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1.
Inf Syst Front ; : 1-25, 2021 Mar 04.
Article in English | MEDLINE | ID: covidwho-2014266

ABSTRACT

Recent years have witnessed the rapid growth of an emerging digital healthcare service - online medical consultation (OMC). Despite its popularity, many OMC platforms have encountered issues in initial adoption and continuance use among patients. We posit that many of the hesitation and resistance may arise from a lack of trust toward OMC, which is a complex phenomenon that involves both interpersonal and technological-oriented considerations. This study seeks to clarify the conceptualization of online trust in the context of OMC. It compares two plausible explanations (i.e., trust as a direct cause vs. trust as a moderator) regarding how interpersonal and technological trust contributes to the service continuance decision in OMC. By contextualizing the valence framework, we identify the critical factors in making the risk-benefit assessment of patients' OMC decision. We conduct an online survey of 365 experienced OMC users and analyze our structural model using a partial least square approach. Our results show that the multidimensional conceptualization approach, which incorporates both interpersonal and technological aspects of trust, is superior to the unitary approach. Besides, our findings suggest that the role trust plays in determining service continuance decisions in OMC is more of a direct cause than a qualifier that buffers the impacts of risk-benefit evaluation. We believe the findings can help both researchers and practitioners recognize the multidimensional perspective of trust and better understand the role trust plays in OMC and other online healthcare delivery problems.

2.
Curr Psychol ; 41(8): 5712-5722, 2022.
Article in English | MEDLINE | ID: covidwho-1982340

ABSTRACT

During the pandemic, people may experience various mental health problems. Psychological strengths may help them to cope with emerging challenges and foster mental health and well-being. This study examined the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19. A total of 220 participants from general public participated this study completing a battery of measures (134 men [M age = 42.36 years, SD = 8.99, range = 18 to 60] and 86 women [M age = 36.73 years, SD = 7.44, range = 18 to 51]). This cross-section study indicated that resilience mediated the relationship between hope and psychological health and subjective well-being. Results also showed that hope, and resilience had significant direct effects on psychological health, and subjective well-being while preventive behaviours did not manifest a significant effect on these two variables except on resilience. Preventive behaviours mediated the relationship between hope and resilience. The results suggest that we should more pay attention to hope and resilience for the development and improvement of well-being and psychological health during the times of crisis.

3.
J Policy Pract Intellect Disabil ; 17(3): 256-269, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1949684

ABSTRACT

The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID-19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID-19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.

4.
Psychosom Med ; 83(4): 322-327, 2021 05 01.
Article in English | MEDLINE | ID: covidwho-1931973

ABSTRACT

OBJECTIVE: This study aimed to compare the mental health and psychological responses in Wuhan, a severely affected area, and other areas of China during the coronavirus disease 2019 (COVID-19) epidemic. METHODS: This cross-sectional study was conducted on February 10-20, 2020. A set of online questionnaires was used to measure mental health and responses. A total of 1397 participants from Wuhan (age, 36.4 ± 10.7 years; male, 36.1%) and 2794 age- and sex-matched participants from other areas of China (age, 35.9 ± 9.9 years; male, 39.0%) were recruited. RESULTS: Compared with their counterparts, participants from Wuhan had a significantly higher prevalence of any mental health problems (46.6% versus 32.2%; adjusted odds ratio [OR] = 1.89, 95% confidence interval [CI] = 1.65-2.17), anxiety (15.2% versus 6.2%; adjusted OR = 2.65, 95% CI = 2.14-3.29), depression (18.3% versus 9.7%; adjusted OR = 2.11, 95% CI = 1.74-2.54), suicidal ideation (10.5% versus 7.1%; adjusted OR = 1.60, 95% CI = 1.28-2.02), and insomnia (38.6% versus 27.6%; adjusted OR = 1.70, 95% CI = 1.48-1.96). Participants from Wuhan had a slightly higher rate of help-seeking behavior (7.1% versus 4.2%; adjusted OR = 1.76, 95% CI = 1.12-2.77) but similar rate of treatment (3.5% versus 2.7%; adjusted OR = 1.23, 95% CI = 0.68-2.24) for mental problems than did their counterparts. In addition, compared with their counterparts, participants from Wuhan gave higher proportions of responses regarding "fearful" (52% versus 36%, p < .001), "discrimination against COVID-19 cases" (64% versus 58%, p = .006), "strictly comply with preventive behaviors" (98.7% versus 96%, p = .003), and "fewer living and medical supplies" (<2 weeks: 62% versus 57%, p = .015). CONCLUSIONS: The COVID-19 epidemic has raised enormous challenges regarding public mental health and psychological responses, especially in the highly affected Wuhan area. The present findings provide important information for developing appropriate strategies for the prevention and management of mental health problems during COVID-19 and other epidemics.


