An investigation of patterns of association between anxiety symptom clusters and mask-wearing during the COVID-19 pandemic in Canada

Several measures have been implemented to reduce the spread of the COVID-19, with mask-wearing among the most widely used measures. Yet, the barriers to mask-wearing are unclear. This study examined whether different types of anxiety symptom clusters (i.e., symptoms of claustrophobia, physical anxiety sensitivity, and social anxiety sensitivity) are associated with mask-wearing tendencies during the COVID-19 pandemic and investigated how anxiety symptom clusters relate to mask-wearing discomfort and self-isolation distress. A total of 556 Canadian adults were recruited online between January and February of 2021. The study was administered online via Qualtrics. Participants completed questionnaires measuring symptoms of claustrophobia, anxiety sensitivity, and isolation distress, along with a measure of mask-wearing behaviours. Linear regression analyses revealed that elevated anxiety symptoms across all symptom clusters predicted more physical and emotional discomfort related to mask-wearing, as well as reduced likelihood of leaving the home due to mask-related discomfort. Leaving home less often due to mask-related discomfort was significantly associated with more self-isolation distress and poorer coping overall. Differential patterns of mask-wearing behaviours across anxiety symptom clusters were not detected. These findings suggest that anxiety symptoms (i.e., including claustrophobia, physical anxiety sensitivity, and social anxiety sensitivity) are positively associated with mask-related distress. This, in turn, may lead people to avoid leaving their home and consequently experience increased self-isolation distress. Furthermore, these findings suggest that people with heightened anxiety symptoms tend to experience more discomfort with mask-wearing, which may perpetuate a cycle of avoidance and poorer coping overall. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (French) Plusieurs mesures ont ete mises en oeuvre pour reduire la propagation de la COVID-19, le port du masque etant l'une des mesures les plus utilisees. Pourtant, les obstacles au port du masque ne sont pas clairs. Cette etude a examine si differents types de groupes de symptomes d'anxiete (c'est-a-dire les symptomes de claustrophobie, de sensibilite a l'anxiete physique et de sensibilite a l'anxiete sociale) etaient associes aux tendances de port du masque pendant la pandemie de COVID-19 et a etudie comment les groupes de symptomes d'anxiete sont lies a l'inconfort du port de masque et a la detresse liee a l'isolement. Un total de 556 adultes canadiens ont ete recrutes en ligne entre janvier et fevrier 2021. L'etude a ete administree en ligne via Qualtrics. Les participants ont rempli des questionnaires mesurant les symptomes de claustrophobie, la sensibilite a l'anxiete et la detresse liee a l'isolement, ainsi qu'une mesure des comportements lies au port du masque. Les analyses de regression lineaire ont revele que des symptomes d'anxiete eleves dans tous les groupes de symptomes predisaient un plus grand inconfort physique et emotionnel lie au port du masque, ainsi qu'une probabilite reduite de quitter le domicile en raison de l'inconfort lie au port du masque. Le fait de quitter le domicile moins souvent en raison d'un inconfort lie au port du masque etait significativement associe a une plus grande detresse liee a l'isolement et a une moins bonne adaptation globale. Il n'a pas ete possible de detecter des comportements differents en matiere de port de masque selon les groupes de symptomes d'anxiete. Ces resultats indiquent que les symptomes d'anxiete (y compris la claustrophobie, la sensibilite a l'anxiete physique et la sensibilite a l'anxiete sociale) sont positivement associes a la detresse liee au port du masque. Cela peut conduire les personnes a eviter de quitter leur domicile et, par consequent, a eprouver une detresse accrue liee a l'isolement. De plus, ces resultats suggerent que les personnes presentant des symptomes d'anxiete eleves ont tendance a eprouver plus d'inconfort lie au port du masque, ce qui peut perpetuer un cycle d'evitement et une moins bonne adaptation globale. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Impact Statement The findings suggest that anxiety symptoms may interfere with engagement in this important public health measure, informing policy-makers of at-risk groups in the population. Moreover, those who experience higher mask-related anxiety are more likely to stay at home, leading to increased self-isolation and isolation-related distress. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Effectiveness of Non-Invasive Ventilation with Awake Prone in Covid-19 Related-Acute Respiratory Distress Syndrome at Covid-19 Isolation Hospital Muzaffarabad

Background: Despite its widespread usage, invasive positive pressure ventilation (IPPV) has a dismal track record in COVID-19 patients with SARDS. Currently, there is a paucity of evidence supporting the usefulness of noninvasive positive pressure ventilation (NIPPV) in the treatment of severe ARDS, as well as a significant risk of aerosol formation in patients with COVID-19 infection. Objective(s): This study aims to assess the efficacy and safety of NIPPV administration to COVID-19 patients. Method(s): The trial included 130 participants with moderate tosevere ARDS based to the Berlin criteria (PaO2/FiO2 ratio of 200mmHg, GCS > 13, respiratory breathing index (RBI) of 105, and no systemic issues). They were treated with NIPPV with awake proaning up to 12 hours per day at a hospital in Muzaffarabad. The addition of a heat and moisture exchanger (HME) and viral/bacterial filters to the expiratory limb of the ventilator circuit represented a minor improvement. Result(s): In an average of six days, the PaO2/FiO2 ratio indicates that the severity of ARDS has improved from moderate/severe to mild in 64 percent of patients. 36 percent of individuals who had a defined airway experienced IPPV or failure of NIV. During the study period, 1 % the of healthcare workers (HCW) were infected with COVID19. The delivery of NIPPV was associated with claustrophobia, nasal crusting, aspiration, and barotrauma (0.7 percent). Conclusion(s): In selected patients, NIV with awake proaning up to 12 hours per day can be employed to give respiratory support without the need for IPPV, hence eliminating the need for IPPV in those patients. However, larger-scale investigations are required to validate our findings. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

