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1.
Leuk Lymphoma ; : 1-4, 2022 Jan 06.
Article in English | MEDLINE | ID: covidwho-1608966

ABSTRACT

Hematology patients are more vulnerable to the effects of COVID-19 than patients with other cancers. We surveyed hematology patients to better understand their experiences of cancer care during the pandemic. A large reduction was observed in the number of healthcare services accessed by respondents. Telehealth assisted with access but requires improvement.

2.
American Journal of Obstetrics and Gynecology ; 226(1):S751-S752, 2022.
Article in English | PMC | ID: covidwho-1588402
3.
Open forum infectious diseases ; 8(Suppl 1):S343-S344, 2021.
Article in English | EuropePMC | ID: covidwho-1564002

ABSTRACT

Background Multi-system inflammatory syndrome in children (MIS-C) is a rare consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). MIS-C shares features with common infectious and inflammatory syndromes and differentiation early in the course is difficult. Identification of early features specific to MIS-C may lead to faster diagnosis and treatment. We aimed to determine clinical, laboratory, and cardiac features distinguishing MIS-C patients within the first 24 hours of admission to the hospital from those who present with similar features but ultimately diagnosed with an alternative etiology. Methods We performed retrospective chart reviews of children (0-20 years) who were admitted to Vanderbilt Children’s Hospital and evaluated under our institutional MIS-C algorithm between June 10, 2020-April 8, 2021. Subjects were identified by review of infectious disease (ID) consults during the study period as all children with possible MIS-C require an ID consult per our institutional algorithm. Clinical, lab, and cardiac characteristics were compared between children with and without MIS-C. The diagnosis of MIS-C was determined by the treating team and available consultants. P-values were calculated using two-sample t-tests allowing unequal variances for continuous and Pearson’s chi-squared test for categorical variables, alpha set at < 0.05. Results There were 128 children admitted with concern for MIS-C. Of these, 45 (35.2%) were diagnosed with MIS-C and 83 (64.8%) were not. Patients with MIS-C had significantly higher rates of SARS-CoV-2 exposure, hypotension, conjunctival injection, abdominal pain, and abnormal cardiac exam (Table 1). Laboratory evaluation showed that patients with MIS-C had lower platelet count, lymphocyte count and sodium level, with higher c-reactive protein, fibrinogen, B-type natriuretic peptide, and neutrophil percentage (Table 2). Patients with MIS-C also had lower ejection fraction and were more likely to have abnormal electrocardiogram. Conclusion We identified early features that differed between patients with MIS-C from those without. Development of a diagnostic prediction model based on these early distinguishing features is currently in progress. Disclosures Natasha B. Halasa, MD, MPH, Genentech (Other Financial or Material Support, I receive an honorarium for lectures - it’s a education grant, supported by genetech)Quidel (Grant/Research Support, Other Financial or Material Support, Donation of supplies/kits)Sanofi (Grant/Research Support, Other Financial or Material Support, HAI/NAI testing) Natasha B. Halasa, MD, MPH, Genentech (Individual(s) Involved: Self): I receive an honorarium for lectures - it’s a education grant, supported by genetech, Other Financial or Material Support, Other Financial or Material Support;Sanofi (Individual(s) Involved: Self): Grant/Research Support, Research Grant or Support James A. Connelly, MD, Horizon Therapeutics (Advisor or Review Panel member)X4 Pharmaceuticals (Advisor or Review Panel member)

4.
Curr Probl Diagn Radiol ; 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1500823

ABSTRACT

OBJECTIVE: Remote workstations were rapidly deployed in our academic radiology practice in late March 2020 in response to the COVID-19 pandemic. Although well-received by faculty, there were concerns for the impact on resident education. MATERIALS AND METHODS: Surveys of the radiology trainees and faculty were conducted online seven- and thirteen-months following workstation deployment as a part of a quality improvement project to assess the impact on radiology education and faculty wellness, as well as assess the desired trajectory of remote work in an academic setting. RESULTS: The majority of trainees (52%) reported the implementation had negatively impacted resident education, greatest among lower level residents (p < .001). This perception did not change despite interventions and perceived improvement in teleconferencing. Greater than 75% of radiologists with remote workstations reported improved wellness and lower stress levels compared to the onsite radiologists. The majority of all respondents voted to continue or expand remote work following the COVID-19 pandemic in both surveys. CONCLUSIONS: Onsite teaching is important for the education of residents, particularly for lower-level residents. However, the adoption of a hybrid model in an academic setting may prove beneficial for faculty wellness and recruitment of the next generation.