Subject(s)
COVID-19/psychology , Mental Health , Adult , Anxiety/epidemiology , Anxiety/etiology , China/epidemiology , Cross-Sectional Studies , Depression/epidemiology , Depression/etiology , Epidemics , Female , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Health/statistics & numerical data , Psychiatric Status Rating Scales , Suicidal Ideation , Surveys and Questionnaires
5.
Ann Med Psychol (Paris) ; 180(6): S23-S28, 2022 Jun.
Article in French | MEDLINE | ID: covidwho-1899509

ABSTRACT

Objectives: This study explored two related questions: (1) the incidence of peri-traumatic distress and dissociation in a general Algerian population during the initial stages of the COVID-19 epidemic; (2) sociodemographic predictors of peri-traumatic reaction. The objective is to better understand the peri-traumatic experience in order to identify vulnerable people to whom psychological care could be offered. Materials and methods: An online descriptive survey containing three questionnaires, a demographic questionnaire, the questionnaire for peri-traumatic distress and the questionnaire for peri-traumatic dissociation experiences, was conducted using the snowball sampling technique to select 1374 Algerians. Results: The results of this survey indicate that 32.7 % of the participants present a peri-traumatic distress and 61.8 % of the participants present a significant level of peri-traumatic dissociation during the initial phases of the COVID-19 pandemic. In addition to confinement, stress, female gender, the origin of a particularly affected department, the average economic situation and a history of psychological problems are predictors of peri-traumatic distress. Conclusion: This study provides the first empirical data on the incidence of peri-traumatic reactions (distress and dissociation), as well as their predictors in an Algerian population during the initial phases of the COVID-19 epidemic. The Algerian population has experienced levels of distress in the low range of what has been described in the literature, while the dissociation shows that the majority of the population is affected. This result demonstrates the importance of measuring the peri-traumatic reactions according to the two dimensions of distress and dissociation, and offering psychological care for the most vulnerable people, in order to prevent the risk of their possible chronicisation, and developing post-traumatic stress disorder in later periods.

6.
Rev Panam Salud Publica ; 44: e154, 2020.
Article in English | MEDLINE | ID: covidwho-1893627

ABSTRACT

OBJECTIVE: To identify emerging mental health problems, strategies to address them, and opportunities to reform mental health systems during the COVID-19 pandemic in South America. METHODS: An online questionnaire was sent to mental health decision-makers of ministries of health in 10 South American countries in mid-April 2020. The semi-structured questionnaire had 12 questions clustered into three main sections: emerging challenges in mental health, current and potential strategies to face the pandemic, and key elements for mental health reform. We identified keywords and themes for each section through summative content analysis. RESULTS: Increasing mental health burden and needs were reported as direct and indirect consequences of the COVID-19 pandemic. National lockdowns challenge the delivery and access to mental health treatment and care. Strategies to meet mental health needs rely heavily on timely and adequate responses by strengthened mental health governance and systems, availability of services, virtual platforms, and appropriate capacity-building for service providers. Short- and medium-term strategies focused on bolstering community-based mental health networks and telemedicine for high-risk populations. Opportunities for long-term mental health reform entail strengthening legal frameworks, redistribution of financial resources, and collaboration with local and international partners. CONCLUSIONS: Mental health and psychosocial support have been identified as a priority area by South American countries in the COVID-19 response. The pandemic has generated specific needs that require appropriate actions, including implementing virtual interventions, orienting capacity-building toward protecting users and health providers, strengthening evidence-driven decision-making, and integrating mental health and psychosocial support in high-level mechanisms guiding the response to COVID-19.

