Impact of the COVID-19 pandemic on the treatment of acute cholangitis caused by choledocholithiasis: A single-center retrospective study in Japan.

Objectives: This study aimed to determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the treatment of acute cholangitis caused by choledocholithiasis. Methods: The Japanese government declared a state of emergency in April 2020 due to the COVID-19 pandemic. We retrospectively reviewed the medical records of 309 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for acute cholangitis caused by choledocholithiasis between April 2017 and December 2022. Results: Patients were categorized into a pregroup (n = 134) and a postgroup (n = 175), depending on whether they were diagnosed before or after the state of emergency declaration. The total number of ERCP cases and the number of ERCP cases with endoscopic stone removals increased after the state of emergency declaration. Compared with the pregroup, the numbers of patients with performance status of 0-1 and surgically altered anatomy increased, whereas the numbers of patients taking oral antiplatelets or anticoagulants and those with cerebrovascular disease decreased in the postgroup. The number of single-stage endoscopic stone removals increased and hospital stays were significantly shorter in the postgroup. No differences in adverse event rates were detected between the two groups. Conclusions: Although our hospital provides tertiary care, the number of patients with cholangitis in good general condition and no underlying disease increased after the state of emergency declaration. The COVID-19 pandemic resulted in an increase in the number of single-stage endoscopic treatments and shortened hospital stays for patients with acute cholangitis caused by choledocholithiasis. No safety issues with ERCP were detected, even during the pandemic.

Death on the permafrost: Revisiting the 1918-20 influenza pandemic in Alaska using death certificates.

The 1918-20 influenza pandemic devastated Alaska's Indigenous populations. We report on quantitative analyses of pandemic deaths due to pneumonia and influenza (P&I) using information from Alaska death certificates dating between 1915 and 1921 (n=7,147). Goals include a reassessment of pandemic death numbers, analysis of P&I deaths beyond 1919, estimates of excess mortality patterns overall and by age using intercensal population estimates based on Alaska's demographic history, and comparisons between Alaska Native (AN) and non-AN residents. Results indicate that ANs experienced 83% of all P&I deaths and 87% of all-cause excess deaths during the pandemic. AN mortality was 8.1 times higher than non-AN mortality. Analyses also uncovered previously unknown mortality peaks in 1920. Both subpopulations showed characteristically high mortality of young adults, possibly due to imprinting with the 1889-90 pandemic virus, but their age-specific mortality patterns were different: non-AN mortality declined after age 25-29 and stayed relatively low for the elderly, while AN mortality increased after age 25-29, peaked at age 40-44, and remained high up to age 64. This suggests a relative lack of exposure to H1-type viruses pre-1889 among AN persons. In contrast, non-AN persons, often temporary residents, may have gained immunity before moving to Alaska.

Mucormycosis during COVID-19 era: A retrospective assessment.

In a retrospective view, this review examines the impact of mucormycosis on health workers and researchers during the COVID era. The diagnostic and treatment challenges arising from unestablished underlying pathology and limited case studies add strain to healthcare systems. Mucormycosis, caused by environmental molds, poses a significant threat to COVID-19 patients, particularly those with comorbidities and compromised immune systems. Due to a variety of infectious Mucorales causes and regionally related risk factors, the disease's incidence is rising globally. Data on mucormycosis remains scarce in many countries, highlighting the urgent need for more extensive research on its epidemiology and prevalence. This review explores the associations between COVID-19 disease and mucormycosis pathology, shedding light on potential future diagnostic techniques based on the fungal agent's biochemical components. Medications used in ICUs and for life support in ventilated patients have been reported, revealing the challenge of managing this dual onslaught. To develop more effective treatment strategies, it is crucial to identify novel pharmacological targets through "pragmatic" multicenter trials and registries. In the absence of positive mycology culture data, early clinical detection, prompt treatment, and tissue biopsy are essential to confirm the specific morphologic features of the fungal agent. This review delves into the history, pathogens, and pathogenesis of mucormycosis, its opportunistic nature in COVID or immunocompromised individuals, and the latest advancements in therapeutics. Additionally, it offers a forward-looking perspective on potential pharmacological targets for future drug development.

WHO and its transformation - A journey from 1978 to 2024.

