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1.
Ir J Psychol Med ; : 1-12, 2022 Oct 26.
Article in English | MEDLINE | ID: covidwho-2087072

ABSTRACT

Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services. AIM: To establish prevalence of MH disorders among youth (under 18) in Ireland. METHOD: A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Empirical studies conducted in Ireland, in youth and focusing on MH disorders were included. RESULTS: From a total of 830 papers identified, 38 papers met inclusion criteria. Significant variation in rates of MH disorders was evident based on study methodology. Screening questionnaires for general psychopathology reported rates of 4.8-17.8% scoring above clinical cut-offs, with higher rates for ADHD (7.3%). Studies examining depression ranged from 4% to 20.8%, while rates for 'current' MH disorder, determined by semi-structured interview, were 15.5%, while 'lifetime' rates varied from 19.9% to 31.2%. Fewer than half (44%) of those identified as 'in need' of specialist MH services were accessing CAMHS. CONCLUSION: Data on MH disorders among Irish youth is limited, and studies showed significant variance in rates, making service planning difficult. There is an urgent need for serial epidemiological surveys, with clear operational criteria for clinically impairing MH difficulties. Such studies are essential to understand potential demand and service planning. This is most urgent given the expected increased demand post Covid-19.

3.
British Journal of Social Work ; 52(6):3559-3577, 2022.
Article in English | Web of Science | ID: covidwho-2042570

ABSTRACT

The global coronavirus SARS-CoV2 (COVID-19) pandemic outbreak caused immediate, far-reaching social schisms and created unprecedented challenges for hospital social work services worldwide. Existing hospital disaster plans were inadequately equipped for pandemics and organisational plans needed to quickly adapt to respond to the increased clinical demands and unique logistical considerations triggered by the virus. Literature reviews provided little in the way of precise guidance for practitioners. Hospital social workers responded not only to a new cohort of patients, but also to all patients affected by the societal repercussions of the pandemic and by governments' attempts to mitigate the impacts of the virus. Psychosocial assessments, the bedrock of social work intervention, needed to adapt and evolve to encompass and address the exacerbation of existing social risks in new ways. This article originated from the authors' interest in identifying practice implications for hospital social work during the COVID-19 pandemic. The authors briefly outline the distinct impact of COVID-19 on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They create a forum of international hospital social work centres to develop a consensus approach for addressing these issues in the context of a social work psychosocial assessment. The global COVID-19 pandemic stretched hospital resources across the globe and presented unique challenges to social work services. Disaster response plans were not adequately applicable given their time-limited nature. The broader social repercussions of the pandemic and governments' approaches to mitigating it meant that the cornerstone of social work intervention in hospitals-psychosocial assessments-needed to consider the aggravation of social risks in entirely new ways. The authors briefly outline the impacts of the pandemic and response on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They consult international hospital social work centres and develop an agreed approach for addressing these issues in the context of a social work psychosocial assessment.

4.
JACCP Journal of the American College of Clinical Pharmacy ; 5(7):774, 2022.
Article in English | EMBASE | ID: covidwho-2003603

