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In addition to physical symptom burden, psychological suffering at end of life (EOL) is quite pervasive. As such, the interdisciplinary team in our Palliative and Supportive Care Unit strives to provide quality care sensitive to the physical and psychosocial needs of patients. Involving and allowing for the presence of family members is one way in which we afford our patients some additional comfort. Unfortunately, the current pandemic has placed limitations on this rather fundamental need for both patients and their family members. Here, we present a case illustrating the effects of visitor restrictions/isolation due to COVID-19 on the suffering of a patient at the EOL.
A male in his 20s with a refractory hematologic malignancy decided to pursue a comfort-based approach to care after a rapid clinical deterioration. Due to visitor restrictions, he had to face this decision with limited support at the bedside, which caused significant distress. He was forced to choose among several immediate family members who would be at his side through his hospitalization, to be his advocate, at times his voice, his confidant, and the person to relay all information to those on the outside. He expressed a wish to be married before he died, which occurred in our palliative care unit. This life goal was one we would normally encourage those he loved to gather around him, but this was not possible. He passed peacefully two days after he was married.
Although social limitations are necessary to help provide safety to the patients and staff in a hospital, they can have a direct impact on the suffering of patients and families at the EOL. Helping to maintain dignity, reflect on their life, and resolve any conflicts in the presence of family members is a benchmark for providing quality palliative care. Being barred from visitation due to isolation, threatens this care and lays the foundation for complicated grief among family members. Further research is needed to help balance the needs of those at the EOL with public safety. One such measure to help ease distress is to allow for more virtual visitation through electronic measures.
Violence against women (VAW) is a major public health problem and a violation of women’s human rights. The coronavirus disease 2019 (COVID-19) pandemic has worsened gender inequality, resulting in a heightened incidence of VAW. This study aims to assess the characteristics of women who admit to the emergency department (ED), both before the pandemic and during the pandemic. The secondary aim is to compare the frequencies of violence cases between periods.
By single-center, retrospective, and cross-sectional design, the periods of April 10 - December 31, 2020 and April 10 - December 31, 2019 were compared. The outcomes of the study were the daily ED admission numbers of both sexes, the prevalence of VAW cases in the ED, as well as sociodemographic and clinical variables of the women who were exposed to violence.
During the pandemic period, number of VAW cases in the ED increased 13% and the ratio of VAW cases to all ED admissions tripled compared to the pre-pandemic period. Women exposed to VAW were more likely to be without social insurance, injured in the trunk part of their body, and having a life-threatening injury in the pandemic period. In both periods, women were attacked by an intimate partner, dominantly (42.6% and 54.1%, respectively). In addition, among all admissions of adults to the ED, women’s percentage decreased while men’s admission ratios increased during the pandemic period. Admissions to ED declined 47.7% during the COVID-19 pandemic compared to the year before.
Cases of VAW tend to increase during the pandemic, and health care settings should be well-organized to respond to survivors.
This study aimed at examining the vulnerability of Central Africa to the Covid-19 pandemic.
Demographic, health and socio-economic indicators were used to describe the vulnerability.
According to demographic indicators, populations appear younger than in Europe, Asia and North America, where evidence showed a higher lethality of Covid-19 and a higher frequency of hospitalization among the elderly. This highlights the protective effect of the age structure of the Central African populations. There is a significant vulnerability of their populations resulting from high morbidity and a considerable deficit in health care. Poverty indicators are not in their favour for a sustainable implementation of effective pandemic control measures. Very low literacy rates in some countries, misinformation and belief in conspiracy theory could affect the community involvement in the response. Several countries are weakened by other humanitarian crises, including; conflicts and other epidemics. The early easing in lockdown restrictions in certain countries could worsen the situation.
This Sub-region, where the largest proportion of the population lives in poverty, poor sanitary conditions, conflicts and humanitarian crises, the questions of standards of prevention could appear to them as luxurious idea relegated to the background. Central African Countries need financial and logistic support for a sustainable effective response. These observations could be easily extrapolated to other Sub-Saharan sub-regions.
