The impact of COVID-19 on non-communicable disease patients in sub-Saharan African countries: A systematic review.

BACKGROUND: COVID-19 and its prevention measures have had a significant impact on patients with non-communicable diseases (NCDs) by disrupting routine healthcare service and increasing risk factors. These challenges were expected to be more severe in sub-Saharan Africa due to the lack of physical infrastructure and inadequate resources. The quantity of studies conducted was limited, and there was a lack of published systematic reviews in the specified region. This systematic review aimed to assess the indirect impacts of the COVID-19 pandemic and associated lockdown measures on individuals with non-communicable diseases (NCDs) in sub-Saharan African countries. METHOD: This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and is registered with PROSPERO (ID CRD42023387755). Extensive searches were conducted in MEDLINE, EMBASE, and CINAHL databases in December 2023, supplemented by a manual search of references, grey literature, and the WHO COVID-19 database. Inclusion criteria encompassed studies that reported on the impact of COVID-19 on NCD patients in sub-Saharan African countries, focusing on access to care, health outcomes, and factors related to NCDs. Critical appraisal of study quality was performed using the Joanna Briggs Institute (JBI) analytical cross-sectional studies critical appraisal tool. Data were extracted and synthesized, highlighting the main findings and relevant limitations. FINDINGS: This review included 30 primary studies with a cumulative sample size of 25634 participants, conducted in seven sub-Saharan African countries. These studies demonstrated that the COVID-19 pandemic significantly disrupted regular NCD patient care provision, with regional variations. The studies also identified a reduction in patient health-seeking behavior and reduced medication adherence, leading to poor treatment outcome. Furthermore, the pandemic and related lockdowns have been implicated in the increased prevalence of substance use, decreased physical exercise, and increased mental health problems. CONCLUSION: This systematic review identified the complex challenges faced by NCD patients in sub-Saharan Africa during the COVID-19 pandemic. It also underlines the need to consider the indirect impact on vulnerable populations while developing pandemic prevention and control strategies for the future. The current NCD management strategies should prioritize the restoration of access to essential healthcare services while considering the multifaceted risks posed by decreased physical activity, poor dietary practices, and increased substance use. The main limitation of this review was the study design and setting. All of the studies included in this review employed a cross-sectional design, which may result in a low quality of evidence. This study identified research conducted in only seven countries among the 46 UN-classified sub-Saharan nations, which may impair the generalizability of the result.

Role of the addiction clinical nurse specialist in acute hospital settings.

BACKGROUND: The role of an addiction clinical nurse specialist (ACNS) is focused on individuals who misuse drugs and alcohol, and several benefits of the role have been identified in the literature. When people who misuse substances are admitted to acute general hospitals, there is an opportunity to engage with them and ensure they access support services to facilitate their recovery. AIM: To determine general nurses' experience of caring for patients who misuse substances, and to gauge nurses' views on the implementation of an ACNS role in an acute general hospital. METHOD: This study used a qualitative design involving online interviews with 11 hospital nurses. FINDINGS: Many participants felt that an ACNS could provide them with education and support around substance misuse, while also advocating for patients who misuse substances, reducing stigma and enhancing patient care. CONCLUSION: Participants indicated several benefits to implementing an ACNS role in their hospital, such as ensuring that patients who misuse substances experienced continuity of care which began at admission, was followed-up during inpatient stays and was maintained in the community.

Retrospective cohort study exploring the impact of universal Tuberculosis (TB) vaccination cessation on the epidemiology of paediatric TB in Ireland, 2011-2021.

