bluuebunny/crossref_metadata_2025 huggingface dataset:
Women and migration
Authors: Shanbhag Vandita , Bojappa Madhura , Chandra Prabha S.
Published: February 2021

Migration affects women and men differently. A discrepancy between gender roles and expectations influence the challenges and coping in immigrants. In this chapter, the importance of understanding migration in a gender-sensitive manner is discussed. Women are likely to have higher rates of psychiatric disorders due to risk factors such as unfavourable socio-economic status, stigma, role burden, and adversities faced during migration. The chapter highlights the protective and risk factors for developing mental health problems in women migrants. Mental health problems in various migrants, such as international, internal, asylum seekers, and vulnerable groups of women such as women in the perinatal period, adolescents and young girls, and elderly women, are discussed. The need to initiate preventive measures before the process of migration and in addition to early detection and intervention for mental health problems by sensitive healthcare providers is emphasized.
Mental health of refugees in primary care
Authors: Hauff Edvard , Brunvatne Reidun
Published: February 2021

Primary health care is usually the first level of formal health services that refugees meet in the country of resettlement. Providing culture-sensitive, accessible, and equitable services is a major challenge in high-income countries but even more so in middle- and low-income countries, where there are fewer resources. Presenting complaints are often multiple and complex. Early screening for mental health problems is controversial, and the priority is to establish a good working alliance and trust at an early stage. Vulnerable patients who may have limited or no social support or social capital due to split families; women and children exposed to sexual violence or trafficking; and torture survivors need special care and attention. Healthcare services are often fragmented making it difficult for people to traverse these services. Furthermore, there is a general need for competency building. The organization of primary mental health care for refugees in Norway is described as an example and a lesson for other countries who are facing similar problems.
Resettlement stressors and family factors in refugee child and adolescent psychopathology
Authors: Hodes Matthew , Koposov Roman A. , Skokauskas Norbert
Published: February 2021

This chapter outlines some of the main stress and protective factors for the mental health of young refugees in resettlement countries. On arrival in resettlement countries the reception for asylum seekers and refugees varies. Some, especially those in sponsored programmes, many receive high support, but many experience hostility, financial hardship, and legal uncertainties. The family may be a buffer to these adversities, but parental psychopathology and strained family relationships may contribute to childhood psychological distress and psychiatric disorder. Unaccompanied refugee minors have experienced higher levels of pre-migration adversities and losses than their accompanied peers, and so are particularly vulnerable. They are less distressed, with higher levels of support, but this may not be offered if their age is disputed. They may experience ongoing daily hassles and acculturative stress. While refugee youngsters have an elevated prevalence of psychiatric disorders especially post-traumatic stress disorder after arrival, over time most achieve improved mental health.
Identifying service needs
Authors: Schouler-Ocak Meryam
Published: February 2021

Millions of migrants, refugees, and asylum seekers live somewhere other than in their regions of origin. More than 244 million people are estimated to be immigrants globally. Worldwide, healthcare systems have to be prepared for this very heterogeneous population, with their different biographies, stress, and resilience factors. Both concepts of health and disease and expectations about treatment depend on cultural background, traditional values, personal experiences, and social worlds, all of which are in a constant state of flux. Barriers to access mental health care must be overcome. To be able to cope with mental health needs among diverse multicultural populations health professionals and service providers need sufficient knowledge and competencies. In this chapter, barriers to access mental health services and the needs of health professionals and mental health services will be identified and discussed.
Dynamics of international medical graduates’ migration
Authors: Rao Nyapati , Ahmed Saeed , Bhugra Dinesh
Published: February 2021