7.
JMIR Form Res ; 4(10): e19876, 2020 Oct 20.
Article in English | MEDLINE | ID: covidwho-1834118

ABSTRACT

BACKGROUND: The COVID-19 outbreak was first reported to the World Health Organization on December 31, 2019, and it was officially declared a public health emergency of international concern on January 30, 2020. The COVID-19 outbreak and the safety measures taken to control it caused many psychological issues in populations worldwide, such as depression, anxiety, and stress. OBJECTIVE: The objectives of this study were to assess the psychological effects of the lockdown due to the COVID-19 outbreak on university students in the United Arab Emirates (UAE) and to investigate the students' awareness of mobile mental health care apps as well as their attitudes toward the use of these apps. METHODS: A two-part self-administered web-based questionnaire was delivered to students at United Arab Emirates University. The first part of the questionnaire assessed the mental state of the participants using the 12-item General Health Questionnaire (GHQ-12), while the second part contained questions investigating the participants' awareness of and attitudes toward mental health care apps. Students were invited to fill out the web-based questionnaire via social media and mailing lists. RESULTS: A total of 154 students participated in the survey, and the majority were female. The results of the GHQ-12 analysis showed that the students were experiencing psychological issues related to depression and anxiety as well as social dysfunction. The results also revealed a lack of awareness of mental health care apps and uncertainty regarding the use of such apps. Approximately one-third of the participants (44/154, 28.6%) suggested preferred functionalities and characteristics of mobile mental health care apps, such as affordable price, simple design, ease of use, web-based therapy, communication with others experiencing the same issues, and tracking of mental status. CONCLUSIONS: Like many groups of people worldwide, university students in the UAE were psychologically affected by the lockdown due to the COVID-19 outbreak. Although apps can be useful tools for mental health care delivery, especially in circumstances such as those produced by the outbreak, the students in this study showed a lack of awareness of these apps and mixed attitudes toward them. Improving the digital health literacy of university students in the UAE by increasing their awareness of mental health care apps and the treatment methods and benefits of the apps, as well as involving students in the app creation process, may encourage students to use these tools for mental health care.

8.
Can J Psychiatry ; 67(5): 371-379, 2022 05.
Article in English | MEDLINE | ID: covidwho-1820041

ABSTRACT

OBJECTIVE: This study examined the scope of common mental health problems and perceived impacts of the COVID-19 pandemic among direct service providers working with people experiencing homelessness in Canada. METHOD: This cross-sectional study used an online survey that was disseminated to homeless service, supportive housing, and harm reduction organizations and networks. Data were collected on depression, anxiety, stress, post-traumatic stress, compassion satisfaction and fatigue, and substance use problems as well as pandemic-related changes in mental health and wellness. A total of 701 service providers completed the survey and were included in data analysis. Descriptive statistics were used to examine the primary research questions, with hierarchical multiple regression models also being fit to explore mental health and wellness differences by occupational service setting. RESULTS: Most direct service providers (79.5%) working with people experiencing homelessness reported a decline in their mental health during the pandemic. There were high rates of common mental health problems within the sample that are largely consistent with those found among health-care workers during the pandemic. Occupational service settings were not associated with the severity of mental health problems, indicating pervasive issues across the workforce, though providers who were younger and spent more time in direct service roles were at greater risk. CONCLUSIONS: The common mental health problems and negative impacts of the pandemic among service providers working with people experiencing homelessness highlight a highly vulnerable workforce that could benefit from improved access to supports. Given the similarities between our findings and other studies examining essential workforces, it is recommended that initiatives that provide accessible mental health care to the health-care workforce during the pandemic be expanded to include homeless and social service providers.


Subject(s)
COVID-19 , Homeless Persons , Canada/epidemiology , Cross-Sectional Studies , Humans , Mental Health , Pandemics
10.
Psychol Res Behav Manag ; 13: 631-640, 2020.
Article in English | MEDLINE | ID: covidwho-1793279

