Vaccine breakthrough infections with SARS-CoV-2: Why older adults need booster vaccinations.

Objectives: COVID-19 vaccinations are highly efficacious in preventing severe illness that can lead to hospitalizations and death, but incidents of vaccine breakthrough (VBT) infections persist. We examined VBT infections within a congregate setting to help guide public health practices. Study design: This is a retrospective cohort study of VBT infections identified via polymerase chain reaction (PCR) testing between 2/1/2021-11/1/2021. Methods: A VBT infection was defined as the detection of SARS-CoV-2 collected from a person ≥14 days after all recommended doses of a COVID-19 vaccine. VBT infections were examined in five California psychiatric inpatient hospitals with a workforce of more than 10,000 hospital staff and approximately 5500 patients. Results: 415 VBT infections out of 14,101 fully vaccinated individuals within our system (2.9%) were identified. Days since final vaccine date ranged from 16 to 291 days. Kruskal-Wallis nonparametric test revealed a statistically significant difference in age between individuals with VBT infections versus all other vaccinated individuals [U = 6.47, p = .01]. A chi-square test of independence revealed no significant sex differences between individuals with VBT infections (58.8% male and 41.2% female) versus all other vaccinated individuals (59.6% male and 40.4% female; X2 (3, N = 14101) = 5.059, p = .167). Out of 415 VBT cases, 65.1% received the Moderna vaccine, 33.2% received Pfizer, and 1.7% received J&J; and 38.1% were asymptomatic at time of VBT infection, 24.1% were symptomatic, while 37.8% were missing symptom data. Conclusions: Vaccination campaigns, including boosters and continued surveillance, are important complimentary strategies for reducing the proliferation of COVID-19 VBT cases and severity of symptoms associated with COVID-19.

The indistinguishables: determining appropriate environments for justice involved individuals.

Criminalizing those with mental illness is a controversial topic with a long and complex history in the United States. The problem has traditionally been dichotomized between criminals (i.e., "bad") in need of placement in jails and prisons and the mentally ill (i.e., "mad") who are need of treatment in psychiatric facilities. Recent trends demonstrate significant increases in the rates of mental illness in jails and prisons, as well as increased rates of violence within psychiatric hospitals. This would suggest that there are a group of justice involved individuals who are "indistinguishable" within the traditional dichotomous categories of dangerousness and mental illness. The authors argue for a more nuanced model that dimensionally conceptualizes dangerousness and mental illness; increased attention to situational factors that create facilities appropriate for those who are dangerous and mentally ill and more diversion programs for those inappropriate for incarceration or hospitalization.

Implementing an ecological approach to violence reduction at a forensic psychiatric hospital: approaches and lessons learned.

Existing literature on aggression within psychiatric hospitals suggests that treating an aggressive patient's symptoms could be complemented by (a) milieu environments that mitigate violence and (b) hospital-wide policies and procedures that focus on creating a safe environment. Described as an ecological approach, examples of how this broader, situational approach can reduce inpatient violence in psychiatric settings are provided throughout. The authors identify potential barriers to focusing on wards and institutional rules as well as patient treatment. Last, details of how this ecological approach has been implemented at one state hospital in California are provided.

Aggression Among Psychiatric Inpatients: The Relationship Between Time, Place, Victims, and Severity Ratings.

BACKGROUND: The rate of aggressive acts perpetrated by psychiatric inpatients remains a pressing issue. To date, few studies have distinguished between incident severities. OBJECTIVE: The aims of the current study were to identify rates of inpatient aggression in an inpatient forensic psychiatric facility and describe the severity of the aggression reported for aggressive incidents. DESIGN: All documented acts of aggression at a 1,500-bed forensic hospital between 2009 and 2013 provided data about the time, location, and victims of aggressive acts. In total, 52,109 unique incidents were analyzed. RESULTS: The findings showed an increase in violence rates during meal, medication, and shift change times. Patients (n = 3,436, 62%) were victimized more often than staff members (n = 2,103, 38%). Fall and winter months showed more acts of aggression than summer and spring, but there were no mean differences between severity ratings by season. The results showed that the swing shift saw more severe aggressive incidents than the morning or overnight shifts, p = .001, and significantly more serious incidents occurred when there were staff members working over time, p = .050. CONCLUSIONS: The current study reports some key findings about aggression rates with a very large sample and presents some valuable data regarding the severity of aggressive acts.