ABSTRACT

Introduction: Despite a reduction in opioid prescribing, drug-related mortality continues to rise. California has passed legislation to expand access to naloxone, including a bill allowing pharmacists to furnish naloxone and a bill requiring providers to offer a prescription for naloxone under certain conditions. Research Question or Hypothesis: Did California legislation impact paid claims for naloxone among Medi-Cal (California's Medicaid program) beneficiaries? Study Design: Retrospective administrative claims analyses Methods: All Medi-Cal paid pharmacy claims for naloxone were evaluated with a date of service between January 1, 2015, and September 30, 2021. Prescriber NPI was reviewed to determine if naloxone was pharmacist-furnished. The primary and secondary outcomes were the change in total paid claims for naloxone and the change in paid claims for pharmacist-furnished naloxone, respectively. Results: Between January 1, 2015, and September 30, 2021, a total of 171,199 Medi-Cal beneficiaries had 235,790 paid claims for naloxone, with 32% (n = 75,567) occurring during the first nine months of 2021. The number of counties in California with a paid claim for naloxone in the Medi-Cal program increased from only 29 in 2015 to almost all counties (56 out of 58) by 2019. Between the 4th quarter of 2018 and the 1st quarter of 2019, total paid claims for naloxone increased by 250% and pharmacist-furnished naloxone increased by 150%. The highest percentage of pharmacist-furnished naloxone (22.8%) was observed during the 2nd quarter of 2020 early in the COVID-19 pandemic after the Stay-at-home Order was issued. Conclusion: These findings suggest both allowing pharmacists to furnish naloxone and mandating that prescribers offer naloxone under certain conditions increased access to naloxone across California. During the pandemic, while many clinics closed and use of health care services declined precipitously, pharmacists played an especially key role in ensuring uninterrupted access to lifesaving naloxone.

5.
Gastroenterology ; 162(7):S-463-S-464, 2022.
Article in English | EMBASE | ID: covidwho-1967308

ABSTRACT

Background Although a higher body mass index (BMI) has been reported to be associated with severe COVID-19 pneumonia (severe disease), it is unclear if metabolic status plays a role. Being metabolically unhealthy (MU) is defined as having either hypertension, hyperlipidemia, type 2 diabetes mellitus/pre-diabetes, or non-alcoholic fatty liver disease. We aimed to derive a risk score to predict severe disease in patients with obesity or overweight according to metabolic status. Methods A retrospective study was performed for patients hospitalized with COVID-19 pneumonia between March 2020 and August 2021 at a single tertiary center. Patients were excluded if they were immunocompromised or had a BMI < 25.0. Wilcoxon rank sum test or Fisher's Exact test were performed. Univariate logistic regression was performed followed by multivariate logistic regression to derive a risk score to predict severe disease. Variables with the highest p-values were sequentially removed until removal led to less than a 1-point reduction (improvement) in the Akaike information criterion. Accuracy of the model was calculated using bootstrap resampling estimates of the area under the receiver operating characteristic curve (AUROCC). Results 334 of 450 patients hospitalized with COVID-19 pneumonia (74.2%) were MU. Older age, higher BMI, being a former smoker, and having been vaccinated for SARS-CoV-2 were associated with being MU. There was no difference in treatments for COVID-19 pneumonia according to metabolic status. Patients who were MU had a higher death rate (10.5% vs. 2.6%) and longer total length of stay (median 6 vs. 5 days). Figure 1. On univariate analysis, age at admission, male gender, Asian race, hypertension, and type 2 diabetes mellitus were significant predictors of severe disease, whereas being MU was not, p=0.27. On multivariate logistic regression, older age, male gender, and Asian race were associated with having severe disease. Not being vaccinated was associated with a doubled odds of severe disease (OR 2.24, 95% CI: 1.07, 4.59). Figure 2. The AUROCC of the final model was 0.66 (95% CI: 0.60 to 0.71). The risk score at the lowest quintile had a 33.1% to 65.5% predicted risk and a 58.7% observed risk of severe disease, whereas at the highest quintile there was an 85.7% to 97.7% predicted risk and an 89.7% observed risk of severe disease in our cohort. Conclusion In this retrospective study of hospitalized patients with COVID-19 pneumonia, being MU was not a predictor of severe disease, even though mortality rate and total length of stay were higher in this group despite having higher rates of vaccination. Older age at admission, male gender, Asian race, and being unvaccinated were associated with severe disease. Using this risk score may help to predict severe disease in hospitalized patients with obesity or overweight. External validation is recommended (Table Presented)(Table Presented)