ABSTRACT

PURPOSE: COVID-19 pandemic is a World Health Organization day-to-day work and has a significant crisis on the physical and mental health of humans. However, little is known about the mental health crisis of the pandemic in Sub-Saharan countries. Therefore, this study aimed to determine the magnitude of psychological problems and associated factors among communities living in Addis Ababa, Ethiopia. METHODS: A community-based cross-sectional study design was conducted from March 10 to 30, 2020. Data were collected from 420 respondents selected using a consecutive sampling technique. An online self-administered and Depression, Anxiety, and Stress Scale (DASS-21) survey during the initial phase of the pandemic was conducted to assess the presence of psychological problems for the last two weeks in response to the infection. RESULTS: The magnitude of the psychological problem from moderate to severe levels was 66.4%. The predictor variables of the outcome were female gender, above the secondary level of education, monthly income below 3000 ETB, and more than three family size at 95% CI, P<0.05. CONCLUSION: At the time of the initial COVID-19 pandemic in Ethiopia, nearly two-thirds of the respondents reported moderate to severe levels of psychological problems. Therefore, working on those identified factors would be vital to promote the mental resilience of a community towards the pandemic.

11.
Front Psychol ; 11: 2255, 2020.
Article in English | MEDLINE | ID: covidwho-1792945

ABSTRACT

INTRODUCTION: In times of economic crisis, the literature shows that young people have always been in the high-risk category. The COVID-19 outbreak and the consequence on the economic level have increased the sense of uncertainty and precariousness experienced by young people. The current scenario has forced young people at the school-to-work transition point to re-think their career plans. Although the difficulties of the school-to-work transition already lead to distress and mental health problems in young people, the slowdown imposed by the coronavirus could add up to these difficulties. The present study aimed to explore the process of career development and career planning in the coronavirus era. Twenty Italian university graduates were involved. METHODS: A quantitative measure was used to evaluate the affective (positive/negative) experience. A narrative prompt was used to understand the individual dimensions of career planning. Cluster analysis was carried out by an unsupervised ascendant hierarchical method to explore the themes of the narration. RESULTS: Italian young adults have tended to experience negative affects in the recent weeks of quarantine. The themes highlighted in the narratives showed that Italian young adults experience feelings of fear, uncertainty, and anxiety about the post-pandemic future. CONCLUSION: The results appear as a starting point to re-think possible interventions for this group post-lockdown and post-pandemic.

13.
Onkologe (Berl) ; 27(8): 783-789, 2021.
Article in German | MEDLINE | ID: covidwho-1709849

ABSTRACT

BACKGROUND: During the current pandemic situation, the public health care system must ensure the ongoing provision of regular medical care as well as the treatment of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infected patients. Resident oncologists and their practices are equally affected. OBJECTIVES: The study examines resident oncologists' challenges, experiences and approaches in the delivery of care for oncological patients receiving palliative treatment and their relatives during the pandemic. Findings will support future pandemic preparedness for cancer treatment in outpatients. MATERIALS AND METHODS: Content analyses of 13 guideline-based telephone interviews with resident oncologists. RESULTS: Solid local networks, staff and structural rearrangements and infection control within offices helped oncologists maintaining quality of care. Required treatments have been continued. The interrupted information flow towards patients' relatives and catching up on previously postponed primary, control or follow-up consultations have been reported as a challenge. Other issues have been linked to suspected SARS-CoV­2 infection in patients and staff. The lack of information, temporal inaccessibility of health care authorities and physicians' associations, and additional costs for infection control material caused further problems. CONCLUSIONS: Due to the firmly implemented infection control and the re-organisation of facilities and staff, oncologists have been able to maintain treatment and care for cancer patients and their relatives. Hygiene procedures proved to work well and might be re-activated. An increased use of digital applications for treatment monitoring might be considered. Furthermore, solutions to meet additional financial and personnel demands caused by infection control must be identified. The design of suitable concepts for the prevention of health-related hazards due to visiting bans for relatives and therapeutic staff such as physio- and occupational therapists is inevitable.

14.
J Athl Train ; 57(2): 136-139, 2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1708768

ABSTRACT

OBJECTIVE: To define and discuss the role of population health as a framework to improve care and clinical decision making in athletic training practice. BACKGROUND: Athletic trainers (ATs) are allied health professionals who are uniquely suited to provide preventive and educational health and wellness programs to improve health outcomes across a physically active population. Athletic trainers are often the first contacts for high school athletes seeking health and wellness education, which may allow ATs to be the first intervention or prevention point for reducing or eliminating negative health behaviors and outcomes among their patients. CONCLUSIONS: Integrating a population-health framework into the athletic training setting prepares ATs to address complex health concerns in communities that result from factors that influence determinants of health. The field of athletic training could benefit from a population-health approach to care by broadening consideration of the factors that affect the health of homogeneous populations that are served by ATs.


