DEMENTIA CAREGIVER PERCEPTIONS OF TELE-DEMENTIA CARE FOR VETERANS DURING THE COVID-19 PANDEMIC

The estimated 5 million persons living with dementia in the United States have been greatly impacted by the medical and psychosocial impacts of the COVID-19 pandemic, respite program closures, social isolation, and Veterans seen within the Veterans Health Administration system are particularly vulnerable. Telemedicine provides needed specialty dementia care to these patients with complex needs in their homes, and its uptake has increased during the pandemic. This qualitative, observational study explored informal caregivers' perceptions of tele-dementia care for Veterans seen at 2 sites, Palo Alto and Cleveland, via semi-structured interviews. Twenty-five caregivers (Mean age = 67y, SD=12y, 88% women) were interviewed over telephone following a tele-dementia visit. Themes that emerged from the interviews were that tele-dementia visits: (1) saved caregivers 2.6h±1.5h (Range: 0.5 to 6h) of travel time, (2) required limited preparation compared to in-person visits, (3) mitigated COVID-19 risk and avoided needs for masking and social distancing, (4) avoided behavioral challenges during appointments, and (5) allowed participation from home with minimal disruption of routine. Caregivers described significant physical challenges that made leaving the home for appointments difficult including balance issues, incontinence, and difficulties getting into vehicle. Caregivers plan to continue using tele-dementia services beyond the pandemic due to the convenience. Taken together, these findings indicate that caregivers find tele-dementia care convenient, comfortable, helpful, and timesaving and highly satisfactory. A combination of both in-person and virtual visits would be an ideal future state. This study illustrates how caregivers experience virtual visits for dementia care and will shape future intervention design.

CHALLENGES AND SUPPORTS FOR VETERAN CAREGIVERS DURING THE COVID-19 PANDEMIC: A MIXED-METHODS STUDY

Informal caregivers face challenges in supporting older or medically-complex Veterans, which could be exacerbated by the COVID-19 pandemic. Our mixed methods observational study explored Veteran caregivers' supports, challenges, and self-identified impacts during the pandemic. Caregivers whose veterans needed help with at least one activity of daily living for the last year and received care at one of five Veterans Health Administration (VA) study sites were eligible. Survey participants (n=46) were 96% female, 32-83 years old (median 59);most (83%) cared for a spouse. A majority (67%, n=31) reported increased stress since the start of the pandemic. Top sources of increased stress included worry about COVID-19 infection, increased caregiving responsibility, delayed access to care, concerns about vaccine safety, and employment or financial concerns. Caregiver interviews (n=26) qualitatively analyzed using a rapid, templated approach identified the following themes: (1) the benefits and challenges of VA COVID precautions to Veteran care access (e.g. telehealth, getting care for new problems), (2) supports afforded by and limits of the expansion of the VA Caregiver Support Program, (3) declines in Veteran physical and cognitive functioning, (4) increased caregiver role in Veterans' support and care, (5) changes in work and living situations to address increased caregiving needs and/or reduce risk of exposure, and (6) loss of and then return to more usual routines and social outlets amid ongoing COVID-related uncertainties. Recommendations include targeted, personalized outreach to engage caregivers in existing supports, removing barriers and streamlining processes for obtaining services, and creating durable caregiver-to-caregiver, peer support opportunities.

The Associations of Prescription Drug Insurance and Cost-Sharing With Drug Use, Health Services Use, and Health - A Systematic Review of Canadian Studies

Objectives: In Canada, basic primary health coverage for physician and hospital services is provided without cost-sharing, while drug insurance is provided through a patchwork system of public and private plans that often have substantial cost-sharing, resulting in important inequities. The COVID-19 pandemic has further exposed the limit of Canada's drug insurance systems, as mass layoffs have resulted in millions losing employment-based drug coverage. Method(s): We conducted a systematic review to examine the association of prescription drug insurance and cost-sharing with drug use, health services use, and health, in Canada. We searched four electronic databases, two grey literature databases, five specialty journals and two working paper repositories. At least two reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. Result(s): Results from 37 studies consistently demonstrated that the expansion and/or provision of drug insurance were associated with higher drug use, while increases in and higher levels of cost-sharing were associated with lower drug use. Although many studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were small and unlikely clinically meaningful. Among five studies that examined the association of drug insurance and cost-sharing with health, one found a statistically significant and clinically meaningful association. Lastly, we found little evidence that socioeconomic status or sex were effect modifiers;however, some evidence suggested that health modified the association between drug insurance and cost-sharing with drug use. Conclusion(s): Increased cost-sharing is likely to affect the use of essential and nonessential drugs. Universal pharmacare without cost-sharing may reduce health inequities as it may increase drug use among lower-income relative to higher-income populations. These findings may inform drug insurance policy in Canada, as well as other jurisdictions. Copyright © 2022

Mental health and COVID-1919: A review on post-pandemic mental health implications and its response in the context of India