5.
Eur J Dent Educ ; 2021 Sep 20.
Article in English | MEDLINE | ID: covidwho-1434683

ABSTRACT

BACKGROUND: COVID-19 pandemic has led to major life changes including suspension of dental education programmes worldwide. The impact of this unexpected disruption in clinical teaching needs to be assessed. AIM: The aim of this study was to evaluate the impact of the COVID-19 restriction measures on the undergraduate dental students' perception regarding their physical, mental and social well-being as well as financial stress and anxiety for their future careers. MATERIALS AND METHODS: An electronic questionnaire (Qualtrics, Provo, Utah, USA) with main themes (general well-being, academic stressors, financial implications and dental career concerns) related to the COVID-19 lockdown was sent to the undergraduate dental students at the University Of Otago, New Zealand. Participants were asked to rank their answers according to a 5-level Likert scale (strongly disagreed-strongly agreed). Other questions included demographic, fee-paying status and living situation. RESULTS: There were 301 out of 376 students who responded to the survey. Generally, the students perceived that the COVID-19 restrictions affected their behavioural and social well-being (3.20 ± 0.75) and less impact on their physical (2.75 ± 0.82) and psychological (2.79 ± 0.62) well-being. Students were significantly worried about their academic work and future careers (3.41 ± 1.20), but less concerned with their financial situation (2.74 ± 1.14). CONCLUSIONS: The study provides valuable information on the impact of COVID-19 pandemic on undergraduate dental students, and areas that the University should consider when providing support to the affected students. It is important that the University is proactive and prepared to deal with future pandemics effectively and efficiently.

6.
Psychooncology ; 2021 Sep 09.
Article in English | MEDLINE | ID: covidwho-1400971

ABSTRACT

OBJECTIVE: Haematological cancer patients are particularly vulnerable to the effects of COVID-19. In addition to being immunocompromised, pandemic-related travel restrictions have impacted access to treatments and overseas stem cell donations for patients requiring transplantation. Given this vulnerability, people with haematological cancers are at risk of experiencing heightened distress during the pandemic. This study aimed to explore haematological cancer patients' experiences and needs. METHODS: Twenty-four Australian haematological cancer patients completed semi-structured interviews exploring their concerns and worries during the pandemic, impact of pandemic on management of disease, access to information and support, lifestyle changes, and attitudes towards emerging models of healthcare during the pandemic. Interview transcripts were thematically analysed. RESULTS: Four themes reflecting the experiences of haematological cancer patients during the pandemic were identified: 'Fears about contracting COVID-19' (behaviour changes to protect health, impact on daily routine and habits, annoyance at dismissive attitude of others toward COVID-19); 'Reduced sense of connection and support' (reduced social support and access to external support services); 'New challenges' (increased financial hardship, worsened health), and; 'Underlying system and communication issues' (access to trusted information, satisfaction/dissatisfaction with care, navigating telehealth). Participants expressed a need for improved access to support services and trusted information. CONCLUSIONS: The findings emphasise the additional challenges experienced by haematological cancer patients during the COVID-19 pandemic and their impact on daily life. Results point to the importance of validation of increased distress during periods of uncertainty; reinforcing recommendations about high-quality sources of information; and facilitating access to support services when face-to-face care is limited.

