Mental health and resilience after the covid-19 pandemic: a multi-ethnic longitudinal survey.

BACKGROUND: Longitudinal work on the impact of COVID-19 on population mental health and resilience beyond the first year of the pandemic is lacking. We aimed to understand how mental health and resilience evolved during the pandemic (2020) and two years later (2022) in a multi-ethnic Singaporean population. In addition, we assessed what characteristics were associated with mental health and resilience scores. METHODS: We surveyed and analysed two balanced panel samples up to four times between 30th April 2020 and 11th July 2022. One panel assessed psychological distress (Kessler-10) and well-being (short Warwick Edinburgh Mental Well-being scale) n = 313, and one panel assessed resilience (10-item Connor-Davidson Resilience Scale©) n = 583. A linear panel regression model with random effects assessed the temporal patterns for psychological distress, well-being, and resilience. RESULTS: Mean psychological distress scores (Kessler-10) were relatively stable over time and were not statistically significantly worse than baseline at any follow-up. Well-being scores improved over time and were significantly better than baseline by the third survey (22nd Jul-18th Aug 2020) (0.54 p = 0.007, Cohen's d 0.12). Scores had worsened by the last survey (27th June-11th July 2022) but were not significantly different from baseline 0.20 p = 0.30. Resilience scores declined over time. Scores at both follow-ups (14th Aug- 4th Sep 2020 and 27th June-11th July 2022) were statistically significantly lower than baseline: -1.69 p < 0.001 (Cohen's d 0.25) and -0.96 p = 0.006 (Cohen's d 0.14), respectively. CONCLUSIONS: Our study joins a body of work measuring the longitudinal effects of COVID-19 on population mental health and resilience. While, the magnitude of the effect related to resilience decline is small, our findings indicate that particular attention should be given to ongoing population surveillance, with the aim of maintaining good health and well-being.

Implementing an Integrated Generalist-Led Inpatient Care Model: Results of a Mixed-Method Evaluation.

Introduction: Healthcare integration has become prevalent as health systems manage a growing population of older adults with multi-morbid conditions. The integrated general hospital (IGH) is the latest example of how services can be remodelled to achieve greater care integration. Methods: We conducted a mixed-method evaluation to identify factors impacting the implementation and effectiveness of the IGH model. Data were collected through in-depth interviews (n = 15) and focus group discussions (n = 8 groups) with hospital staff, and a staff survey (n = 226). Results: Staff perceived improvements in clinical practice and better clinical outcomes for patients. The care model empowered nursing and allied health staff through a more collegial team structure. However, staff reported an unequal workload distribution; a third reported burnout; and some observed inconsistencies between leaders' aspirations for IGH and what was happening on the ground. For IGH to sustain, staff's education on the IGH model needs to be improved. Further examination of work processes is recommended to boost staff morale and prevent burnout. Conclusion: Overall, IGH provided better integrated, team-based care. The model challenged traditional team structures and empowered staff to expand their roles and responsibilities. Policymakers could consider the IGH model a successful approach for integrating services across the care continuum.

Sirtuins as Modifiers of Huntington's Disease (HD) Pathology.

Sirtuins and their pharmacological activators/inhibitors have been associated with a range of neuroprotective effects or disease modifying influences in neurological disorders. Huntington's disease (HD) is an autosomal-dominant, progressive neurodegenerative disease characterized by movement disorder, psychiatric symptoms and cognitive decline. The monogenic mutation in HD encodes a variant of the protein Huntingtin (HTT). The disease is a consequence of a CAG repeat extension leading to an abnormally long polyglutamine (Q) stretch at HTT's N-terminus, which likely confers a toxic gain of function to the mutant polypeptide. HD has currently no effective disease-modifying therapy or preventive measures. In the past 2decades, a sizable body of work on Sirtuins' modification of HD pathology using HD cell and animal models has accumulated. In this chapter, evidence for Sirtuin activities as potential modifiers of HD pathology is reviewed. The conflicting findings of the impacts of mammalian Sirtuin paralogs on HD pathogenesis and disease progression are highlighted. The possible cellular and molecular mechanisms underlying Sirtuin activities in HD are discussed with reference to pathophysiological mechanisms of transcription perturbation, proteostasis, mitochondrial function, and microtubule dynamics. A brief therapeutic perspective on the use of Sirtuin activators and inhibitors is also presented.

Lentiviral silencing of GSK-3ß in adult dentate gyrus impairs contextual fear memory and synaptic plasticity.

Attempts have been made to use glycogen synthase kinase-3 beta (GSK3ß) inhibitors for prophylactic treatment of neurocognitive conditions. However the use of lithium, a non-specific inhibitor of GSK3ß results in mild cognitive impairment in humans. The effects of global GSK3ß inhibition or knockout on learning and memory in healthy adult mice are also inconclusive. Our study aims to better understand the role of GSK3ß in learning and memory through a more regionally, targeted approach, specifically performing lentiviral-mediated knockdown of GSK3ß within the dentate gyrus (DG). DG-GSK3ß-silenced mice showed impaired contextual fear memory retrieval. However, cue fear memory, spatial memory, locomotor activity and anxiety levels were similar to control. These GSK3ß-silenced mice also showed increased induction and maintenance of DG long-term potentiation (DG-LTP) compared to control animals. Thus, this region-specific, targeted knockdown of GSK3ß in the DG provides better understanding on the role of GSK3ß in learning and memory.