The Alma-Ata Declaration of 1978 was a historic hallmark in the history of public health of the 20th century. It stressed on comprehensive primary health care and led to the slogan of "Health for All by 2000 A.D." The Conference documents made it clear that primary health care was essential health care based on practical, scientifically sound, and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country could afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. It was proclaimed to form an integral part of a country's health system. In addition, as a consequence, the overall social and economic development of the community depended on its survival. It was regarded as the first level of contact of individuals, the family, and community with the national health system bringing health care as close as possible to where people live and work. Instead of disease-centred vertical programs, it emphasised to adopt the horizontal community-based programs. Though the worldwide stir caused by the historic Alma-Ata Conference (1978), giant MNCs of the world remained hibernated for some time but never gave up to turn "health" into "health care" as commodity. Intriguingly enough, health was "forgotten" when the Covenant of the League of Nations was drafted after the First World War. Only at the last moment, world health was included, leading to the Health Section of the League of Nations. Recently, Intergovernmental Negotiating Body has drafted a new Pandemic Treaty which might become disastrous for general well-being and rightful living for citizens in future. All these observations are very much relevant if family medicine and primary care are given due importance at the present moment.

Repurposing surgical wards in pandemics - An appraisal of outcomes of COVID-19 patients treated in Orthopaedic wards.

Background: The COVID-19 pandemic resulted in a shift in the way healthcare resources were used. While India faced limited effects in the first COVID wave primarily due to strict lockdown of the county, it was one of the worst affected in the second wave and at one time reported the highest number of daily cases. To address the lack of intensive care units (ICU) beds, the surgical wards of our institute were repurposed to take care of patients requiring supplementary oxygen and other supportive care till either they improved or an ICU bed was available. The medical personnel in charge of the surgical wards were entrusted with the care of patients with support from intensive care support teams (ICST). Aims: We aimed to examine the clinical details of patients admitted in the repurposed orthopaedic wards during the second COVID wave and to evaluate the factors that might affect the clinical outcomes in such patients. Methods: This was a retrospective review of records of patients admitted in the repurposed orthopaedic wards between 16 April 2021 and 20 May 2021. Details related to demography, COVID-19 presentation, COVID-19-related management and clinical course, including transfers to ICUs, and outcomes in terms of either discharge to home or death were recorded. They were analysed using statistical software. Results: One hundred and twenty three patients were treated during the said period. Twenty patients died during treatment, resulting in a mortality rate of 16.3%. Age, gender, RT-PCR status, pre-existing comorbidities, SpO2 at admission, method of supplemental oxygen supply, total leukocyte counts, haemoglobin values, serum C-reactive protein, Lactate dehydrogenase (LDH) and creatinine values had no statistically significant association with death of a patient during treatment. Conclusion: Based on the results, one can state that clinicians of surgical specialities having background knowledge of internal medicine from undergraduate education can manage patients of COVID-19 with support from ICST with reasonable outcomes. In case of future pandemics, surgical wards can be repurposed to tide over exigencies. Additionally, primary care physicians, who are often the first point of contact for patients, can allay their apprehensions adequately in future pandemics, thus preventing widespread panic and burdening of healthcare resources.

A Cross-Sectional Study of Emergency Care Services During the COVID-19 Pandemic: A Multicenter Study of Healthcare Staff Perspectives.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted various aspects of healthcare services, including emergency care services. Healthcare staff face mental issues and physical exertion when caring for patients potentially infected with COVID-19. Understanding the experiences and perspectives of emergency department (ED) healthcare staff during the COVID-19 pandemic is essential to inform evidence-based interventions and strategies to mitigate the impact on emergency care services. This study aims to investigate the experiences of ED healthcare staff regarding emergency care services during the COVID-19 pandemic, thus providing valuable insights into the challenges faced. MATERIALS AND METHODS: This study utilized a cross-sectional study design. Data were collected from 256 ED healthcare staff working in nine different hospitals located in Turkey between November 15, 2021, and December 30, 2021. Data were analyzed using descriptive statistics. RESULTS: A total of 256 participants were included in the study. Of the participants, 58.6% were nurses, 19.5% were ED doctors, and 21.9% were emergency medical technicians. In addition, 67.2% of the participants were infected with COVID-19, and almost all of them (94.1%) were psychologically affected by the pandemic process. It was found that 85.2% of ED healthcare staff felt excluded by society due to being healthcare staff and 71.9% had to be separated from their families. Nurses were separated from their families at the highest rate (78%) during this period. CONCLUSION: More than half of the ED healthcare staff had problems accessing protective equipment and were separated from their families during the pandemic due to the risk of COVID-19 transmission. Although the number of ED visits decreased because of restrictions at the beginning of the pandemic, ED visits increased again with the abolition of restrictions.

