Recent Submissions

  • Nutritional interventions in older people with COVID-19: an overview of the evidence

    Archer, Elizabeth (2021)
    Older people are a high-risk group for coronavirus disease 2019 (COVID-19) because of a range of factors, including age-related changes in anatomical pulmonary and muscle function, decreased immunity and increased inflammation. These factors partly explain why older people with COVID-19 experience more severe symptoms and higher mortality than younger adults and are more likely to require nutritional support. Furthermore, there is an association between suboptimal nutritional status and poorer recovery from COVID-19. Therefore, nutritional interventions are an important aspect of care for older people with COVID-19. All members of the multidisciplinary team, including dietitians and nurses, need to assess, treat and prevent nutritional deficiencies in older people with COVID-19. This literature review provides an overview of the evidence regarding the role of nutritional interventions in the treatment of, and recovery from, COVID-19 in older people.
  • Public adoption of and trust in the NHS COVID-19 contact tracing app in the United Kingdom: Quantitative online survey study

    Perez Vallejos, Elvira (2021)
    BACKGROUNDDigital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems.OBJECTIVEThe aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom.METHODSAn online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities).RESULTSA total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works.CONCLUSIONSWhile compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps.
  • Virtual balint group experience due to the COVID-19 pandemic

    Brown, Rebecca; Philips, NIcola (2021)
    Aims In the changes brought about by remote working, the local psychotherapy case discussion group (Balint Group) has developed as a remote service via video consultation. It is important to consider the effect that this change in method of delivery has had on experience. Method An anonymous survey was distributed to determine the benefits and challenges from participants and facilitators with at least a month of virtual Balint Group experience. The open-ended survey questions captured extended answer responses from 16 students and trainees, and 5 (co-)facilitators, within Nottinghamshire Healthcare NHS Foundation Trust. The qualitative feedback was analysed by thematic analysis, identifying three main themes. Result The first theme of practicalities was centred around access to the group. The virtual format had benefits in terms of reducing travel and time commitment and so improving attendance. However, disadvantages were in technological issues and finding a private and safe environment, individuals often not leaving the work environment on which they were reflecting. The second theme of communication identified how virtual methods are a less natural way of interacting (for example sequential point making), losing both immediacy of reactions and non-verbal communication. There was a loss of essential communication cues, with disjointed conversation affecting contribution. The third theme of group dynamics had some advantages, feeling less intimidating virtually. Yet disadvantages included loss of group cohesion, with participants not building the same relationships (on arriving and leaving a group space), and trust. The more subtle emotions in the group might be missed and opinions given less openly. The facilitators needed to be more directive and experienced difficulties maintaining group engagement and managing the frame. Conclusion The advantages of virtual format are more based on accessibility and the disadvantages more experiential. There are elements of being physically remote that lead to a disembodied experience, that might impact on capacity to reflect emotionally. This might make it more difficult to identify unconscious processes and the experience might be more cognitive. There is a risk that virtually participants will feel more alone with difficult feelings and unsupported by the group. When mental health is being affected by social isolation due to the pandemic, having groups virtually can mimic this isolation in working life. Overall the preference remained for an in-person group. However, it was clear that access to some form of a group was important, to contain anxiety during these unprecedented times.
  • Referrals to liaison services for older adults with deliberate self harm during the SARS-CoV-2 national lockdown - a collaborative service evaluation using liaison referral data

    Junaid, Kehinde; Deylami, Rogin; Sawle, Tristan (2021)
    Aims Social isolation and living alone have been associated with increased suicidality in older adults. During the SARS-CoV-2 pandemic, older adults were advised to keep isolated and maintain social distancing. Lockdown periods in England may have led to increased isolation and loneliness in older people, possibly resulting in an increased rates of DSH and suicide. This study aimed to explore whether numbers of older adults referred to liaison services with deliberate self harm changed during the SARS-CoV-2 pandemic. Method Reason for referral and total number of referrals to liaison services for older adults data were collected across 6 mental health trusts who had access to robust data sets. Data were collected prospectively for three months from the start of the UK national lockdown and for the corresponding 3 month period in 2019, via trust reporting systems. This study was registered as service evaluation within each of the participating mental health trusts. Result Overall numbers of referrals to older adult liaison services went down, but the proportion of referrals for older adults with DSH increased. Across the six mental health trusts there there were a total of 2167 referrals over the first three month lockdown period in 2020, and 170 (7.84%) of these referrals were for deliberate self harm. During a corresponding time period in 2019, there were a total of 3416 referrals and 155 (4.54%) of these referrals were for deliberate self harm Conclusion Although numbers of referrals for older adults with delberate self harm appeared to stay the same, the severity of these presentations is not clear. Outcomes of referrals and severity of self harm could be explored by examining individual case records. As there have been subsequent lockdowns the data collection period should also be extended to include these. Triangulation with national and local datasets on completed suicide is planned.
  • The COVID-19 pandemic altered the modality, but not the frequency, of formal cognitive assessment