7.
Lancet Reg Health Am ; 3: 100060, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1377783

ABSTRACT

Background: Transplant centers saw a substantial reduction in deceased donor solid organ transplantation since the beginning of the coronavirus 2019 (COVID-19) pandemic in the United States. There is limited data on the impact of COVID-19 on adult and pediatric heart transplant volume and variation in transplant practices. We hypothesized that heart transplant activity decreased during COVID-19 with associated increased waitlist mortality. Methods: The United Network for Organ Sharing (UNOS) database was used to identify patients at the time of listing for heart transplant from 2017-2020. Patients were categorized as pediatric (<18 years) or adult (≥18 years) and as pre-COVID (2017-2019) or post-COVID (2020). Regional and statewide data were taken from United States Census Bureau. CovidActNow project was used to obtain COVID-19 mortality rates. Findings: Among pediatric patients, average time on the waiting list decreased by 28 days. Even though the average number of pediatric transplants (n=39 per month) did not change significantly during 2020, there was a temporal decline in the first quarter of 2020 followed by a sharp increase. Overall absolute pediatric waitlist mortality decreased from 5•31 to 4•73, however female mortality increased by 2%. Regional differences in pediatric mortality were observed: Northeast, decreased by 7•5%; Midwest, decreased by 9%; West, increased by 3•5%; and South, increased by 13%. North Dakota (0•55), Oklahoma (0•21) and Hawaii (0•33) showed higher mortality than other states per 100,000. In adults, average time on waiting list increased by 40 days and there was an increase in the number of transplants from 242 to 266. Adult waitlist mortality had a larger decrease, 18•44 to 15•70, with an increase in female mortality of 7%. Regional differences in adult mortality were also observed: Northeast, decreased by 3%; Midwest, increased by 5•5%; West, increased by 4•5% and South, decreased by 5%. Iowa (0•37), Wyoming (0•22), Arkansas (0•18) and Vermont (0•19) had the highest mortality per 100,000 compared to the other states. Interpretation: Pediatric heart transplant volume declined in early 2020 followed by a later increase, while adult transplant volume increased all year round. Although, overall pediatric waitlist mortality decreased, female waitlist mortality increased for both adults and pediatrics. Regional differences in waitlist mortality were observed for both pediatrics and adults. Future studies are needed to understand this initial correlation and to determine the impact of COVID-19 on heart transplant recipients. Funding: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

8.
Future Healthc J ; 8(2): e288-e292, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1319837

ABSTRACT

Introduction: In March 2020, due to the COVID-19 pandemic, there were increasing demands on medical and intensive care departments in the UK. Medical staff from surgical departments were redeployed. The aim of this study was to determine whether the department was able to maintain standards with the use of the physician associate / medical doctor (PA/MD) model of care. Methods: A mix of questionnaires and audit data was collected prospectively and compared with pre-COVID and the general surgical team which did not have PAs. Results: Sixty-five per cent of responses indicated an improvement compared with pre-COVID conditions and 35% indicated care was the same. The electronic discharge notification audit showed an 89% completion rate for orthopaedics compared with 73% for general surgery. Venous thromboembolism assessment compliance was better compared with general surgery. Conclusion: Overall, the study supports the hypothesis that a PA/MD model of care is non-inferior to a MD-only model of care and was effective.

9.
Ann Glob Health ; 87(1): 51, 2021 06 24.
Article in English | MEDLINE | ID: covidwho-1296121

ABSTRACT

Background: Nurses working in treating patients with COVID-19 are exposed to various stressors, such as fear of COVID-19, stress, and high workload, leading to burnout. Objectives: This study aimed to identify the level of burnout and its predictors in nurses working in hospitals for COVID-19 patients. Methods: Participants in this study were nurses working in 11 hospitals for COVID-19 patients in the Fars province of Iran. The Maslach burnout and the UK Health and Safety stress questionnaires were used to assess burnout and stress, respectively. Analysis, using multiple regression in the SPSS21 software, aimed to identify the factors affecting burnout. Findings: The mean level of burnout in the nurses at the COVID-19 hospitals was 57 out of 120, and burnout was affected by workload (ß = 0.69, p < 0.001), job stress (ß = 0.25, p < 0.001) and inadequate hospital resources for the prevention of COVID-19 (ß = -0.16, p < 0.001). These three variables explained 87% of the variance in burnout. Conclusions: The burnout of nurses directly exposed to COVID-19 patients is more than nurses in other wards, and workload is the most significant cause of burnout in them. Therefore, necessary measures such as hiring more nurses, reducing working hours and increasing rest periods are necessary to reduce workload. In addition, the job stress of these nurses should be managed and controlled, and the hospital resources needed to prevent this disease should be provided.