Demographic and clinical profile of adolescents suicide attempters admitted to an emergency department during the COVID-19 pandemic - a retrospective cohort study using hospital information system.

Background: The prevalence of suicidal attempts among adolescents during COVID-19 significantly increased compared with pre-pandemic estimates. The aim of the study was to explore the demographic and clinical profile of adolescent suicide attempters admitted to the emergency department during the COVID-19 pandemic. Material and method: The retrospective analysis included, on the basis of electronic medical records in the CliniNet system, sociodemographic and clinical data of patients aged 10-18 years with a diagnosis of suicide attempt. Follow-up period: from March 20, 2020 to May 16, 2023. Results: During the COVID-19 pandemic, there were 425 emergency department visits among adolescents aged 11-17 due to a suicide attempt, with the largest number in the 15-17 (69%) age range. The percentage of emergency department visits was higher among females (80%) and urban residents (75.3%). Self-poisoning was the most common cause of suicide attempts (52.4%), followed by self-harm (41.4%), hanging (3.2%) and jumping from a height (2.1%). The most common toxic substances in self-poisonings were antidepressants and antipsychotics, followed by paracetamol. About 70% of visits were associated with adolescent mental disorders, of which depressive disorder was the most common. One death per 425 visits was recorded (0.2%). Conclusions: Adolescents attempting suicide during COVID-19 were most likely female, aged 15-17, city dwellers, undergoing psychiatric treatment mainly for depressive disorders. The mental health consequences of the pandemic may be more long term, and further monitoring will be needed in the years to come.

Lessons learned: avoiding bias via multi-state analysis of patients' trajectories in real-time.

Objectives: Many studies have attempted to determine the disease severity and patterns of COVID-19. However, at the beginning of the pandemic, the complex patients' trajectories were only descriptively reported, and many analyses were worryingly prone to time-dependent-, selection-, and competing risk biases. Multi-state models avoid these biases by jointly analysing multiple clinical outcomes while taking into account their time dependency, including current cases, and modelling competing events. This paper uses a publicly available data set from the first wave in Israel as an example to demonstrate the benefits of analysing hospital data via multi-state methodology. Methods: We compared the outcome of the data analysis using multi-state models with the outcome obtained when various forms of bias are ignored. Furthermore, we used Cox regression to model the transitions among the states in a multi-state model. This allowed for the comparison of the covariates' influence on transition rates between the two states. Lastly, we calculated expected lengths of stay and state probabilities based on the multi-state model and visualised it using stacked probability plots. Results: Compared to standard methods, multi-state models avoid many biases in the analysis of real-time disease developments. The utility of multi-state models is further highlighted through the use of stacked probability plots, which visualise the results. In addition, by stratification of disease patterns by subgroups and visualisation of the distribution of possible outcomes, these models bring the data into an interpretable form. Conclusion: To accurately guide the provision of medical resources, this paper recommends the real-time collection of hospital data and its analysis using multi-state models, as this method eliminates many potential biases. By applying multi-state models to real-time data, the gained knowledge allows rapid detection of altered disease courses when new variants arise, which is essential when informing medical and political decision-makers as well as the general population.

Effect of COVID-19 on Continuing Education Activities and Learner Interactions: Report from Six Accreditation Systems.

The COVID-19 pandemic has had disruptive effects on all parts of the health-care system, including the continuing education (CE) landscape. This report documents, what has happened in six different CE accreditation systems to CE activities as well as learners. Complete lockdown periods in the first part of the COVID-19 pandemic have inevitably led to reductions in numbers of the then predominant format of education, i.e. onsite in-person meetings. However, with impressive speed CE providers have switched to online educational formats. With regard to learner interactions this has compensated, and in some systems even overcompensated, the loss of in-person educational opportunities. Thus, our data convincingly demonstrate the resilience of CPD in times of a global health crisis and offer important insights in how CPD might become more effective in the future.

Impact of the SARS-CoV-2 Pandemic on Hospitalizations in an Acute Psychiatric Ward.

