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To investigate the prevalence of suicidal thoughts and behaviours (STB; i.e. suicidal ideation, plans or attempts) in the Spanish adult general population during the first wave of the Spain coronavirus disease 2019 (COVID-19) pandemic (March−July, 2020), and to investigate the individual- and population-level impact of relevant distal and proximal STB risk factor domains.
Methods
Cross-sectional study design using data from the baseline assessment of an observational cohort study (MIND/COVID project). A nationally representative sample of 3500 non-institutionalised Spanish adults (51.5% female; mean age = 49.6 [s.d. = 17.0]) was taken using dual-frame random digit dialing, stratified for age, sex and geographical area. Professional interviewers carried out computer-assisted telephone interviews (1–30 June 2020). Thirty-day STB was assessed using modified items from the Columbia Suicide Severity Rating Scale. Distal (i.e. pre-pandemic) risk factors included sociodemographic variables, number of physical health conditions and pre-pandemic lifetime mental disorders; proximal (i.e. pandemic) risk factors included current mental disorders and a range of adverse events-experiences related to the pandemic. Logistic regression was used to investigate individual-level associations (odds ratios [OR]) and population-level associations (population attributable risk proportions [PARP]) between risk factors and 30-day STB. All data were weighted using post-stratification survey weights.
Results
Estimated prevalence of 30-day STB was 4.5% (1.8% active suicidal ideation; n = 5 [0.1%] suicide attempts). STB was 9.7% among the 34.3% of respondents with pre-pandemic lifetime mental disorders, and 1.8% among the 65.7% without any pre-pandemic lifetime mental disorder. Factors significantly associated with STB were pre-pandemic lifetime mental disorders (total PARP = 49.1%) and current mental disorders (total PARP = 58.4%), i.e. major depressive disorder (OR = 6.0; PARP = 39.2%), generalised anxiety disorder (OR = 5.6; PARP = 36.3%), post-traumatic stress disorder (OR = 4.6; PARP = 26.6%), panic attacks (OR = 6.7; PARP = 36.6%) and alcohol/substance use disorder (OR = 3.3; PARP = 5.9%). Pandemic-related adverse events-experiences associated with STB were lack of social support, interpersonal stress, stress about personal health and about the health of loved ones (PARPs 32.7–42.6%%), and having loved ones infected with COVID-19 (OR = 1.7; PARP = 18.8%). Up to 74.1% of STB is potentially attributable to the joint effects of mental disorders and adverse events−experiences related to the pandemic.
Conclusions
STB at the end of the first wave of the Spain COVID-19 pandemic was high, and large proportions of STB are potentially attributable to mental disorders and adverse events−experiences related to the pandemic, including health-related stress, lack of social support and interpersonal stress. There is an urgent need to allocate resources to increase access to adequate mental healthcare, even in times of healthcare system overload.
Since the beginning of the coronavirus (COVID-19) global pandemic, digital contact-tracing applications (apps) have been at the centre of attention as a digital tool to enable citizens to monitor their social distancing, which appears to be one of the leading practices for mitigating the spread of airborne infectious diseases. Many countries have been working towards developing suitable digital contact-tracing apps to allow the measurement of the physical distance between citizens and to alert them when contact with an infected individual has occurred. However, the adoption of digital contact-tracing apps has faced several challenges so far, including interoperability between mobile devices and users’ privacy concerns. There is a need to reach a trade-off between the achievable technical performance of new technology, false-positive rates, and social and behavioural factors. This paper reviews a wide range of factors and classifies them into three categories of technical, epidemiological and social ones, and incorporates these into a compact mathematical model. The paper evaluates the effectiveness of digital contact-tracing apps based on received signal strength measurements. The results highlight the limitations, potential and challenges of the adoption of digital contact-tracing apps.