    Kontou, Eirini (2021)
    Purpose We investigated the impacts of the COVID-19 pandemic on the modality of formal cognitive assessments (in-person versus remote assessments). Materials and methods We created a web-based survey with 34 items and collected data from 114 respondents from a range of health care professions and settings. We established the proportion of cognitive assessments which were face-to-face or via video or telephone conferencing, both pre- and post-March 2020. Further, we asked respondents about the assessment tools used and perceived barriers, challenges, and facilitators for the remote assessment of cognition. In addition, we asked questions specifically about the use of the Oxford Cognitive Screen. Results We found that the frequency of assessing cognition was stable compared to pre-pandemic levels. Use of telephone and video conferencing cognitive assessments increased by 10% and 18% respectively. Remote assessment increased accessibility to participants and safety but made observing the subtleties of behaviour during test administration difficult. The respondents called for an increase in the availability of standardised, validated, and normed assessments. Conclusions We conclude that the pandemic has not been detrimental to the frequency of cognitive assessments. In addition, a shift in clinical practice to include remote cognitive assessments is clear and wider availability of validated and standardised remote assessments is necessary.
  • Audit on structure of assessment for remote consultation during COVID-19 pandemic

    Das, Astha; Kuklewicz, Margaret (2021)
    Aims According to the Royal College of Psychiatry, GMC guidelines and NHS England, it is necessary to consider remote consultation to enable service delivery to those requiring shielding or facing additional health risk, and to avoid transition of infection. To audit whether the standards of Mobile and Remote access work are met. To audit whether the standards of Consent to Examination and Treatment are met. To also evaluate whether the remote consultation due to the COVID-19 pandemic is being explicitly documented or not. To suggest to the policy makers the need to establish some standards of practice concerning remote consultation and consent in the COVID-19 pandemic Method Inclusion criteria – sample of service users who had remote consultation in April, May, and mid-June 2020 by doctors of MHSOP community mental health team at Bassetlaw Hospital. Data collection: Retrospective. Data source(s) used: Patient/Client medical/care records Anticipated benefits of this audit: Due to the nature of current COVID-19 pandemic situation, it is essential to minimise contacts with vulnerable groups to prevent transmission of infection. It is anticipated that the number of remote consultations will grow in the forthcoming months. This audit creates an opportunity to develop a new policy and improve the quality of remote consultations documentation. Result Documentation for remote consultation was done in 81% of case notes whereas documentation of consent obtained was present in 57% of patients’ electronic notes. 90% of entries had documentation of ‘addressed concerns’. Around 50-70% of patients’ documents showed good record keeping on domains of ‘ability to maintain effective communication’, ‘mental state examination’, ‘risk assessment’ and ‘ability to understand medication plus side effects’. About 40% of documentation met standards for good record keeping on ‘management plan’, ‘concerns raised’, ‘chance given to ask about management plan’. Conclusion Most of the standards of good consultations are being met despite the change in the type of Consultation due to COVID-19. However, there are identified areas for improvement which could be focused on. For example, documentation can be clearer when consent is gained for remote consultation. It should not be presumed that, as patients are booked in a certain type of clinic, they have been properly consented beforehand. Key Success: Almost in all domains 40% have met the standards Key Concerns: There are areas where a lot of evidence is partially documented. The above results can be explained as a consequence of a sudden change in the normal working pattern in a community-based setting, having minimal protocols and procedures on standards of working in the situation of COVID19 remote consultation. Following this audit, we aim to increase the amount of information recorded during remote consultation. The plan is to develop a template that would cover the requirements for a remote consultation recommended by national guidelines The proposal of a letter template following a remote consultation will be disseminated to the MHSOP CMHT teams for any suggestions/approval.
  • Ethnic differences in SARS-CoV-2 vaccine hesitancy in United Kingdom healthcare workers: Results from the UK-REACH prospective nationwide cohort study

