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1.
Preprint | EuropePMC | ID: ppcovidwho-296855

ABSTRACT

This study used two British birth cohorts to examine whether pre-pandemic trajectories of psychological distress were associated with a greater risk of changes in financial and employment situation during the pandemic, as well as increased need for government support and use of other methods to mitigate their economic situation. We identified 5 differential life-course trajectories of psychological distress from adolescence to midlife and explored their relation to changes in financial and employment circumstances at different stages during the pandemic from May 2020 to March 2021, applying multinomial logistic regression and controlling for numerous early life covariates. In addition, we ran modified Poisson models with robust standard errors to identify whether different trajectories were more likely to have been supported by the benefit system, payment holidays, borrowing and other methods of mitigating the economic shock. We found that despite the UK governments economic response package economic inequalities for pre-pandemic psychological distress trajectories with differential onset, severity and chronicity across the life-course were exacerbated by the COVID-19 economic shock. Furthermore, the subsequent cut in government support, alongside increases in the cost of living may widen economic inequalities for differential pre-pandemic psychological distress trajectories, which in turn may also worsen mental health. This work highlights, different pre-pandemic trajectories of psychological distress were more vulnerable to economic shock.

2.
Thorax ; 76(Suppl 2):A125-A126, 2021.
Article in English | ProQuest Central | ID: covidwho-1506327

ABSTRACT

P108 Table 1Delivery of annual physiotherapy reviews before and during COVID-19Year Patients for review Patients reviewed % patients reviewed 31/03/2019–2020 392 226 57.7 01/04/2020–2021 408 130 31.9 ConclusionThe respiratory workforce has been central in the acute response to COVID-19, whilst reduced provision of pulmonary rehabilitation and specialist respiratory clinics has led to a significant reduction in access to care for patients with chronic respiratory conditions reliant on highly specialised management. It is anticipated that the consequences on chronic disease burden will continue to unfold long after the pandemic has been controlled.This research identifies a significant unmet need of physiotherapy within a specialist respiratory service, exacerbated by COVID-19. A wider exploration into respiratory workforce nationally will help to further understand the increased need in a COVID-19 world.ReferencesBTS. British Thoracic Society Guidelines for Bronchiectasis in Adults. Thorax, 2019 December;74(1):3.Chudasama Y., et al. Impact of COVID-19 on routine care for chronic diseases: A global survey of views from healthcare professionals. Diabetes Metab Syndr. 2020;14(5):965–967.NHS. The NHS Long Term Plan. 2019. [Online] Available at: www.longtermplan.nhs.uk [Accessed 15 June 2021].

5.
Preprint in English | PubMed | ID: ppcovidwho-290159

ABSTRACT

The microbial populations in the gut microbiome have recently been associated with COVID-19 disease severity. However, a causal impact of the gut microbiome on COVID-19 patient health has not been established. Here we provide evidence that gut microbiome dysbiosis is associated with translocation of bacteria into the blood during COVID-19, causing life-threatening secondary infections. Antibiotics and other treatments during COVID-19 can potentially confound microbiome associations. We therefore first demonstrate that the gut microbiome is directly affected by SARS-CoV-2 infection in a dose-dependent manner in a mouse model, causally linking viral infection and gut microbiome dysbiosis. Comparison with stool samples collected from 97 COVID-19 patients at two different clinical sites also revealed substantial gut microbiome dysbiosis, paralleling our observations in the animal model. Specifically, we observed blooms of opportunistic pathogenic bacterial genera known to include antimicrobial-resistant species in hospitalized COVID-19 patients. Analysis of blood culture results testing for secondary microbial bloodstream infections with paired microbiome data obtained from these patients suggest that bacteria translocate from the gut into the systemic circulation of COVID-19 patients. These results are consistent with a direct role for gut microbiome dysbiosis in enabling dangerous secondary infections during COVID 19.

