Characterizing the mental health and functioning of Canadian respiratory therapists during the COVID-19 pandemic.

Introduction: Healthcare professionals (HCPs) appear to be at increased risk for negative psychological outcomes [e.g. depression, anxiety, post-traumatic stress disorder (PTSD), moral distress] and associated impacts on functioning throughout the COVID-19 pandemic. HCPs working on designated COVID-19 units may be further impacted than their colleagues not on these units given added demands of patient care and risk of contracting COVID-19. Little is known, however, about the mental health and functioning of specific professional groups beyond nurses and physicians, including respiratory therapists (RTs), over the course of the pandemic. Accordingly, the purpose of the present study was to characterize the mental health and functioning of Canadian RTs and compare profiles between RTs working on and off designated COVID-19 units.Methods: Canadian RTs completed an online survey between February and June 2021, including demographic information (e.g. age, sex, gender,) and measures of depression, anxiety, stress, PTSD, moral distress and functional impairment. Descriptive statistics, correlation analyses and between-groups comparisons were conducted to characterize RTs and compare profiles between those on and off COVID-19 units.Results: Two hundred and eighteen (N = 218) RTs participated in this study. The estimated response rate was relatively low (6.2%) Approximately half of the sample endorsed clinically relevant symptoms of depression (52%), anxiety (51%) and stress (54%) and one in three (33%) screened positively for potential PTSD. All symptoms correlated positively with functional impairment (p's < .05). RTs working on COVID-19 units reported significantly greater patient-related moral distress compared to those not on these units (p < .05).Conclusion: Moral distress and symptoms of depression, anxiety, stress and PTSD were prevalent among Canadian RTs and were associated with functional impacts. These results must be interpreted with caution given a low response rate, yet raise concern regarding the long-term impacts of pandemic service among RTs.

Research on RTs' mental health prior to and during the COVID-19 pandemic is scant, especially in comparison to other HCPs.RTs in the present study reported experiencing moral distress and clinically significant symptoms of depression, anxiety and PTSD, with associated functional impairment.One in three RTs screened positive for likely PTSD on the PCL-5.There is a need to provide RTs with adequate mental health supports and to understand the long-term impacts of pandemic service among RTs.

Type 1 diabetes mellitus and SARS-CoV-2 in pediatric and adult patients - Data from the DPV network.

BACKGROUND: Data on patients with type 1 diabetes mellitus (T1DM) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections are sparse. This study aimed to investigate the association between SARS-CoV-2 infection and T1DM. METHODS: Data from the Prospective Diabetes Follow-up (DPV) Registry were analyzed for diabetes patients tested for SARS-CoV-2 by polymerase chain reaction (PCR) in Germany, Austria, Switzerland, and Luxembourg during January 2020-June 2021, using Wilcoxon rank-sum and chi-square tests for continuous and dichotomous variables, adjusted for multiple testing. RESULTS: Data analysis of 1855 pediatric T1DM patients revealed no differences between asymptomatic/symptomatic infected and SARS-CoV-2 negative/positive patients regarding age, new-onset diabetes, diabetes duration, and body mass index. Glycated hemoglobin A1c (HbA1c) and diabetic ketoacidosis (DKA) rate were not elevated in SARS-CoV-2-positive vs. -negative patients. The COVID-19 manifestation index was 37.5% in individuals with known T1DM, but 57.1% in individuals with new-onset diabetes. 68.8% of positively tested patients were managed as outpatients/telemedically. Data analysis of 240 adult T1MD patients revealed no differences between positively and negatively tested patients except lower HbA1c. Of these patients, 83.3% had symptomatic infections; 35.7% of positively tested patients were hospitalized. CONCLUSIONS: Our results indicate low morbidity in SARS-CoV-2-infected pediatric T1DM patients. Most patients with known T1DM and SARS-CoV-2 infections could be managed as outpatients. However, SARS-CoV-2 infection was usually symptomatic if it coincided with new-onset diabetes. In adult patients, symptomatic SARS-CoV-2 infection and hospitalization were associated with age.

