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1.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-334305

ABSTRACT

This study provides valuable insight into impacts of COVID-19 emergency public health “lockdown” measures upon traffic flow, active travel and gaseous pollutant concentrations (NO, NO 2 , and O 3 ) in Oxford city centre during 2020. Comparisons of traffic counts indicated pronounced changes in traffic volume associated with national lockdown periods. Car volume reduced by 77.5% (statistically significant) during the first national lockdown, with lesser changes in goods vehicles and public transport (bus) activity during the second lockdown. Cycle flow reduced substantively during the first lockdown only. These changes resulted in a reduction in nitric oxide (NO) and nitrogen dioxide (NO 2 ) concentrations of 75.1% and 47.4%, respectively at roadside, and 71.8% and 34.1% at urban background during the first lockdown period. In contrast ozone (O 3 ) concentrations increased at the urban background site by 22.3% during the first lockdown period, with no significant changes in gaseous concentrations during the second lockdown at either roadside or urban background location. The diurnal pattern of peak mean NO and NO 2 concentrations reduced in magnitude and was shifted approximately 2 hours earlier in the morning and 2 hours later in the evening (roadside) and 3 hours earlier in the morning and 3 hours later in the evening (urban background). Our findings provide an example of how gaseous air quality in urban environments could respond to future urban traffic restrictions, suggesting benefits from reductions in peak and daily NO 2 exposures may be offset by health harms arising from increases in ground level O 3 concentrations in the summer months.

2.
PLoS One ; 17(1): e0262530, 2022.
Article in English | MEDLINE | ID: covidwho-1627791

ABSTRACT

BACKGROUND: The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan. METHOD: Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively. FINDINGS: Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988-1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999-1.013, p = 0.082). INTERPRETATION: In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Disease Susceptibility/metabolism , Fasting/adverse effects , Adult , Aged , Arabs , Communicable Disease Control/methods , Communicable Diseases/drug therapy , Communicable Diseases/transmission , Electronic Health Records , Female , Humans , Interrupted Time Series Analysis/methods , Islam , Male , Middle Aged , Practice Patterns, Physicians' , Primary Health Care/trends , Retrospective Studies , United Kingdom/epidemiology
3.
JMIR Ment Health ; 8(8): e29671, 2021 Aug 12.
Article in English | MEDLINE | ID: covidwho-1357485

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, we saw telehealth rapidly become the primary way to receive mental health care. International research has validated many of the benefits and challenges of telehealth known beforehand for specific population groups. However, if telehealth is to assume prominence in future mental health service delivery, greater understanding of its capacity to be used to provide psychosocial support to people with complex and enduring mental health conditions is needed. OBJECTIVE: We focused on an Australian community-managed provider of psychosocial intervention and support. We aimed to understand service user and worker experiences of psychosocial support via telehealth throughout the COVID-19 pandemic. METHODS: This study was jointly developed and conducted by people with lived experience of mental ill health or distress, mental health service providers, and university-based researchers. Semistructured interviews were conducted between August and November 2020 and explored participant experiences of receiving or providing psychosocial support via telehealth, including telephone, text, and videoconferencing. Qualitative data were analyzed thematically; quantitative data were collated and analyzed using descriptive statistics. RESULTS: Service users (n=20) and workers (n=8) completed individual interviews via telephone or videoconferencing platform. Service users received psychosocial support services by telephone (12/20, 60%), by videoconferencing (6/20, 30%), and by both telephone and videoconferencing (2/20, 10%). Of note, 55% (11/20) of service user participants stated a future preference for in-person psychosocial support services, 30% (6/20) preferred to receive a mixture of in-person and telehealth, and 15% (3/20) elected telehealth only. Two meta-themes emerged as integral to worker and service user experience of telehealth during the pandemic: (1) creating safety and comfort and (2) a whole new way of working. The first meta-theme comprises subthemes relating to a sense of safety and comfort while using telehealth; including trusting in the relationship and having and exercising choice and control. The second meta-theme contains subthemes reflecting key challenges and opportunities associated with the shift from in-person psychosocial support to telehealth. CONCLUSIONS: Overall, our findings highlighted that most service users experienced telehealth positively, but this was dependent on them continuing to get the support they needed in a way that was safe and comfortable. While access difficulties of a subgroup of service users should not be ignored, most service users and workers were able to adapt to telehealth by focusing on maintaining the relationship and using choice and flexibility to maintain service delivery. Although most research participants expressed a preference for a return to in-person psychosocial support or hybrid in-person and telehealth models, there was a general recognition that intentional use of telehealth could contribute to flexible and responsive service delivery. Challenges to telehealth provision of psychosocial support identified in this study are yet to be fully understood.

4.
J Marital Fam Ther ; 47(2): 259-288, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1175078

ABSTRACT

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.


Subject(s)
Couples Therapy/organization & administration , Family Therapy/organization & administration , Physical Therapists/statistics & numerical data , Remote Consultation/organization & administration , Telerehabilitation/organization & administration , Attitude of Health Personnel , COVID-19/epidemiology , Female , Humans , Male , Telemedicine/statistics & numerical data
5.
Psychol Psychother ; 94(3): 854-883, 2021 09.
Article in English | MEDLINE | ID: covidwho-1096921

ABSTRACT

PURPOSE: The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD: Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS: Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS: Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS: Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.


Subject(s)
Behavior Therapy/standards , Mental Disorders/therapy , Patient Satisfaction , Process Assessment, Health Care , Telemedicine/standards , Therapeutic Alliance , Videoconferencing/standards , COVID-19/prevention & control , Humans
6.
Diabetes Obes Metab ; 23(1): 263-269, 2021 01.
Article in English | MEDLINE | ID: covidwho-802778

ABSTRACT

Sodium-glucose co-transporter-2 (SGLT2) inhibitors are widely prescribed in people with type 2 diabetes. We aimed to investigate whether SGLT2 inhibitor prescription is associated with COVID-19, when compared with an active comparator. We performed a propensity-score-matched cohort study with active comparators and a negative control outcome in a large UK-based primary care dataset. Participants prescribed SGLT2 inhibitors (n = 9948) and a comparator group prescribed dipeptidyl peptidase-4 (DPP-4) inhibitors (n = 14 917) were followed up from January 30 to July 27, 2020. The primary outcome was confirmed or clinically suspected COVID-19. The incidence rate of COVID-19 was 19.7/1000 person-years among users of SGLT2 inhibitors and 24.7/1000 person-years among propensity-score-matched users of DPP-4 inhibitors. The adjusted hazard ratio was 0.92 (95% confidence interval 0.66 to 1.29), and there was no evidence of residual confounding in the negative control analysis. We did not observe an increased risk of COVID-19 in primary care amongst those prescribed SGLT2 inhibitors compared to DPP-4 inhibitors, suggesting that clinicians may safely use these agents in the everyday care of people with type 2 diabetes during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Disease Susceptibility , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Aged , Diabetes Mellitus, Type 2/drug therapy , Female , Humans , Male , Middle Aged , Pandemics , Propensity Score , Retrospective Studies , SARS-CoV-2 , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use
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