Subject(s)
Burnout, Professional , COVID-19 , Nurses , Occupational Stress , Work Schedule Tolerance/psychology , Workload , Adult , Burnout, Professional/epidemiology , Burnout, Professional/prevention & control , Burnout, Professional/psychology , COVID-19/epidemiology , COVID-19/nursing , COVID-19/psychology , Fear/psychology , Female , Health Services Needs and Demand , Humans , Infection Control/methods , Iran/epidemiology , Male , Nurses/psychology , Nurses/supply & distribution , Occupational Stress/complications , Occupational Stress/prevention & control , SARS-CoV-2 , Workload/psychology , Workload/standards , Workload/statistics & numerical data
10.
Support Care Cancer ; 29(12): 7755-7764, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1281279

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a disruptive effect on people with haematological cancers, who represent a high-risk population due to the nature of their disease and immunosuppressive treatments. We aimed to identify the psychological impacts of the COVID-19 pandemic on haematology patients and identify correlated factors to inform the development of appropriate supportive interventions. METHODS: Three hundred and ninety-four respondents volunteered their participation in response to a study advertisement distributed online through established haematology groups. Participants completed a self-report online survey exploring wellbeing, psychological distress, unmet supportive care needs, and fear of cancer recurrence. RESULTS: At least 1 in 3 respondents (35%) reported clinical levels of distress and nearly 1 in 3 (32%) identified at least one unmet need. Among respondents in remission (n = 134), clinical fear of cancer recurrence was reported by nearly all (95%). Unmet needs, pre-existing health conditions, younger age, financial concerns, and perceived risk of contracting COVID-19 were the dominant factors contributing to psychological distress during the pandemic. Psychological distress, lost income, perceived inadequate support from care team, perceived risk of contracting COVID-19, and being a woman were significantly associated with unmet needs. Psychological distress and concern about the impact of COVID-19 on cancer management were significantly associated with fear of cancer recurrence among respondents in remission. CONCLUSION: Results highlight the high psychological burden and unmet needs experienced by people with haematological cancers during the COVID-19 pandemic and indicate a need for innovative solutions to rapidly identify distress and unmet needs during, and beyond, pandemic times.


Subject(s)
COVID-19 , Hematologic Neoplasms , Neoplasms , Psychological Distress , Cross-Sectional Studies , Fear , Female , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Humans , Neoplasms/epidemiology , Neoplasms/therapy , Pandemics , Prevalence , SARS-CoV-2 , Stress, Psychological/epidemiology , Surveys and Questionnaires
11.
Journal of Sustainable Tourism ; : 1-17, 2021.
Article in English | Academic Search Complete | ID: covidwho-1279978

ABSTRACT

The special issue dedicated to events and sustainability is introduced here. We provide synopses of the papers, preceded by an introductory essay that examines how event studies has approached the relationship between events and sustainable development. Existing work too often assumes that sustainability means reducing negative environmental impacts with other aspects of the sustainability paradigm neglected. And whilst social issues have risen to prominence in events research generally, this work is usually considered outwith sustainability debates, and without considering environmental and economic interrelationships. We argue that event scholars should examine how events might contribute to sustainable development, rather than merely exploring how individual events could be made more sustainable. Accordingly, there needs to be further work addressing how events might change attitudes and behaviours by promoting sustainable lifestyles, communities and technologies. Following this discussion, we justify the focus on social sustainability in the special issue, clarify what this actually means, and question whether this is always the most appropriate way of framing research on the social impacts of events. Given the timing of the special issue, there is also a short review of how the coronavirus crisis affected the events sector, and what the implications might be for sustainability. [ABSTRACT FROM AUTHOR] Copyright of Journal of Sustainable Tourism is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

12.
Brain Behav Immun Health ; 15: 100285, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1267606

ABSTRACT

The mental health of healthcare workers (HCWs) is critical to their long-term well-being and future disaster preparedness. Goal 1 of this study was to identify rates of mental health problems experienced by HCWs. Goal 2 was to test a model of risk stemming from pandemic-related stressors and vulnerability factors. This cross-sectional study included HCWs (N â€‹= â€‹2,246 [1,573 clinical providers; 673 non-clinical staff]) in the Rocky Mountain West who voluntarily completed an online survey in April/May 2020. Respondents completed measures for traumatic stress symptoms, depression, anxiety, alcohol use, and sleep. Logistic regressions stratified by professional role (clinical versus non-clinical) were specified to predict clinical screening cutoff (positive/negative) as a function of five pandemic-related stressors (immunocompromised self; immunocompromised household member; care provision to infected patients; clinical management role; positive cases). Results showed that more than half of HCWs surveyed (52.5%) screened positive (above cutoff) for traumatic stress, depression, or anxiety, with ~20% reporting problematic alcohol use, and variable insufficient sleep from ~10% off shift to ~50% on shift. Clinical employees with an immunocompromised household member had increased odds of screening positive for a mental health problem. Non-clinical HCWs who were immunocompromised were at elevated risk for screening positive a mental health problem. Being female, minority status, and younger increased odds for mental health problems. Implications include alleviating a portion of the mental health burden of HCWs involved in response to the SARS-CoV-2 pandemic by considering policies to protect immunocompromised HCWs and their families (e.g., vaccine priorities, telework options).