Subject(s)
Population Health , Sports , Athletes , Humans , Schools
15.
PLoS One ; 16(3): e0248916, 2021.
Article in English | MEDLINE | ID: covidwho-1575923

ABSTRACT

Since the first nationwide movement control order was implemented on 18 March 2020 in Malaysia to contain the coronavirus disease 2019 (COVID-19) outbreak, to what extent the uncertainty and continuous containment measures have imposed psychological burdens on the population is unknown. This study aimed to measure the level of mental health of the Malaysian public approximately 2 months after the pandemic's onset. Between 12 May and 5 September 2020, an anonymous online survey was conducted. The target group included all members of the Malaysian population aged 18 years and above. The Depression Anxiety Stress Scale (DASS-21) was used to assess mental health. There were increased depressive, anxiety and stress symptoms throughout the study period, with the depression rates showing the greatest increase. During the end of the data collection period (4 August-5 September 2020), there were high percentages of reported depressive (59.2%) and anxiety (55.1%) symptoms compared with stress (30.6%) symptoms. Perceived health status was the strongest significant predictor for depressive and anxiety symptoms. Individuals with a poorer health perception had higher odds of developing depression (odds ratio [OR] = 5.68; 95% confidence interval [CI] 3.81-8.47) and anxiety (OR = 3.50; 95%CI 2.37-5.17) compared with those with a higher health perception. By demographics, young people-particularly students, females and people with poor financial conditions-were more vulnerable to mental health symptoms. These findings provide an urgent call for increased attention to detect and provide intervention strategies to combat the increasing rate of mental health problems in the ongoing COVID-19 pandemic.


Subject(s)
Anxiety Disorders/pathology , COVID-19/pathology , Depressive Disorder/pathology , Adolescent , Adult , Anxiety Disorders/epidemiology , COVID-19/epidemiology , COVID-19/virology , Cross-Sectional Studies , Depressive Disorder/epidemiology , Female , Humans , Malaysia/epidemiology , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pandemics , SARS-CoV-2/isolation & purification , Stress, Psychological , Surveys and Questionnaires , Young Adult
16.
J Med Internet Res ; 23(2): e25363, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1575084

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. OBJECTIVE: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. METHODS: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ≥3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. RESULTS: Of the 4322 eligible participants, 4004 (92.6%) completed the online survey. Of them, 1481 (37.0%), 1644 (41.1%), and 879 (22.0%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3%), followed by traditional media (68.7%) and family members (34.9%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. CONCLUSIONS: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted.


Subject(s)
Anxiety/epidemiology , COVID-19/epidemiology , Depression/epidemiology , Health Education/statistics & numerical data , Internet Use/statistics & numerical data , Mental Health/statistics & numerical data , Sleep Initiation and Maintenance Disorders/epidemiology , Stress, Psychological/epidemiology , Adult , Cross-Sectional Studies , Disease Outbreaks , Female , Humans , Male , Middle Aged , Pandemics , Social Media/supply & distribution , Surveys and Questionnaires , Thailand/epidemiology
17.
Curr Psychol ; 40(12): 6271-6274, 2021.
Article in English | MEDLINE | ID: covidwho-1525625

ABSTRACT

The current pandemic of the coronavirus disease 2019 (COVID-19) has negatively impacted medical workers' mental health in many countries including Japan. Although research identified poor mental health of medical workers in COVID-19, protective factors for their mental health remain to be appraised. Accordingly, this study aimed to investigate relationships between mental health problems, loneliness, hope and self-compassion among Japanese medical workers, and compare with the general population. Online self-report measures regarding those four constructs were completed by 142 medical workers and 138 individuals in the general population. T-tests and multiple regression analysis were performed. Medical workers had higher levels of mental health problems and loneliness, and lower levels of hope and self-compassion than the general population. Loneliness was the strongest predictor of mental health problems in the medical workers. Findings suggest that Japanese medical workplaces may benefit from targeting workplace loneliness to prevent mental health problems among the medical staff.