In this manuscript, we discuss the implementation and deployment of mobile integrated health and community paramedicine (MIH/CP) testing sites to provide screening, testing, and community outreach during the first months of the 2019 coronavirus disease (COVID-19) pandemic in the metropolitan region of Charlotte, North Carolina. This program addresses the need for an agile testing strategy during the current pandemic. We disclose the number of patients evaluated as “persons under investigation” and the proportion with positive severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) results from these sites. We describe how the programs were applied to patient care and include considerations on how additional staffing, scalability, and flexibility of these services may be applied to future patient and health care crises.
Methods:
This is a descriptive report of the implementation of MIH/CP test sites in our health care system’s early response to the COVID-19 pandemic in March 2020. Retrospective data on the number of patients and their associated demographics are reported here as raw data. No statistical analysis was performed.
Results:
Between March 15, 2020, and April 15, 2020, our 6 MIH/CP test sites evaluated 4342 patients. Of these, 401 patients (9.2%) had positive test results, 62.8% of whom were women. The estimated duration of each patient encounter under investigation was 3 to 5 minutes. The paramedics were able to perform a brief history, specific physical examination, and screening for signs of hypoxemic respiratory failure. There were no cases of accidental exposure or failure of personal protective equipment for the MIH/CP paramedics.
Conclusions:
In our health care system, we pivoted the traditional MIH/CP model to rapidly initiate remote drive-through testing for COVID-19 in pre-screened individuals. This model allowed us to test patients with suspected COVID-19 patients away from traditional health care sites and mitigate exposure to health care workers and other patients.
The aim of this study was to assess the current status of disease-related knowledge and to analyze the relationship among the general condition, illness perception, and psychological status of patients with coronavirus disease 2019 (COVID-19).
Methods:
A hospital-based cross-sectional study was conducted on 118 patients using convenience sampling. The general questionnaire, disease-related knowledge questionnaire of COVID-19, Illness Perception Questionnaire (IPQ), and Profile of Mood States (POMS) were used to measure the current status of participants.
Results:
The overall average score of the disease-related knowledge of patients with COVID-19 was (79.19 ± 14.25), the self-care situation was positively correlated with knowledge of prevention and control (r = 0.265; P = 0.004) and total score of disease-related knowledge (r = 0.206; P = 0.025); the degree of anxiety was negatively correlated with the knowledge of diagnosis and treatment (r = −0.182; P = 0.049). The score of disease-related knowledge was negatively correlated with negative cognition (volatility, consequences, emotional statements) and negative emotions (tension, fatigue, depression) (P < 0.05); positively correlated with positive cognition (disease coherence) and positive emotion (self-esteem) (P < 0.05).
Conclusions:
It was recommended that we should pay more attention to the elderly and low-income groups, and increase the knowledge about diagnosis and treatment of COVID-19 and self-care in the future health education for patients.
Coronavirus disease 2019 (COVID-19) is a communicable disease transmitted via respiratory droplet from 1 person to another caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to investigate the knowledge, attitudes, and practice of Jordanian people toward COVID-19 during the COVID-19 pandemic. In addition, the paper explores the lack of perception and adherence to preventive measures toward COVID-19.
Methods:
A quantitative, cross-sectional, descriptive online survey was used to explore study variables. A convenience sample of individual who are of Jordanian nationality, were aged 18 years or older, understood the content of the questionnaire, and agreed to participate voluntarily was surveyed.
Results:
The average correct score of COVID-19 knowledge was 84.44% (12.66/15). In addition, knowledge scores significantly differed across demographic characteristics of participants. Moreover, 93.8% (1009) of the study sample had confidence that Jordan can win the battle against the COVID-19 virus. However, study participants acknowledged that they did not visit crowded places in recent days (91.6%), while 71.3% (767) wore masks when leaving home.
Conclusions:
The current study added a new knowledge that generally the Jordanian people during the quarantine period have a high knowledge and optimistic attitudes and practices toward COVID-19.