13.
Can J Pain ; 5(1): 139-150, 2021.
Article in English | MEDLINE | ID: covidwho-1233827

ABSTRACT

Background: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics. Aims: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic. Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2). Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n = 9/13, 69%) or occurrence of pain flares (n = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non-emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges. Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.

14.
Reprod Biomed Online ; 42(6): 1087-1096, 2021 06.
Article in English | MEDLINE | ID: covidwho-1208380

ABSTRACT

RESEARCH QUESTION: The economic and reproductive medicine response to the coronavirus disease 2019 (COVID-19) pandemic in the USA has reduced the affordability and accessibility of fertility care. What is the impact of the 2008 financial recession and the COVID-19 recession on fertility treatments and cumulative live births? DESIGN: The study examined annual US natality, Centers for Disease Control and Prevention IVF cycle activity and live birth data from 1999 to 2018 encompassing 3,286,349 treatment cycles, to estimate the age-stratified reduction in IVF cycles undertaken after the 2008 financial recession, with forward quantitative modelling of IVF cycle activity and cumulative live births for 2020 to 2023. RESULTS: The financial recession of 2008 caused a 4-year plateau in fertility treatments with a predicted 53,026 (95% confidence interval [CI] 49,581 to 56,471) fewer IVF cycles and 16,872 (95% CI 16,713 to 17,031) fewer live births. A similar scale of economic recession would cause 67,386 (95% CI 61,686 to 73,086) fewer IVF cycles between 2020 and 2023, with women younger than 35 years overall undertaking 22,504 (95% CI 14,320 to 30,690) fewer cycles, compared with 4445 (95% CI 3144 to 5749) fewer cycles in women over the age of 40 years. This equates to overall 25,143 (95% CI 22,408 to 27,877) fewer predicted live births from IVF, of which only 490 (95% CI 381 to 601) are anticipated to occur in women over the age of 40 years. CONCLUSIONS: The COVID-19 recession could have a profound impact on US IVF live birth rates in young women, further aggravating pre-existing declines in total fertility rates.


Subject(s)
COVID-19/economics , Fertility/physiology , Live Birth , Reproductive Techniques, Assisted/economics , Adult , Birth Rate , Female , Humans , Pandemics , Pregnancy
15.
Lancet ; 397(10282): 1351-1362, 2021 04 10.
Article in English | MEDLINE | ID: covidwho-1157794

ABSTRACT

BACKGROUND: A new variant of SARS-CoV-2, B.1.1.7, emerged as the dominant cause of COVID-19 disease in the UK from November, 2020. We report a post-hoc analysis of the efficacy of the adenoviral vector vaccine, ChAdOx1 nCoV-19 (AZD1222), against this variant. METHODS: Volunteers (aged ≥18 years) who were enrolled in phase 2/3 vaccine efficacy studies in the UK, and who were randomly assigned (1:1) to receive ChAdOx1 nCoV-19 or a meningococcal conjugate control (MenACWY) vaccine, provided upper airway swabs on a weekly basis and also if they developed symptoms of COVID-19 disease (a cough, a fever of 37·8°C or higher, shortness of breath, anosmia, or ageusia). Swabs were tested by nucleic acid amplification test (NAAT) for SARS-CoV-2 and positive samples were sequenced through the COVID-19 Genomics UK consortium. Neutralising antibody responses were measured using a live-virus microneutralisation assay against the B.1.1.7 lineage and a canonical non-B.1.1.7 lineage (Victoria). The efficacy analysis included symptomatic COVID-19 in seronegative participants with a NAAT positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to vaccine received. Vaccine efficacy was calculated as 1 - relative risk (ChAdOx1 nCoV-19 vs MenACWY groups) derived from a robust Poisson regression model. This study is continuing and is registered with ClinicalTrials.gov, NCT04400838, and ISRCTN, 15281137. FINDINGS: Participants in efficacy cohorts were recruited between May 31 and Nov 13, 2020, and received booster doses between Aug 3 and Dec 30, 2020. Of 8534 participants in the primary efficacy cohort, 6636 (78%) were aged 18-55 years and 5065 (59%) were female. Between Oct 1, 2020, and Jan 14, 2021, 520 participants developed SARS-CoV-2 infection. 1466 NAAT positive nose and throat swabs were collected from these participants during the trial. Of these, 401 swabs from 311 participants were successfully sequenced. Laboratory virus neutralisation activity by vaccine-induced antibodies was lower against the B.1.1.7 variant than against the Victoria lineage (geometric mean ratio 8·9, 95% CI 7·2-11·0). Clinical vaccine efficacy against symptomatic NAAT positive infection was 70·4% (95% CI 43·6-84·5) for B.1.1.7 and 81·5% (67·9-89·4) for non-B.1.1.7 lineages. INTERPRETATION: ChAdOx1 nCoV-19 showed reduced neutralisation activity against the B.1.1.7 variant compared with a non-B.1.1.7 variant in vitro, but the vaccine showed efficacy against the B.1.1.7 variant of SARS-CoV-2. FUNDING: UK Research and Innovation, National Institute for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midlands NIHR Clinical Research Network, and AstraZeneca.