18.
BMJ Open ; 11(3): e044888, 2021 03 15.
Article in English | MEDLINE | ID: covidwho-1455712

ABSTRACT

INTRODUCTION: Type 2 diabetes is a global health priority. People with diabetes are more likely to experience mental health problems relative to people without diabetes. Diabetes guidelines recommend assessment of depression and diabetes distress during diabetes care. This systematic review will examine the effect of routinely assessing and addressing depression and diabetes distress using patient-reported outcome measures in improving outcomes among adults with type 2 diabetes. METHODS AND ANALYSIS: MEDLINE, Embase, CINAHL Complete, PsycInfo, The Cochrane Library and Cochrane Central Register of Controlled Trials will be searched using a prespecified strategy using a prespecified Population, Intervention, Comparator, Outcomes, Setting and study design strategy. The date range of the search of all databases will be from inception to 3 August 2020. Randomised controlled trials, interrupted time-series studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies published in peer-reviewed journals in the English language will be included. Two review authors will independently screen abstracts and full texts with disagreements resolved by a third reviewer, if required, using Covidence software. Two reviewers will undertake risk of bias assessment using checklists appropriate to study design. Data will be extracted using prespecified template. A narrative synthesis will be conducted, with a meta-analysis, if appropriate. ETHICS AND DISSEMINATION: Ethics approval is not required for this review of published studies. Presentation of results will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidance. Findings will be disseminated via peer-reviewed publication and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42020200246.


Subject(s)
Diabetes Mellitus, Type 2 , Adult , Cross-Sectional Studies , Depression/diagnosis , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/therapy , Humans , Meta-Analysis as Topic , Patient Reported Outcome Measures , Prospective Studies , Research Design , Retrospective Studies , Systematic Reviews as Topic
19.
Cochrane Database Syst Rev ; 4: CD000479, 2021 04 23.
Article in English | MEDLINE | ID: covidwho-1453523