Background: The Sars-CoV-2 pandemic imposed unprecedented and drastic changes in health care organizations all over the world. Purpose: To evaluate the impact of the pandemic on hospitalizations in an acute psychiatric ward. Patients and Methods: We retrospectively identified and compared acute psychiatric hospitalizations in the Service for Psychiatric Diagnosis and Care (SPDC) of AUSL-Modena during the pre-pandemic (n = 1858) and pandemic period (n = 1095), from 01/01/2017 to 31/12/2022. Data were statistically analyzed using STATA12. Results: We collected 1858 hospitalizations in the pre-pandemic and 1095 in the pandemic. During the pandemic, we observed a progressively sharp reduction in voluntary hospitalizations, whereas involuntary ones remained stable with an increase in 2022 (p < 0.001), longer hospital stays (12.32 mean days vs 10.03; p < 0.001), longer periods of involuntary hospitalizations (8.45 mean days vs 5.72; p < 0.001), more frequent aggressive behaviour (16.10% vs 9.12%; p < 0.001) and referral to psychiatric communities at discharge (11.04% vs 6.13%; p < 0.001); non-Italians (p = 0.001), people with disability pension (p < 0.001) and Support Administrator (p < 0.001) were more frequently hospitalized. Conclusion: During the pandemic, voluntary psychiatric hospitalizations decreased, but not involuntary ones, and the most vulnerable people in serious clinical conditions were hospitalized.

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece.

INTRODUCTION: Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this study is to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greece as well as analyze the quantitative and qualitative parameters of patient characteristics and management data. METHODS: This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specifically between 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. RESULTS: In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively. In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. CONCLUSION: Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.

Did the COVID-19 quarantine policies applied in Cochabamba, Bolivia mitigated cases successfully? an interrupted time series analysis.

BACKGROUND: The COVID-19 pandemic prompted varied policy responses globally, with Latin America facing unique challenges. A detailed examination of these policies' impacts on health systems is crucial, particularly in Bolivia, where information about policy implementation and outcomes is limited. OBJECTIVE: To describe the COVID-19 testing trends and evaluate the effects of quarantine measures on these trends in Cochabamba, Bolivia. METHODS: Utilizing COVID-19 testing data from the Cochabamba Department Health Service for the 2020-2022 period. Stratified testing rates in the health system sectors were first estimated followed by an interrupted time series analysis using a quasi-Poisson regression model for assessing the quarantine effects on the mitigation of cases during surge periods. RESULTS: The public sector reported the larger percentage of tests (65%), followed by the private sector (23%) with almost double as many tests as the public-social security sector (11%). In the time series analysis, a correlation between the implementation of quarantine policies and a decrease in the slope of positive rates of COVID-19 cases was observed compared to periods without or with reduced quarantine policies. CONCLUSION: This research underscores the local health system disparities and the effectiveness of stringent quarantine measures in curbing COVID-19 transmission in the Cochabamba region. The findings stress the importance of the measures' intensity and duration, providing valuable lessons for Bolivia and beyond. As the global community learns from the pandemic, these insights are critical for shaping resilient and effective health policy responses.

Main findings: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.Added knowledge: By providing a detailed analysis of testing disparities and quarantine policies' effectiveness within a specific Latin American context, our research fills a critical gap in understanding their impacts on health system responses and disease control.Global health impact for policy and action: The findings highlight the importance of stringent quarantine measures in managing infectious disease outbreaks, offering valuable insights for policymakers worldwide in strategizing effective public health interventions.

Influence of the first wave of COVID-19 on Chinese students' psychology and behavior: a case study approach.

During the first wave of COVID-19, China demonstrated a strong commitment to epidemic prevention and control. This case study focuses on Z University, which adopted closed management when the epidemic was serious, and examines the influence of COVID-19 on students' psychology and behavior through interviews with 10 students. The research reveals that while students perceive closed management during the epidemic as enhancing safety and promoting learning engagement to some extent, the epidemic also has adverse effects on their physical health, psychology, and social life. These impacts included deteriorating physical health, feelings of rebellion and depression regarding college life, alongside concerns and aspirations regarding future job stability. In the discussion, we suggest that higher education institutions can utilize this information to shape policies and procedures, particularly concerning mental health and risk communication, not only during the current pandemic but also in future emergency or disaster scenarios.

Single stage laparoscopic cholecystectomy with intraoperative endoscopic retrograde cholangiopancreatography for cholecysto-choledocholithiasis. Lesson learnt from the COVID-19 pandemic.