BACKGROUND: Since 2010, Ireland's Tuberculosis (TB) crude incidence rate (CIR) remains below 10 per 100,000 population defining it as a low TB incidence country. Ireland maintained a universal BCG vaccination programme until its discontinuation in 2015 due to lack of vaccine supply. This study explores the impact of discontinuing a national universal BCG vaccination programme on the epidemiology of paediatric TB cases. METHODS: We retrospectively analysed TB notifications aged 0-6 years old reported to the Irish National TB Surveillance System between 2011 and 2021. Key epidemiological characteristics and temporal trends in TB age specific incidence rates (ASIRs) were compared between 0 and 6 year old cases born during a period of universal BCG vaccination (2007-2015) and 0-6 year old cases born after BCG vaccination ceased (2015-2021). RESULTS: No significant temporal trend was detected in the overall 0-6 year old ASIR by notification year during 2011-2021 (IRR:0.95; 0.86-1.1). However, the temporal trend for cases born during universal vaccination showed a significant decline (0.74; CIR: 0.62-0.89) while cases born after BCG vaccination ceased had a non-significant increase (1.2; CIR: 0.73-1.86). A significantly declining temporal trend was detected among cases born in Ireland during universal vaccination (IRR:0.73; 0.62-0.86), but no significant trend was detected in the cases born outside Ireland during universal vaccination (IRR:0.83; 0.53-1.31). No significant trend was detected in cases born after vaccination ceased in either cases born in Ireland (IRR:1.0; 0.60-1.65) or those born outside Ireland (IRR:0.64; 0.29-1.40). CONCLUSIONS: Universal BCG cessation has not yet directly impacted on TB cases among 0-6 year olds in Ireland. However, interruption of the previously declining temporal trend in this cohort during universal vaccination may be an early warning of a future increase. Paediatric TB cases remain an important cohort for timely surveillance to monitor trends in this primarily unvaccinated cohort to evaluate the long-term effects.

'Selling their souls?' Nurses' understanding of addiction and recovery in acute hospital settings.

BACKGROUND: Nursing disciplines do not currently have a shared understanding of addiction or recovery to address their contribution to their patients' needs. Recent developments of addiction nursing models, alongside an international move to standardise language, is slow to be reflected in nurses' perceptions in acute hospital settings. AIM: To explore nurses' understanding of addiction and recovery in acute general hospitals. METHODS: A qualitative study with semi-structured open-ended questions informed by a prior literature review was undertaken with nurses working in an acute general hospital in Dublin, Ireland. RESULTS: The identified themes were the knowledge of addiction, including physical and psychological needs, and the understanding of recovery, patient-centred services and the impact of the individual's environment. CONCLUSION: Standardising language for addiction and recovery and improving addiction education will give nurses a better understanding of the chronic nature of substance use and the importance of this in providing high-quality health care.

Nurse prescribing practices across the globe for medication-assisted treatment of the opioid use disorder (MOUD): a scoping review.

BACKGROUND: Despite the dramatic increase in opioid-related deaths in recent years, global access to treatment remains poor. A major barrier to people accessing Medication-assisted treatment of the opioid use disorder (MOUD) is the lack of providers who can prescribe and monitor MOUD. According to the World Drug Report, more young people are using drugs compared with previous generations and people in need of treatment cannot get it, women most of all. Nurse prescribers have the potential to enhance both access and treatment outcomes. Nurse prescribing practices do, however, vary greatly internationally. The aim of this scoping review is to explore nurse prescribing practices for MOUD globally with a view to informing equitable access and policies for people seeking MOUD. METHODS: This scoping review was informed by the preferred reporting items for systematic reviews and meta-analysis extension for scoping reviews (PRISMA-ScR). Electronic searches from 2010 to date were conducted on the following databases: PsycInfo, PubMed, Embase, and CINAHL. Only studies that met the eligibility criteria and described nurse prescribing policies and/or behaviours for MOUD were included. RESULTS: A total of 22 articles were included in the review which found several barriers and enablers to nurse prescribing of MOUD. Barriers included legislation constraints, lack of professional education and training and the presence of stigmatizing attitudes. Enablers included the presence of existing supportive services, prosocial messaging, and nurse prescriber autonomy. CONCLUSION: The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment. Nurse prescribing of MOUD can increase the numbers of people in treatment from 'hard to reach' cohorts such as rural settings, or those with less financial means. It holds significant potential to reduce a wide range of harms and costs associated with high-risk opiate use. To reduce drug-related death and the global burden of harm to individuals, families, and communities, there is an urgent need to address the two key priorities of nurse prescriber legislation and education. Both of which are possible given political and educational commitment.