Profiles in COVID-19: peritraumatic stress symptoms and their relation with death anxiety, anxiety sensitivity, and emotion dysregulation.

Background: The COVID-19 pandemic might be experienced as an ongoing traumatic event and could result in peritraumatic stress symptoms. Evidence implies that individuals' levels of death anxiety, anxiety sensitivity, and difficulties in emotion regulation may contribute to their peritraumatic stress symptomatology in the aftermath of trauma exposure. Objective: The current study aimed to explore these hypotheses in the context of the COVID-19 pandemic. Method: An online survey was conducted among a convenience sample of 846 Israeli adults from April 2 to 19 April 2020. COVID-19-related stressors, death anxiety, anxiety sensitivity, difficulties in emotion regulation, and peritraumatic stress symptoms were assessed via self-report questionnaires. Results: Analyses indicated significant relations between death anxiety, anxiety sensitivity, and emotion regulation difficulties, on the one hand, and peritraumatic stress symptoms, on the other. Three distinct profiles were identified. Furthermore, profile type - namely having low, medium, and high levels of death anxiety, anxiety sensitivity, and emotion dysregulation - had a significant effect in explaining peritraumatic stress symptoms. Conclusions: Results suggest that during the pandemic, levels of death anxiety, anxiety sensitivity, and emotion dysregulation may explain heterogeneity in individuals' trauma-related symptomatology.

Antecedentes: La pandemia del COVID-19 podría ser experimentada como un evento traumático en curso y podría resultar en síntomas de estrés peritraumático. La evidencia implica que los niveles individuales de la ansiedad por la muerte, la sensibilidad de la ansiedad, y las dificultades en la regulación emocional podrían contribuir a su sintomatología del estrés peritraumático en las secuelas de la exposición al trauma.Objetivo: El presente estudio buscó explorar estas hipótesis en el contexto de la pandemia del COVID-19.Método: Se realizó una encuesta en línea en una muestra por conveniencia de 846 adultos israelíes desde el 2 al 19 de abril de 2020. Los estresores relacionados al COVID-19, la ansiedad por la muerte, la sensibilidad de ansiedad, las dificultades en la regulación emocional, y los síntomas de estrés peritraumático fueron evaluados por medio de cuestionarios de auto-reporte.Resultados: Los análisis indicaron relaciones significativas entre la ansiedad por la muerte, la sensibilidad de la ansiedad, y las dificultades de regulación emocional, por un lado, y los síntomas de estrés peritraumático, por el otro lado. Tres perfiles distintivos fueron identificados. Además, el tipo de perfil ­ específicamente tener niveles bajos, medios, y altos de ansiedad por la muerte, sensibilidad de la ansiedad, y desregulación emocional ­ tuvieron un efecto significativo en explicar los síntomas de estrés peritraumático.Conclusión: Los resultados sugieren que, durante la pandemia, los niveles de ansiedad por la muerte, sensibilidad de la ansiedad, y desregulación emocional podrían explicar la heterogeneidad en la sintomatología relacionada al trauma de los individuos.

The COVID-19 Pandemic's Influence on Family Systems Therapists' Provision of Teletherapy.

The COVID-19 pandemic has altered life globally like no other event in modern history, and psychological service changes to meet the resultant impacts on families have not been assessed in the empirical literature. The purpose of the current study was to examine whether family systems therapists increased their teletherapy use during the pandemic relative to prepandemic usage, and whether projected postpandemic rates would remain at the same level; further, environmental and demographic predictors of these changes were examined. In May 2020, a sample of 626 family systems therapists (58.6% women, 40.6% men; M = 57.4 years old; M years in practice = 25.5) completed a national online study assessing these variables. Results suggested that family systems therapists performed 7.92% of their clinical work using teletherapy before the pandemic and 88.17% during the pandemic. They also projected that they would perform 36.57% of their clinical work using teletherapy after the pandemic. Teletherapy uptake was unrelated to primary practice setting, provider age, gender, race/ethnicity, and practice location (urban/suburban vs. rural) but was higher for family systems therapists who reported increased supportive teletherapy policies and training in their practice setting. Organizational infrastructure and availability of training played an important role in influencing teletherapy uptake during the pandemic. Family systems therapists have a unique opportunity to deploy teletherapy modalities to meet the needs of families during the COVID-19 pandemic, and infrastructure and training to do so may facilitate that work.