International medical graduates (IMGs) provide an invaluable service in many high-income countries. Their migration patterns vary and the post-migration adjustments need to be understood to ensure that they remain well and are looked after. They hail from a variety of medical schools and with varying linguistic skills. Their religious backgrounds vary, as do reasons for migration and personal responses to changes in working in different healthcare systems. With many students from high-income countries going into low-income countries to do their medical training, the processes of adjustment can bring certain challenges. The waves of IMGs have changed from Europe to Hispanic to South Asian IMGs. The training needs of IMGs include an understanding of the healthcare system, as well as picking up evidence-based care. Language barriers and social isolation, especially for those who did not speak English as their first language or are working in remote areas can create problems in functioning well.
Supervising a CPET
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes the basic competencies required to safely conduct a cardiopulmonary exercise test (CPET). These include basic life support, electrocardiogram interpretation, and understanding of the normal blood pressure (BP) response to exercise. The ability to detect when a patient is becoming unwell during a CPET is developed by supervising a large number of tests. A CPET should be terminated if the BP rises excessively, but a fall in BP during exercise is also a worrying sign. The development of a dysrhythmia is almost always an indication to stop the test. Monitoring should be continued for several minutes after the cessation of exercise. The referring clinician will gain more information from a CPET if they attend the test.
Respiratory exchange ratio
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes how the respiratory exchange ratio (RER) is calculated by dividing carbon dioxide output (VCO2) by the oxygen uptake (VO2). At the start of a cardiopulmonary exercise test (CPET), this ratio is less than 1.0. Once anaerobic metabolism starts to kick in, more carbon dioxide is produced from buffering of lactic acid and the RER starts to climb. At peak exercise, RER values of 1.4 or higher indicate that the subject’s effort is pretty maximal. An erratic RER trace is seen in dysfunctional breathing, when psychological, rather than physiological, processes are involved in controlling breathing.
Respiratory compensation point
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes how acidaemia stimulates ventilation in the later stages of a cardiopulmonary exercise test (CPET). This happens after the anaerobic threshold, once the capacity of the blood to buffer lactic acid has been used up. The respiratory compensation point (RCP) can be identified from an increase in the slope when minute ventilation (VE) is plotted against carbon dioxide output (VCO2), or from a rise in the ventilatory equivalents for carbon dioxide (VeqCO2). The presence of a clear RCP indicates that the subject has made a fairly maximal effort during the CPET. An RCP also argues against significant lung disease, since it implies the ability to increase ventilation in response to acidaemia.
Interpretative strategy
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter outlines the approach to producing a cardiopulmonary exercise test (CPET) report. A CPET is rarely diagnostic and should be looked at in the context of the clinical background and what key question is being asked. Cardiovascular, ventilatory, and gas exchange responses are looked at in turn, then reviewed in a systematic and iterative way. If the maximum oxygen uptake (VO2max) is within the normal range, abnormalities seen in other parameters should be interpreted cautiously.
Clinical scenarios
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes the typical pattern of abnormality seen on a cardiopulmonary exercise test (CPET) in different clinical conditions. The difficulty of differentiating deconditioning from mild disease is discussed. The effects of obesity and anaemia on CPET results are described. Classical patterns are recognized for conditions affecting the lungs, heart, pulmonary vasculature, peripheral vasculature, and muscles. Few subjects display all the classical features.
Christianity and suicide
Authors: Ekeberg Øivind , Retterstøl Nils
Published: February 2021

First, the views on suicide as found in the Old and New Testament are presented. In the early Christian period, suicide does not seem to be prohibited. St Augustine (350–430 AD), however, considered it a sin, violating the fifth commandment, ‘Thou shall not kill’. Later, synods of the church gave strong regulation as to how the suicidee should be buried. The same negative attitudes were expressed throughout most of the Middle Ages across Europe. The European Enlightenment movement brought about moderated views on suicide, challenging former Christian condemnations. From about 1800, psychiatry was established, stating that most people who committed suicide were mentally ill. Contemporary official Christian attitudes are presented with special reference to the Roman, Greek, and Russian Orthodox Church, as well as the Protestant Church. The viewpoints on euthanasia are presented briefly. Finally, we discuss how Christian traditions influence suicide prevention today.
International perspectives on non-suicidal self-injury (NSSI)
Authors: Brunner Romuald , Mikan Kathrin , Niebler Maximilian , Kandsperger Stephanie
Published: February 2021

Non-suicidal self-injury (NSSI) is a clinically relevant symptom with high prevalence in teenagers and young adults worldwide. NSSI is associated with a variety of psychiatric disorders, is known to cause serious harm and acts as predictive factor for suicidal ideation and suicide attempts. Social and biological risk factors play an important role in the onset and maintenance of NSSI. Various terms are used in the world-literature for the study of self-injurious behaviour (SIB). These inconsistencies have to be taken into account in the assessment of recent and current international data. Along with further clarifying the different terms of SIBs, there is yet an urgent need to further examine contributing neurobiological factors, develop innovative international valid methods of risk-assessments, and to develop new evidence-based treatment approaches, as well as prevention strategies that consider neurobiological findings.
Biological theories of suicidal behaviour
Authors: Turecki Gustavo
Published: February 2021

The biological underpinnings of suicide and suicidal behaviours are incompletely understood. Many models have been proposed to describe suicide risk, and although each contributes a different level of understanding, they converge on the existence of heterogeneous contributors to suicide risk and the role of both distal factors and proximal factors. Over the last few decades, a wealth of information has been produced to better explain the relationships between psychopathology and suicide, and the changes observed in distinct biological systems. In this chapter, we review the key avenues of biological research into suicide and suicidal behaviour, highlighting some of the theoretical and methodological challenges involved, and some of the exciting avenues of future research.
Suicide during transition in the former Soviet Republics
Authors: Värnik Airi , Värnik Peeter , Mokhovikov Alexander
Published: February 2021

Social, political, and economic changes in the countries of the former Soviet Union present a model for investigation of the impact of environment on suicide mortality during times of transition. Throughout the period of perestroika (1985–1990), when social changes were rapid, a significant decrease of suicide mortality was observed in all 15 republics of the USSR. One factor that contributed to the decrease was the antialcohol policy implemented in 1985 and suspended by 1989. Times of spiritual liberation, the aspiration of democracy, social optimism, and hopes for higher living standards could also have attributed to the suicide decrease. During 1990–1994, after the disintegration of the Soviet Union, the suicide rates in post-Soviet countries increased, with the exception of prevailingly Muslim Central Asiatic, and the Caucasus countries. The transitional period called for high adaptation capacity and the necessity of developing suicide prevention programmes to increase social support and re-education measures.
The role of the clinical interview in suicide risk assessment
Authors: Schechter Mark , Maltsberger John T.
Published: February 2021