Women over 50 who use alcohol and their engagement with primary and preventative health services: a narrative review using a systematic approach.

BACKGROUND: Women who are over 50 years are drinking alcohol in higher quantities and more frequently than in previous decades. Good engagement with primary care is crucial for women's physical and psychological health, particularly if they use alcohol. However, there is little known about the alcohol use of women over 50 and their use of primary care. METHODS: A systematic search was conducted on six databases; CINAHL, Medline, PsycINFO, Academic Search Complete, EMBASE and Web of Science to identify literature on primary health care engagement of women 50 years and older (50+) who use alcohol. Titles and abstracts were reviewed and full texts were independently reviewed by two researchers. A narrative review, critical appraisal and synthesis of the eligible studies produced common themes and key findings. RESULTS: After excluding 3822 articles, 13 articles were deemed eligible for the review. For this age group (50+), findings were: 1) women who drink heavily were less likely than men to attend General Practitioners (GPs), moderate drinkers were more likely than abstainers to attend mammogram screening, 2) GPs were less likely to ask questions or discuss alcohol with women than with men, 3) GPs offered less advice on alcohol to women than to men, and 4) less women than men received alcohol screening from their GP. DISCUSSION: While women 50+ are drinking more, their alcohol use is underreported and insufficiently provided for in primary health. As women's life expectancy increases, improved GP engagement will benefit women's health and reduce future healthcare costs.

Increasing awareness of bullying through small-scale initiatives in higher education.

Employees are entitled to work in an environment that upholds their dignity and respect, but bullying still exists in many disciplines, including in nurse education and nursing practice. Researchers have suggested that to address bullying employers need to intervene at team and/or organisational level rather than focusing solely on the individuals involved. To reduce the incidence of bullying and other adverse social behaviours in the workplace, many higher education institutions and healthcare organisations have developed dignity and respect (D&R) policies. In this article, the authors describe the development and implementation of several small-scale initiatives designed to increase awareness of bullying and D&R policy among staff and students at the School of Nursing and Midwifery at Trinity College Dublin. The interventions were informed by the concepts of distributed leadership and implementation science.

Leadership and community healthcare reform: a study using the Competing Values Framework (CVF).

PURPOSE: The Health Service Executive in Ireland seeks to further develop healthcare in the community. It has identified that this reform requires developing leadership amongst the staff. This study aims to identify what kind of leadership staff in community healthcare observe in practice and their leadership preferences. The core objective has been to identify the readiness of the organisation to implement the adopted national policy of integrated community care reform in terms of leadership development. DESIGN/METHODOLOGY/APPROACH: An online cross-sectional survey was conducted using the Organisational Cultural Assessment Instrument, based on the Competing Values Framework. This tool identifies four overarching leadership types: Clan (Collaborative), Adhocracy (Creative), Market (Competitive) and Hierarchy (Controlling). Participants (n = 445) were a representative sample of regional community health care employees. They were asked to identify presently observed leadership and preferred leadership in practice. The statistical analysis emphasised a comparison of observed and preferred leadership types. FINDINGS: Participants reported the current prevailing leadership type as Market (M = 34.38, SD = 6.22) and Hierarchical (M = 34.38, SD = 22.62), whilst the preferred or future style was overwhelmingly Clan (M = 40.38, SD = 18.08). Differences were significant (all p's < 0.001). The overall outcome indicates a predominance of controlling and competitive leadership and a lack of collaborative leadership to implement the planned reform. ORIGINALITY/VALUE: During reform in healthcare, leadership in practice must be aligned to the reform strategy, demonstrating collaboration, flexibility and support for innovation. This unique study demonstrates the importance of examining leadership type and competencies to indicate readiness to deliver national community health care reform.

Dynamics of the COVID-19 epidemic in Ireland under mitigation.