Introduction: Choledocholithiasis, a common complication of gallstone disease, poses significant risks including cholangitis and pancreatitis. Various treatment approaches exist, including single-stage and two-stage techniques, with recent literature suggesting advantages of the single-stage approach in terms of outcomes and cost-effectiveness. This study evaluates the feasibility, efficacy, and safety of single-stage laparoscopic cholecystectomy combined with intraoperative endoscopic retrograde cholangiopancreatography (LC + iERCP) compared to the previously adopted two-stage approach. Methods: A retrospective analysis was conducted on patients undergoing single-stage LC + iERCP for cholecysto-choledocholithiasis during the COVID-19 pandemic (2020-2022). Data on demographics, preoperative assessments, intraoperative parameters, and postoperative outcomes were collected and compared with an historical control group undergoing the two-stage approach (LC + preopERCP). Hospitalization costs were also compared between the two groups. Results: A total of 190 patients were included, with 105 undergoing single-stage LC + iERCP. The single-stage approach demonstrated successful completion without cystic duct cannulation, with no conversions to open surgery. Operative time was comparable to the two-stage approach, while hospital stay, and costs were significantly lower in the single-stage group. Complication rates were similar between the groups. Conclusions: Single-stage LC + iERCP appears to be a feasible, effective, and safe approach for treating cholecysto-choledocholithiasis, offering potential benefits in terms of reduced hospital stay, OR occupation time, and costs compared to the two-stage approach. Integration of this approach into clinical practice warrants consideration, unless there are logistical challenges that cannot be overcome or lack of endoscopic expertise also for treating challenging urgent cases.

Wastewater-based epidemiology to monitor 68 NPS/conventional drug use in Taipei metropolitan area in Taiwan during and after COVID-19 pandemic.

Amidst far-reaching COVID-19 effects and social constraints, this study leveraged wastewater-based epidemiology to track 38 conventional drugs and 30 new psychoactive substances (NPS) in northern Taiwan. Analyzing daily samples from four Taipei wastewater plants between September 2021 and January 2024-encompassing club reopenings, holidays, Lunar New Year, an outbreak, and regular periods-thirty-one drugs were detected, including 5 NPS. Tramadol, zolpidem tartrate, CMA, and MDPV were newly detected in Taiwanese sewage with frequency of 1.4 %- 89.0 %. Conventional drug use typically increased post-pandemic, aside from benzodiazepines and methadone. Methamphetamine showed 100 % frequency, indicating ongoing daily consumption despite COVID-19 measures. Methamphetamine and morphine's consumption dipped then rose around club reopening, hinting at limited access. The consumption trend of methadone appeared to compensate for the use of morphine. Ketamine and NPS demonstrated similar patterns throughout the entire period. NPS as party drugs seemed influenced by an unstable supply chain and complexities in implementation. Benzodiazepines, commonly abused alongside synthetic cathinones in Taiwan exhibited an opposing trend to NPS while aligned with acetaminophen, suggesting elevated stress and anxiety levels during the pandemic. No significant differences were observed in drug consumption between weekdays and weekends, potentially indicating that COVID-19 measures blurred the traditional distinctions between these timeframes. ENVIRONMENTAL IMPLICATION: New psychoactive substances refer to chemically modified variants of controlled drugs designed to mimic the effects of the original drugs while evading modern detection methods, categorizing them as hazardous materials. The study presents a sewage monitoring project conducted from 2021 to 2024, collecting samples from four WWTPs to analyze NPS and conventional drug trends during and after the COVID-19 pandemic. The findings uncovered connections between drug consumption patterns and pandemic-related policies. In light of the persistent drug abuse and their environmental presence, the results bear critical importance for both environmental and public health. We provide a thorough assessment of these relationships and prioritize areas for future research.

Perceived impact of the COVID-19 pandemic on residency training in American College of Veterinary Anesthesia and Analgesia programs in North America: a quantitative survey.