In this text, the role of the clinical interview in the assessment of suicide risk is discussed. In assessing risk, both the ‘objective/descriptive’ and the ‘experiential’ perspectives are important, which will be described in more detail. In addition to the role of the clinical interview in assessing risk, this critical clinical interaction is also the beginning of the treatment relationship and crisis intervention; thus, it has a role in reducing the risk of suicide. Finally, we comment briefly on the clinician’s conscious, as well as unconscious responses to the patient or ‘countertransference’ that can arise in the interview of potentially suicidal patients, and their potential impact on the assessment of risk.
Countertransference in the treatment of suicidal patients
Authors: Goldblatt Mark J. , Maltsberger John T.
Published: February 2021

Countertransference is an inescapable component of all psychotherapy. Intense countertransference reactions often occur during the treatment of suicidal patients. Lack of awareness of countertransference reactions of malice and aversion may be suicide-inviting. On the other hand, awareness of these reactions may enhance the treatment by alerting therapists that the suicidal patient is fomenting issues he is unable or unwilling to articulate. Problems that arise in the course of psychotherapy of suicidal patients may be understood in relation to the therapist’s countertransference reactions. In this chapter, we review case examples of countertransference manifestations and their effects on the treatment of the suicidal patient.
Art in suicide treatment and prevention
Authors: Bronisch Thomas , von Spreti Flora
Published: February 2021

The theme ‘suicide’ in paintings mirror social, cultural, religious, and philosophical stances to suicide. However, behind these more public aspects of the artist’s work there is often a personal meaning. The motives and interests of the artists go beyond the theme of suicide. An important factor in suicidal behaviour is a depressive mood or disorder. However, the depressive mood as well as the underlying manic-depressive illness of some artists may be seen as an important prerequisite for their creativity. Despite the importance of suicidality in art and that art therapy is well-established for treating patients in psychiatry and psychotherapy, only a small body of empirical literature about the role of art therapy in depressed and suicidal patients exists. In paintings and sculptures of art therapy, done by patients primarily reflect the inner experiences of their illness and biography. Art therapy can help the patient to alleviate self-destructive ways of acting.
Universal suicide prevention in schools
Authors: Carli Vladimir , Iosue Miriam , Wasserman Danuta
Published: February 2021

Schools are one of the most important settings for health promotion and preventive interventions for young people and therefore became one of the main targets of youth suicide prevention programmes. School-based suicide prevention interventions are presented here according to the Universal/Selective/Indicated model. Evidence of the effectiveness of the different programmes is discussed. Universal interventions proved to be the most effective. Particularly, Signs of Suicide (SOS) and Youth Aware of Mental health (YAM) programme showed to significantly reduce suicidal ideation and behaviours. Gatekeeper training, especially QPR (Question, Persuade, and Refer), are also widely implemented but their efficacy was mostly evaluated as changes in knowledge and attitudes towards suicide. Screening programmes do not have iatrogenic effects and are effective in identifying at-risk students who otherwise would not be recognized, however their level of sensitivity and specificity require further improvements. Some systematic reviews suggested that a combination of programmes may be most effective.
Protecting bridges in suicide prevention
Authors: Carli Vladimir , Iosue Miriam
Published: February 2021

In comparison to other methods, suicide by jumping is not as common but nonetheless remains an issue due to its high lethality and accessibility. The majority of suicides by jumping occur from buildings, yet those that are executed from bridges are considered to be more lethal due to a higher fatality rate. One must also take into account that bridges tend to gain more notoriety as suicide hotspots, which can be influenced by media reporting; further highlighting the need for discussion. This text explores the characteristics related to suicide by jumping from a bridge such as psychiatric disorders and socio-demographics, as well as suicide prevention measures including barriers and safety nets, and the role of media reporting.
Advanced renal disease/renal impairment
Authors: Blakey Hannah , Bramham Kate
Published: February 2021

There is an increased incidence of chronic kidney disease (CKD) in patients with underlying rheumatic disease. For a proportion of patients, CKD is diagnosed for the first time in pregnancy through routine antenatal blood and urine testing. Pregnancy places increased physiological demand on the kidneys, and women with CKD have increased risks of adverse pregnancy outcomes, including pre-eclampsia (PET), pre-term delivery, and low birth weight babies. These risks increase incrementally with declining baseline renal function. Thorough pre-conception counselling and regular antenatal review by teams specializing in the care of renal and/or rheumatological conditions is recommended to mitigate these risks and optimize outcome for mother and baby. This chapter describes, through case-based discussion, the investigation and management of abnormal renal function presenting in pregnancy, pre-pregnancy counselling for women with CKD, and the principles of antenatal care for women with impaired renal function.
Managing organ-specific flares
Authors: Bermas Bonnie L. , Chakravarty Eliza
Published: February 2021