6.
Heart ; 107(SUPPL 1):A44-A45, 2021.
Article in English | EMBASE | ID: covidwho-1325131

ABSTRACT

Introduction Increased mortality is thought to be associated with an elevated troponin in addition to co-morbidities and age. International studies have demonstrated that troponin is an independent predictor of mortality in COVID-19 patients but to our knowledge this has not been assessed in a UK hospitalised population. We performed a single-centre retrospective observational study investigating the association between troponin positivity in patients hospitalised with COVID-19 and increased mortality in the short term. Methods All adults admitted with swab-proven RT-PCR COVID-19 to Homerton University Hospital (HUH) from 04.02.20 to 30.04.20 were eligible for inclusion. We retrospectively analysed data collected from the physical and electronic patient records (EPR) including demographic and biochemical data (e.g. serum high sensitivity Troponin I). Data was analysed according to the primary outcome of death at 28 days during hospital admission. Troponin positivity was defined above the upper limit of normal according to our local laboratory assay (>15.5ng/l for females, >34 ng/l for males). Univariate and multivariate logistical regression analyses were performed to evaluate the link between troponin positivity and death. Results The total number of adults with swab-proven RT-PCR COVID-19 to HUH from the date of the first positive swab to 30th April 2020 was 402. Mean length of stay for all patients was 9.1 days(SD 12.0). Table 1 shows selected demographics. This is a highly comorbid population with modest ethnic minority representation. Mean age was 65.3 years for men compared to 63.8 years for women. In those with a positive initial troponin, there was a high burden of mortality at 28 days post-admission. Mortality in troponin positive and negative patients is shown in table 2. A chi-squared test showed that survival of COVID-19 patients was significantly higher in those with a negative troponin (p = 3.23 x10-10) compared to those with a positive troponin. A Mann Whitney U test showed that initial troponin was significantly higher in those who died (p = 2.24 x10-12) compared to those who were alive. Mean initial troponin was 89.8 (95% CI 43.1 - 136.5). In the multivariate logistical regression, lung disease, age, troponin positivity and CPAP were all significantly associated with death, with an AUC of 0.8872, sensitivity of 0.9004 and specificity of 0.6292 for the model. Within this model, troponin positivity was independently associated with short term mortality (OR 3.23 , 95% CI 1.53-7.16, p=0.00278). Conclusions We demonstrated an independent association between troponin positivity and increased short-term mortality in COVID-19 in a London district general hospital. The mechanisms implicated in myocardial injury in COVID-19 are not fully understood but are likely multi-factorial.

7.
13th Conference on Creativity and Cognition, C and C 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1304274

ABSTRACT

We are developing quilt design generation software for Code Crafters workshops, which aim to broaden public awareness of computational thinking and build links between computer science and quilting. The software generates quilt designs, which will be manipulated and modified by workshop participants. Due to COVID, our workshops will be conducted remotely, so the software has been designed to increase the sense of community by providing opportunities for the types of social interactions that take place in colocated quilting workshops. © 2021 Owner/Author.

8.
Journal of the American Geriatrics Society ; 69(SUPPL 1):S112, 2021.
Article in English | EMBASE | ID: covidwho-1214851

ABSTRACT

Home visits are an important and positive part of geriatric education for medical students (MS), but the main lessons learned by MS are not known. As part of the new Aging/End of Life Care curricular theme at Harvard Medical School, first year medical and dental students participate in older adult home visits with geriatrics faculty to learn about the geriatric assessment. Our mixed methods analysis explores students' main lessons learned. We collected anonymous evaluation forms from 310 students following a one-time geriatric home visit over a 3 year period. Using a 5-point Likert scale, MS rated their comfort with various aspects of geriatric assessment and rated whether their interest in geriatrics increased after the home visit. MS described two lessons learned. Two coders analyzed 604 lessons learned and identified major themes which were then organized into the Geriatric 5Ms Framework (Multicomplexity, Mobility, Mind, Matters Most, Medications). Qualitative and quantitative data were analyzed using Excel, Dedoose and JMP statistical software. A majority of MS (72%) reported their interest in geriatrics somewhat or greatly increased after the home visit. Of the 604 lessons learned that were coded, 51% related to mobility. 56% of responses related to multicomplexity, of which the most common was understanding different living facilities (43%). After a geriatric home visit, MS interest in geriatrics increases as they learn about applying the Geriatric 5Ms Framework. The most common lessons learned related to mobility and multicomplexity, essential areas of focus in a geriatrics curriculum. Though more difficult to arrange in the COVID-19 era, educational home visits are an important opportunity to increase MS interest in geriatrics and build their skills to improve the care of older adults.

