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Patients with cardiovascular disease can achieve very low levels of low-density lipoprotein (LDL) cholesterol with evolocumab without worrying about cognitive impairment, according to a study published in NEJM Evidence.
Objectives
This study aimed to explore how emergency department (ED) organisations and clinicians adapted to altered prerequisites during the first wave of the COVID-19 pandemic, the processes involved and the consequences. In addition, we examined how the ordinary state affected resilient performance during this period.
Design
This qualitative study involved inductive thematic analysis of semi-structured interviews and narratives.
Setting
Three hospital-based EDs, one county and two rural hospitals, located in two Swedish regions were studied.
Participants
A total of 12 participants, 80% of whom were women, were recruited. The participants included two physicians, three registered nurses, three assistant nurses and four nursing managers working at the three EDs before and during the first pandemic wave.
Results
The overarching theme ‘anchored in the eye of the storm’ emerged. This theme suggests that resilient performance during the pandemic was facilitated by ordinary adaptive capacity in the ED. A thematic map and seven main themes with a total of 25 subthemes explain the process. The ordinary state of conditions in the ED was challenged with the emergence of the COVID-19 pandemic. Altered prerequisites were perceived partly as a new reality in addition to business as usual. The adaptations included organise to regain control and developing new strategies to manage the situation, mainly by initiatives among clinicians. The consequences included perceived strain and frustration and partially impacted quality of care. However, an increased sense of cohesion among clinicians and enhanced knowledge were also noted.
Conclusion
During the pandemic, a partially new reality was experienced, although work also continued largely as business as usual based on experiences of crowding, established preparedness plans and ordinary adaptive capacity. Despite dealing with a previously unknown patient group, the experience of working with critically ill patients and establishing structured work processes proved advantageous and facilitated resilient performance.
Background
Understanding the impact of COVID-19 on the unplanned patient flow within hospitals is crucial for future preparedness planning and response strategies. We examined the impact of COVID-19 on the unplanned patient flow in a Danish healthcare region, with particular focus on emergency departments (EDs).
Methods
A descriptive multicentre cohort study was conducted comparing unplanned patient contacts during the first year of the COVID-19 pandemic (1 March 2020–28 February 2021) with the previous year (1 March 2019–29 February 2020). The study examined changes in patient flow and key flow variables—number of contacts, length of stay (LOS), triage, re-contacts, mortality, International Classification of Diseases (ICD)-10 codes, isolations and SARS-CoV-2-positive patients—and compared differences between five EDs in the Central Denmark Region.
Results
The overall number of unplanned patient contacts decreased 3.6% from the previous period (257 657) to the COVID-19 period (248 706). The decrease was lowest in EDs compared with other departments and was primarily detected during lockdowns, which were followed by months of increased ED contacts.
Although overall patient contacts decreased, an increase in proportions was observed in contacts with a LOS
Objectives
To investigate the prevalence and factors of COVID-19 infection in children aged 0–6 years within Hunan Province following the deregulation of epidemic control.
Design
This is an observational study in epidemiology, using an on-site questionnaire survey to investigate the current status of COVID-19 infection and its influencing factors in children aged 0–6 years in Hunan Province from 16 February to 24 March 2023.
Setting
Multi-stage stratified sampling method was applied in this study. The regions were categorised as developed, medium and underdeveloped. One municipality was selected from each category. In each municipality, one district and one county were chosen for cluster sampling.
Participants
Children aged 0–6 years in Hunan Province.
Results
A total of 78 115 children aged 0–6 years were enrolled in this study, of 30 659 (39.2%) had a confirmed positive SARS-CoV-2 test result or related clinical symptoms. The majority of COVID-19 infections in children were of mild type (92.0%), and very few were severe and critical (0.4% and 0.1%). The majority (74.6%–88.7%) of children had minimal lifestyle behavioural changes after infected with COVID-19. Parents of the child working as a staff member (OR=0.654, 95% CI: 0.603, 0.709) and civil servant (OR=0.865, 95% CI: 0.794, 0.941), living in a rural area (OR=0.384, 95% CI: 0.369, 0.400) and no COVID-19 exposure (OR=0.108, 95% CI: 0.104, 0.113) were protective factors for COVID-19 infection in children.