Rheumatologic disorders involve multiple organ systems. As such managing patients during pregnancy means not only controlling disease activity but also addressing challenging organ-specific involvement. This chapter reviews several complications of rheumatic diseases during pregnancy and recommends different treatments. The approach will incorporate the caveat that not all medications are compatible with pregnancy. Caring for women with rheumatic diseases during pregnancy is challenging. Disease can flare, can be stable, or can go into remission, moreover it is often impossible to predict how a particular patient’s disease will fare. At baseline patients have disparate organ involvement, further complicating a clinicians’ ability to predict disease course during pregnancy.
Systemic lupus erythematosus
Authors: Schreiber Karen , Østensen Monika
Published: February 2021

Women account for roughly 90% of patients with systemic lupus erythematosus (SLE) and they are typically diagnosed when they are in their childbearing age. Patients with SLE are at increased risk of premature cardiovascular disease (CVD) representing the major cause of morbidity and mortality in this patient group. Premature CVD is significantly pronounced in women with SLE who have a history of pre-eclampsia compared to those who have no history of pre-eclampsia. Therefore, the prevention of future CVD is particularly important in women with a previous pregnancy history complicated by pre-eclampsia. Patients worry about the possible risk for future CVD.
Systemic sclerosis
Authors: Chakravarty Eliza
Published: February 2021

Systemic sclerosis (SSc) is characterized by a non-inflammatory vasculopathy as well as fibrosis of the skin and vital organs. It presents in two distinct subtypes depending on the extent of cutaneous involvement, with each subtype (diffuse vs limited SSc) having different relative prevalence of extra-cutaneous manifestations. Experience describing pregnancy outcomes in SSc is limited because of disease onset mainly in the 4th and 5th decade. Common symptoms, including cutaneous fibrosis and Raynaud’s phenomenon, are not worsened, and may even improve during pregnancy. Severe organ manifestations of SSc, including pulmonary fibrosis, scleroderma renal crisis, and pulmonary arterial hypertension, are associated with increased risks of pregnancy complications and can be more difficult to treat during pregnancy. Therapies for SSc are mostly directed at managing symptoms with vasodilators, angiotensin-renin antagonists, proton pump inhibitors, and immunosuppressives in the case of pulmonary fibrosis.
Targeting TGF-β pathway with COVID-19 Drug Candidate ARTIVeda/PulmoHeal Accelerates Recovery from Mild-Moderate COVID-19
Authors: Trieu Vuong , Saund Saran , Rahate Prashant V. , Barge Viljay B. , Nalk K. Sunil , Windlass Hitesh , Uckun Fatih M.
Published: February 2021

Our COVID-19 drug candidate ARTIVeda™/PulmoHeal is a novel gelatin capsule formulation of the Artemisia extract Ayurveda for oral delivery of TGF-β targeting anti-malaria phytomedicine Artemisinin with documented anti-inflammatory and anti-SARS-CoV-2 activity. Here we report the safety and efficacy of ARTIVeda™ in adult COVID-19 patients with symptomatic mild-moderate COVID-19, who were treated in a randomized, open-label Phase IV study in Bangalore, Karnataka, India (Clinical Trials Registry India identifier: CTRI/2020/09/028044). ARTIVeda showed a very favorable safety profile, and the only ARTIVeda-related adverse events were transient mild rash and mild hypertension. Notably, ARTIVeda, when added to the SOC, accelerated the recovery of patients with mild-moderate COVID-19. While all patients were symptomatic at baseline (WHO score = 2-4), 31 of 39 (79.5%) of patients treated with ARTIVeda plus SOC became asymptomatic (WHO score = 1) by the end of the 5-day therapy, including 10 of 10 patients with severe dry cough 7 of 7 patients with severe fever. By comparison, 12 of 21 control patients (57.1%) treated with SOC alone became asymptomatic on day 5 (P=0.028, Fisher’s exact test). This clinical benefit was particularly evident when the treatment outcomes of hospitalized COVID-19 patients (WHO score = 4) treated with SOC alone versus SOC plus ARTIVeda were compared. The median time to becoming asymptomatic was only 5 days for the SOC plus ARTIVeda group (N=18) but 14 days for the SOC alone group (N=10) (P=0.004, Log-rank test). These data provide clinical proof of concept that targeting the TGF-β pathway with ARTIVeda may contribute to a faster recovery of patients with mild-moderate COVID-19 when administered early in the course of their disease.
Ultra–short-wave diathermy shortens the course of moderate and severe COVID-19: a randomized trial
Authors: Huang Liangjiang , Li Qian , Sayed Shah Zulfiqar Ali , Mohammad Nasb , Chen Bin , Iftikhar MPhil Ali , Xie Lingfeng , Hu Jifa , Chen Hong
Published: February 2021

Question

Is ultra-short-wave diathermy (USWD) safe and effective in coronavirus disease 2019 (COVID-19) ?

Design

Single-centre, evaluator-blinded, two-arm, parallel design, randomized controlled clinical trial.

Participants

Moderate and severe COVID-19 patients with acute respiratory syndrome.