6.
Irish Journal of Medical Science ; 191:S72-S73, 2022.
Article in English | EMBASE | ID: covidwho-1966177

ABSTRACT

The waiting list in Clinical Genetics is prolonged. Anecdotally, we noted our service receiving duplicate referrals (referrals for patients already on the waiting list who hadn't yet been seen). Each of these waste both consultant and administrative time, it diverts attention away from ongoing cases and therefore is a clinical risk. We audited duplicate referrals over a 3 month period (01/11/2020-31/01/2021) to estimate costs to the Irish health service;82/986 (9%) referrals that were received were duplicate referral, 26/82 were a triplicate or more referral for same patient. The average length of time between first and second referral was 378 days indicating they arise at annual review with original referrer;52 (63%) were from the same initial referring consultant. Duplicate referrals changed the triage outcome in 7/82 (8.54%) cases. We performed time analyses managing duplicate referrals from both the referring and receiving consultant and administrative teams. Each individual re-referral costs €47.6. For the study period, the total cost of re-referrals to the health care system was €3,908.6. The National treatment purchase fund (www. ntpf. ie) cited > 200,000 patient waiting > 12 months for an appointment in the Irish Republic on 01/01/2021. Assuming duplicate referrals are occurring at a similar rate in other specialties (9%), then ∼ 18,000 duplicate referrals are sent annually within the HSE. Extrapolating from this, we estimate the overall cost to the HSE being €856,800 per annum. Our study was carried out during covid 19, referrals were down 10% indicating that the true cost is likely higher.

7.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927889

ABSTRACT

SARS-CoV-2 is detectable in gastrointestinal secretions and has been associated with changes to the gut microbiome during severe infection. However, the majority of individuals with COVID-19 will develop mild infection and remain outpatient for the duration of infection, with a relative paucity of information on the gut microbiome of this group. Furthermore, symptoms can persist for 6 months or longer in some patients, which has presented additional health care burdens given incomplete understanding of the long term impact of SARS-CoV-2 infection. To fill these knowledge gaps, we longitudinally sampled the gut microbial community of subjects infected with SARS-CoV-2 and their household contacts living in San Francisco at varying lengths of time after infection. We report an association between COVID-19 and the gut microbiome. COVID-19 positive subjects exhibited greater variability in the gut microbiome over time. In concordance with this finding, COVID-19 positive gut microbial communities were more self-distinct when compared to COVID-19 negative individuals across sample collections. Population level social distancing practices varied during the time of sample collection in our cohort, and we found an association between population level movement and gut microbial community variation. To better define the impacts of SARS-Cov-2 independent of genetic and environmental variables, are utilizing five SARS-CoV-2 variants (Alpha, Beta, Washington, Delta, and Omicron) in separate mouse models to test the impact of SARSCoV- 2 on the gut microbiome in severe and mild infections to define the impacts of SARS-CoV-2 on gut microbial ecology independent of genetic and environmental variables. We conclude that even mild cases of COVID-19 result in months-long disruption in the gut microbial community, with additional perturbations linked to massive shifts in population level social distancing practices.

8.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925183

ABSTRACT

Objective: N/A Background: The full scope of the mid- and long-term effects of SARS-CoV2 infection is currently being reported. The immune response might contribute not only to the development of ARDS, but also to other systemic complications after the acute setting. Some disorders, including those of autoimmune or presumed autoimmune etiology, have been reported to be triggered, exacerbated, or unmasked during the COVID-19 pandemic. Sarcoidosis is a multi-systemic inflammatory disorder believed to occur due to an exaggerated immune response to unknown antigens in the setting of genetic susceptibility. We present a case of neuro-sarcoidosis after COVID-19. Design/Methods: Descriptive study, case report. Results: A 51-year-old right-handed female presented with multiple cranial neuropathies and paresthesia after a mild case of COVID-19. Her symptoms included vertigo, hypoacusis, balance issues, left facial palsy, and paresthesia in her upper extremities. Her brain MRI with contrast showed bilateral enhancement of the VII and VIII cranial nerves. CSF analysis showed mild protein elevation and elevated CD4:CD8 ratio. Serum sIL-2R was also elevated. Her chest CT scan was abnormal, prompting a lymph node biopsy that was consistent with non-caseating granulomas. A diagnosis of probable neuro-sarcoidosis was made and she showed improvement with steroids. She was later started on methotrexate as a steroid sparing agent in the outpatient setting. Conclusions: To our knowledge, neuro-sarcoidosis has not been previously described in temporal association with COVID-19. It might be that this infection acts as one of the triggers for sarcoidosis. Some common pathways shared by these conditions could explain the possibility of such a trigger. These pathways include the ACE2 receptor, the TMRPPS gene, and certain cytokines. When aberrant, causing incomplete clearance of an antigen, these pathways might lead to the formation of granulomas. Further research surrounding the non-immediate effects of the novel coronavirus is needed to better delineate possible autoimmune consequences of this serious infection.