La pandemia de la COVID-19 ha alterado la vida a nivel mundial como ningún otro acontecimiento de la historia moderna, y los cambios en el servicio psicológico para atender los efectos resultantes en las familias no se han evaluado en las publicaciones empíricas. El propósito del presente estudio fue analizar si los terapeutas de sistemas familiares aumentaron el uso de la teleterapia durante la pandemia en comparación con el uso previo a la pandemia, y si los índices previstos para después de la pandemia se mantendrían al mismo nivel. Además, se analizaron los predictores ambientales y demográficos de estos cambios. En mayo de 2020, una muestra de 626 terapeutas de sistemas familiares (el 58.6 % mujeres, el 40.6 % hombres, edad promedio=57.4 años; promedio de años en ejercicio de la profesión= 25.5) completó un estudio nacional en línea que evaluaba estas variables. Los resultados sugirieron que los terapeutas de sistemas familiares realizaron el 7.92 % de su trabajo clínico usando teleterapia antes de la pandemia y el 88.17 % durante la pandemia. También pronosticaron que harían un 36.57 % de su trabajo clínico usando teleterapia después de la pandemia. La adopción de la teleterapia no estuvo relacionada con el ámbito de práctica principal, ni con la edad, el género, la raza o la etnia de los profesionales, ni tampoco con el lugar de práctica (urbano o suburbano frente a rural), pero fue mayor entre los terapeutas de sistemas familiares que informaron un aumento de las políticas de apoyo de la teleterapia y de la capacitación en su ámbito de práctica. La infraestructura organizacional y la disponibilidad de capacitación jugaron un papel importante a la hora de influir en la adopción de la teleterapia durante la pandemia. Los terapeutas de sistemas familiares tienen una oportunidad única de implementar modalidades de teleterapia para atender las necesidades de las familias durante la pandemia de la COVID-19, y la infraestructura y la capacitación para hacerlo pueden facilitar ese trabajo.

Clinical characteristics and outcomes of COVID-19 in patients with type 2 diabetes in Turkey: A nationwide study (TurCoviDia).

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been reported to be associated with a more severe course in patients with type 2 diabetes mellitus (T2DM). However, severe adverse outcomes are not recorded in all patients. In this study, we assessed disease outcomes in patients with and without T2DM hospitalized for COVID-19. METHODS: A nationwide retrospective cohort of patients with T2DM hospitalized with confirmed COVID-19 infection from 11 March to 30 May 2020 in the Turkish Ministry of Health database was investigated. Multivariate modeling was used to assess the independent predictors of demographic and clinical characteristics with mortality, length of hospital stay, and intensive care unit (ICU) admission and/or mechanical ventilation. RESULTS: A total of 18 426 inpatients (median age [interquartile range, IQR]: 61 [17] years; males: 43.3%) were investigated. Patients with T2DM (n = 9213) were compared with a group without diabetes (n = 9213) that were matched using the propensity scores for age and gender. Compared with the group without T2DM, 30-day mortality following hospitalization was higher in patients with T2DM (13.6% vs 8.7%; hazard ratio 1.75; 95% CI, 1.58-1.93; P < .001). The independent associates of mortality were older age, male gender, obesity, insulin treatment, low lymphocyte count, and pulmonary involvement on admission. Older age, low lymphocyte values, and pulmonary involvement at baseline were independently associated with longer hospital stay and/or ICU admission. CONCLUSIONS: The current study from the Turkish national health care database showed that patients with T2DM hospitalized for COVID-19 are at increased risk of mortality, longer hospital stay, and ICU admission.

Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes.