Background - Mental health care and concerns are usually overlooked when there are limited resources available to contain the pandemic. In this global COVID-19 crisis, mental health issues have increased and became one of the most underrated and widespread health concerns globally. Objectives - This study is an attempt to review the existing mental health concerns in the post-pandemic era through various strategies related to mental health care and global experiences with special emphasis on the context of India. By reviewing existing evidence, this study proposes recommendations and conceptual framework for mental health concerns in the pandemic. Methodology - The researchers have searched through Google Scholar and various electronic databases like PubMed, Web of Science, SCOPUS, etc. with the search terms like "psychiatry", "mental health", "COVID-19", "Coronavirus", "SARS-CoV-2", "anxiety", "stress", "depression", etc. in several combinations. They compiled information from published magazines, newspaper articles, journals, official websites of several NGOs and institutions and web pages, press releases, verified pages on social media, etc. Results - Some of the common health concerns reported were anxiety, stress, insomnia, depression, anger, denial, and fear. Some of the most vulnerable groups were older people and children, people with current mental health problems, and frontline workers. Suicide attempts were also very common amidst the pandemic. A lot of measures are taken across the world to address issues related to mental health by using intervention strategies and guidelines. Social media has played a great role in this context. State-sponsored intervention, toll-free numbers to address behavioral and psychological problems and tele-psychiatry consultations have been provided by the Indian government. Conclusion - A need-based intervention approach is needed that is specific to vulnerable groups with a positive approach and risk management strategies at par with epidemiology of Coronavirus evolving these days. Prioritization and planning of mental health care would be instrumental in serving the most vulnerable population. © 2022 International Journal of Health Sciences. All rights reserved.

The use of convalescent plasma as a novel treatment in pandemic disease: a review

At present, antibody-based therapies are undergoing a renaissance. In the wake of being created and afterward to a great extent relinquished in the twentieth century, many antibody preparations are presently in clinical use. Interest in utilizing antibodies to treat irresistible infections is now being fuelled by the wide dissemination of drug-resistant pathogens, the rise of new pathogens, the overall inefficacy of medications in immunocompromised hosts and the fact that antibody-based treatments are the main way to give prompt resistance against biological weapons. Given the requirement for new drug therapies and numerous ongoing innovative advances in the field of immunoglobulin research, there is generous affirmation concerning improved applications of antibody- based therapy for the anticipation and treatment of infectious diseases. The advent of new pathogens for which there is no compelling treatment alternative has redrawn the regard for the usefulness of convalescent plasma. To be sure, convalescent plasma can be an alternate and quick remedial choice in outbreaks of infectious diseases such as Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome (SARS), H1N1 flu, H5N1 flu, Ebola, Poleomyelitis, Measles and COVID-19.

Review on COVID-19: a global pandemic disease

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) signifies the causative agent of a potentially lethal disease that is of abundant world-wide public health concern. It was emerged in Wuhan, China and spread globally. On 30 January 2020, World Health Organization (WHO) officially professed the COVID-19 epidemic as a public health emergency of international concern. In accordance to the genomic analysis, Genomic analysis revealed that SARSCoV-2 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, therefore bats could be the possible primary reservoir. Despite of unknown intermediate source, the rapid human to human transfer has been widely assured. Extensive strategies have come forward to reduce person-to-person transmission of COVID-19 in order to control the current outbreak. Special attention and efforts should be taken into consideration to protect or reduce transmission in susceptible population including children, health care providers, and elderly people. There is no clinically approved antiviral drug or vaccine available till date against COVID-19. However, investigations have been carried out using broad-spectrum antiviral drugs against COVID-19 in clinical trials, that resulted in clinical recovery. In this review, we have discussed about the symptoms, structure, epidemiology, transmission, pathogenesis, diagnosis and potential treatment availability to control the spread of this fatal disease.

Review on COVID-19: A global pandemic disease

Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) signifies the causative agent of a potentially lethal disease that is of abundant world-wide public health concern. It was emerged in Wuhan, China and spread globally. On 30 January 2020, World Health Organization (WHO) officially professed the COVID-19 epidemic as a public health emergency of international concern. In accordance to the genomic analysis, Genomic analysis revealed that SARSCoV-2 is phylogenetically related to severe acute respiratory syndrome-like (SARS-like) bat viruses, therefore bats could be the possible primary reservoir. Despite of unknown intermediate source, the rapid human to human transfer has been widely assured.Extensive strategies have come forward to reduce person-to-person transmission of COVID-19 in order to control the current outbreak. Special attention and efforts should be taken into consideration to protect or reduce transmission in susceptible population including children, health care providers, and elderly people.There is no clinically approved antiviral drug or vaccine available till date against COVID-19. However, investigations have been carried out using broad-spectrum antiviral drugs against COVID-19 in clinical trials,that resulted in clinical recovery. In this review, we have discussed about the symptoms,structure, epidemiology, transmission, pathogenesis, diagnosis and potential treatment availability to control the spread of this fatal disease. Copyright © Journal of Global Trends in Pharmaceutical Sciences.

The use of convalescent plasma as a novel treatment in pandemic disease: A review

At present, antibody-based therapies are undergoing a renaissance. In the wake of being created and afterward to a great extent relinquished in the twentieth century, many antibody preparations are presently in clinical use. Interest in utilizing antibodies to treat irresistible infections is now being fuelled by the wide dissemination of drug-resistant pathogens, the rise of new pathogens, the overall inefficacy of medications in immunocompromised hosts and the fact that antibody-based treatments are the main way to give prompt resistance against biological weapons. Given the requirement for new drug therapies and numerous ongoing innovative advances in the field of immunoglobulin research, there is generous affirmation concerning improved applications of antibody-based therapy for the anticipation and treatment of infectious diseases. The advent of new pathogens for which there is no compelling treatment alternative has redrawn the regard for the usefulness of convalescent plasma. To be sure, convalescent plasma can be an alternate and quick remedial choice in outbreaks of infectious diseases such as Middle East Respiratory Syndrome, Severe Acute Respiratory Syndrome (SARS), H1N1 flu, H5N1 flu, Ebola, Poleomyelitis, Measles and COVID-19. Copyright © Journal of Global Trends in Pharmaceutical Sciences.