9.
13th IEEE Global Engineering Education Conference, EDUCON 2022 ; 2022-March:2022-2027, 2022.
Article in English | Scopus | ID: covidwho-1874216

ABSTRACT

Although programming has increasingly become an integral part of Mathematics education in universities, the closed book exam, which excludes programming, remains the preferred main assessment component. However, the switch towards open book online assessments necessitated by the Covid pandemic has seen programming content being included in end of year assessments. In this paper we look at how programming has been integrated into the end of year open book online assessments in Mathematics at two UK universities. Preliminary conclusions suggest that open book online assessments incorporating programming content can be a viable replacement for the traditional closed book exam. © 2022 IEEE.

10.
Irish Journal of Medical Science ; 191(SUPPL 1):S30, 2022.
Article in English | EMBASE | ID: covidwho-1866672

ABSTRACT

Mental illness in young people is a growing concern, with an estimated 10-20% of adolescents suffering from mental illness worldwide.1 In Ireland, referrals to CAMHS (Child and Adolescent Mental Health Services) have increased by 26% in recent years.2 These services are already under-resourced leading to long waiting lists. The adverse psychological impact of Covid-19 has disproportionately affected youth and is likely to result in increased demand for CAMHS. Given these circumstances, an understanding of pre-Covid-19 prevalence of mental illness among youth in Ireland is imperative to help inform & plan services. The aim of this research is to report on prevalence of mental illness in youth (aged 0-18) in Ireland. A systematic review using pre-defined search terms in PubMed, PsycInfo, Embase and CINAHL was conducted. Studies included youth population health empirical studies conducted in Ireland, focusing on mental illness. From a total of 624 papers identified, 43 papers were selected by Title/ selection, and 38 following full paper review. 2 nationally representative studies (Growing Up in Ireland & My World Survey) identified 10-15% to be 'at risk' by one-stage screening. A two-stage study (Challenging Times) reported rates of 'any' mental health disorder in 15% of adolescents, with other studies reporting on specific disorders. Although data on mental illness among Irish youth is limited, available data of illness and risk suggest rates similar to international levels. Attention needs to be given post Covid-19 to regular reliable data collection, and dedicated CAMHS funding to allow best use of a scarce resource.

11.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-330704

ABSTRACT

Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections including in patients with coronavirus disease 2019 (COVID-19). Using a combination of tracheal aspirate bulk and single-cell RNA sequencing (scRNA-seq) we assessed lower respiratory tract immune responses and microbiome dynamics in 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill uninfected controls. Two days before VAP onset we observed a transcriptional signature of bacterial infection. Two weeks prior to VAP onset, following intubation, we observed a striking impairment in immune signaling in COVID-19 patients who developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients with VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. These findings suggest that COVID-19 patients who develop VAP have impaired antibacterial immune defense detectable weeks before secondary infection onset.

