ACT2COPE: A pilot randomised trial of a brief online acceptance and commitment therapy intervention for people living with chronic health conditions during the COVID-19 pandemic

It is well established that the COVID-19 pandemic increased psychological distress in many populations, particularly for people with chronic health conditions (CHCs). Web-based mental health interventions provide a scalable and cost-effective approach to providing psychological support for people disproportionately affected by the COVID-19 pandemic. The current study aimed to explore the feasibility and acceptability of a one-week web-based psychological intervention (ACT2COPE) and explore preliminary effects of the intervention on reducing depression, anxiety, and stress symptoms, and improving wellbeing and psychological flexibility in adults living with CHCs during the COVID-19 pandemic in Aotearoa (New Zealand). A pilot randomised waitlist-controlled trial explored the acceptability and preliminary efficacy of ACT2COPE among 40 participants (n = 20 in the ACT2COPE group and n = 20 in the waitlist control group). Focus groups and open-ended questions explored usability and acceptability of the intervention as well as levels of engagement and adherence to the intervention. Mixed model ANOVAs explored within and between-group differences in psychological outcomes. Qualitative findings suggested that participants found ACT2COPE acceptable and engaging. Depressive symptoms significantly decreased over time compared to the waitlist group at 4-weeks follow-up (p =.012). No other between-group differences were found. The online ACT2COPE intervention presents a promising, scalable intervention that may improve psychological outcomes in adults living with CHCs during the COVID-19 pandemic. Future research is needed to confirm these findings in a larger and more diverse population and over a longer timeframe. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Child Health and Illness

Child and adolescent health has improved globally over the last two decades;however inequities exist. These inequities may be magnified in the face of chronic illness and global pandemics [i.e., Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)- COVID-19]. Chronic illness will be explored in detail, with specific focus on pediatric chronic pain, cystic fibrosis (CF), and congenital heart disease (CHD). The existing literature surrounding the impact of the COVID-19 pandemic on children and adolescents will be reviewed. Future research directions and clinical implications with be discussed. © 2022 Elsevier Ltd. All rights reserved

Access to Healthcare for Children and Adolescents with a Chronic Health Condition during the COVID-19 Pandemic: First Results from the KICK-COVID Study in Germany.

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0−10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany.

The impact of the COVID-19 pandemic on paediatric health service use within one year after the first pandemic outbreak in New South Wales Australia - a time series analysis.

BACKGROUND: The first wave of the COVID-19 pandemic hit New South Wales (NSW) Australia in early 2020, followed by a sharp state-wide lockdown from mid-March to mid-May. After the lockdown, there had been a low level of community transmission of COVID-19 over a year. Such pandemic experiences provide unique opportunity to understand the impact of the pandemic on paediatric health service use as countries emerge from the pandemic. METHODS: We examined the difference between the observed and the predicted numbers of inpatient admissions and emergency department (ED) attendances, respectively, related to chronic, acute infectious and injury conditions, for each month during the COVID-19 period (January 2020-February 2021), based on the numbers from 2016 to 2019, using records from two major paediatric hospitals in NSW. All analyses were conducted using autoregressive error models and were stratified by patient age, sex and socioeconomic status. FINDINGS: Health service use was significantly lower than predicted for admissions and/or ED attendances related to chronic conditions, acute infections, and injury during the lockdown in 2020. Change in health service use varied by chronic conditions, from the largest decrease for respiratory conditions (40-78%) to non-significant change for cancer and mental health disorders. After the lockdown, health service use for most health conditions returned to pre-COVID-19 predicted levels. However, for mental health disorders, increased health service use persisted from June 2020 up to February 2021 by 30-55%, with higher increase among girls aged 12-17 years and those from socioeconomically advantaged areas. There was persistently lower health service use for acute infections and increased health service use for injuries. Differences by socio-demographic factors were noted for mental health disorders and injuries. INTERPRETATION: The immediate return to pre-COVID-19 levels for most chronic conditions after the first lockdown in NSW highlights the healthcare needs for children affected by chronic conditions. Persistently lower health service use for acute infections is likely attributable to the decreased social contact. Sustained and targeted mental health support is essential to address the potentially increased demand for services among children during and beyond the pandemic. FUNDING: Financial Markets Foundation for Children Chair (RL, NN), NHMRC Investigator Grant (APP1197940) (NN), NHMRC Career Development fellowship (GNT1158954) (SW).

Living with primary immunodeficiency disease during the Covid-19 pandemic.

Aim: The purpose of this survey study was to investigate the impact of Covid-19 on the lives of individuals living with primary immunodeficiency disease (PID). Subject and methods: An online survey was distributed through social media to individuals with a diagnosis of PID to investigate behaviors and concerns during the Covid-19 pandemic. Results: Five hundred and fifty seven responses were collected, of which 495 surveys were 100% complete; partial responses were analyzed. Respondents have been extremely cautious and have minimized their potential Covid-19 exposure risk. In this study, 56.6% (n = 289) participated in telehealth visits with the physician responsible for managing their PID during the Covid-19 pandemic. Respondents reported they would be somewhat comfortable with returning to normal activities if there was widespread herd immunity (40.9%, n = 209), an effective vaccine (46.0%. n = 235), or public health protections (44.0%, n = 225). The majority of respondents were extremely concerned (57.3%, n = 293) about additional waves of Covid-19 cases when their state or country reopens. Conclusion: The PID community is aware of the health risks posed by this public health crisis, and have done as much as possible to minimize their risk to community exposure. This pandemic has highlighted the importance of continuous medical care for a vulnerable population through the use of telemedicine. Healthcare providers should be aware of the emotional burden and increased psychiatric distress, often presenting as fear, anxiety, or depression, in patients with a chronic medical condition during a public health crisis such as the Covid-19 pandemic.