This brief report analyzes a first-episode psychosis (FEP) clinic’s shift from in-person treatment to the provision of services through telemental health during the 2019 coronavirus disease (COVID-19) pandemic. The feasibility of using this technology was examined by assessing client engagement.
Methods:
The authors created and implemented procedures for the clinic’s transition to telemental health. Once clients’ consents were obtained, the Health Insurance Portability and Accountability Act (HIPAA) compliant platform was used to continue service provision.
Results:
Client engagement during this period improved compared to that of the same quarter in the previous year. Telemental health was also practical for providing groups and other supportive services to meet clients’ needs.
Conclusion:
Telemental health is an effective approach to providing care at an FEP clinic during a pandemic. Successes and lessons learned from the first wave of the pandemic can be used to prevent an uptick in symptoms and sustain engagement for this vulnerable population during the anticipated second wave.
The 2019 coronavirus disease (COVID-19) is a global pandemic with no therapy, and pharmacists being a part of the health care system have a vital role in the management of COVID-19. The purpose of this study is to assess the knowledge, attitude, and practices of community pharmacists (CPs) regarding COVID-19.
Method:
An online survey was conducted among 393 CPs in 2 provinces of Pakistan during the lockdown period. A validated questionnaire (Cronbach’s alpha, 0.745) was used for data collection. All statistical analyses were analyzed by using SPSS, version 21 (IBM Corp, Armonk, NY).
Results:
Among 393 participants, 71.5% (n = 281) had good knowledge, 44% (n = 175) had a positive attitude, and 57.3% (n = 225) had good practices regarding COVID-19. Social media (45.29%, n = 178) were reported as the main source to seek information of COVID-19. Good knowledge, age ≥ 26 years, and a PhD degree level were the substantial determinants (P = < 0.05) of a good attitude. Similarly, a CP with experience of > 5 years, a PhD degree, good knowledge, and a good attitude has higher odds of having good practices as compared with reference categories (P = < 0.05).
Conclusion:
In short, a majority of the CPs had good knowledge but had a poor attitude and practice toward the management of COVID-19. Standard-structured educational and counseling programs for CPs regarding COVID-19 are needed for effective management.
This study evaluates the personal and professional experiences of physician mothers during the coronavirus disease 2019 (COVID-19) pandemic and the impact of the pandemic on the lives of physician mothers.
Methods:
Using social media to reach a broad range of physicians, a convenience sample of physician mothers completed an on-line survey posted between April 27 and May 11. Members were encouraged to repost on social media and share with personal contacts resulting in a passive snowball sampling effect.
Results:
A total of 2709 physician mothers from 48 states, Puerto Rico, and 19 countries representing more than 25 medical specialties completed the survey. Most were between 30 and 39 y of age, 67% self-identified as white, 17% as Asian, 4% as African American. Most had been working for 11-16 y. A total of 91% had a spouse/partner of the opposite sex. Over half were practicing in an area they identified as high COVID-19 density, while 50% had personally cared for a person with COVID-19. Physician mothers were most concerned about exposing their children to COVID-19 and about the morale and safety of their staff.
Conclusions:
This is one of the first studies to explore the personal and professional challenges facing physician mothers during a pandemic. Physician mothers were most concerned about exposing their families to COVID-19. Mothers continued to work and at times increased their work, despite having domestic, childcare, and schooling responsibilities.
This exercise aimed to validate New Taipei City’s strategic plan for a city lockdown in response to coronavirus disease (COVID-19). The main goal of all solutions was the principle of “reducing citizen activity and strengthening government control.”
Methods:
We created a suitable exercise, creating 15 hypothetical situations for 3 stages. All participating units designed and proposed policy plans and execution protocols according to each situation.
Results:
In the course of the exercise, many existing policies and execution protocols were validated. These addressed (1) situations occurring in Stage 1, when the epidemic was spreading to the point of lockdown preparations; (2) approaches to curb the continued spread of the epidemic in Stage 2; and (3) returning to work after the epidemic was controlled and lockdown lifted in Stage 3. Twenty response units participated in the exercise. Although favorable outcomes were obtained, the evaluators provided comments suggesting further improvements.
