Predictors of acute insomnia during the COVID-19 pandemic beyond perceived stress

Introduction Stress is a common precipitant of acute insomnia and likely contributed to increased reports of sleep disturbances during the COVID-19 pandemic. However, many other sleep and lifestyle changes may have also precipitated acute insomnia. This study aimed to clarify which factors, beyond perceived stress, contributed to the development of acute insomnia during the COVID-19 pandemic. Methods The study consisted of 578 participants with acute insomnia and 741 good sleepers. Participants completed an online survey assessing insomnia symptoms, sleep, lifestyle changes and mental health during the COVID-19 pandemic. Logistic regression analyses were conducted to identify contributing factors to acute insomnia when controlling for demographic differences between groups. Results Perceived stress was a significant predictor of acute insomnia during the pandemic (p<.001). However, after adjusting for stress, individuals who altered their sleep timing (p<.001) or increased their use of technology before bed (p=.037) during the pandemic were at a 3-fold increased risk of acute insomnia. Other sleep factors associated with acute insomnia included dream changes (p=.001), sleep effort (p<.001), and cognitive pre-sleep arousal (p<.001). For pandemic factors, being very worried about contracting COVID-19 (p<.002) and more stringent COVID-19 government restrictions (p<.001) increased the risk. Anxiety (p<.001) and depressive (p<.001) symptoms, as well as the personality trait of agreeableness (p=.010), also contributed to acute insomnia. Discussion To reduce acute insomnia during the COVID-19 pandemic, public health messaging should promote stress reduction and mental health care, but also modifiable behaviours such as keeping consistent sleep patterns and reducing technology use before bed.

‘We are developing our bubble': role of the built environment in supporting physical and social activities in independent-living older adults during COVID-19

This study explores how the built environment can support and challenge a bubble strategy designed to protect older adults from virus transmission while at the same time allowing them maintain their physical and social activities during COVID-19. We conducted a case study of older adults in an independent-living building and the surrounding neighborhood in Edmonton, Alberta, Canada. Data were collected through building and neighborhood observations, and 11 semi-structured in-depth interviews with 6 building residents and 6 stakeholders. Data were analyzed through mapping and interpretative phenomenological analysis (IPA). Complex and nuanced relationships between human and nonhuman factors that supported and challenged the bubble are elaborated in three built environment categories. (1) ‘Building interiors', where residents conduct routine activities and attend physical and social activities with neighbors, were central to the bubble. (2) ‘Neighborhood environments' were extensions of the bubble that affected residents' outdoor activities. (3) ‘Building edges' were important for balancing residents' needs for connecting to the world outside and protecting themselves from the virus. Communities should consider the bubble strategy combined with built environment supports to assist older adults in protecting themselves against virus transmission, and maintaining physical and social activities during the ongoing pandemic and future epidemics. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Changes in Depression and Anxiety Among Children and Adolescents From Before to During the COVID-19 Pandemic: A Systematic Review and Meta-analysis.

Importance: There is a growing body of high-quality cohort-based research that has examined changes in child and adolescent mental health during the COVID-19 pandemic vs before the pandemic. Some studies have found that child and adolescent depression and anxiety symptoms have increased, while others have found these symptoms to have remained stable or decreased. Objective: To synthesize the available longitudinal cohort-based research evidence to estimate the direction and magnitude of changes in depression and anxiety symptoms in children and adolescents assessed before and during the pandemic. Data Sources: Medline, Embase, and PsycInfo were searched for studies published between January 1, 2020, and May 17, 2022. Study Selection: Included studies reported on depression and/or anxiety symptoms, had cohort data comparing prepandemic to pandemic estimates, included a sample of children and/or adolescents younger than 19 years, and were published in English in a peer-reviewed journal. Data Extraction and Synthesis: In total, 53 longitudinal cohort studies from 12 countries with 87 study estimates representing 40 807 children and adolescents were included. Main Outcomes and Measures: Standardized mean changes (SMC) in depression and anxiety symptoms from before to during the pandemic. Results: The analysis included 40 807 children and adolescents represented in pre-COVID-19 studies and 33 682 represented in during-COVID-19 studies. There was good evidence of an increase in depression symptoms (SMC, 0.26; 95% CI, 0.19 to 0.33). Changes in depression symptoms were most conclusive for study estimates among female individuals (SMC, 0.32; 95% CI, 0.21 to 0.42), study estimates with mid to high income (SMC, 0.35; 95% CI, 0.07 to 0.63), and study estimates sourced from North America (SMC, 0.25; 95% CI, 0.15 to 0.36) and Europe (SMC, 0.35; 95% CI, 0.17 to 0.53). There was strong evidence that anxiety symptoms increased slightly during the pandemic (SMC, 0.10; 95% CI, 0.04 to 0.16), and there was some evidence of an increase in study estimates with mid to high income. Conclusions: This systematic review and meta-analysis of longitudinal studies including children and adolescents found an increase in depression symptoms during the COVID-19 pandemic, particularly among female individuals and those from relatively higher-income backgrounds.