Conclusion
Children experienced a large number of COVID-19 infections following the deregulation, fewer severe cases and fewer changes in lifestyle. Easing epidemic control measures in the later stage of the pandemic did not aggravate the consequences of the epidemic.
This cohort study assesses the severity and long-term mortality of COVID-19, influenza, and respiratory syncytial virus in a large cohort of nonhospitalized veterans.
To the Editor The claim in the study by Walker et al that vaccination may mitigate psychiatric implications of COVID-19 infection comprises 2 subclaims: (1) vaccination protects against COVID-19 infections/severe illness, and (2) COVID-19 infections/severe illness have psychiatric outcomes.
In Reply We agree with Ophir and Shir-Raz that our study did not directly assess protection by COVID-19 vaccination against severe COVID-19 infection. This was not our aim. Such protection is well established, as noted in our Introduction. We studied 3 cohorts: pre–vaccine availability, vaccinated, and unvaccinated (ie, people who had not been vaccinated 12 weeks after vaccine eligibility).
Studio di Università Milano-Bicocca e Brescia su 6.609 studenti
Objective
To explore the impact of South Africa’s COVID-19 hard lockdown on the provision of services to survivors of violence against women (VAW).
Design
We conducted a qualitative study using semistructured interviews. Data was analysed thematically. We conducted 18 semistructured interviews (10 face-to-face and 8 online or by phone) with service providers and key informants (KIs).
Setting
The study was conducted across healthcare facilities, social services, national helplines and shelters in Gauteng province, South Africa. Data was collected between September 2022 and October 2023.
Participants
The sample included 18 participants, purposively selected, comprising 13 frontline service providers (nurses, social workers and managers) and 5 KIs. Participants shared their experiences of delivering VAW services during the lockdown.
Results
The findings highlight five key themes affecting VAW service provision during COVID-19. (1) Confusion and uncertainty: initial uncertainty about whether VAW services were essential led to temporary closures and reduced availability. (2) Decreased demand for services: fear of mobility restrictions and reporting barriers reduced access, particularly in the first lockdown month. (3) Adaptations by providers: services shifted to remote counselling, while shelters paused new intakes. (4) Challenges in service provision: staff shortages, resource constraints (eg, personal protective equipment shortages) and disrupted referral systems hindered service delivery. (5) Emotional impact on frontline workers: health and helpline workers faced stress, fear of infection, social stigma and burnout, affecting their well-being and capacity to respond effectively.
Conclusions
The study highlights how South Africa’s COVID-19 hard lockdown disrupted essential VAW services, emphasising the need for resilient service delivery models during crises. Strengthening staffing, resources and improving referral pathways are critical for mitigating the emotional and operational challenges faced by service providers and for ensuring sustained support for survivors.
In Europa copertura all’11%, somministrati 15 milioni di vaccini
Computed tomographic angiography–guided management lowered incidence of myocardial infarction and death, but invasive angiography rates were similar.
Objectives
To explore the literature about the role of unpaid informal carers in medication management for people with long-term conditions.
Design
Systematic review designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Information source
MEDLINE (Ovid), Embase (Ovid), PsycINFO, Cumulated Index in Nursing and Allied Health Literature (EBSCO), Scopus and Web of Science were searched from inception until April 2024. Additional papers were identified by searching backwards and forwards the reference lists of included papers.
Eligibility criteria
Primary research studies were included if they reported medication-related activities undertaken by carers for people with long-term conditions. Qualitative and mixed methods studies were considered without restriction on language or country.
Data extraction and synthesis
Relevant data were extracted and summarised in a table. The Mixed Method Appraisal Tool was used for quality assessment. Data were narratively synthesised.