Subject(s)
Antibodies, Neutralizing/blood , COVID-19 Vaccines/immunology , COVID-19/prevention & control , COVID-19/virology , SARS-CoV-2/immunology , Adolescent , Adult , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing , COVID-19 Vaccines/adverse effects , Female , Humans , Male , Middle Aged , Nucleic Acid Amplification Techniques , Pandemics/prevention & control , Single-Blind Method , United Kingdom/epidemiology , Viral Load , Young Adult
16.
The American Journal of Geriatric Psychiatry ; 29(4, Supplement):S108-S109, 2021.
Article in English | ScienceDirect | ID: covidwho-1135416

ABSTRACT

Introduction We are living in a global pandemic of SARS-CoV-2 (COVID-19) that has infected over 63 million people across the world to date. Even though social-distancing is recommended as a key method of reducing risk, such measures disproportionately impact older adults (OA) whose social contacts are often outside their home. Thus, it is both timely and critical to examine the impact of pandemic-related social isolation on OA's mental health. Also, it is unclear whether OAs experiencing depressive symptoms have increased risk of being adversely impacted by social isolation. The current ongoing study utilizes a combination of remotely conducted interviews and online questionnaires to investigate how OA's mental health has been impacted by pandemic-related social isolation. We present preliminary findings from the first wave of our study. We hypothesized that OAs who report higher degrees of reduced quality and frequency in social relationships and communication will be at greater risk of depression, anxiety, and loneliness. Furthermore, we predicted that OAs who endorse depressive symptoms in the recent past will show a stronger association between adverse changes resulting from limited social activity and mental health. Methods We recruited 143 OA participants aged 55 years or older (Mean age= 64.9, SD= 5.3, 87% female). Prospective participants were excluded for self-reported history of neurological disorders, cognitive impairment, or changes in dosage of any psychotropic medications within the past 4 weeks. Otherwise, individuals with current and/or past history of depression or anxiety were included. Following informed consent, participants were screened for cognitive impairment using the MoCA-mini. Participants then filled out a series of questionnaires related to a self-reported diagnostic screen (SAGE-SR), current symptoms of stress (Perceived Stress Scale), depression (Center for Epidemiologic Studies Depression Scale), anxiety (Geriatric Anxiety Scale), loneliness (UCLA-Loneliness), perceived social support (Multidimensional Scale of Perceived Social Support), and perceived social contribution (Social Contribution subscale of the Social Well-being scale). Moreover, we obtained participants’ self-reported appraisal regarding the magnitude of adverse impact caused by COVID-19 pandemic-related social isolation on the quality of their personal social relationships and communication frequency with their loved ones. Results Overall, participants who reported greater detriment to social relationships and communication frequency also indicated higher degrees of depressive symptoms (r=.32, p<.001), and loneliness (r=.26, p<.005). Interestingly, frequency of using remote forms of communication with friends and family outside the home were inversely related to pathological mental health symptoms. In other words, those who report frequently keeping in touch with loved ones outside their homes also indicated having lower symptoms of depression (r=-.18, p<.05), anxiety (r=-.18, p<.05), and loneliness (r=-.24, p<.005). Notably, household size was not predictive of the above-mentioned symptoms, but was predictive of stress, such that greater household size was associated with higher levels of stress (r=.21, p<.05). We then separately examined two groups of OAs – those who reported having experienced at least some DSM-5 depressive disorders symptoms in the past 30 days, and those who did not. Self-reported magnitude of pandemic-related detriment to social behavior significantly predicted the severity of loneliness, but only in OAs who report some depressive disorder symptoms (r=.24, p<.05). Similarly, in this group, lower perceived social support significantly predicted higher stress (r=-.46, p<.0001) and lower self-reported social contribution predicted higher loneliness (r=-.33, p<.01) respectively. Conclusions The preliminary data from our study suggest that greater levels of pandemic-related social isolation are associated with higher severity of symptoms of depression, anxiety, and loneliness. Importantly, OAs with depressive symptoms appear to be at risk of adversely being impacted by loss of social support and absence of meaningful outlet for social contributions during prolonged social isolation. Conversely, our data suggest utilizing psychosocial interventions designed to shore up social support and greater agency in social contribution may be particularly beneficial to OAs who experience depressive symptoms. The correlational nature of our current data is a limitation that will be addressed by our future work gathering responses from the same group of participants who are expected to resume social activity outside the context of pandemic-related social isolation (i.e., Wave 2). Our future work will also address how social isolation relates to day-to-day experience and control of emotions, which is a significant dimensional predictor of functional impairment and distress across multiple psychopathologies. Funding Funding support from Special Emphasis: Emerging COVID-19/SARS-CoV-2 Research seed grant awarded to J. Kim, through the Immunology, Inflammation and Infectious Diseases Initiative and the Office of the Vice President for Research at the University of Utah