    Simpson, Sandra (2021)
    Background: In most countries, healthcare workers (HCWs) represent a priority group for vaccination against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) due to their elevated risk of COVID-19 and potential contribution to nosocomial SARS-CoV-2 transmission. Concerns have been raised that HCWs from ethnic minority groups are more likely to be vaccine hesitant (defined by the World Health Organisation as refusing or delaying a vaccination) than those of White ethnicity, but there are limited data on SARS-CoV-2 vaccine hesitancy and its predictors in UK HCWs. Methods: Nationwide prospective cohort study and qualitative study in a multi-ethnic cohort of clinical and non-clinical UK HCWs. We analysed ethnic differences in SARS-CoV-2 vaccine hesitancy adjusting for demographics, vaccine trust, and perceived risk of COVID-19. We explored reasons for hesitancy in qualitative data using a framework analysis. Findings: 11,584 HCWs were included in the cohort analysis. 23% (2704) reported vaccine hesitancy. Compared to White British HCWs (21.3% hesitant), HCWs from Black Caribbean (54.2%), Mixed White and Black Caribbean (38.1%), Black African (34.4%), Chinese (33.1%), Pakistani (30.4%), and White Other (28.7%) ethnic groups were significantly more likely to be hesitant. In adjusted analysis, Black Caribbean (aOR 3.37, 95% CI 2.11 - 5.37), Black African (aOR 2.05, 95% CI 1.49 - 2.82), White Other ethnic groups (aOR 1.48, 95% CI 1.19 - 1.84) were significantly more likely to be hesitant. Other independent predictors of hesitancy were younger age, female sex, higher score on a COVID-19 conspiracy beliefs scale, lower trust in employer, lack of influenza vaccine uptake in the previous season, previous COVID-19, and pregnancy. Qualitative data from 99 participants identified the following contributors to hesitancy: lack of trust in government and employers, safety concerns due to the speed of vaccine development, lack of ethnic diversity in vaccine studies, and confusing and conflicting information. Participants felt uptake in ethnic minority communities might be improved through inclusive communication, involving HCWs in the vaccine rollout, and promoting vaccination through trusted networks. Interpretation: Despite increased risk of COVID-19, HCWs from some ethnic minority groups are more likely to be vaccine hesitant than their White British colleagues. Strategies to build trust and dispel myths surrounding the COVID-19 vaccine in these communities are urgently required. Emphasis should be placed on the safety and benefit of SARS-CoV-2 vaccination in pregnancy and in those with previous COVID-19. Public health communications should be inclusive, non-stigmatising and utilise trusted networks.
  • Race, ethnicity and COVID-19 vaccination: a qualitative study of UK healthcare staff

    Clifford, Naomi (2021)
    OBJECTIVE: COVID-19-related inequities experienced by racial and ethnic minority groups including healthcare professionals mirror wider health inequities, which risk being perpetuated by lower uptake of vaccination. We aim to better understand lower uptake among racial and ethnic minority staff groups to inform initiatives to enhance uptake. DESIGN: Twenty-five semi-structured interviews were conducted (October 2020-January 2021) with UK-based healthcare staff. Data were inductively and thematically analysed. RESULT(S): Vaccine decision-making processes were underpinned by an overarching theme, 'weighing up risks of harm against potential benefits to self and others'. Sub-themes included 'fear of harm', 'moral/ethical objections', 'potential benefits to self and others', 'information and misinformation', and 'institutional or workplace pressure'. We identified ways in which these were weighted more heavily towards vaccine hesitancy for racial and ethnic minority staff groups influenced by perceptions about institutional and structural discrimination. This included suspicions and fear around institutional pressure to be vaccinated, racial injustices in vaccine development and testing, religious or ethical concerns, and legitimacy and accessibility of vaccine messaging and communication. CONCLUSION(S): Drawing on a critical race perspective, we conclude that acknowledging historical and contemporary abuses of power is essential to avoid perpetuating and aggravating mistrust by de-contextualising hesitancy from the social processes affecting hesitancy, undermining efforts to increase vaccine uptake.
  • How Brazilian therapeutic communities are facing COVID-19?