ABSTRACT

BACKGROUND: Varicoceles are associated with male subfertility; however, the mechanisms by which varicoceles affect fertility have yet to be satisfactorily explained. Several treatment options exist, including surgical or radiological treatment, however the safest and most efficient treatment remains unclear.  OBJECTIVES: To evaluate the effectiveness and safety of surgical and radiological treatment of varicoceles on live birth rate, adverse events, pregnancy rate, varicocele recurrence, and quality of life amongst couples where the adult male has a varicocele, and the female partner of childbearing age has no fertility problems. SEARCH METHODS: We searched the following databases on 4 April 2020: the Cochrane Gynaecology and Fertility Group Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL. We also searched the trial registries and reference lists of articles. SELECTION CRITERIA: We included randomised controlled trials (RCTs) if they were relevant to the clinical question posed and compared different forms of surgical ligation, different forms of radiological treatments, surgical treatment compared to radiological treatment, or one of these aforementioned treatment forms compared to non-surgical methods, delayed treatment, or no treatment. We extracted data if the studies reported on live birth, adverse events, pregnancy, varicocele recurrence, and quality of life. DATA COLLECTION AND ANALYSIS: Screening of abstracts and full-text publications, alongside data extraction and 'Risk of bias' assessment, were done dually using the Covidence software. When we had sufficient data, we calculated random-effects (Mantel-Haenszel) meta-analyses; otherwise, we reported results narratively. We used the I2 statistic to analyse statistical heterogeneity. We planned to use funnel plots to assess publication bias in meta-analyses with at least 10 included studies. We dually rated the risk of bias of studies using the Cochrane 'Risk of bias' tool, and the certainty of evidence for each outcome using the GRADE approach. MAIN RESULTS: We identified 1897 citations after de-duplicating the search results. We excluded 1773 during title and abstract screening. From the 113 new full texts assessed in addition to the 10 studies (11 references) included in the previous version of this review, we included 38 new studies, resulting in a total of 48 studies (59 references) in the review providing data for 5384 participants. Two studies (three references) are ongoing studies and two studies are awaiting classification. Treatment versus non-surgical, non-radiological, delayed, or no treatment Two studies comparing surgical or radiological treatment versus no treatment reported on live birth with differing directions of effect. As a result, we are uncertain whether surgical or radiological treatment improves live birth rates when compared to no treatment (risk ratio (RR) 2.27, 95% confidence interval (CI) 0.19 to 26.93; 2 RCTs, N = 204; I2 = 74%, very low-certainty evidence). Treatment may improve pregnancy rates compared to delayed or no treatment (RR 1.55, 95% CI 1.06 to 2.26; 13 RCTs, N = 1193; I2 = 65%, low-certainty evidence). This suggests that couples with no or delayed treatment have a 21% chance of pregnancy, whilst the pregnancy rate after surgical or radiological treatment is between 22% and 48%. We identified no evidence on adverse events, varicocele recurrence, or quality of life for this comparison. Surgical versus radiological treatment We are uncertain about the effect of surgical versus radiological treatment on live birth and on the following adverse events: hydrocele formation, pain, epididymitis, haematoma, and suture granuloma. We are uncertain about the effect of surgical versus radiological treatment on pregnancy rate (RR 1.13, 95% CI 0.75 to 1.70; 5 RCTs, N = 456, low-certainty evidence) and varicocele recurrence (RR 1.31, 95% CI 0.82 to 2.08; 3 RCTs, N = 380, low-certainty evidence). We identified no evidence on quality of life for this comparison. Surgery versus other surgical treatment We identified 19 studies comparing microscopic subinguinal surgical treatment to any other surgical treatment. Microscopic subinguinal surgical treatment probably improves pregnancy rates slightly compared to other surgical treatments (RR 1.18, 95% CI 1.02 to 1.36; 12 RCTs, N = 1473, moderate-certainty evidence). This suggests that couples with microscopic subinguinal surgical treatment have a 10% to 14% chance of pregnancy after treatment, whilst the pregnancy rate in couples after other surgical treatments is 10%. This procedure also probably reduces the risk of varicocele recurrence (RR 0.48, 95% CI 0.29, 0.79; 14 RCTs, N = 1565, moderate-certainty evidence). This suggests that 0.4% to 1.1% of men undergoing microscopic subinguinal surgical treatment experience recurrent varicocele, whilst 1.4% of men undergoing other surgical treatments do. Results for the following adverse events were inconclusive: hydrocele formation, haematoma, abdominal distension, testicular atrophy, wound infection, scrotal pain, and oedema. We identified no evidence on live birth or quality of life for this comparison. Nine studies compared open inguinal surgical treatment to retroperitoneal surgical treatment. Due to small sample sizes and methodological limitations, we identified neither treatment type as superior or inferior to the other regarding adverse events, pregnancy rates, or varicocele recurrence. We identified no evidence on live birth or quality of life for this comparison. Radiological versus other radiological treatment One study compared two types of radiological treatment (sclerotherapy versus embolisation) and reported 13% varicocele recurrence in both groups. Due to the broad confidence interval, no valid conclusion could be drawn (RR 1.00, 95% CI 0.16 to 6.20; 1 RCT, N = 30, very low-certainty evidence). We identified no evidence on live birth, adverse events, pregnancy, or quality of life for this comparison. AUTHORS' CONCLUSIONS: Based on the limited evidence, it remains uncertain whether any treatment (surgical or radiological) compared to no treatment in subfertile men may be of benefit on live birth rates; however, treatment may improve the chances for pregnancy. The evidence was also insufficient to determine whether surgical treatment was superior to radiological treatment. However, microscopic subinguinal surgical treatment probably improves pregnancy rates and reduces the risk of varicocele recurrence compared to other surgical treatments. High-quality, head-to-head comparative RCTs focusing on live birth rate and also assessing adverse events and quality of life are warranted.


Subject(s)
Embolization, Therapeutic , Infertility, Male/therapy , Sclerotherapy/methods , Varicocele/therapy , Bias , Confidence Intervals , Embolization, Therapeutic/adverse effects , Female , Humans , Infertility, Male/etiology , Infertility, Male/surgery , Live Birth , Male , Outcome Assessment, Health Care , Postoperative Complications/etiology , Pregnancy , Pregnancy Rate , Randomized Controlled Trials as Topic , Recurrence , Sclerotherapy/adverse effects , Sperm Count , Testicular Hydrocele/etiology , Varicocele/complications , Varicocele/surgery
20.
Medicine (Baltimore) ; 99(1): e18611, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-1455400

ABSTRACT

BACKGROUND: This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). METHODS: We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. RESULTS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. CONCLUSION: the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.


Subject(s)
Developing Countries , Neurodevelopmental Disorders/therapy , Child , Humans , Neurodevelopmental Disorders/economics , Systematic Reviews as Topic
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