Conclusions:
Our exercise demonstrated a successful example to help policy-making and revision in a large city of over 4 million people during the COVID-19 pandemic. It also enhanced participants’ subject knowledge and familiarity with the implementation of a city lockdown. For locations intending to go into lockdown, similar tabletop exercises are an effective verification option.
The lockdown for the COVID-19 pandemic affects lifestyle patterns globally and impacts children and adolescents. This study aims to assess the effect of the lockdown on body weight, eating habits, and physical activity of Jordanian youth (children and adolescents).
Methods:
A cross-sectional study was conducted on a sample of 477 Jordanian children and adolescents aged 6-17 y. The study tool was a structured validated questionnaire. It comprised 4 parts, including a general description of the study purpose, sociodemographic and anthropometric data, physical activity data, and food intake pattern. Questions were reported before and during lockdown. Changes in outcomes over the 2 study time points were evaluated.
Results:
After the lockdown period, the mean body weight and body mass index for age Z-scores (BAZ) showed a significant increase (P < 0.001) compared with before the lockdown period. More than 50% of the subjects reported that they spent more than 3 h in front of the screen during the lockdown. The percent of subjects who watched TV for more than 3h was increased. Moreover, physical inactivity was increased significantly during the lockdown. All food groups consumption was significantly increased during the lockdown compared to before the lockdown.
Conclusions:
COVID-19 lockdown period was characterized by an increase in the use of screen-based devices, lower physical activity, uncontrolled food intake, and weight gain.
Before coronavirus disease 2019 (COVID-19), few hospitals had fully tested emergency surge plans. Uncertainty in the timing and degree of surge complicates planning efforts, putting hospitals at risk of being overwhelmed. Many lack access to hospital-specific, data-driven projections of future patient demand to guide operational planning. Our hospital experienced one of the largest surges in New England. We developed statistical models to project hospitalizations during the first wave of the pandemic. We describe how we used these models to meet key planning objectives. To build the models successfully, we emphasize the criticality of having a team that combines data scientists with frontline operational and clinical leadership. While modeling was a cornerstone of our response, models currently available to most hospitals are built outside of their institution and are difficult to translate to their environment for operational planning. Creating data-driven, hospital-specific, and operationally relevant surge targets and activation triggers should be a major objective of all health systems.
Respiratory disease vaccines may affect coronavirus disease 2019 (COVID-19) - associated infection and mortality rates due to vaccine nonspecific effects against viral infections. We compared the infection and mortality rates in relation to COVID-19 between countries with and without universal respiratory disease vaccine policies.
Methods:
In this ecological study, 186 countries with COVID-19 statistics from the World Health Organization (WHO) were included.
Results:
The study found that countries with universal BCG (bacillus Calmette Guérin) vaccine had significantly lower total infection and mortality rates, 0.2979 and 0.0077 versus 3.7445, and 0.0957/1000 people and confirmed cases (P < 0.001). The countries with universal pneumococcal vaccine (PCV), including PCV1, PCV2, and PCV3 vaccines, had significantly higher total mortality, 0.0111 versus 0.0080, respectively (P = 0.032). Higher income was associated with increasing total infection and mortality rates. Whereas, BCG vaccination was associated with a lower total mortality rate only (P = 0.030). The high-income countries were more likely to not receive universal BCG and receive second dose of meningococcal conjugate vaccine (MCV2) and third dose of PCV3 vaccination coverage. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates increased with increasing years of the second dose of measles-containing vaccine (P = 0.026) and pneumococcal conjugate third dose (PCV3).
Conclusions:
This study suggests that BCG vaccination could reduce the infection caused by COVID-19, and MCV2 vaccine years increases the total infection rate. This study identified high economic characteristics and not having universal BCG coverage as the independent risk factors of mortality by multivariate analysis.