OBJECTIVE: To characterize the extent of the impact of the COVID-19 pandemic on aspects of the anesthesia residency experience from the perspective of American College of Veterinary Anesthesia and Analgesia (ACVAA) mentors and trainees. This includes the residency interview process, didactic training and availability and variety of clinical cases for resident learning. STUDY DESIGN: Cross-sectional, online, anonymous voluntary survey. SAMPLE POPULATION: A total of 58 respondents, representing 30 residency program mentors and 28 residents. METHODS: Surveys were distributed by email to 94 residency program mentors and 70 residents, representing programs and residents registered with the ACVAA during the years of 2019-2021. Anonymous links to an online survey were provided via a link embedded in the email. Questions included perceived impacts (-5 to +5 scale) on didactic and clinical training, case distribution, workload, residency application and selection process, and mental health. Responses were summarized with descriptive statistics [median (IQR) or mean ± SD]. RESULTS: The overall survey response rate was 31.9% (30/94) and 40.0% (28/70) for resident program mentors and residents, respectively. There was a negative perceived impact on overall residency training reported: -1.0 (IQR -2.0 to 0) for program mentors and -1.5 ± 1.5 for residents. The reported perceived impact of travel limitations on case log completion was -2.0 (IQR -4.0 to -1.0) for program mentors and -2.4 ± 2.0 for residents. Program mentors and residents had incongruent feelings on the impact of the pandemic on work hours, with residents reporting a perceived increase in work hours [+2.1 ± 2.1 versus 0 (IQR -1.0 to 0)]. CONCLUSIONS: Residency program mentors and residents generally agreed that the COVID-19 pandemic had negatively impacted multiple aspects of residency interview and training process. A broader, objective analysis of veterinary anesthesia training programs is required to fully elucidate the scale of the impact on veterinary anesthesia training.

Predictors of COVID-Related stress in a community sample in Turkey: a cross-sectional study.

The distinctive mental health features associated with COVID-19 have gained importance as the psychological effects of the pandemic on the community become more visible. This study aims to assess the COVID-related stress status and associated factors in the community sample of Turkey. The sample of this cross-sectional study is composed of 2.065 people between the ages of 18-90. Data were collected through an online survey prepared by Google.docs between October-December, 2020. Mild to moderate stress was found in the community with the most common symptoms of the fear of contamination and danger. Some variables, such as being female and the severity of COVID-19 illness, were associated with higher COVID-related stress. Vulnerable groups associated with high stress should be monitored during the pandemic. The findings of this study will guide the practices of professionals working in the field of public health, healthcare, or mental health in possible future pandemics.

Risk of emergency hospital admission related to adverse events after antibiotic treatment in adults with a common infection: impact of COVID-19 and derivation and validation of risk prediction models.

BACKGROUND: With the global challenge of antimicrobial resistance intensified during the COVID-19 pandemic, evaluating adverse events (AEs) post-antibiotic treatment for common infections is crucial. This study aims to examines the changes in incidence rates of AEs during the COVID-19 pandemic and predict AE risk following antibiotic prescriptions for common infections, considering their previous antibiotic exposure and other long-term clinical conditions. METHODS: With the approval of NHS England, we used OpenSAFELY platform and analysed electronic health records from patients aged 18-110, prescribed antibiotics for urinary tract infection (UTI), lower respiratory tract infections (LRTI), upper respiratory tract infections (URTI), sinusitis, otitis externa, and otitis media between January 2019 and June 2023. We evaluated the temporal trends in the incidence rate of AEs for each infection, analysing monthly changes over time. The survival probability of emergency AE hospitalisation was estimated in each COVID-19 period (period 1: 1 January 2019 to 25 March 2020, period 2: 26 March 2020 to 8 March 2021, period 3: 9 March 2021 to 30 June 2023) using the Kaplan-Meier approach. Prognostic models, using Cox proportional hazards regression, were developed and validated to predict AE risk within 30 days post-prescription using the records in Period 1. RESULTS: Out of 9.4 million patients who received antibiotics, 0.6% of UTI, 0.3% of URTI, and 0.5% of LRTI patients experienced AEs. UTI and LRTI patients demonstrated a higher risk of AEs, with a noted increase in AE incidence during the COVID-19 pandemic. Higher comorbidity and recent antibiotic use emerged as significant AE predictors. The developed models exhibited good calibration and discrimination, especially for UTIs and LRTIs, with a C-statistic above 0.70. CONCLUSIONS: The study reveals a variable incidence of AEs post-antibiotic treatment for common infections, with UTI and LRTI patients facing higher risks. AE risks varied between infections and COVID-19 periods. These findings underscore the necessity for cautious antibiotic prescribing and call for further exploration into the intricate dynamics between antibiotic use, AEs, and the pandemic.