BACKGROUND: In Ireland and across the European Union the COVID-19 epidemic waves, driven mainly by the emergence of new variants of the SARS-CoV-2 have continued their course, despite various interventions from governments. Public health interventions continue in their attempts to control the spread as they wait for the planned significant effect of vaccination. METHODS: To tackle this challenge and the observed non-stationary aspect of the epidemic we used a modified SEIR stochastic model with time-varying parameters, following Brownian process. This enabled us to reconstruct the temporal evolution of the transmission rate of COVID-19 with the non-specific hypothesis that it follows a basic stochastic process constrained by the available data. This model is coupled with Bayesian inference (particle Markov Chain Monte Carlo method) for parameter estimation and utilized mainly well-documented Irish hospital data. RESULTS: In Ireland, mitigation measures provided a 78-86% reduction in transmission during the first wave between March and May 2020. For the second wave in October 2020, our reduction estimation was around 20% while it was 70% for the third wave in January 2021. This third wave was partly due to the UK variant appearing in Ireland. In June 2020 we estimated that sero-prevalence was 2.0% (95% CI: 1.2-3.5%) in complete accordance with a sero-prevalence survey. By the end of April 2021, the sero-prevalence was greater than 17% due in part to the vaccination campaign. Finally we demonstrate that the available observed confirmed cases are not reliable for analysis owing to the fact that their reporting rate has as expected greatly evolved. CONCLUSION: We provide the first estimations of the dynamics of the COVID-19 epidemic in Ireland and its key parameters. We also quantify the effects of mitigation measures on the virus transmission during and after mitigation for the three waves. Our results demonstrate that Ireland has significantly reduced transmission by employing mitigation measures, physical distancing and lockdown. This has to date avoided the saturation of healthcare infrastructures, flattened the epidemic curve and likely reduced mortality. However, as we await for a full roll out of a vaccination programme and as new variants potentially more transmissible and/or more infectious could continue to emerge and mitigation measures change silent transmission, challenges remain.

First back-calculation and infection fatality multiplier estimate of the hidden prevalence of COVID-19 in Ireland.

BACKGROUND: To date computer models with multiple assumptions have focussed on predicting the incidence of symptomatic cases of COVID-19. Given emerging vaccines, the aim of this study was to provide simple methods for estimating the hidden prevalence of asymptomatic cases and levels of herd immunity to aid future immunization policy and planning. We applied the method in Ireland. METHODS: For large scale epidemics, indirect models for estimating prevalence have been developed. One such method is the benchmark multiplier method. A further method is back-calculation, which has been used successfully to produce estimates of the scale of a HIV infected population. The methods were applied from March to October 2020 and are applicable globally. RESULTS: Results demonstrated that the number of infected individuals was at least twice and possibly six times the number identified through testing. Our estimates ranged from ∼100 000 to 375 000 cases giving a ratio of 1-6 hidden cases for every known case within the study time frame. While both methods are subject to assumptions and limitations, it was interesting to observe that estimates corroborated government statements noting that 80% of people testing positive were asymptomatic. CONCLUSIONS: As Europe has now endured several epidemic waves with the emergence globally of new variants, it essential that both policy makers and the public are aware of the scale of the hidden epidemic that may surround them. The need for social distancing is as important as ever as we await global immunization rollout.

A mechanistic and data-driven reconstruction of the time-varying reproduction number: Application to the COVID-19 epidemic.

The effective reproduction number Reff is a critical epidemiological parameter that characterizes the transmissibility of a pathogen. However, this parameter is difficult to estimate in the presence of silent transmission and/or significant temporal variation in case reporting. This variation can occur due to the lack of timely or appropriate testing, public health interventions and/or changes in human behavior during an epidemic. This is exactly the situation we are confronted with during this COVID-19 pandemic. In this work, we propose to estimate Reff for the SARS-CoV-2 (the etiological agent of the COVID-19), based on a model of its propagation considering a time-varying transmission rate. This rate is modeled by a Brownian diffusion process embedded in a stochastic model. The model is then fitted by Bayesian inference (particle Markov Chain Monte Carlo method) using multiple well-documented hospital datasets from several regions in France and in Ireland. This mechanistic modeling framework enables us to reconstruct the temporal evolution of the transmission rate of the COVID-19 based only on the available data. Except for the specific model structure, it is non-specifically assumed that the transmission rate follows a basic stochastic process constrained by the observations. This approach allows us to follow both the course of the COVID-19 epidemic and the temporal evolution of its Reff(t). Besides, it allows to assess and to interpret the evolution of transmission with respect to the mitigation strategies implemented to control the epidemic waves in France and in Ireland. We can thus estimate a reduction of more than 80% for the first wave in all the studied regions but a smaller reduction for the second wave when the epidemic was less active, around 45% in France but just 20% in Ireland. For the third wave in Ireland the reduction was again significant (>70%).