    MacDonald-Winship, Lewis (2021)
    Purpose: This paper aims to reflect upon the findings of a fast-track study carried out in April 2020, by the Brazilian Federation of Therapeutic Communities, focused on the impact of the first measures taken by the Brazilian therapeutic communities (TCs) in response to COVID-19. Design/methodology/approach: An electronic survey was disseminated to TCs in the different regions of Brazil through online platforms. A total of 144 TCs responses were used in the final analysis. The survey collected the following information: suspected and confirmed cases of COVID-19 (only one case of COVID-19 was confirmed), changes in treatment protocols, the impact in admissions and daily activities and the safety measures adopted to stop or reduce the transmission between residents, families and staff. Findings: The survey successfully collected general data regarding interruptions (82.6% of TCs interrupted admissions, 100% of TCs interrupted volunteer’s activities, 94% of TCs interrupted family visits and 93% of TCs interrupted external activities). Research limitations/implications: The caveat of this study is the fact that there were tight deadlines for the TCs to generate their responses and the limited availability of staff to answer long surveys. Because of this, the study could not explore other important qualitative data. The results were shared in Brazil and Latin America with the staff of TCs, the national Federations of Therapeutic Communities and government agencies linked with them, in all Latin America. Originality/value: This research aims to contribute to the adoption of developed prophylaxis and prevention protocols in response to COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: journal abstract)
  • Experiences and emotional strain of NHS frontline workers during the peak of the COVID19 pandemic

    Newman, Kristina L.; Majumder, Pallab (2021)
    Background: The mental health of the population has been negatively affected due to the pandemic. Frontline healthcare workers with increased exposure to COVID diagnosis, treatment and care were especially likely to report psychological burden, fear, anxiety and depression. Aim: To elicit how working as a health professional during the pandemic is impacting on the psychological wellbeing of frontline staff. Method: United Kingdom population of healthcare workers were approached by advertising the survey via social media, NHS trusts and other organisations. Open-ended survey answers were qualitatively explored using content analysis. Results: Survey collected data from 395 NHS staff was developed into three themes; (1) Despair and uncertainty: feeling overwhelmed trying to protect everyone, (2) Behavioural and psychological impact: affecting wellbeing and functioning and (3) Coping and employer support: getting the right help. Conclusion: NHS staff felt enormous burden to adequately complete their professional, personal and civil responsibility to keep everyone safe leading to negative psychological and behavioural consequences and desire for NHS employers to offer better support. As the pandemic progresses, the results of this study may inform NHS employers on how optimum support can be offered to help them cope with negative psychological consequences of the pandemic.
  • Cabin fever: Surviving lockdown in the coronavirus pandemic

    Crawford, Paul (2021)
    This short book discusses the origins, definitions, social and cross-cultural history of the popularly framed condition of cabin fever in relation to what became the greatest confinement in history resulting from the coronavirus pandemic in 2020 (henceforth simply referred to as 'the pandemic') as governments imposed lockdown measures—e.g. quarantines, stay-at-home orders, shelter-in-place orders, shutdowns and curfews—to slow the spread of the virus. Indeed, it is estimated that around 4.2 billion, 54% of the global population, were subject to complete or partial lockdowns at the height of the pandemic (IEA, 2020). The book also examines creative individual and community responses to mass enforced isolation in its various forms. In the former, engagement and relationships may be limited, or at best, achieved only in virtual contexts such as through social media. For groups or communities, direct, physical connection presents a different challenge, not least achieving distance from others or wanting a break from them. The book examines the origins and definitions of cabin fever and related folk terminology or idioms. It explores the social and cross-cultural history of this phenomenon in relation to life at close quarters at sea, on land, in the air and in space. The book reviews the different antidotes to cabin fever, not least how isolation at home can provoke creative activities that mitigate and reduce its negative impacts. Whether one frames the greatest confinement in history as a kind of hibernation, suspended animation or perhaps more starkly as the kind of prolonged isolation found in penal systems there are aspects to the 'new normal' that defy passive suffering, trauma or irresolution. What has been particularly striking is the agency, ingenuity and creativity of individuals and communities while indoors. (PsycInfo Database Record (c) 2021 APA, all rights reserved) (Source: chapter)
  • Voices from the frontline: the psychological impact and coping mechanisms used by healthcare staff during COVID-19

