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1.
SSRN; 2022.
Preprint in English | SSRN | ID: ppcovidwho-337937

ABSTRACT

The COVID-19 pandemic and its mobility restrictions have been an external shock, influencing wellbeing. However, does risk exposure affect the welfare effect of lockdowns? This paper examines the ‘welcomed lockdown’ hypothesis, namely the extent to which there is a level of risk where mobility restrictions are not a hindrance to wellbeing. We exploit the differential timing of the effect of the pandemic across European countries, and the different stringency of lockdown to examine the effects on two mental health conditions, namely anxiety and depression. We examine whether differences in symptoms of anxiety and depression are explained by mortality and stringency of lockdown measures using ad event study that draws on Coarsened Exact Matching (CEM), Difference-in-Difference (DiD) and Regression Discontinuity Design (RDD). Our estimates suggest an average increase in depression (3.95%) and anxiety (10%) symptoms relative to the mean level on the day that the lockdown took effect. However, such effects are wiped out when a country exhibits high mortality (‘pandemic category 5’). Hence, we conclude that in an environment of high mortality, lockdowns no longer give rise to a reduction in well-being consistent with the ‘welcome lockdown’ hypothesis.

2.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-336121

ABSTRACT

Background: People living in care homes have experienced devastating impact from COVID-19. As interventions to prevent the transmission of COVID-19 are developed and evaluated, there is an urgent need for researchers to agree on the outcomes used when evaluating their effectiveness. Having an agreed set of outcomes that are used in all relevant trials can ensure that study results can be compared. Objective The aim of the study was to develop a core outcome set (COS) for trials assessing the effectiveness of pharmacological and non-pharmacological interventions for preventing COVID-19 infection and transmission in care homes. Methods The study used established COS methodology. A list of candidate outcomes was identified by reviewing registered trials to evaluate interventions to prevent COVID-19 in care homes. Seventy key stakeholders participated in a Delphi survey, rating the candidate outcomes on a nine-point scale over two rounds, with the opportunity to propose additional outcomes. Stakeholders included care home representatives (n = 19), healthcare professionals (n = 20), people with personal experience of care homes (n = 7), researchers (n = 15) and others (n = 9). Outcomes were eligible for inclusion if they met an a priori threshold. A consensus meeting with stakeholders resulted in agreement of the final outcome set. Results Following the Delphi and consensus meeting, twenty-four outcomes were recommended for inclusion. These are grouped across four domains of infection, severity of illness, mortality, and those specific to interventions. Due to the considerable heterogeneity between care homes, residents, and interventions, the relevance and importance of outcomes may differ between trial contexts. Intervention specific outcomes would be included only where relevant to a given trial, thus reducing the measurement burden. Conclusion Using a rapid response approach, a COS for COVID-19 prevention interventions in care homes has been developed. Future work should focus on identifying instruments for measuring these outcomes, and the interpretation and application of the COS across different trial contexts. Beyond COVID-19, the outcomes identified in this COS may have relevance to other infectious diseases in care homes, and the rapid response approach may be useful as preparation for future pandemics.

3.
Alzheimers Dement (N Y) ; 8(1): e12236, 2022.
Article in English | MEDLINE | ID: covidwho-1819398

ABSTRACT

Introduction: COVID-19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods: In a UK cohort study, pre- and post-pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life. Results: Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life. Discussion: Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post-diagnostic care.

4.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-332156

ABSTRACT

Background: Evidence-based rehabilitative interventions, if widely implemented, could equip people with dementia and their families to manage life with the condition and reduce the need for health and care services. The aim of this translational study, building on evidence from the GREAT randomised controlled trial, was to develop a foundation for implementing the GREAT Cognitive Rehabilitation intervention in community-based services for people with mild-to-moderate dementia. Methods: The implementation strategy drew on several theoretical frameworks;key elements were identifying and supporting managerial and clinical leadership, conducting collaborative planning and target-setting, training and supporting practitioners, and providing external facilitation. We developed implementation plans with, and trained staff in, 14 organisations. We subsequently worked closely with 11 of these, 10 National Health Service organisations and one private home care provider, to support practitioners to deliver GREAT Cognitive Rehabilitation over a 12-month period. Outcome evaluation examined the perspectives of local steering group members, practitioners and service users, and the reach, effectiveness and cost of the intervention. Results: Implementation was disrupted by the COVID-19 pandemic, but six organisations completed at least six months of intervention delivery. Forty-one practitioners, mainly occupational therapists, provided the intervention, and 54 people with dementia completed a course of GREAT Cognitive Rehabilitation. Goal attainment by people with dementia exceeded levels of improvement seen in the original trial. People with dementia, carers and practitioners all evaluated the intervention positively. Economic analysis indicated that the intervention could be provided at modest cost. Local steering group members believed the intervention benefitted staff and led to better outcomes for people with dementia, but identified a range of organisational barriers that impeded implementation and limited the potential for sustainability. Conclusions: GREAT Cognitive Rehabilitation benefits people with dementia, can be delivered effectively at modest cost in routine services, and is viewed positively by people with dementia, family carers and practitioners. To fully realise these benefits and achieve widespread and sustainable implementation, however, requires sufficient resources and a reorientation of service priorities towards preventive and rehabilitative approaches. Registration National Institute for Health Research (NIHR) Central Portfolio Management System, registration number 38994

5.
BMJ Open ; 11(10): e049472, 2021 10 07.
Article in English | MEDLINE | ID: covidwho-1462960

ABSTRACT

OBJECTIVES: Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS: A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS: The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS: A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.