9.
Thorax ; 76(SUPPL 1):A120-A121, 2021.
Article in English | EMBASE | ID: covidwho-1194303

ABSTRACT

Introduction and Objectives COVID-19 can cause serious respiratory complications. One form of treatment utilises aerosolised therapeutics concurrently with mechanical ventilation (MV). Clinicians have adopted low tidal volume ventilation (LTV) strategies (4-6 mL/kg body weight)1 in these patients. Nebuliser performance is typically characterised in accordance with international ventilatory standard ISO274272 (ISO ventilation). The objective of this study was to compare the aerosol dose delivered to a simulated adult model with either LTV ventilation or ISO ventilation settings. Methods A 2.5 ml dose of 1 mg/ml of salbutamol (GlaxoSmithKline Ltd., Ireland) was aerosolised with a vibrating mesh nebuliser (VMN) (Aerogen Ltd., Ireland) positioned on the dry side of the humidifier within a dual limb circuit (Fisher & Paykel, New Zealand) during simulated MV (Servo-I, Maquet, Sweden). Two adult breath patterns were generated: 1) ISO ventilation, Tidal Volume VT: 500 mL, Breathing Rate BR = 15 BPM, Inhalation Exhalation ratio I:E: 1:1, and 2) LTV, VT: 400 mL, BR = 20 BPM, I:E: 1:2. A capture filter (Respirgard, Baxter, Ireland) was placed between the ETT (8.0 mm, Flexicare Medical Inc., UK) and the test lung. The mass of drug was determined using UV spectrophotometry (276 nm). Results are expressed as the percentage of the nominal dose placed in the nebuliser's medication cup. All testing was performed in triplicate. Results The results of this study, presented in figure 1, highlight the difference in the aerosol dose delivered to the simulated patient at the two different ventilatory settings. Conclusions Study results confirm that a simulated adult patient undergoing MV utilising LTV ventilation strategy would receive approximately half of the aerosol dose delivered in comparison with the ISO ventilation parameters typically used in reporting nebuliser performance. These findings should provide clinicians with an approximation of the administered dose that is delivered. This may be useful when optimising aerosol dosing strategies during LTV ventilation in COVID-19 patients.

11.
J Hosp Infect ; 108: 135-141, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-956513

ABSTRACT

BACKGROUND: During manual resuscitation, nebulizer therapy may be used to deliver therapeutics to patients in respiratory distress. However, the devices used to generate and deliver these medical aerosols have the potential to release these therapeutics into the local environment and expose caregivers to unwanted medical aerosols. AIM: To quantify the levels of fugitive medical aerosol released into the environment during aerosol drug delivery using a manual resuscitation bag with and without filtration. METHODS: Time-varying fugitive aerosol concentrations were measured using an aerodynamic particle sizer placed at a position designed to mimic a caregiver. Two nebulizer types were assessed, a vibrating mesh nebulizer and a jet nebulizer. The aerosol dose delivered to the simulated patient lung was also quantified. FINDINGS: Filtration of the exhalation port of the manual resuscitation bag was seen to reduce fugitive medical aerosols to ambient levels for both nebulizer types. The vibrating mesh nebulizer delivered the greatest quantity of aerosol to the simulated adult patient (18.44 ± 1.03% versus 3.64 ± 0.26% with a jet nebulizer). CONCLUSIONS: The results highlight the potential for exposure to fugitive medical aerosols released during the delivery of aerosol therapy with a manual resuscitation bag and also the potential for significant variation in patient lung dose depending on nebulizer type.


Subject(s)
Aerosols/analysis , Albuterol/analysis , Bronchodilator Agents/analysis , Nebulizers and Vaporizers/classification , Administration, Inhalation , Equipment Design
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