Objective structured clinical examinations (OSCEs) play a pivotal role in medical education assessment. The Advanced Clinical Skills (ACS) OSCE examines clinical skills in psychiatry, general practice, obstetrics and gynaecology and paediatrics. This study examined if the 2020 ACS OSCE for fourth year medical students attending the National University of Ireland, Galway, was associated with any significant result differences compared to the equivalent 2019 OSCE. Additionally, we assessed students’ satisfaction and explored any organisational difficulties in conducting a face-to-face OSCE during the COVID-19 pandemic.
Materials and methods:
This study compared anonymised data between the 2019 and 2020 ACS OSCEs and analysed anonymised student feedback pertaining to the modified 2020 OSCE.
The mean total ACS OSCE result achieved in 2020 was statistically higher compared to the 2019 OSCE [62.95% (SD = 6.21) v. 59.35% (SD = 5.54), t = 6.092, p < 0.01], with higher marks noted in psychiatry (p = 0.001), paediatrics (p = 0.001) and general practice (p < 0.001) with more students attaining honours grades (χ2 = 27.257, df = 3, p < 0.001). No difference in failure rates were found. Students reported feeling safe performing the 2020 OSCE (89.2%), but some expressed face-mask wearing impeded their communication skills (47.8%).
This study demonstrates that conducting a face-to-face OSCE during the pandemic is feasible and associated with positive student feedback. Exam validity has been demonstrated as there was no difference in the overall pass rate.
Considerable literature has examined the COVID-19 pandemic’s negative mental health sequelae. It is recognised that most people experiencing mental health problems present to primary care and the development of interventions to support GPs in the care of patients with mental health problems is a priority. This review examines interventions to enhance GP care of mental health disorders, with a view to reviewing how mental health needs might be addressed in the post-COVID-19 era.
Five electronic databases (PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO ‘Global Research on COVID-19’) were searched from May – July 2021 for papers published in English following Arksey and O’Malley’s six-stage scoping review process.
The initial search identified 148 articles and a total of 29 were included in the review. These studies adopted a range of methodologies, most commonly randomised control trials, qualitative interviews and surveys. Results from included studies were divided into themes: Interventions to improve identification of mental health disorders, Interventions to support GPs, Therapeutic interventions, Telemedicine Interventions and Barriers and Facilitators to Intervention Implementation. Outcome measures reported included the Seven-item Generalised Anxiety Disorder Scale (GAD-7), the Nine-item Patient Health Questionnaire (PHQ-9) and the ‘The Patient Global Impression of Change Scale’.
With increasing recognition of the mental health sequelae of COVID-19, there is a lack of large scale trials researching the acceptability or effectiveness of general practice interventions. Furthermore there is a lack of research regarding possible biological interventions (psychiatric medications) for mental health problems arising from the pandemic.
Chapter 6 indexes the influence of American religious exceptionalism on domestic matters. The authors speak of the vast attention paid to the role of Christian nationalists in the 2016 election and the policies of the Trump administration, by investigating how adherence to American religious exceptionalism explains the willingness to entertain illiberal policies and even undemocratic governance such as autocracy and military rule. The context of the pandemic is also addressed. Specifically, this chapter provides evidence of disciples’ doubling down on support for their savior Donald Trump, regardless of their proximity to the virus’s effect on their personal networks. The authors demonstrate the remarkable connection disciples share to their most unexpected and less-than-religious yet beloved crusading leader. The authors further provide strong statistical evidence that disciples’ vote choice, partisanship, domestic policy attitudes, and political activities are motivated by the need to promote the divine purpose of the nation amidst the internalized threats posed to a culturally homogeneous image of God’s country.
This chapter focuses on how people create psychological walls around life domains that contain negative affect to prevent spillover of these bad feelings into other life domains. Several segmentation strategies are desribed: temporal, physical, behavior, and communication.
This chapter summarises the main themes of the book and illustrates the methods discussed through applications to texts around the coronavirus pandemic. The issues of corpus-building, using quantitative and qualitative techniques, and ‘being useful’ are illustrated from this perspective.