Defining Health: Update From ASHRAE SGPC10 Committee, Interactions Affecting The Achievement Of Acceptable Indoor Environments

Healthy Buildings has become the marketing focus, if not the goal, for an increasing number of projects and organizations in the past five years. The current COVID-19 pandemic has placed a new and compelling spotlight directly onto buildings of all types, whether offices, homes, retail, restaurants, hotels, or schools. The issues are no longer limited to the functional parameters of the building design, construction, maintenance, and use. Neither do the concerns remain within the legacy boundaries of the expansion from indoor air quality (IAQ) to indoor environmental quality (IEQ). The driving concern now is how the parameters of building functioning affect the occupants. To do so requires measurements for assessment followed by measurements for verification. Those measurements do not exist. The public health risk to occupants of buildings, prioritized by the COVID-19 pandemic and climate change, needs complex metrics, both theoretical and practical. The committee discussion and recommendations highlight why there is no operational definition of health, challenges in moving forward, and points to a conceptual and practical direction.

Comparison of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation before and during the COVID-19 pandemic: a systematic review and meta-analysis.

BACKGROUND: There is a lack of consensus about the effect of the COVID-19 pandemic on the mental health of children and adolescents. We aimed to compare rates of paediatric emergency department visits for attempted suicide, self-harm, and suicidal ideation during the pandemic with those before the pandemic. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO for studies published between Jan 1, 2020, and Dec 19, 2022. Studies published in English with data on paediatric (ie, those aged <19 years) emergency department visits before and during the COVID-19 pandemic were included. Case studies and qualitative analyses were excluded. Changes in attempted suicide, self-harm, suicidal ideation, and other mental-illness indicators (eg, anxiety, depression, and psychosis) were expressed as ratios of the rates of emergency department visits during the pandemic compared with those before the pandemic, and we analysed these with a random-effects meta-analysis. This study was registered with PROSPERO, CRD42022341897. FINDINGS: 10 360 non-duplicate records were retrieved, which yielded 42 relevant studies (with 130 sample-estimates) representing 11·1 million emergency department visits for all indications of children and adolescents across 18 countries. The mean age of the samples of children and adolescents across studies was 11·7 years (SD 3·1, range 5·5-16·3), and there were on average 57·6% girls and 43·4% boys as a proportion of emergency department visits for any health reasons (ie, physical and mental). Only one study had data related to race or ethnicity. There was good evidence of an increase in emergency department visits for attempted suicide during the pandemic (rate ratio 1·22, 90% CI 1·08-1·37), modest evidence of an increase in emergency department visits for suicidal ideation (1·08, 0·93-1·25), and good evidence for only a slight change in self-harm (0·96, 0·89-1·04). Rates of emergency department visits for other mental-illness indications showed very good evidence of a decline (0·81, 0·74-0·89), and paediatric visits for all health indications showed strong evidence of a reduction (0·68, 0·62-0·75). When rates for attempted suicide and suicidal ideation were combined as a single measure, there was good evidence of an increase in emergency department visits among girls (1·39, 1·04-1·88) and only modest evidence of an increase among boys (1·06, 0·92-1·24). Self-harm among older children (mean age 16·3 years, range 13·0-16·3) showed good evidence of an increase (1·18, 1·00-1·39), but among younger children (mean age 9·0 years, range 5·5-12·0) there was modest evidence of a decrease (0·85, 0·70-1·05). INTERPRETATION: The integration of mental health support within community health and the education system-including promotion, prevention, early intervention, and treatment-is urgently needed to increase the reach of mental health support that can mitigate child and adolescent mental distress. In future pandemics, increased resourcing in some emergency department settings would help to address their expected increase in visits for acute mental distress among children and adolescents. FUNDING: None.