Intervention

USWD for 10 minutes twice daily for 12 consecutive days along with standard medical treatment (USWD group, n = 25), versus standard medical treatment alone (control group, n = 25).

Outcome measures

The primary outcomes were the duration of recovery and negative conversion rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on days 7, 14, 21, and 28. Secondary outcomes included clinical status (seven-category ordinal and systemic inflammatory response syndrome (SIRS) scores), computed tomography (CT), routine blood tests, and adverse events.

Results

Time to clinical recovery (USWD 36.84±9.93 vs. control 43.56±12.15, P = 0.037) was significantly shortened with a between-group difference of 6.72 days. Clinical status was improved with significant between-group differences on day 28 (SIRS, P = 0.011; seven-category scale, P = 0.003). The rate of RNA negative conversion at days 7 (P = 0.066), 14 (P = 0.239), 21 (P = 0.269), and 28 (P = 0.490) was statistically insignificant. Moreover, insignificant differences were observed in the artificial intelligence-assisted CT analysis. No treatment-associated adverse events or worsening of pulmonary fibrosis were observed.

Conclusion

USWD, as adjunctive therapy, shortened the recovery course and improved clinical status of patients with COVID-19 without aggravating pulmonary fibrosis. the findings are limited due to the small sample size and early termination.

Registration

ChiCTR2000029972
Differences in detected viral loads guide use of SARS-CoV-2 antigen-detection assays towards symptomatic college students and children
Authors: Gomez Marti Juan Luis , Gribschaw Jamie , McCullough Melissa , Mallon Abbie , Acero Jamie , Kinzler Amy , Godesky Jamie , Heidenrich Kelly , Iagnemma Jennifer , Vanek Marian , Pasculle A William , Phan Tung , Hoberman Alejandro , Williams John V , Mitchell Stephanie , Wells Alan
Published: February 2021

Limitations in timely testing for SARS-CoV-2 drive the need for new approaches in suspected COVID-19 disease. We queried whether viral load (VL) in the upper airways at presentation could improve the management and diagnosis of patients. This study was conducted in a 9 hospital system in Allegheny County, Pennsylvania between March 1-August 31 2020. Viral load was determined by PCR assays for patients presenting to the Emergency Departments (ED), community pediatrics practices and college health service. We found that for the ED patients, VL did not vary substantially between those admitted and not. VL was relatively equivalent across ages, except for the under 25 age groups that tended to present with higher loads. To determine if rapid antigen testing (RAT) could aid diagnosis in certain populations, we compared BD Veritor and Quidel Sofia to SOC PCR-based tests. The antigen assay provided a disease-detection sensitivity of >90% in a selection of 32 positive students and was modeled to have an 80% sensitivity in all positive students. In the outpatient pediatric population, the antigen assay detected 70% of PCR-positives. Extrapolating these findings to viral loads in older hospitalized patients, a minority would be detected by RAT (40%). Higher loads did correlate with death, though the prognostic value was marginal (ROC AUC of only 0.66). VL did not distinguish between those needing mechanical ventilation and routine inpatients. We conclude that VL in upper airways, while not prognostic for disease management, may aid in selecting proper testing methodologies for certain patient populations.
Uncovering Survivorship Bias in Longitudinal Mental Health Surveys During the COVID-19 Pandemic
Authors: Czeisler M. , Wiley J. , Czeisler C. , Rajaratnam S. , Howard M.
Published: February 2021

Aims

Markedly elevated adverse mental health symptoms were widely observed early in the coronavirus disease 2019 (COVID-19) pandemic. Unlike the U.S., where cross-sectional data indicate anxiety and depression symptoms have remained elevated, such symptoms reportedly declined in the U.K., according to analysis of repeated measures from a largescale longitudinal study. However, nearly 40% of U.K. respondents (those who did not complete multiple follow-up surveys) were excluded from analysis, suggesting that survivorship bias might partially explain this discrepancy. We therefore sought to assess survivorship bias among participants in our longitudinal survey study as part of The COVID-19 Outbreak Public Evaluation (COPE) Initiative.

Methods

Survivorship bias was assessed 4,039 U.S. respondents who completed surveys including the assessment of mental health as part of The COPE Initiative in April 2020 and were invited to complete follow-up surveys. Participants completed validated screening instruments for symptoms of anxiety, depression, and insomnia. Survivorship bias was assessed for (1) demographic differences in follow-up survey participation, (2) differences in initial adverse mental health symptom prevalences adjusted for demographic factors, and (3) differences in follow-up survey participation based on mental health experiences adjusted for demographic factors.

Results

Adjusting for demographics, individuals who completed only one or two out of four surveys had higher prevalences of anxiety and depression symptoms in April 2020 (e.g., one-survey versus four-survey, anxiety symptoms, adjusted prevalence ratio [aPR]: 1.30, 95% confidence interval [CI]: 1.08-1.55, P=0.0045; depression symptoms, aPR: 1.43, 95% CI: 1.17-1.75, P=0.00052). Moreover, individuals who experienced incident anxiety or depression symptoms had higher odds of not completing follow-up surveys (adjusted odds ratio [aOR]: 1.68, 95% CI: 1.22-2.31, P=0.0015, aOR: 1.56, 95% CI: 1.15-2.12, P=0.0046, respectively).