Subject(s)
COVID-19 , Stress Disorders, Post-Traumatic , Adult , Cost-Benefit Analysis , Humans , Pandemics , Quality-Adjusted Life Years , SARS-CoV-2 , State Medicine , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy
7.
Int J Geriatr Psychiatry ; 36(11): 1597-1639, 2021 11.
Article in English | MEDLINE | ID: covidwho-1233187

ABSTRACT

OBJECTIVES: In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research. METHODS: We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature. RESULTS: Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies. CONCLUSIONS: The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.


Subject(s)
COVID-19 , Dementia , Consensus , Dementia/epidemiology , Humans , Pandemics , Quality of Life , SARS-CoV-2
8.
Lancet ; 397(10288): 2012-2022, 2021 05 22.
Article in English | MEDLINE | ID: covidwho-1219074

ABSTRACT

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this Health Policy paper, we look at the economic impact of the COVID-19 pandemic and historical spending in the UK and comparable countries, assess the role of private spending, and review spending projections to estimate future needs. Public spending on health has increased by 3·7% a year on average since the National Health Service (NHS) was founded in 1948 and, since then, has continued to assume a larger share of both the economy and government expenditure. In the decade before the ongoing pandemic started, the rate of growth of government spending for the health and care sector slowed. We argue that without average growth in public spending on health of at least 4% per year in real terms, there is a real risk of degradation of the NHS, reductions in coverage of benefits, increased inequalities, and increased reliance on private financing. A similar, if not higher, level of growth in public spending on social care is needed to provide high standards of care and decent terms and conditions for social care staff, alongside an immediate uplift in public spending to implement long-overdue reforms recommended by the Dilnot Commission to improve financial protection. COVID-19 has highlighted major issues in the capacity and resilience of the health and care system. We recommend an independent review to examine the precise amount of additional funds that are required to better equip the UK to withstand further acute shocks and major threats to health.


Subject(s)
COVID-19/economics , Health Expenditures/statistics & numerical data , Health Policy/economics , State Medicine/economics , Financing, Government , Humans , Social Support , United Kingdom
9.
Lancet ; 397(10288): 1979-1991, 2021 05 22.
Article in English | MEDLINE | ID: covidwho-1219658

ABSTRACT

The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and there is a growing burden of mental illness. Successes exist, such as the striking improvements in oral health, but inequalities in health persist as well. The growth of the ageing population relative to the working-age population, the rise of multimorbidity, and persistent health inequalities, particularly for preventable illness, are all issues that the National Health Service (NHS) will face in the years to come. Meeting the challenges of the future will require an increased focus on health promotion and disease prevention, involving a more concerted effort to understand and tackle the multiple social, environmental, and economic factors that lie at the heart of health inequalities. The immediate priority of the NHS will be to mitigate the wider and long-term health consequences of the COVID-19 pandemic, but it must also strengthen its resilience to reduce the impact of other threats to health, such as the UK leaving the EU, climate change, and antimicrobial resistance.


Subject(s)
Delivery of Health Care/trends , Demography/trends , State Medicine/organization & administration , Aging , COVID-19 , Cost of Illness , Healthcare Disparities/trends , Humans , Life Expectancy , Maternal-Child Health Services , Mental Health , Multimorbidity/trends , Oral Health/trends , State Medicine/trends , United Kingdom/epidemiology
10.
ProQuest Central; 2020.
Preprint in English | ProQuest Central | ID: ppcovidwho-2112

ABSTRACT

We argue that predictions of a ‘tsunami’ of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated;feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health. Some people will need specialised mental health support, especially those already leading tough lives;we need immediate reversal of years of underfunding of community mental health services. However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pumfunds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations. Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care. Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

11.
Wellcome Open Res ; 5: 166, 2020.
Article in English | MEDLINE | ID: covidwho-657527

ABSTRACT

We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.  Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services.  However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations.  Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care.  Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

12.
J Aging Soc Policy ; 32(4-5): 365-372, 2020.
Article in English | MEDLINE | ID: covidwho-526819

ABSTRACT

This perspective examines the challenge posed by COVID-19 for social care services in England and describes responses to this challenge. People with social care needs experience increased risks of death and deteriorating physical and mental health with COVID-19. Social isolation introduced to reduce COVID-19 transmission may adversely affect well-being. While the need for social care rises, the ability of families and social care staff to provide support is reduced by illness and quarantine, implying reductions in staffing levels. Consequently, COVID-19 could seriously threaten care availability and quality. The government has sought volunteers to work in health and social care to help address the threat posed by staff shortages at a time of rising need, and the call has achieved an excellent response. The government has also removed some barriers to effective coordination between health and social care, while introducing measures to promote the financial viability of care providers. The pandemic presents unprecedented challenges that require well-co-coordinated responses across central and local government, health services, and non-government sectors.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Social Work/organization & administration , State Medicine/organization & administration , Betacoronavirus , COVID-19 , Humans , Infection Control/organization & administration , Pandemics , Personnel Staffing and Scheduling/organization & administration , SARS-CoV-2 , Social Isolation , United Kingdom/epidemiology
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