Results
From 12 473 identified records, 107 underwent full text screening and 20 studies were included. Family carers were the predominant type of carer. Spouses and adult children constituted the largest caregiving dyads. Based on the required skills, two groups of roles were identified: physical roles, such as prescription management, and cognitive roles, such as decision-making. Carers used different strategies and tools to undertake medication-related activities including compliance aids and alarms. However, carers reported challenges in their experiences of caregiving, flagging up their need for additional support and education to commence such activities.
Conclusion
Informal carers undertake a wide variety of medication-related activities. The studies emphasised the need to support families as partners in health outcomes. This systematic review identifies the importance of bridging the gap between carers and healthcare providers. More efforts are needed to empower carers towards better and safer caregiving. Future work could address how to optimise carer involvement and engagement and provide best practice recommendations for carers’ support.
PROSPERO registration number
CRD42024506694.
Background
During the COVID-19 pandemic, 40 mental health and well-being hubs were funded in England to support health and social care staff affected by the pandemic.
Aims
To describe the characteristics of staff accessing four hubs for support and identify characteristics associated with clinically significant mental health difficulties and work and social functioning.
Method
Routinely collected screening data were analysed from 1973 individuals across 4 hubs, including mental health, demographic and occupational data and pandemic-related stressors. Factors associated with clinically significant mental health difficulties were identified via logistic regression.
Results
Most hub clients identified as white women who worked for the UK National Health Service; other groups were less well represented. Hub clients reported high levels of clinically significant mental health difficulties: 60% had severe and often co-occurring difficulties (ie, depression, anxiety, post-traumatic stress disorder or alcohol use) and 80% reported significantly impaired functioning. Younger age, disability status, identifying as from a minority ethnic group, and sexual orientations excluding heterosexual were associated with higher likelihood of having clinically significant mental health difficulties. Suffering financial loss during the pandemic, and prepandemic emotional well-being concerns were the most consistent factors associated with higher difficulties.
Conclusions
The hubs supported health and social care staff with significant mental health difficulties. Outreach and engagement with under-represented groups should be undertaken to address potential barriers to service access. The findings add to the knowledge base on the support needs of the health and social care workforce and the planning of support in response to future crises.
To the Editor Myocarditis, pericarditis, and myopericarditis are inflammatory heart conditions recognized as adverse events linked to COVID-19 mRNA vaccines, but their population-level clinical outcomes remain underdocumented. In a recent JAMA article, Ms Semenzato and colleagues provided valuable insights by comparing different myocarditis etiologies; the exclusion of pericarditis is notable. Accurate identification of myocarditis is crucial for both diagnosis and management. Case definitions from the Centers for Disease Control and Prevention and the Brighton Collaboration offer structured criteria, especially for vaccine-related cases. In the study by Semenzato and colleagues, myocarditis occurring within 7 days of vaccination was classified as postvaccine myocarditis, while myocarditis occurring within 30 days of SARS-CoV-2 infection was labeled post–COVID-19 myocarditis. In contrast, the Brighton Collaboration’s definitions, widely used in Canada for evaluating myocarditis and pericarditis after vaccination, include graduated levels of diagnostic certainty (definite, probable, possible) and consider events occurring within 6 weeks of vaccination as likely vaccine-associated. The Centers for Disease Control and Prevention reports onset of myocarditis symptoms ranging from 0 to 40 days after vaccination. while data from the Vaccine Adverse Event Reporting System, one of the largest global systems for tracking vaccine-associated adverse events, suggest that onset of myocarditis and pericarditis can extend beyond 120 days after vaccination. The study’s 7-day window may underestimate vaccine-associated myocarditis.
In Reply We thank Drs Yang and Tebbutt for their critical analysis of our recent study on the long-term clinical outcomes of COVID-19 vaccine–related myocarditis.
Noting that approximately 30% of individuals hospitalized with COVID-19 experience acute kidney injury, a study published in JAMA Network Open suggests that effects on the organ could persist over time.