Coronavirus disease 2019 (COVID-19) is a recent pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus. Diabetes (mostly type 2 diabetes mellitus, T2DM) and hyperglycemia are among the major comorbidities in patients with COVID-19 leading to poor outcomes. Reports show that patients with diabetes and COVID-19 are at an increased risk for developing severe complications including acute respiratory distress syndrome, multi-organ failure, and death. Here we explore potential mechanistic links that could explain the observed higher morbidity and mortality in this patient population. Patients with T2DM have an underlying increased level of inflammation associated with obesity and insulin resistance in addition to other comorbidities including hypertension, obesity, cardiovascular disease, dyslipidemia, and being older. We review evidence that T2DM with hyperglycemia are among factors that lead to elevated expression of angiotensin-converting enzyme 2 (ACE2) in lungs and other tissues; ACE2 is the cellular "receptor" and port of viral entry. The preexisting chronic inflammation with augmented inflammatory response to the infection and the increasing viral load leads to extreme systemic immune response ("cytokine storm") that is strongly associated with increased severity of COVID-19. Based on the available evidence, it is recommended by a panel of experts that safe but stringent control of blood glucose, blood pressure, and lipids be carried out in patients with T2DM, measures that could potentially serve to decrease the severity of COVID-19 should these patients contract the viral infection. Once the infection occurs, then attention should be directed to proper glycemic control with use of insulin and frequent monitoring of blood glucose levels.

Determinants of mental health outcomes among people with and without diabetes during the COVID-19 outbreak in the Arab Gulf Region.

AIMS: To determine the prevalence and factors associated with depression and anxiety among people with and without diabetes during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: A cross-sectional questionnaire-based study collecting demographic and mental health data from 2166 participants living in the Arab Gulf region (568 with diabetes, 1598 without diabetes). Depression and anxiety were assessed using the 9-item Patient Health Questionnaire and the 7-item Generalized Anxiety Disorder scale, respectively. RESULTS: The prevalence of depression and anxiety symptoms were 61% and 45%, in people with diabetes (PWD) and 62% and 44%, respectively, in people without diabetes. PWD who have had their diabetes visit canceled by the clinic were more likely to report depression and anxiety symptoms than those without diabetes (odds ratio [95% confidence interval]: 1.37 [1.02, 1.84] and 1.37 [1.04, 1.80], for depression and anxiety; respectively). PWD who had no method of telecommunication with their health care providers (HCP) during the pandemic, PWD with A1C of ≥ 10%, women, employees (particularly HCPs), students, unmarried individuals, and those with lower income were more likely to report depression and/or anxiety symptoms (all P < 0.01). Fear of acquiring the coronavirus infection; running out of diabetes medications; or requiring hospitalization for hypoglycemia, hyperglycemia, or diabetic ketoacidosis; and lack of telecommunication with HCPs were all associated with significantly higher odds of having depression and anxiety symptoms among PWD. CONCLUSIONS: The remarkably high prevalence of depression and anxiety symptoms during the COVID-19 pandemic, particularly among subgroups of PWD, calls for urgent public health policies to address mental health during the pandemic and reestablish health care access for PWD.

A Mixed-method Study of Individual, Couple, and Parental Functioning During the State-regulated COVID-19 Lockdown in Spain.

During the recent COVID-19 outbreak in Spain, we explored the individual and relational well-being of people confined together with their partners and/or children during the first 3 weeks of state-regulated lockdown. Adults 18 years or older (N = 407) completed an online survey that included demographic, household, and employment information along with standardized measures of psychological distress (State-Trait Anxiety and Beck Depression) and relationship functioning-either the Dyadic Adjustment Scale if there were no children in the household or a Basic Family Relations Evaluation Questionnaire (CERFB) measuring conjugal, parental, and coparental functions. Qualitative analyses of responses to an open-ended question about perceived changes in couple or family dynamics during lockdown revealed nine specific themes comprising two overarching categories: relational improvement and deterioration. The overall prevalence of improvement themes (61.7%) exceeded deterioration themes (41.0%), with increased (re)connection and conflict atmosphere cited most often. Quantitative analyses found elevated levels of state anxiety but not trait anxiety or depression during lockdown. Consistent with the qualitative results, couples having no children at home reported high levels of dyadic adjustment, but with children present CERFB parental functioning exceeded conjugal functioning, a pattern sometimes associated with child triangulation into adult conflicts. Although correlates of psychological distress (e.g., unemployment, perceived economic risk) were relatively stable across subgroups, predictors of relationship functioning varied substantially with household/parental status (e.g., telecommuting and employment facilitated conjugal functioning only for couples with children).