    Majumder, Pallab; Sales, Christian P. (2021)
    Background/Aims Healthcare workers have been affected by the physical and psychological consequences of working during the COVID-19 pandemic. This study explored the effects of the pandemic on the psychological wellbeing of UK healthcare workers, as well as the coping mechanisms used and the workplace support that they found helpful. Methods A self-administered questionnaire was distributed to healthcare workers across various settings, including primary care, community services, hospital settings and specialist or tertiary service settings. A convenience sample was used to select the participants. The responses were collected for 1 month at the height of the first wave of COVID-19 in the UK (10 April 2020-10 May 2020). Results were collated and analysed using the Statistical Package for the Social Sciences software. Results Responses to the questionnaire showed the negative emotional, behavioural and cognitive impact of the pandemic on staff, with many experiencing issues such as anxiety, anger, disrupted sleep and worries about contracting the virus. A concerning number also reported symptoms of severe psychological distress, including depersonalisation, derealisation, self-harm and suicidal thoughts. Practical coping mechanisms were generally preferred. Older, male staff were significantly less likely to reach out for support than their younger and female counterparts. Respondents also expressed a preference for practical support from their employer, such as more managerial support at work, time off and financial incentives.
  • Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population

    Gibbon, Simon D.; McPhail, Emma; Mills, Georgina; McBride, Martin; Storer, Rebekah; Taylor, Nicholas; McCarthy, Lucy (2021)
    Patients in medium secure hospitals may be at particularly increased risk of coronavirus disease 2019 (COVID-19) infection and complications. We undertook a service evaluation involving all current in-patients within a single, English medium secure hospital to describe the uptake of the COVID-19 vaccine among this population. Data regarding capacity to consent to the vaccine, acceptance/refusal of this (and reasons for refusal) and demographics was retrospectively collected from the patients' clinical records and analysed. In total, 85 patients (92.4% of eligible patients) had capacity to decide if they wanted the COVID-19 vaccine. Of these 68 (80.0%) consented and 17 (20.0%) declined to consent. A similar proportion of patients aged under and over 40 years old consented to have the vaccine. Those from a Black Asian minority ethnic background were more likely to decline the vaccine than White British patients. The reasons for capacitous refusal appeared similar to those seen in the general population.
  • Psychosocial impact of the COVID-19 pandemic on 4378 UK healthcare workers and ancillary staff: initial baseline data from a cohort study collected during the first wave of the pandemic

    French, Veronica (2021)
    OBJECTIVES: This study reports preliminary findings on the prevalence of, and factors associated with, mental health and well-being outcomes of healthcare workers during the early months (April-June) of the COVID-19 pandemic in the UK. METHODS: Preliminary cross-sectional data were analysed from a cohort study (n=4378). Clinical and non-clinical staff of three London-based NHS Trusts, including acute and mental health Trusts, took part in an online baseline survey. The primary outcome measure used is the presence of probable common mental disorders (CMDs), measured by the General Health Questionnaire. Secondary outcomes are probable anxiety (seven-item Generalised Anxiety Disorder), depression (nine-item Patient Health Questionnaire), post-traumatic stress disorder (PTSD) (six-item Post-Traumatic Stress Disorder checklist), suicidal ideation (Clinical Interview Schedule) and alcohol use (Alcohol Use Disorder Identification Test). Moral injury is measured using the Moray Injury Event Scale. RESULTS: Analyses showed substantial levels of probable CMDs (58.9%, 95% CI 58.1 to 60.8) and of PTSD (30.2%, 95% CI 28.1 to 32.5) with lower levels of depression (27.3%, 95% CI 25.3 to 29.4), anxiety (23.2%, 95% CI 21.3 to 25.3) and alcohol misuse (10.5%, 95% CI 9.2 to 11.9). Women, younger staff and nurses tended to have poorer outcomes than other staff, except for alcohol misuse. Higher reported exposure to moral injury (distress resulting from violation of one's moral code) was strongly associated with increased levels of probable CMDs, anxiety, depression, PTSD symptoms and alcohol misuse. CONCLUSIONS: Our findings suggest that mental health support for healthcare workers should consider those demographics and occupations at highest risk. Rigorous longitudinal data are needed in order to respond to the potential long-term mental health impacts of the pandemic.
  • Psychological factors underlying adherence to COVID-19 regulations: A commentary on how to promote compliance through mass media and limit the risk of a second wave