A Special Case of Acute Myocarditis with Left Ventricular Thrombus

Introduction. Acute myocarditis is a potential life-threatening disease and left ventricular thrombus could be a complication. Nowadays, myocarditis has been observed after SARS-CoV-2 vaccination. We report the case of a young adult female with left ventricular thrombus secondary to COVID19 mRNA vaccine-related acute myocarditis. Case report A 33-year-old afro-descendant female was admitted to the ED with dyspnea, heart-pounding and chest pain. The EKG showed sinus tachycardia with diffuse changes in repolarization. The lab tests showed: TnHS 8437 ng/mL, C-reactive protein 3,8 mg/dL, normal white blood cell count, NTproBNP 3800 pg/mL, GOT 171 UI/l, GPT 57 UI/l. She received the first dose of mRNA SARS-CoV-2 vaccine 21 days earlier. The PCR swab test for SARS-CoV-2 was negative. Clinical examination revealed HR 110 bpm, BP 105/75 mmHg, normal lung sounds, tachycardic heart sounds. Transthoracic echocardiogram showed EF 25%, massive apical adherent thrombus and mild diffuse pericardial effusion. Serological analysis for viral and bacterial infection were negative. Coronary angiography, cardiac- MRI, myocardial biopsy were not performed because of patient refuse and claustrophobia. LMWH 8000 UI bid, Ibuprofen 600 mg tid and Colchicine 0,5 mg/die were administered. The patient was discharged after 14 days with no symptoms, no residual thrombus and total EF recovery. The alleged adverse event was reported to the National Pharmacovigilance Network. Conclusions Myocarditis is a potential consequence of both COVID-19 and its mRNA vaccines. Post-vaccine myocarditis is usually self-limiting with a low rate of consequences.

Review of claustrophobia incidence in MRI: A service evaluation of current rates across a multi-centre service.

INTRODUCTION: Magnetic Resonance Imaging remains an anxious experience for many, often exhibiting as fear of enclosed spaces. A useful metric to assess its prevalence and impact in practice is premature termination due to claustrophobia. Incidence varies and depends on many factors such as the physical nature of the imaging equipment and examination being undertaken, as well as the patient themselves. METHODS: Scan appointment data from between April 2019-March 2021 was extracted and reviewed. Analysis included the type of scanner used, patient age, sex, examination area, funding source, attendance and completion status. Binomial logistic regression was performed to look for any relevant predictors of failure to scan due to claustrophobia. RESULTS: Overall incidence of incomplete examinations due to claustrophobia was 0.76%. Whilst the majority of scans were performed on conventional systems, those undergoing Open scans were over three times more likely to fail a scan due to claustrophobia, whilst those undergoing UpRight scanning were half as likely. Likelihood of claustrophobia increases with females, those between 45-64years of age, funded by the NHS and entering the scanner head first or having a head scan. CONCLUSION: Incidence of incomplete scanning is below 1% but with the potential for further reduction with implementation and use of improved scanner design and technology. Understanding the impact of other variables is also useful to raise awareness of those at greater risk of claustrophobia. However, there are wider influences beyond data alone to consider and account for. IMPLICATIONS FOR PRACTICE: Whilst occurrence of claustrophobia is low, there remains a cost impact, as well as an importance in understanding the patient experience. Drawing on operational data can help provide a limited, generalised view to support service improvement.

Making More From Less in a Corona-Encircled Analytic Frame and Situation.

The author describes how the parasitic coronavirus encircled and disrupted the analytic frame and situation, activating anxiety in both therapist and patient. A patient is described with core intimacy difficulties whose primitive anxieties manifested in him the dis-regulation of the too-far (agoraphobic), too-near (claustrophobic) intimacy dialectic. Drawing on Winnicott, the author describes how these increased dialectic tensions, when contained, created a potentially transformational transitional space that helped to enhance the patient's mental and symbolizing capacity, that is, a capacity to make more from less.

Radiographer Perspectives on current occurrence and management of claustrophobia in MRI.

INTRODUCTION: Magnetic Resonance Imaging (MRI) is well known to be a source of anxiety for patients, commonly appearing as claustrophobia. One of the main reasons for this is due to the physical nature of the scanner itself. Despite technological improvements, there is lacking evidence on whether these improvements have resulted in a reduction in claustrophobia and anxiety in the clinical setting. Background anxiety associated with the current COVID-19 pandemic may also have shown an increase in prevalence. Therefore, the aim of this study was to survey MRI radiographers on their perspectives on the occurrence and management of claustrophobia in modern day clinical practice. METHODS: Following ethical approval, an online survey was used to gather the opinions of MRI radiographers. This used closed ranking questions as well as open responses to gain insight into how this issue may be presenting in practice, preferences in management, and barriers to providing support. RESULTS: Responses provide an up-to-date view on how radiographers perceive both displays of anxiety and associated impacts on patient outcome, the considered sources of anxiety, the use and effectiveness of support strategies, barriers to providing this support, and views on how COVID-19 has impacted on practice. CONCLUSION: The study provides a current view from radiographers on their experience of claustrophobia in practice. It shows that this remains a regular part of practice within the modality. Therefore, for MRI radiographers managing this is an essential component of their role. Communication and interaction with the patient are recognised as important, although time is a barrier to always being able to provide patient centred care. IMPLICATIONS FOR PRACTICE: Ongoing support is needed for both patients and radiographers to improve experience within MRI.