The importance of green spaces to public health: a multi-continental analysis.

As green spaces are a common feature of liveable cities, a detailed understanding of the benefits provided by these areas is essential. Although green spaces are regarded as a major contribution to the human well-being in urbanized areas, current research has largely focused on the cities in developed countries and their global importance in terms of public health benefits remains unclear. In this study, we performed a multiple linear regression using 34 cities in different regions across the globe to investigate the relationship between green spaces and public health. Our analysis suggested that for richer cities, green spaces were associated with better public health; whereas a greater area of green spaces was associated with reduced public health in the poorest cities. In contrast to previous studies, which typically found positive relationships between green spaces and health benefits, we demonstrate that health benefits of green spaces could be context dependent.

Acute SARS-CoV-2-induced Psychosis in an Adolescent.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 illness is less common in children than in adults. Here, we report an unvaccinated 16-year-old male, normally fit and well with no previous personal or family history of mental illness, who developed moderate respiratory illness related to SARS-CoV-2 infection that was followed by acute psychosis. Neuropsychiatric manifestations are well documented in adults with SARS-CoV-2 infections; however, there are few reports in the pediatric population. This case illustrates that acute psychosis is a possible complication in children with mild SARS-CoV-2 illness and highlights the need for vigilance.

Acute Confusion as an Initial Presentation of SARS-CoV-2 Infection.

BACKGROUND AND PURPOSE: The respiratory manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been extensively documented. There is emerging evidence that coronavirus disease 2019 (COVID-19) has number of other presenting features which might not be related to the severity of the respiratory disease. We have previously described a case of hypoactive delirium as the first manifestation of COVID-19 without profound lung disease. Here we present five cases of elderly patients, without a prior history of dementia and had no overt COVID-19-related pneumonia, who presented with the acute onset of delirium as the primary manifestation of COVID-19. METHODS: This retrospective, single-center study performed a health informatics search to produce a list of patients who were admitted with acute confusion and tested positive for the SARS-CoV-2 virus between March 1 and June 30, 2020. The electronic medical admission notes were screened for all patients with confusion who tested positive for SARS-CoV-2. Patients with a history of dementia and a high risk of delirium were excluded, such as severe COVID-19-related pneumonia or any other infection, malignancy, drugs, or severe illness of any kind. RESULTS: During the first wave of the COVID-19 pandemic our hospital experienced just over 3,000 SARS-CoV-2 positive patients, and 45 of them had documented confusion upon admission. Secondary causes for their acute confusion were excluded. Five patients were identified as having delirium as the initial presentation of COVID-19-related illness without significant COVID-19-related pneumonitis. None of them had overt chest symptoms or a previous history of confusion, and the 3 patients who underwent head CT scans had normal findings. CONCLUSIONS: This case series illustrates the importance of recognizing acute confusion as the first manifestation of COVID-19 in susceptible individuals.

Prolonged confusional state as first manifestation of COVID-19.

A 77-year-old gentleman, normally fit and well, was admitted with acute confusion. On admission, Glasgow Coma Scale (GCS) was 14/15, vital signs were within the normal limits and bilateral crepitation at the lung base. Head CT scan was normal. CXR showed some air space opacification. Investigations revealed hyponatraemia, raised CRP, and positive for COVID-19. Treated with antibiotics and intravenous saline, sodium returned to normal. Delirium remained unchanged 4 weeks post-incidence. Neurological manifestations were documented in patients with COVID-19; however no report has shown delirium as a primary manifestation. This case illustrates acute confusion may be the only presenting symptom of COVID-19 without overt lung disease.