To successfully address large-scale public health threats such as the novel coronavirus outbreak, policymakers need to limit feelings of fear that threaten social order and political stability. We study how policy responses to an infectious disease affect mass fear using data from a survey experiment conducted on a representative sample of the adult population in the USA (N = 5,461). We find that fear is affected strongly by the final policy outcome, mildly by the severity of the initial outbreak, and minimally by policy response type and rapidity. These results hold across alternative measures of fear and various subgroups of individuals regardless of their level of exposure to coronavirus, knowledge of the virus, and several other theoretically relevant characteristics. Remarkably, despite accumulating evidence of intense partisan conflict over pandemic-related attitudes and behaviors, we show that effective government policy reduces fear among Democrats, Republicans, and Independents alike.
Lebanon, one of the smallest countries in the Middle East, has held for decades a reputation for being the premier medical hub for patients from the Arab world as well as neighboring countries and for offering world-class treatment and advanced medical services. However, this once world-renowned healthcare sector is now facing a risk of imminent collapse as overlapping crises have struck the country since October 2019. In this article, we describe the concomitant political, economic, and financial challenges that Lebanon is facing, which have strained the national healthcare system and have undermined its ability to respond to the coronavirus disease 2019 (COVID-19) pandemic. We present an overview of the political instability, the Lebanese revolution with countrywide protests, as well as the devaluation of the Lebanese currency representing one of the worst economic meltdowns since the 19th century. We describe the unprecedented energy crisis the country is facing and the disastrous consequences of the Beirut port explosion of August 2020. We review the efforts and measures taken by different stakeholders to contain the COVID-19 pandemic amid the multifaceted challenges and the large exodus of healthcare personnel.
There is a concern that the COVID-19 pandemic will lead to an increase in suicides. Several reports from the first months of the pandemic showed no increase in suicide rates while studies with longer observation times report contrasting results. In this study, we explore the suicide rates in Norway during the first year of the pandemic for the total population as well as for relevant subgroups such as sex, age, geographical areas, and pandemic phases.
This is a cohort study covering the entire Norwegian population between 2010 and 2020. The main outcome was age-standardized suicide rates (per 100,000 inhabitants) in 2020 according to the Norwegian Cause of Death Registry. This was compared with 95% prediction intervals (95% PI) based on the suicide rates between 2010 and 2019.
In 2020, there were 639 suicides in Norway corresponding to a rate of 12.1 per 100,000 (95% PI 10.2–14.4). There were no significant deviations from the predicted values for suicides in 2020 when analyzing age, sex, pandemic phase, or geographical area separately. We observed a trend toward a lower than predicted suicide rate among females (6.5, 95% PI 6.0–9.2), and during the two COVID-19 outbreak phases in 2020 (2.8, 95% PI 2.3–4.3 and 2.8, 95% CI 2.3–4.3).
There is no indication that the COVID-19 pandemic led to an increase in suicide rates in Norway in 2020.
Pathogens and humans have coexisted for a long time. Studies suggest that, even before recorded history, nomadic populations are likely to have suffered from a plethora of diseases, such as malaria and perhaps yellow fever. The transition to a sedentary lifestyle anchored around small villages, and later on the establishment of large urban centers from Mesopotamia to the Indus Valley and what is modern-day China, paved the way for the increased spread and diversification of these pathogens. High population density, the comingling of humans and animals, and the proliferation of trade routes linking once-distant urban areas enabled viruses, bacteria, and other pathogens to propagate quickly and travel progressively farther. To this day, these dynamics set forth in antiquity continue to play out in similar ways in a world that has become more connected and densely populated.
The COVID-19 pandemic caused enormous disruption of clinical, research, and academic services around the world. This chapter focuses on the impact of COVID-19 on clinical trials and reflects upon the various measures taken to continue research work while minimizing risk to participants. Through careful observations, we conclude that it is imperative to continue Alzheimer’s disease (AD) drug development programs. With proper infection prevention protocols and precautions in place, it is possible to preserve the safety of both study participants, and investigators/research staff while moving forward with essential drug development processes for the benefit of study participants, and patients in general. Such protocols, once perfected, need to become a part of all institutional review boards and study protocols in order to avoid any loss or delay of essential work in the future.