17.
Cochrane Database Syst Rev ; 3: CD010172, 2021 03 04.
Article in English | MEDLINE | ID: covidwho-1116499

ABSTRACT

BACKGROUND: High-flow nasal cannulae (HFNC) deliver high flows of blended humidified air and oxygen via wide-bore nasal cannulae and may be useful in providing respiratory support for adults experiencing acute respiratory failure, or at risk of acute respiratory failure, in the intensive care unit (ICU). This is an update of an earlier version of the review. OBJECTIVES: To assess the effectiveness of HFNC compared to standard oxygen therapy, or non-invasive ventilation (NIV) or non-invasive positive pressure ventilation (NIPPV), for respiratory support in adults in the ICU. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane COVID-19 Register (17 April 2020), clinical trial registers (6 April 2020) and conducted forward and backward citation searches. SELECTION CRITERIA: We included randomized controlled studies (RCTs) with a parallel-group or cross-over design comparing HFNC use versus other types of non-invasive respiratory support (standard oxygen therapy via nasal cannulae or mask; or NIV or NIPPV which included continuous positive airway pressure and bilevel positive airway pressure) in adults admitted to the ICU. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. MAIN RESULTS: We included 31 studies (22 parallel-group and nine cross-over designs) with 5136 participants; this update included 20 new studies. Twenty-one studies compared HFNC with standard oxygen therapy, and 13 compared HFNC with NIV or NIPPV; three studies included both comparisons. We found 51 ongoing studies (estimated 12,807 participants), and 19 studies awaiting classification for which we could not ascertain study eligibility information. In 18 studies, treatment was initiated after extubation. In the remaining studies, participants were not previously mechanically ventilated. HFNC versus standard oxygen therapy HFNC may lead to less treatment failure as indicated by escalation to alternative types of oxygen therapy (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.45 to 0.86; 15 studies, 3044 participants; low-certainty evidence). HFNC probably makes little or no difference in mortality when compared with standard oxygen therapy (RR 0.96, 95% CI 0.82 to 1.11; 11 studies, 2673 participants; moderate-certainty evidence). HFNC probably results in little or no difference to cases of pneumonia (RR 0.72, 95% CI 0.48 to 1.09; 4 studies, 1057 participants; moderate-certainty evidence), and we were uncertain of its effect on nasal mucosa or skin trauma (RR 3.66, 95% CI 0.43 to 31.48; 2 studies, 617 participants; very low-certainty evidence). We found low-certainty evidence that HFNC may make little or no difference to the length of ICU stay according to the type of respiratory support used (MD 0.12 days, 95% CI -0.03 to 0.27; 7 studies, 1014 participants). We are uncertain whether HFNC made any difference to the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) within 24 hours of treatment (MD 10.34 mmHg, 95% CI -17.31 to 38; 5 studies, 600 participants; very low-certainty evidence). We are uncertain whether HFNC made any difference to short-term comfort (MD 0.31, 95% CI -0.60 to 1.22; 4 studies, 662 participants, very low-certainty evidence), or to long-term comfort (MD 0.59, 95% CI -2.29 to 3.47; 2 studies, 445 participants, very low-certainty evidence). HFNC versus NIV or NIPPV We found no evidence of a difference between groups in treatment failure when HFNC were used post-extubation or without prior use of mechanical ventilation (RR 0.98, 95% CI 0.78 to 1.22; 5 studies, 1758 participants; low-certainty evidence), or in-hospital mortality (RR 0.92, 95% CI 0.64 to 1.31; 5 studies, 