Conclusions

Our findings revealed significant survivorship bias among longitudinal survey respondents, indicating that restricting analytic samples to only respondents who provide repeated assessments in longitudinal survey studies could lead to overly optimistic interpretations of mental health trends over time. Cross-sectional or planned missing data designs may provide more accurate estimates of population-level adverse mental health symptom prevalences than longitudinal surveys.
Early Multidrug Outpatient Treatment of SARS-CoV-2 Infection (COVID-19) and Reduced Mortality Among Nursing Home Residents
Authors: Alexander Paul E , Armstrong Robin , Fareed George , Gill Kulvinder K. , Lotus John , Oskoui Ramin , Prodromos Chad , Risch Harvey A. , Tenenbaum Howard C , Wax Craig M. , McCullough Peter A.
Published: February 2021

The outbreak of COVID-19 from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world with tremendous morbidity and mortality in the elderly. In-hospital treatment addresses the multifaceted nature of the illness including viral replication, cytokine storm, and endothelial injury with thrombosis. We identified nine reports of early treatment outcomes in COVID-19 nursing home patients. Multi-drug therapy including hydroxychloroquine with one or more anti-infectives, corticosteroids, and antithrombotic agents can be extended to seniors in the nursing home setting without hospitalization. Data from nine studies found multidrug regimens relying on the use of hydroxychloroquine as well as other agents including doxycycline were associated with a statistically significant and >60% reductions in mortality. Going forward, we theorize and based on the evidence, that early empiric treatment for the elderly with COVID-19 in the nursing home setting (or similar congregated settings with elderly residents/patients) has a genuine probability of success and acceptable safety. This group remains our highest at-risk group and warrants acute treatment focus that will prevent the development and/or worsening of problems associated with COVID-19, most particularly isolation, hospitalization, and death. In fact, with the rapidity and severity of SARS-CoV-2 outbreaks in nursing homes, in-center treatment of patients with acute COVID-19 is possibly the most rational and importantly feasible strategy to reduce the risks of hospitalization and death. If the approach remains ‘wait-and-see’ and elderly high-risk patients in such congregated nursing room type settings are allowed to worsen with no early treatment, they may be too sick and fragile to benefit from in-hospital therapeutics and are at risk for pulmonary failure, life-ending micro-thrombi of the lungs, kidneys etc. We put forth the notion that the most important factor in this regard, is making available early therapeutic intervention as described here. These drugs include and under supervision by skilled doctors, combination/sequenced ivermectin, hydroxychloroquine, colchicine, azithromycin, doxycycline, bromhexine hydrochloride, and favipiravir (outside the US), along with inhaled steroids such as budesonide and oral steroids including dexamethasone and prednisone, and anti-thrombotic anti-clotting drugs such as heparin). As the clinical trials data on treatments for COVID-19 mature, this early treatment therapeutic option deserves serious, urgent, and sober consideration by the medical establishment and respective decision-makers.
Single-Blind and Double-Blind Peer Review: Effects on National Representation
Authors: Kalavar Meghana , Watane Arjun , Wu David , Sridhar Jayanth , Mruthyunjaya Prithvi , Parikh Ravi
Published: February 2021

Background/Objectives

To assess whether the type of peer-review (single-blinded vs double-blinded) has an impact on nationality representation in journals.

Methods

A cross-sectional study analyzing the top ten nationalities contributing to the number of articles across 16 ophthalmology journals.

Results

There was no significant difference in the percentage of articles published from the journal’s country of origin between the top single-blind journals and top double-blind journals (SB= 42.0%, DB = 26.6%, p=0.49) but there was a significant difference between the percentage of articles from the US (SB=48.0%, DB=22.8%, p=0.02). However, there was no significant difference for both country of origin (SB =38.0%, DB =26.6%, p=0.43) and articles from the US (SB=35.0%, DB=22.8%, p=0.21) when assessing the top 8 double-blind journals matched with single-blind journals of a similar impact factor. The countries that most commonly made the top ten lists for highest number of articles were the US (n=16, 100%) and England (n=16, 100%). This held true even for journals established outside the United States (US=11/12, England=11/12).

Conclusions

There was no statistically significant difference in country-of-origin representation between single-blind journals and double-blind journals. However, higher income countries contributed most often to the journals studied even among journals based outside the US.
Significance of SARS-CoV-2 Specific Antibody Testing during COVID-19 Vaccine Allocation
Authors: Fujimoto Akane B. , Yildirim Inci , Keskinocak Pinar
Published: February 2021

Objective

To assess the value of using SARS-CoV-2 specific antibody testing to prioritize the vaccination of susceptible individuals as part of a COVID-19 vaccine distribution plan when vaccine supply is limited.