This study, which aims to reveal the metaphorical perceptions of social media users regarding the term, “Covid-19,” is in accordance with the phenomenological method.
The phenomenological method was used in this study. In July 2020, a total of 125 social media users voluntarily participated in this research study and were asked to derive metaphors regarding the concept of Covid-19.
With the participation of social media users, metaphors about Covid-19 were determined. These metaphors, which were provided comletely voluntarily in response to social media posts, reveals that the participants approached the Covid-19 phenomenon with a variety of meanings.
When the metaphors derived by the participants are examined through different categories, it can be seen that a variety of metaphors are produced and almost all of them attribute negative meanings to Covid-19. A significant part of the metaphors evoke disasters and unexpected events. The absence of more hopeful metaphors regarding the end of the pandemic, may stem from the fact that this study took place during the middle of the pandemic, when discussions of the “new normal” were being made just after the first wave.
The Afterword addresses the historical dominance of white voices in British nature writing, and the marginality of race, class and gender politics in the genre. This tendency matches continuing inequalities in the social and ethnic composition of British environmentalist movements. Contemporary nature writing also reflects regional inequalities, with many of its leading figures clustering around East Anglia. Nonetheless, Elizabeth-Jane Burnett’s recent book The Grassling exemplifies British nature writing that stands out not only through the unconventional background of its author, but also through its experimental techniques. At the same time, platforms such as The Willowherb Review suggest that the genre and the critical culture around it are gradually changing to allow room for more diverse voices. However, nature writers of colour venturing into rural environments still find themselves contending with the stark racial divide between Britain’s cities and countryside. Similarly, a growing range of LGBTQ* nature writers are becoming increasingly visible in the genre and challenging heteronormative codings of the rural. In the aftermath of Brexit and a global pandemic, Britain’s nature writers confront a nation highly divided and isolated, and a literary heritage permeated by elitist elements which need to be reckoned with.
In the wake of the pandemic, a new world is in the making. There can be no returning to the old world before Covid-19. In this new pandemic world, trade and trade rules are challenged along with all the other foundations of postwar liberal internationalism. The WTO rules that help link trade remain necessary. New rules are urgently needed to address the links between trade and nature and between trade and other aspects of sustainable development. New rules are equally needed to help spur a green recovery from the economic collapse caused by the pandemic.
The lethal Covid-19 pandemic has forever changed the world with untold consequences for human health and the global economy. New vaccines have offered hope for health safety and economy recovery. Yet the pandemic has persisted in many countries; climate change and other ecological threats have intensified; and the trade links supported by WTO rules have been sorely tested by the backlash against globalization that has accompanied the pandemic.
The pandemic has turned the world inward and toward such perennial false promises of self-sufficiency as localism and protectionism. The trade links made possible by global supply chains are being questioned along with all else that connects the global economy. Amid this questioning, in the ongoing battle to end the pandemic, tariffs and other barriers to trade in medicines and other medical goods must be eliminated; vaccine nationalism must be replaced by vaccine multilateralism; and trade restrictions on the global supply of food must be avoided.
We examined the association between contact with children and the clinical course of COVID-19 among COVID-19-positive adult patients. Participants completed a survey to assess demographics, medical information related to their COVID-19 diagnosis, contact with children at home and at the workplace. Patients were aged 45.68 ± 14.38 years, mostly female (72.1%), 842 were not hospitalized and 167 were hospitalized. At home, there were no differences between groups for the number of child contact hours or total child hours (hours × number of children) per week (Ps > 0.05). The number of children at home was greater among patients not hospitalized (P < 0.05), however this was no longer significant after controlling for covariates (P > 0.05). At the workplace, there were no differences between groups (all Ps > 0.05). Sub-group analysis found the proportion of patients that were treated in the intensive care unit (ICU) was greater among patients with no child contact (P < 0.05). A secondary analysis found that patients with no child contact had an increased likelihood of thromboembolism (P < 0.05) and a trend towards more overall COVID-19-related complications (P = 0.076). Overall, an association between contact with children and hospitalization was not found when adjusting for covariates. Sub-group analysis indicated a possible protective effect for more severe disease; however, these findings need further study.