Effects of migration on tuberculosis epidemiological indicators in low and medium tuberculosis incidence countries: A systematic review.

BACKGROUND: Tuberculosis (TB) remains one of the top ten causes of death each year globally. While the risk of migrant TB is linked to the TB incidence in their country of origin, the migration process can increase the TB risk. OBJECTIVE: We aimed to synthesis the evidence on key differences in the epidemiological profile of TB between migrants from high TB incidence birth countries and non-migrants resident in low to medium incidence TB countries. METHODS: We conducted a systematic review where the population was all active TB cases in countries with low to medium TB incidence (<40/100,000 population), the exposure was migration to a low or medium TB incidence country and the comparator was non-migrant TB cases in low or medium incidence countries. Overall proportions were compared between migrants and non-migrants, using Fisher's exact test. Meta-analysis of proportions was carried out for the primary outcome (active TB) while meta-analyses of odds ratios (ORs) were performed using a random effects model for secondary outcomes; sputum-smear positivity, any first line drug resistance, multi-drug resistance (MDR), clustered cases, HIV coinfections and successful treatment. Heterogeneity was evaluated and sources were investigated using subgroup and sensitivity analysis. RESULTS: Significant differences were found in the overall proportions of high TB incidence migrants and non-migrants for MDR cases, clustered cases, HIV coinfections and successful treatment, as well as a significant difference in the OR among MDR cases (3.91). CONCLUSION: This review has demonstrated significant differences in key epidemiological indicators between high TB incidence migrants and non-migrants, indicating policy implications.

The Healthy Addiction Treatment Recovery Model: Developing a Client-Driven, Nurse-Led Addiction Nursing Model.

ABSTRACT: The current model of nursing within international addiction services has been described as task oriented and reactive. Yet, it is known that nursing models should be led by client need and operate within the domain of the client and their wider environment. The aim of this study was to address this gap within addiction nursing and to develop an evidence-based addiction nursing model.To objectively assess the needs of clients, a cross-sectional survey was implemented within a representative selection of six drug treatment clinics and a sample of clients in receipt of opiate agonist treatment in Dublin, Ireland. The Opiate Treatment Index with the General Health Questionnaire embedded was used to measure heroin use, polydrug use, infectious disease risk, physical health, psychological adjustment, criminality and social well-being. To develop the addiction model, a mapping of relevant features of potential nursing models was conducted by nurses working in addiction services.The key finding from the client assessments was a lack of psychological adjustment; a cutoff score of 4 was recommended. The mean score among women was 11 (95% CI [8, 14]), and that among men was 8 (95% CI [6, 10]). Findings from the mapping of models highlighted the benefits of the BRENDA, FRAMES, and Tidal models. A focus on practical implementation and measurable outcomes was stressed. Results informed the development of the Healthy Addiction Treatment Recovery Model. The model refocused services on clients' objective needs and eradicated entrenched practices.

Prevalence and concordance of oral HPV infections with cervical HPV infections in women referred to colposcopy with abnormal cytology.

BACKGROUND: Considering the shared aetiology of Human Papillomavirus infections in oropharyngeal and cervical cancers and the possible role for sexual transmission, several key aspects of the relationship between cervical and oral infections merit investigation, including prevalence of concomitant oral HPV infection and type-specific concordance with concurrent cervical infections. METHODS: A cross-section study was performed on women referred to colposcopy clinics with cytological abnormalities and a cervical HPV infection. An oral rinse sample was taken from the participants at their baseline visit for HPV testing, and a demographic and risk factor questionnaire was also administered. HPV DNA testing was carried out on the Cobas 4800 platform and extended genotyping was carried out with the INNO-LiPA HPV Genotyping Extra II assay. HPV genotyping was also carried out on the concurrent cervical tissue samples on all women who had a positive oral HPV infection. RESULTS: The prevalence of oral HPV infections was 10.0% (95%CI:5.9-13.7) in the study population. HPV18 was the most frequent genotype (7.0%). Concordant oral and cervical HPV infections were detected in 28.6% of women. Age (p = 0.005) and level of education (p = 0.02) were significantly associated with a prevalent oral HPV infection. CONCLUSION: Concomitant oral HPV infections were present in 10.0% of women referred to colposcopy with a pre-existing cervical HPV infections and cytological abnormalities. Although mild type-specific concordance was observed between oral and cervical HPV infections, findings suggest that infections at these sites may not be independent of each other.

