR testing and immunoassays for IgG antibodies. 1128/10,034 (11.2%) staff had evidence of Covid-19 at some time. Using questionnaire data provided on potential risk-factors, staff with a confirmed household contact were at greatest risk (adjusted odds ratio [aOR] 4.82 [95%CI 3.45-6.72]). Higher rates of Covid-19 were seen in staff working in Covid-19-facing areas (22.6% vs. 8.6% elsewhere) (aOR 2.47 [1.99-3.08]). Controlling for Covid-19-facing status, risks were heterogenous across the hospital, with higher rates in acute medicine (1.52 [1.07-2.16]) and sporadic outbreaks in areas with few or no Covid-19 patients. Covid-19 intensive care unit staff were relatively protected (0.44 [0.28-0.69]), likely by a bundle of PPE-related measures. Positive results were more likely in Black (1.66 [1.25-2.21]) and Asian (1.51 [1.28-1.77]) staff, independent of role or working location, and in porters and cleaners (2.06 [1.34-3.15]).

Effects of long-haul transmeridian travel on physiological, sleep, perceptual and mood markers in Olympic team support staff.

The objective of this study was to holistically examine the impact of long-haul transmeridian travel (LHTT) on perceptual, mood, sleep and physiological markers in Olympic team support staff travelling to Japan for the 2020 Summer Olympic Games. An observational descriptive study design was used. Nine support staff members of the Irish Olympic team (2 M/7 F; age 34.3 ± 8.3 y (mean ±SD)) embarked on a long-haul (LH) eastward flight across eight time-zones from Ireland to Japan (approx. 24 h total travel time), to work at the Irish Team's 2020 Summer pre-Olympic Games camp, postponed to July 2021 due to Covid-19 pandemic. Perceived jet lag and travel fatigue symptoms, mood states and salivary markers for circadian rhythm and stress were assessed in the morning and evening during the week prior to travel as baseline (BL) measures and on days 1 to 8 (C1-C8) and day 15 (C15) post-travel. Night-time sleep (duration and quality) was monitored via actigraphy monitors and self-report sleep diaries. Participants perceived themselves to be significantly jet lagged for six days post-travel (p < .05). Morning sCort decreased by 66% on C1 and remained significantly lower than BL until C6 (p ≤ .03). On arrival participants perceived sleep to be worse than BL on arrival (C1, C2, C4, C5; p ≤ .04), with significantly shorter sleep duration (C2, C3, C6; p ≤ .01) and lower sleep efficiency (C2, C6; p ≤ .04) recorded by actigraphy, all normalizing by C7. Negative changes in mood states were evident in the evening time following LHTT, with significant elevations in confusion (C2, C3, p ≤ .02), fatigue (C2, C3; p ≤ .03) and depression (C3, C7; p < .05) and reduction in vigour (C2, C6, C7; p < .05). Following LHTT in an eastward direction across eight time-zones, it took seven days for perceived jet lag, physiological markers for circadian rhythm and sleep to normalize in Olympic team support staff. Despite alleviation of jet lag and fatigue and return of sleep to normal by C15, vigor remained low, indicating a "submerged" mood profile in these Olympic team support staff. These findings highlight the need to put strategies in place before and after LHTT for the Olympic Games to assist Olympic team support staff to maximize sleep, minimize stress and assist with expediating recovery from jet lag and travel fatigue, allowing them to perform optimally in supporting Olympic athletes in their final preparations for the Games.

Making trials part of good clinical care: lessons from the RECOVERY trial.

When COVID-19 hit the UK in early 2020, there were no known treatments for a condition that results in the death of around one in four patients hospitalised with this disease. Around the world, possible treatments were administered to huge numbers of patients, without any reliable assessments of safety and efficacy. The rapid generation of high-quality evidence was vital. RECOVERY is a streamlined, pragmatic, randomised controlled trial, which was set up in response to this challenge. As of April 2021, over 39,000 patients have been enrolled from 178 hospital sites in the UK. Within 100 days of its initiation, RECOVERY demonstrated that dexamethasone improves survival for patients with severe disease; a result that was rapidly implemented in the UK and internationally saving hundreds of thousands of lives. Importantly, it also showed that other widely used treatments (such as hydroxychloroquine and azithromycin) have no meaningful benefit for hospitalised patients. This was only possible through randomisation of large numbers of patients and the adoption of streamlined and pragmatic procedures focused on quality, together with widespread collaboration focused on a single goal. RECOVERY illustrates how clinical trials and healthcare can be integrated, even in a pandemic. This approach provides new opportunities to generate the evidence needed for high-quality healthcare not only for a pandemic but for the many other conditions that place a burden on patients and the healthcare system.

Gaming Your Mental Health: A Narrative Review on Mitigating Symptoms of Depression and Anxiety Using Commercial Video Games.

Globally, depression and anxiety are the two most prevalent mental health disorders. They occur both acutely and chronically, with various symptoms commonly expressed subclinically. The treatment gap and stigma associated with such mental health disorders are common issues encountered worldwide. Given the economic and health care service burden of mental illnesses, there is a heightened demand for accessible and cost-effective methods that prevent occurrence of mental health illnesses and facilitate coping with mental health illnesses. This demand has been exacerbated post the advent of the COVID-19 pandemic and the subsequent increase in incidence of mental health disorders. To address these demands, a growing body of research is exploring alternative solutions to traditional mental health treatment methods. Commercial video games have been shown to impart cognitive benefits to those playing regularly (ie, attention control, cognitive flexibility, and information processing). In this paper, we specifically focus on the mental health benefits associated with playing commercial video games to address symptoms of depression and anxiety. In light of the current research, we conclude that commercial video games show great promise as inexpensive, readily accessible, internationally available, effective, and stigma-free resources for the mitigation of some mental health issues in the absence of, or in addition to, traditional therapeutic treatments.

Impact of COVID-19 on service delivery for an evidence-based behavioral treatment for families involved in the child welfare system.

The novel coronavirus, COVID-19, has dramatically impacted clinical service delivery, particularly substance use treatment. The Families Actively Improving Relationships (FAIR) program is an action-oriented, evidence-based behavioral treatment for opioid and methamphetamine disorders in parents involved in the child welfare (CW) system. A seven-clinician team operates out of a Medicaid-funded clinic, primarily delivering services in the community. Attending to underlying mechanisms of FAIR's intervention strategies that promote client engagement and clinical outcomes, FAIR rapidly adapted procedures in response to COVID-19-onset disruptions. This study analyzed administrative records and Medicaid claims data from January 2019 to July 2020, including 157 clients and 17,449 claims. Analyses considered COVID-19 presence as March-July 2020. The study examined changes in the frequency and reimbursement volume of FAIR service delivery pre- and postonset of COVID-19. Although average monthly reimbursement per clinician did not significantly decline, reimbursement per client significantly declined by 31% (pre: $1005 [$732]; post: $698 [$546], p < .001). Clinicians delivered services on significantly more days per month during COVID-19 (mean (sd) = 16.73 (6.33); 20.26 (7.24), t(127) = -2.70, p < .01). Average clinician caseload size was stable, as was the average monthly service receipt days for clients. Thus, this study attributes reductions in reimbursement per client when FAIR provided services remotely to the elimination of in-person billable services and reductions in session length, but not in frequency. Medicaid-funded clinics and community-based substance use treatment interventions such as FAIR can successfully sustain and implement substance use treatment practices with deliberate, rapid adaptation to ensure that families receive needed supports in the face of contextual crises.