Methods

A compartmental model was used to simulate COVID-19 spread when considering diagnosis, isolation, and vaccination of a cohort of 1 million individuals. The scenarios modeled represented 4 pandemic severity scenarios and various times when the vaccine becomes available during the pandemic. Eligible individuals have a probability p of receiving antibody testing prior to vaccination (p = 0, 0.25, 0.5, 0.75, and 1). The value of serology testing was evaluated by comparing the infection attack rate, peak infections, peak day, and deaths.

Results

The use of antibody testing to prioritize the allocation of limited vaccines reduces infection attack rates and deaths. The size of the reduction depends on when the vaccine becomes available relative to the infection peak day. The largest reduction in cases and deaths occurs when the vaccine is deployed before and close to the infection peak day. The reduction in the number of cases and deaths diminishes as vaccine deployment is delayed and moves closer to the peak day.

Conclusions

Antibody testing as part of the vaccination plan is an effective method to maximize the benefit of a COVID-19 vaccine. Decision-makers need to consider relative timing between the infection peak day and when the vaccine becomes available.
Estimating the COVID-19 Prevalence in Spain with Indirect Reporting via Open Surveys
Authors: Garcia-Agundez Augusto , Ojo Oluwasegun , Hernandez Harold , Baquero Carlos , Frey Davide , Georgiou Chryssis , Goessens Mathieu , Lillo Rosa , Menezes Raquel , Nicolaou Nicolas , Ortega Antonio , Stavrakis Efstathios , Anta Antonio Fernandez
Published: February 2021

During the initial phases of the COVID-19 pandemic, accurate tracking has proven unfeasible. Initial estimation methods pointed towards case numbers that were much higher than officially reported. In the CoronaSurveys project, we have been addressing this issue using open online surveys with indirect reporting. We compare our estimates with the results of a serology study for Spain, obtaining high correlations (R squared 0.89). In our view, these results strongly support the idea of using open surveys with indirect reporting as a method to broadly sense the progress of a pandemic.
Robust spike antibody responses and increased reactogenicity in seropositive individuals after a single dose of SARS-CoV-2 mRNA vaccine
Authors: Krammer Florian , Srivastava Komal ,   the PARIS team, Simon Viviana
Published: February 2021

An important question is arising as COVID-19 vaccines are getting rolled out: Should individuals who already had a SARS-CoV-2 infection receive one or two shots of the currently authorized mRNA vaccines. In this short report, we show that the antibody response to the first vaccine dose in individuals with pre-existing immunity is equal to or even exceeds the titers found in naïve individuals after the second dose. We also show that the reactogenicity is significantly higher in individuals who have been infected with SARS-CoV-2 in the past. Changing the policy to give these individuals only one dose of vaccine would not negatively impact on their antibody titers, spare them from unnecessary pain and free up many urgently needed vaccine doses.
Correlation of SARS-CoV-2 serology and clinical phenotype amongst hospitalised children in a tertiary children’s hospital in India
Authors: Venkataraman Aishwarya , Balasubramanian S , Putilibai Sulochana , Lakshan Raj S , Amperayani Sumanth , Senthilnathan S , Manoharan Anand , Sophi Arokia , Amutha R , Sadasivam Kalaimaran , Goenka Anu , Ramanan A V
Published: February 2021

Introduction

Children usually present with minimal or no symptoms of SARS-CoV-2 infection. Antibody responses to SARS-CoV-2 in children from low- and middle-income countries (LMIC) have not been well described. We describe the prevalence of anti-SARS-CoV-2 antibodies and clinical phenotype of seropositive children admitted to a tertiary children’s hospital in South India.

Methods

To determine the seropositivity and describe the clinical characteristics of SARS-CoV-2 infection amongst hospitalised children, we performed a prospective clinical data collection and blood sampling of children admitted to Kanchi Kamakoti CHILDS Trust Hospital, Chennai, India over 4 months of the COVID-19 pandemic. In seropositive children, we compared antibody titres between children with and without PIMS-TS.

Results

Of 463 children, 91 (19.6%) were seropositive. The median (range) age of seropositive children was 5 years (1 month - 17 years). Clinical presentation was consistent with Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) in 48% (44/91) of seropositive children. The median (range) antibody titre was 54.8 (11.1–170.9) AU/ml among all seropositive children. The median antibody titre among the children with PIMS-TS (60.3 AU/mL) was significantly (p=0.01) higher when compared to the children without PIM-TS (54.8 AU/mL).

Conclusion

We describe the antibody responses to SARS-CoV-2 amongst hospitalised children in a LMIC tertiary children’s hospital. Almost half of the seropositive children had PIMS-TS. Antibody levels may be helpful in the diagnosis and disease stratification of PIMS-TS.