One strategy for the containment of a pandemic is mass testing. Magen David Adom (MDA), the Israeli National Emergency Medical Services (EMS) Organization undertook this mission by operating a nationwide series of drive-through testing complexes. The objective of this study is to learn lessons from an analysis of these centers. Data from 198 stationary and mobile drive-through complexes from March 20, 2020, through October 17, 2020, were analyzed for temporal and geographic factors, and cost. Also, an operational improvement program was implemented and analyzed. A total of 931,074 patients were sampled in the MDA drive-through system: 46.9% in stationary complexes, and 53.1% in mobile complexes. The optimized cost per patient of home testing was estimated at 74.5 USD compared with 6.55 USD in the drive-through centers. An operational improvement program lowered the total sampling time from 128 s/patient to 98 s and decreased the total cost per patient from 6.55 USD to 6.27 USD. The EMS led drive-through complexes were cost-effective and efficient in performing large numbers of viral tests, especially when compared with home testing. Established concepts in clinical operations should be implemented to increase the number of persons that can be tested and decrease cost.
Due to the high incidence of COVID-19 case numbers internationally, the World Health Organization (WHO) declared a Public Health Emergency of global relevance, advising countries to follow protocols to combat pandemic advance through actions that can reduce spread and consequently avoid a collapse in the local health system. This study aimed to evaluate the dynamics of the evolution of new community cases, and mortality records of COVID-19 in the State of Pará, which has a subtropical climate with temperatures between 20 and 35 °C, after the implementation of social distancing by quarantine and adoption of lockdown. The follow-up was carried out by the daily data from the technical bulletins provided by the State of Pará Public Health Secretary (SESPA). On 18 March 2020, Pará notified the first case of COVID-19. After 7 weeks, the number of confirmed cases reached 4756 with 375 deaths. The results show it took 49 days for 81% of the 144 states municipalities, distributed over an area of approximately 1 248 000 km2 to register COVID-19 cases. Temperature variations between 24.5 and 33.1 °C did not promote the decline in the new infections curve. The association between social isolation, quarantine and lockdown as an action to contain the infection was effective in reducing the region's new cases registration of COVID-19 in the short-term. However, short periods of lockdown may have promoted the virus spread among peripheral municipalities of the capital, as well as to inland regions.
Our hospital is one of the tertiary care hospitals in Oman receiving coronavirus disease (COVID-19; C19) patients. To meet the expected surge of patients, a number of changes was made to the emergency department (ED), especially regarding capacity building and patient flow. At first, few changes were made to the main ED, which mainly includes the addition of a COVID suspect room with the use of a separate resuscitation area. The major drawback of the abovementioned system was the inability to see more than 2 patients simultaneously. A later separate COVID emergency department (CED) was used. In the CED, pending admissions was the major problem, as the C19 ward and C19 intensive care unit were becoming full; this problem was solved through central command help. In the normal ED, the main problem was the presentation of C19-positive patients sometimes hiding their symptoms and reaching inside the main ED, exposing the staff and patients. In order to combat this problem, all patients with an acute respiratory problem, even if C19 is not suspected, were taken to the corner cubicle. In this report, the changes made in the ED to combat C19 spread are discussed.
This study explores how social networks for coronavirus disease (COVID-19) are differentiated by regions.
Methods:
This study employs a social network analysis for Twitter in New York and California.
Results:
National key players play an important role in New York, whereas regional key players exert a significant impact on California. Some key players, such as the US President, play an essential role in both New York and California. Hispanic key players play a crucial role in California. Each group is more likely to show communication networks within groups in New York, whereas it is more apt to exhibit communication networks across groups in California. Government players play a different role in social networks according to regions.
Conclusions:
Governments should understand how social networks for COVID-19 are differentiated by regions to control the ongoing pandemic effectively.