12.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-297038

ABSTRACT

Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections. Critically ill patients with coronavirus disease 2019 (COVID-19) face an elevated risk of VAP, although susceptibility varies widely. Because mechanisms underlying VAP predisposition remained unknown, we assessed lower respiratory tract host immune responses and microbiome dynamics in 36 patients, including 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill controls. We employed a combination of tracheal aspirate bulk and single cell RNA sequencing (scRNA-seq). Two days before VAP onset, a lower respiratory transcriptional signature of bacterial infection was observed, characterized by increased expression of neutrophil degranulation, toll-like receptor and cytokine signaling pathways. When assessed at an earlier time point following endotracheal intubation, more than two weeks prior to VAP onset, we observed a striking early impairment in antibacterial innate and adaptive immune signaling that markedly differed from COVID-19 patients who did not develop VAP. scRNA-seq further demonstrated suppressed immune signaling across monocytes/macrophages, neutrophils and T cells. While viral load did not differ at an early post-intubation timepoint, impaired SARS-CoV-2 clearance and persistent interferon signaling characterized the patients who later developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients who developed VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. Together, these findings demonstrate that COVID-19 patients who develop VAP have impaired antibacterial immune defense weeks before secondary infection onset. One sentence summary: COVID-19 patients with secondary bacterial pneumonia have impaired immune signaling and lung microbiome changes weeks before onset.

13.
International Journal of Practice-Based Learning in Health and Social Care ; 9(2):11-20, 2021.
Article in English | Scopus | ID: covidwho-1574921

ABSTRACT

The aim of this evaluation was to explore practice educators' and speech and language therapy (SLT) students' experiences of a rapid response telehealth placement in response to the COVID-19 pandemic in order to inform quality improvement. In March 2020, public health restrictions were imposed across Ireland in efforts to 'flatten the curve' in response to the COVID-19 pandemic. All placements were cancelled. According to an Irish Association of Speech and Language Therapists survey in April 2020, 47% of SLTs were redeployed to swabbing and contact tracing roles, and many remain redeployed seven months later. This redeployment, along with strict public health measures in clinical sites, significantly reduced the availability of clinical placements. A rapid response was required to enable students to develop clinical competencies. Although telehealth has been used to deliver speech and language therapy in other countries, it had not been used routinely in service provision in Ireland. In this article, we outline how we built on existing partnerships with practice educators, both on- and off-site, to design a much-needed telehealth placement. We explored educators' and students' experiences using an online focus group and online survey respectively. The evaluations of practice educators were positive in that despite their initial apprehension, they reported that this placement provided valuable learning opportunities for students while also providing benefits for clients. They also reported some technological and sustainability challenges. The students also evaluated this placement positively with 83.3% of respondents rating the placement as 'excellent 'and 16.7% rating it as 'good'. All stakeholders valued this learning experience. © 2021 Coventry University. All rights reserved.

14.
American Journal of Respiratory and Critical Care Medicine ; 203(9):3, 2021.
Article in English | Web of Science | ID: covidwho-1407570
15.
American Journal of Respiratory and Critical Care Medicine ; 203(9), 2021.
Article in English | EMBASE | ID: covidwho-1277488