1758 participants; low-certainty evidence). We are very uncertain about the effect of using HFNC on incidence of pneumonia (RR 0.51, 95% CI 0.17 to 1.52; 3 studies, 1750 participants; very low-certainty evidence), and HFNC may result in little or no difference to barotrauma (RR 1.15, 95% CI 0.42 to 3.14; 1 study, 830 participants; low-certainty evidence). HFNC may make little or no difference to the length of ICU stay (MD -0.72 days, 95% CI -2.85 to 1.42; 2 studies, 246 participants; low-certainty evidence). The ratio of PaO2/FiO2 may be lower up to 24 hours with HFNC use (MD -58.10 mmHg, 95% CI -71.68 to -44.51; 3 studies, 1086 participants; low-certainty evidence). We are uncertain whether HFNC improved short-term comfort when measured using comfort scores (MD 1.33, 95% CI 0.74 to 1.92; 2 studies, 258 participants) and responses to questionnaires (RR 1.30, 95% CI 1.10 to 1.53; 1 study, 168 participants); evidence for short-term comfort was very low certainty. No studies reported on nasal mucosa or skin trauma. AUTHORS' CONCLUSIONS: HFNC may lead to less treatment failure when compared to standard oxygen therapy, but probably makes little or no difference to treatment failure when compared to NIV or NIPPV. For most other review outcomes, we found no evidence of a difference in effect. However, the evidence was often of low or very low certainty. We found a large number of ongoing studies; including these in future updates could increase the certainty or may alter the direction of these effects.


Subject(s)
Critical Care/methods , Intubation/methods , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Acute Disease , Adult , Barotrauma/epidemiology , Bias , Hospital Mortality , Humans , Intubation/adverse effects , Intubation/instrumentation , Length of Stay , Masks , Nasal Mucosa/injuries , Noninvasive Ventilation/methods , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/instrumentation , Patient Reported Outcome Measures , Pneumonia/epidemiology , Randomized Controlled Trials as Topic , Respiration, Artificial/adverse effects , Treatment Failure
18.
Behav Sci (Basel) ; 11(1)2021 Jan 06.
Article in English | MEDLINE | ID: covidwho-1067686

ABSTRACT

(1) Background: During the COVID-19 pandemic, strict lock-down and quarantine were widely imposed by most governments to minimize the spread of the virus. Previous studies have investigated the consequences of the quarantine and social isolation on mental health and the present study examines loneliness and problematic internet use. (2) Methods: The current research used a cross-sectional survey during a lock-down phase of the COVID-19 pandemic. A sample of 593 participants from the Middle East region (Kuwait, Saudi Arabia) were tested using the short form of the Revised UCLA Loneliness Scale and the Internet Addiction Test. (3) Results: Results from regression analyses showed an association between loneliness and Problematic Internet Use (PIU), and an association between loneliness and the number of hours spent online. Younger participants reported greater loneliness. The quality of the relationship with the person(s) with whom they were spending their lock-down was also correlated with loneliness. Those who reported greater loneliness also obtained frequent news about the pandemic from social media. Problematic internet use was associated with loneliness and the predictors of loneliness. ANOVA analyses showed a dose-response between the predictors and PIU. (4) Conclusions: This study highlights the influence of the social characteristics of the local culture during the COVID-19 lock-down on feelings of loneliness and on PIU.

19.
Preprint in English | SSRN | ID: ppcovidwho-6412
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