    Bellato, Alessio (2020)
    Considering the possibility of a second wave of the COVID-19 pandemic, this brief commentary is intended to share some suggestions on how to phrase public health advice about maintaining social distancing, using face masks in public spaces and adhering to personal hygiene measures. The discussion will be focused on three factors: empathy, positive mood and social influence. The commentary concludes with a series of brief suggestions aimed at policy makers and stakeholders involved in promoting adherence to regulations to avoid a second wave of the pandemic through mass media communications.
  • Mental health of people with multiple sclerosis during the COVID-19 outbreak: A prospective cohort and cross-sectional case-control study of the UK MS Register

    Morriss, Richard K.; das Nair, Roshan
    Background: People with MS (pwMS) have had higher rates of anxiety and depression than the general population before the COVID-19 pandemic, placing them at higher risk of experiencing poor psychological wellbeing during the pandemic. Objective: To assess mental health and its social/lifestyle determinants in pwMS during the first wave of the outbreak in the United Kingdom. Methods: This is a community-based, prospective longitudinal cohort and cross-sectional case–control online questionnaire study. It includes 2010 pwMS from the UK MS Register and 380 people without MS. Results: The Hospital Anxiety and Depression Scale scores of pwMS for anxiety and depression during the outbreak did not change from the previous year. PwMS were more likely to have anxiety (using General Anxiety Disorder-7) and/or depression (using Patient Health Questionnaire-9) than controls during the outbreak (OR: 2.14, 95% CI: 1.58–2.91). PwMS felt lonelier (OR: 1.37, 95% CI: 1.04–1.80) reported worse social support (OR: 1.90, 95% CI: 1.18–3.07) and reported worsened exercise habits (OR: 1.65, 95% CI: 1.18–2.32) during the outbreak than controls. Conclusion: Early in the pandemic, pwMS remained at higher risk of experiencing anxiety and depression than the general population. It is important that multidisciplinary teams improve their support for the wellbeing of pwMS, who are vulnerable to the negative effects of the pandemic on their lifestyle and social support.
  • COVID-19 is associated with new symptoms of multiple sclerosis that are prevented by disease modifying therapies

    das Nair, Roshan (2021)
    Background: Infections can trigger exacerbations of multiple sclerosis (MS). The effects of the coronavirus disease 2019 (COVID-19) on MS are not known. The aim of this study was to understand the impact of COVID-19 on new and pre-existing symptoms of MS. Method(s): The COVID-19 and MS study is an ongoing community-based, prospective cohort study conducted as part of the United Kingdom MS Register. People with MS and COVID-19 were invited by email to complete a questionnaire about their MS symptoms during the infection. An MS exacerbation was defined as developing new MS symptoms and/or worsening of pre-existing MS symptoms. Result(s): Fifty-seven percent (230/404) of participants had an MS exacerbation during their infection; 82 developed new MS symptoms, 207 experienced worsened pre-existing MS symptoms, and 59 reported both. Disease modifying therapies (DMTs) reduced the likelihood of developing new MS symptoms during the infection (OR 0.556, 95%CI 0.316-0.978). Participants with a higher pre-COVID-19 webEDSS (web-based Expanded Disability Status Scale) score (OR 1.251, 95%CI 1.060-1.478) and longer MS duration (OR 1.042, 95%CI 1.009-1.076) were more likely to experience worsening of their pre-existing MS symptoms during the infection. Conclusion(s): COVID-19 infection was associated with exacerbation of MS. DMTs reduced the chance of developing new MS symptoms during the infection. Copyright © 2021 IS - 2211-0348 EN - 2211-0356 DO -
  • Changes in daily mental health service use and mortality at the commencement and lifting of COVID-19 'lockdown' policy in 10 UK sites: A regression discontinuity in time design