Lay summary

Children usually present with minimal or no symptoms of SARS-CoV-2 infection. However, Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) has emerged as a distinctive paediatric illness related to SARS-CoV-2. Recently, antibody testing for SARS-CoV-2 is being used increasingly as a diagnostic test for PIMS-TS. However, data on the antibody responses to SARS-CoV-2 in children is sparse. We therefore, attempted to identify the seropositivity and describe the clinical spectrum of SARS-CoV-2 infection amongst infants and children getting hospitalised in a children’s hospital in south India. Nearly one-fifth of the hospitalised children tested serology positive over 4 months. Antibody levels in children with PIMS-TS were significantly higher in comparison to the other two groups (acute SARS-CoV-2 infection and children without PIMS-TS). Results from our study suggest that all children are at risk of SARS-CoV-2 infection though they may present with mild illness or no symptoms. We also observed that antibody testing may have a possible role in diagnosis of PIMS-TS.
MOATAI-VIR - an AI algorithm that predicts severe adverse events and molecular features for COVID-19’s complications
Authors: Astore Courtney , Zhou Hongyi , Jacob Joshy , Skolnick Jeffrey
Published: February 2021

Following SARS-CoV-2 infection, some COVID-19 patients experience severe adverse events caused by pathogenic host responses. To treat these complications, their underlying etiology must be identified. Thus, a novel AI-based methodology, MOATAI-VIR, which predicts disease-protein-pathway relationships for 22 clinical manifestations attributed to COVID-19 was developed. SARS-CoV-2 interacting human proteins and GWAS identified respiratory failure associated risk genes provide the input from which the mode-of-action (MOA) proteins/pathways of the resulting disease comorbidities are predicted. These comorbidities are then mapped to their clinical manifestations. Three uncharacterized manifestation categories are found: neoplasms, mental and behavioral disorders, and congenital malformations, deformations, and chromosomal abnormalities. The prevalence of neoplasms suggests a possible association between COVID-19 and cancer, whether by shared molecular mechanisms between oncogenesis and viral replication, or perhaps, SARS-CoV-2 is an oncovirus. To assess the molecular basis of each manifestation, the proteins shared across each group of comorbidities were prioritized and subject to global pathway analysis. From these most frequent pathways, the molecular features associated with hallmark COVID-19 phenotypes, such as loss of sense of smell/taste, unusual neurological symptoms, cytokine storm, and blood clots were explored. Results of MOATAI-VIR are available for academic users at: http://pwp.gatech.edu/cssb/MOATAI-VIR/.
How best do we engage the general population in testing for COVID-19?
Authors: Watson Daniella , Baralle Natalia Laverty , Alagil Jawahr , Anil Krithika , Ciccognani Sandy , Dewar-Haggart Rachel , Fearn Sarah , Groot Julia , Knowles Kathryn , Meagher Claire , McGrath Carmel , Muir Sarah , Musgrove Jo , Glyn-Owen Kate , Woods-Townsend Kath , Mortimore Andrew , Roderick Paul , Baird Janis , Inskip Hazel , Godfrey Keith , Barker Mary
Published: February 2021

The UK Scientific Advisory Group for Emergencies (SAGE) emphasises the need for high levels of engagement with communities and individuals to ensure the effectiveness of any COVID-19 testing programme. A novel pilot health surveillance programme to assess the feasibility of weekly mass RT-LAMP testing for the SARS-CoV-2 virus using saliva samples collected at home was developed and piloted by the University of Southampton and Southampton City Council. Rapid qualitative evaluation was conducted to explore experiences of those who took part in the programme, of those who declined and of those in the educational and healthcare organisations involved in the pilot testing who were responsible for roll-out. This included 77 interviews and 20 focus groups with 223 staff, students, pupils and household members from four schools, one university, and one community healthcare NHS trust. Conversations revealed that high levels of communication, trust and convenience were necessary to ensure people’s engagement with the programme. This suggests community leaders and stakeholder organisations should be involved throughout programme development and implementation to optimise these features of the testing. Participants’ and stakeholders’ motivations, challenges and concerns need to be understood and these insights used to modify the programme in a continuous, real-time process to ensure and sustain engagement with testing over the extended period necessary.
Illusory social agents within and beyond voices: a computational linguistics analysis of the experience of psychosis
Authors: Shiel Lisha , Demjén Zsófia , Bell Vaughan
Published: February 2021

Aims

Psychosis has a strong social component and often involves the experience of being affected by ‘illusory social agents’. However, this experience remains under-characterised, particularly for social agents in delusions and non-vocal hallucinations. One useful approach is a form of computational linguistics called corpus linguistics that studies texts to identify patterns of meaning encoded in both the semantics and linguistic structure of the text.

Methods

Twenty people living with psychosis were recruited from community and inpatient services. They participated in open-ended interviews on their experiences of social agents in psychosis and completed a measure of psychotic symptoms. Corpus linguistics analysis was used to identify key phenomenological features of vocal and non-vocal social agents in psychosis.

Results

Social agents are i) represented with varying levels of richness in participants’ experiences, ii) are attributed with different kinds of identities including physical characteristics and names, iii) are perceived to have internal states and motivations that are different from those of the participants, and iv) interact with participants in various ways including through communicative speech acts, affecting participants’ bodies and moving through space. These representation were equally rich for agents associated with hallucinated voices and those associated with non-vocal hallucinations and delusions.

Conclusions

We show that the experience of illusory social agents is a rich and complex social experience reflecting many aspects of genuine social interaction and is not solely present in auditory hallucinations, but also in delusions and non-vocal hallucinations.