Backtalk: What principals need to know to respond to a crisis

Principals face unexpected crises, big and small, regularly. Yet, as the COVID-19 pandemic illustrated, they aren't always prepared for them when they come. Mario Jackson describes some of the challenges principals faced during the pandemic and the specific attributes that helped them manage. Specifically, equity-oriented leadership, crisis communication, and emotional intelligence skills were crucial to leaders during the pandemic. These skills can be beneficial in a variety of crises, and Jackson suggests that principal preparation programs help leaders grow in these areas. © 2023 by Phi Delta Kappa International.

Combination Eravacycline Therapy for Carbapenem-Resistant Acinetobacter baumannii Pneumonia

Background. Acinetobacter baumannii typically causes infections in debilitated, hospitalized patients and is difficult to treat due to multiple virulence factors and the presence of intrinsic and acquired antibiotic resistance mechanisms leading to frequent isolation of multi-drug resistant (MDR) phenotypes. Due to problematic pharmacokinetics and/or dose-limiting toxicities of salvage agents, combination therapy with aminoglycosides, ampicillin/sulbactam, polymyxins, minocycline, or tigecycline, is often used. Eravacycline has demonstrated greater in-vitro potency against A. baumannii compared to other tetracycline derivatives making it potentially the more appealing option. However, its utility is hindered by a lack of data supporting pharmacodynamic targets and adequate dosing strategies for CRAB. The goal of this case series was to describe our experience with the use of combination eravacycline therapy for the treatment of CRAB pneumonia. Methods. This case series included all patients >= 18 years of age, diagnosed with SARS-CoV-2, >= 1 sputum culture positive for CRAB and a clinical diagnosis of new bacterial pneumonia, who received at least one dose of eravacycline between April 1st and October 1st, 2020. The primary outcome was clinical resolution of CRAB pneumonia. Secondary outcomes evaluated microbiological resolution, need for extended durations of therapy, and frequency of re-starting CRAB therapy within 48 hours of completion. Results. In total, 25 patients were included in this case series. The median duration of combination therapy was 10 days. Most patients (96%) received eravacycline + ampicillin/sulbactam, with 7 of those patients also receiving inhaled colistin (Table 2). In total, 17 (68%) patients achieved clinical resolution of CRAB pneumonia. Post-treatment sputum cultures were collected in 18 patients, of which 13 (72%) achieved microbiological resolution. One patient received > 14 days of therapy and no patients re-initiated therapy within 48 hours of eravacycline completion. Table 1: Baseline Characteristics Table 2: Study Outcomes Conclusion. In this small case series, eravacycline showed favorable clinical outcomes in patients with CRAB pneumonia. In light of limited treatment options, this agent can be considered for CRAB pneumonia salvage therapy.

MEI LING, MARY, AND MICHAELA: Mapping drama teaching journeys

This is an account of how two pre-service student teachers had the initiative and the courage to try teaching some drama for the first time during their practicum (classroom) placements and who achieved successful and rewarding learning and teaching experiences. These are stories from the time of COVID-19 from teachers who faced and learned from the hurdle of drama teaching in uncertain times. From a three-way collegial discussion, this chapter reports what contributed to their success and draws out what we might learn from their experience. © 2022 selection and editorial matter, Michaela Jack and Mary Jackson.