ABSTRACT

Rationale: The Coronavirus Disease 2019 (COVID-19) pandemic has greatly impacted health care delivery patterns, including for patients with asthma and chronic obstructive pulmonary disease (COPD). Patients who experience both asthma and COPD symptoms, referred to as asthma-COPD overlap (ACO), have increased morbidity and healthcare utilization than patients with either disease alone. Methods: We obtained de-identified encounter-level electronic health record (EHR) data for adult asthma and COPD encounters within Penn Medicine occurring between January 1, 2015 and October 31, 2020. Variables extracted included codified demographic information, ICD-10 encounter codes and encounter type (i.e., office visit, hospital encounter, telemedicine or other). Patients were included if they were aged at least 18 years at first encounter and had at least two encounters over a period of at least a year. We classified patients as having asthma, COPD or ACO based on ICD-10 diagnoses (J45∗ for asthma and J41-44∗ for COPD) and medication prescriptions (short-acting β2-agonist for asthma and either shortacting β2-agonist or short-acting muscarinic antagonist for COPD), where ACO patients were defined as those meeting asthma and COPD criteria. We compared asthma and COPD healthcare encounters before (pre-pandemic) and after (pandemic) March 17, 2020 in terms of encounter volume and type. We also tested for differences in the demographic distributions of telemedicine vs. in-person visits using t- and χ2-tests. Results: A total 66,191 patients met our inclusion criteria, of which 46,257 (70%) had asthma, 12,580 (19%) had COPD, and 7,354 (11%) had ACO. Average monthly volume of office visits and hospital encounters for asthma/COPD decreased considerably during the pandemic (>50% decrease in office visits and >25% decrease in hospital encounters across all patient groups), while the volume of telemedicine visits increased dramatically (from 0-1 to 481-1,343 average monthly telemedicine visits across all patient groups) [Figure 1]. During the pandemic, non-Hispanic Black patients were more likely to be encountered via telemedicine than in-person encounters across all patient groups (39% vs. 34% of asthma patients encountered via telemedicine and in-person visits, respectively, were non-Hispanic Black;33% vs. 26% of COPD patients, and 50% vs. 44% among ACO patients;p<0.01 for all comparisons). Telemedicine and in-person visits for asthma/COPD during the pandemic did not differ significantly by mean age or sex among any of the patient groups. Conclusions: Telemedicine visits for asthma and COPD increased dramatically during the COVID-19 pandemic, while office visits and hospital encounters decreased. Further study.

16.
PubMed; 2021.
Preprint in English | PubMed | ID: ppcovidwho-8864

ABSTRACT

Secondary bacterial infections, including ventilator-associated pneumonia (VAP), lead to worse clinical outcomes and increased mortality following viral respiratory infections including in patients with coronavirus disease 2019 (COVID-19). Using a combination of tracheal aspirate bulk and single-cell RNA sequencing (scRNA-seq) we assessed lower respiratory tract immune responses and microbiome dynamics in 28 COVID-19 patients, 15 of whom developed VAP, and eight critically ill uninfected controls. Two days before VAP onset we observed a transcriptional signature of bacterial infection. Two weeks prior to VAP onset, following intubation, we observed a striking impairment in immune signaling in COVID-19 patients who developed VAP. Longitudinal metatranscriptomic analysis revealed disruption of lung microbiome community composition in patients with VAP, providing a connection between dysregulated immune signaling and outgrowth of opportunistic pathogens. These findings suggest that COVID-19 patients who develop VAP have impaired antibacterial immune defense detectable weeks before secondary infection onset.

17.
Physical Education and Sport Pedagogy ; 2021.
Article in English | Scopus | ID: covidwho-1199409

ABSTRACT

Introduction: Even though advocacy for poststructural feminist lenses to change/challenge physical education (PE) has grown over the years, there is an evident gap in qualitative research using poetic forms of representation in PE. Purpose: The purpose of this study was to use a poststructural feminist framework to challenge a particular kind of hegemonic reproduction of PE, particularly to explore the notion of ‘Joe Wicks as PE’. Participants and settings: Collaborative autoethnography framed this study and participants included three queer leaning female-identified early/mid-career PE teacher educators. Data collection/analysis: Over the course of eight weeks, we collected and generated a variety of texts individually and collectively. To capture our reactions, we decided to collect data around two ‘prompts’, namely the recorded podcast titled ‘Is Joe Wicks the face of PE?’ of an Association Internationale des Écoles Supérieures d’Éducation Physique (AIESEP) hosted chat, and our participation in a 9 am ‘PE with Joe’ session. We presented the data gathered in this project poetically. Findings: We divided the findings into two parts corresponding with our responses (collaborative autoethnographies) to the two themes, namely ‘We can’t fix this/that’ (aka ‘Banging our heads against a brick wall’) and ‘Joe Wicks as PE’ (aka ‘Feminist killjoys’). Implications: We believe that a poetic representation, in addition to nurturing and amplifying the emotional and lyrical data collected, presented an opportunity to contribute to, and extends this kind of representational style in PE. In addition to this, collaborative autoethnography allowed us as a community to advance scholarship and provides a space for collective empowerment. © 2021 Association for Physical Education.

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