    Nixon, Neil L. (2021)
    Objectives To investigate changes in daily mental health (MH) service use and mortality in response to the introduction and the lifting of the COVID-19 'lockdown' policy in Spring 2020. Design A regression discontinuity in time (RDiT) analysis of daily service-level activity. Setting and participants Mental healthcare data were extracted from 10 UK providers. Outcome measures Daily (weekly for one site) deaths from all causes, referrals and discharges, inpatient care (admissions, discharges, caseloads) and community services (face-to-face (f2f)/non-f2f contacts, caseloads): Adult, older adult and child/adolescent mental health; early intervention in psychosis; home treatment teams and liaison/Accident and Emergency (AE). Data were extracted from 1 Jan 2019 to 31 May 2020 for all sites, supplemented to 31 July 2020 for four sites. Changes around the commencement and lifting of COVID-19 'lockdown' policy (23 March and 10 May, respectively) were estimated using a RDiT design with a difference-in-difference approach generating incidence rate ratios (IRRs), meta-analysed across sites. Results Pooled estimates for the lockdown transition showed increased daily deaths (IRR 2.31, 95% CI 1.86 to 2.87), reduced referrals (IRR 0.62, 95% CI 0.55 to 0.70) and reduced inpatient admissions (IRR 0.75, 95% CI 0.67 to 0.83) and caseloads (IRR 0.85, 95% CI 0.79 to 0.91) compared with the pre lockdown period. All community services saw shifts from f2f to non-f2f contacts, but varied in caseload changes. Lift of lockdown was associated with reduced deaths (IRR 0.42, 95% CI 0.27 to 0.66), increased referrals (IRR 1.36, 95% CI 1.15 to 1.60) and increased inpatient admissions (IRR 1.21, 95% CI 1.04 to 1.42) and caseloads (IRR 1.06, 95% CI 1.00 to 1.12) compared with the lockdown period. Site-wide activity, inpatient care and community services did not return to pre lockdown levels after lift of lockdown, while number of deaths did. Between-site heterogeneity most often indicated variation in size rather than direction of effect. Conclusions MH service delivery underwent sizeable changes during the first national lockdown, with as-yet unknown and unevaluated consequences. Copyright © 2021 BMJ Publishing Group. All rights reserved.
  • Challenges of developing, conducting, analysing and reporting a COVID-19 study as the COVID-19 pandemic unfolds: An online co-autoethnographic study

    das Nair, Roshan
    To capture the complexities and unique experience of a newly formed multidisciplinary and multicentre research team developing and deploying a COVID-19 study and to identify lessons learnt. Co-autoethnographic study. Staff at two UK academic institutions, a national charity and two major UK hospitals. Researchers, clinicians, academics, statisticians and analysts, patient and public involvement representatives and national charity. The sampling frame was any content discussed or shared between research team members (emails, meeting minutes, etc), standard observational dimensions and reflective interviews with team members. Data were thematically analysed. Data from 34 meetings and >50 emails between 17 March and 5 August 2020 were analysed. The analysis yielded seven themes with 'Managing our stress' as an overarching theme. Mutual respect, flexibility and genuine belief that team members are doing the best they can under the circumstances are essential for completing a time-consuming study, requiring a rapid response during a pandemic. Acknowledging and managing stress and a shared purpose can moderate many barriers, such as the lack of face-to-face interactions, leading to effective team working. Copyright © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
  • Digital approaches to music-making for people with dementia in response to the COVID-19 pandemic: Current practice and recommendations

    Dowson, Becky; Schneider, Justine (2021)
    Before COVID-19, dementia singing groups and choirs flourished, providing activity, cognitive stimulation, and social support for thousands of people with dementia in the UK. Interactive music provides one of the most effective psychosocial interventions for people with dementia; it can allay agitation and promote wellbeing. Since COVID-19 has halted the delivery of in-person musical activities, it is important for the welfare of people with dementia and their carers to investigate what alternatives to live music making exist, how these alternatives are delivered and how their accessibility can be expanded. This community case study examines recent practice in online music-making in response to COVID-19 restrictions for people with dementia and their supporters, focusing on a UK context. It documents current opportunities for digital music making, and assesses the barriers and facilitators to their delivery and accessibility. Online searches of video streaming sites and social media documented what music activities were available. Expert practitioners and providers collaborated on this study and supplied input about the sessions they had been delivering, the technological challenges and solutions they had found, and the responses of the participants. Recommendations for best practice were developed and refined in consultation with these collaborators. Over 50 examples of online music activities were identified. In addition to the challenges of digital inclusion and accessibility for some older people, delivering live music online has unique challenges due to audio latency and sound quality. It is necessary to adapt the session to the technology's limitations rather than expect to overcome these challenges. The recommendations highlight the importance of accessibility, digital safety and wellbeing of participants. They also suggest ways to optimize the quality of their musical experience. The pandemic has prompted innovative approaches to deliver activities and interventions in a digital format, and people with dementia and their carers have adapted rapidly. While online music is meeting a clear current need for social connection and cognitive stimulation, it also offers some advantages which remain relevant after COVID-19 restrictions are relaxed. The recommendations of this study are intended to be useful to musicians, dementia care practitioners, and researchers during the pandemic and beyond.

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