Parallel trends in the transmission of SARS-CoV-2 and retail/recreation and public transport mobility during non-lockdown periods.

Recent literature strongly supports the hypothesis that mobility restriction and social distancing play a crucial role in limiting the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, it was shown that mobility restriction reduced transmission significantly. This study found that, in the period between the first two waves of the COVID-19 pandemic, there was high positive correlation between trends in the transmission of SARS-CoV-2 and mobility. These two trends oscillated simultaneously, and increased mobility following the relaxation of lockdown rules was significantly associated with increased transmission. From a public health perspective, these results highlight the importance of tracking changes in mobility when relaxing mitigation measures in order to anticipate future changes in the spread of SARS-CoV-2.

The second wave: estimating the hidden asymptomatic prevalence of COVID-19 in Ireland as we plan for imminent immunisation.

Since the first case of COVID-19 in Ireland was recorded policy makers have introduced mitigation measures to control the spread of infection. Infection is spread by both known cases and hidden, undetected asymptomatic cases.  Asymptomatic individuals are people who transmit the virus but display no clinical symptoms. Current evidence reveals that this population is a major contributing factor to the spread of the disease. There is little or no knowledge of the scale of the hidden prevalence of all infections both asymptomatic and symptomatic in Ireland. Furthermore, as governments plan for the roll out of imminent immunisation programmes, the need to know the scale of the hidden prevalence and hence knowledge of the level of immunisation required is essential. We describe and analyse the numbers of reported cases of COVID-19 in Ireland from the first case in February 2020 to mid-December 2020. Using the method of back-calculation we provide estimates of the asymptomatic prevalence of cases from June to December 2020. The descriptive analysis highlighted two epidemic waves of known cases in the time period. Wave two from June to December included twice as many cases as wave one and cases were significantly younger. The back-calculation estimates of asymptomatic prevalence during this time period revealed that for every case known there was an additional unknown case and total prevalence in wave two was estimated to be approximately 95,000 as opposed to the reported 48,390 cases. As prevalence in wave two is known to be spreading within and from younger age groups the role of mixing patterns on spread needs to be disseminated to the wider public to adequately inform them how personal modifications in behaviour can contribute to the control of the epidemic. While universally imposed lockdowns and mitigation measures may be essential, personal behavioural mixing choices are powerful protectors.

Journeying with fear: Young people's experiences of cannabis use, crime and violence before treatment entry.

PROBLEM: The experiences of crime and policing from the perspective of adolescent cannabis users before treatment entry are not often understood by practitioners. METHODS: A qualitative design within an interpretivist paradigm was used. Data were collected using one-to-one semi-structured interviews. A convenience sample was recruited through two treatment centers in Dublin, Ireland in 2015. A deductive thematic analysis was used. FINDINGS: In-depth interviews with eight young people were conducted. At the individual level, there was a common theme of naïve crimes with the introduction of debt and developing violence. Young people often stole from their families and obtained credit from dealers. Policing was initially viewed as benign. Families suffered as a result of the drug debts but young people also spoke of intergenerational drug use. As the young person's use progressed, the oppressed became the oppressor, young people were entrapped, violence escalated and real fear of incarceration and remorse was expressed. CONCLUSION: Findings highlight the commonality of fear and the seriousness of personal and familial violent harms. The need for targeted developmental preventions in vulnerable settings is proposed. Parents and professionals need to have an awareness of money in the home and the role of intergenerational substance use.