Durante el reciente brote de la COVID-19 en España, analizamos el bienestar individual y relacional de las personas confinadas con sus parejas o hijos durante las primeras tres semanas de confinamiento regulado por el estado. Un grupo de adultos mayores de 18 años (N=407) completó una encuesta con datos demográficos, información sobre la vivienda y el empleo, evaluaciones estandarizadas de distrés psicológico (ansiedad-rasgo y ansiedad-estado, depresión de Beck) y funcionamiento familiar (la Escala de ajuste diádico si no había niños en la vivienda o un Cuestionario básico de evaluación de las relaciones familiares (CERFB) que miden las funciones conyugales, parentales y coparentales. Los análisis cualitativos de las respuestas a una pregunta abierta acerca de los cambios percibidos en la dinámica de pareja o familiar durante el confinamiento revelaron nueve temas específicos que comprenden dos categorías dominantes: la mejora y el deterioro relacional. La prevalencia general de los temas de mejora (61.7 %) excedió los temas de deterioro (41.0 %), y se mencionó con más frecuencia una mayor (re)conexión y un ambiente de conflicto. Los análisis cuantitativos indicaron niveles elevados de ansiedad-estado pero no de ansiedad-rasgo ni de depresión durante el confinamiento. De acuerdo con los resultados cualitativos, las parejas que no tienen hijos en la casa informaron niveles altos de ajuste diádico, pero con los niños presentes, el funcionamiento parental del CERFB excedió el funcionamiento conyugal, un patrón asociado a veces con la triangulación de los niños en los conflictos de los adultos. Aunque las relaciones de distrés psicológico (p. ej.: desempleo, riesgo económico percibido) fueron relativamente estables entre los subgrupos, los predictores del funcionamiento relacional variaron considerablemente con la situación habitacional/parental (p. ej: el teletrabajo y el empleo facilitaron el funcionamiento conyugal solo en el caso de las parejas con niños).

COVID-19 and comorbidities: A role for dipeptidyl peptidase 4 (DPP4) in disease severity?

The coronavirus disease 2019 (COVID-19) pandemic is caused by a novel betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), similar to SARS-CoV and Middle East respiratory syndrome (MERS-CoV), which cause acute respiratory distress syndrome and case fatalities. COVID-19 disease severity is worse in older obese patients with comorbidities such as diabetes, hypertension, cardiovascular disease, and chronic lung disease. Cell binding and entry of betacoronaviruses is via their surface spike glycoprotein; SARS-CoV binds to the metalloprotease angiotensin-converting enzyme 2 (ACE2), MERS-CoV utilizes dipeptidyl peptidase 4 (DPP4), and recent modeling of the structure of SARS-CoV-2 spike glycoprotein predicts that it can interact with human DPP4 in addition to ACE2. DPP4 is a ubiquitous membrane-bound aminopeptidase that circulates in plasma; it is multifunctional with roles in nutrition, metabolism, and immune and endocrine systems. DPP4 activity differentially regulates glucose homeostasis and inflammation via its enzymatic activity and nonenzymatic immunomodulatory effects. The importance of DPP4 for the medical community has been highlighted by the approval of DPP4 inhibitors, or gliptins, for the treatment of type 2 diabetes mellitus. This review discusses the dysregulation of DPP4 in COVID-19 comorbid conditions; DPP4 activity is higher in older individuals and increased plasma DPP4 is a predictor of the onset of metabolic syndrome. DPP4 upregulation may be a determinant of COVID-19 disease severity, which creates interest regarding the use of gliptins in management of COVID-19. Also, knowledge of the chemistry and biology of DPP4 could be utilized to develop novel therapies to block viral entry of some betacoronaviruses, potentially including SARS-CoV-2.