Patterns of Deaths in People With Dementia and Alzheimer's During the COVID-19 Pandemic in England: Lessons for Palliative Care Before the Next Pandemic

Background/aims: Older people had the highest death rates in England during the COVID-19 pandemic, before the vaccination programme. Deaths in care homes were especially high in the 1st Wave (W1) - April 2020 of the pandemic, with a lower peak in the 2nd Wave (W2) - December 2020/January 2021. People with Dementia and Alzheimer's (D&A)) were among the most vulnerable to become victims to COVID-19. Aims: To describe mortality patterns in people with (D&A) during the COVID-19 pandemic to learn lessons for Palliative and End of Life Care (P&EOLC) for D&A in pandemics. Methods: Mortality data in England, January 2019 to May 2021 analysed by calendar month and place of death for D&A as underlying cause (UC) and contributory cause (CC) on death registrations. The key underlying causes for D&A CC deaths were identified. Comparisons were made for 2020 with 2019 and for W1 and W2 the same months in 2019/20 using descriptive statistics. Results: In 2019, 64,468 people died with D&A as UC vs. 67,872 in 2020 (+5.3%), but strikingly deaths with D&A as CC increased 69% (26,445 to 44,624). The W1 and W2 peaks for D&A deaths were highly significant but different in nature. In W1 79% (8,435) D&A UC deaths were in care homes vs. 64% (3,435) 2019. For D&A CC deaths in W1 (April 2020) there was ∼400% increase in deaths (2,146 to 10,682) and 325% and 569% increases in hospital and care home deaths. In W1 COVID-19 (7,496 deaths) was the main (70%) UC for people dying with D&A as CC, increases also for Circulatory Disease +44%, Cancer +31%, Parkinsons +117% and respiratory disease (COPD) + 69.3%. W2 saw a 19% reduction in D&A UC deaths but +139% as CC with COVID-19 main UC. Conclusions: People with D&A were extremely vulnerable to risk of death during the COVID-19 pandemic, especially if living in a care-home and due to pressures on healthcare. The speed of surge in deaths and impact on care homes highlights the critical need for Advance Care Plans/Power of Attorney for people with D&A and especially training of care home staff in P&EOLC.

Pulmonary rehabilitation and digital applications: Patient engagement, experience and feedback

Keywords: Digital, Engagement, Pulmonary Rehabilitation Purpose: In response to the COVID-19 pandemic, the service delivery of Pulmonary Rehabilitation (PR) expanded to provide patients with the option of online digital applications for education. At Liverpool Heart and Chest Hospital, those with a diagnosis of Chronic Obstructive Pulmonary Disease (COPD) were offered the MyCOPD app as a digital self-management tool. Initially, only 43% of patients had completed the app, therefore the Breathe Programme conducted a short survey, between September 2020 and January 2021, to gain patient feedback regarding their experiences of the app. Thus, the objective of this study was to utilise patient feedback to explore ways that digital engagement could be optimised within PR. Methods: A convenience sampling method was used to identify 227 patients with COPD who were eligible for the MyCOPD app. Eligibility was further determined by whether they had internet access via a digital device and an appropriate skill set, which was reported by the patient during triage. All patients were encouraged to visit the MyCOPD website for further information before accepting. Those who declined were offered a traditional PR programme. Each patients’ level of engagement was monitored weekly via the app's online dashboard. Weekly text messages and app notifications were sent to each patient during their time on the programme to encourage engagement. Those who accepted and completed the programme (26) completed a feedback questionnaire upon discharge. Feedback was both qualitative and quantitative. Results: 57 patients (25%) accepted the MyCOPD app whilst 170 (75%) of patients originally opted for traditional PR. The most significant reasons for declining were found to be lack of internet access and lack of skill set. 31 patients dropped out;11 were discharged due to lack of engagement and the remaining 20 patients later opted for traditional PR due to lack of digital skills. They reported finding paper educational packs easier for education. The majority of patients accessed the app via their smartphone. 92% of patients reported the app was either “Very Valuable” or “Valuable” in improving their confidence to self-manage their condition. Weekly text messages helped to improve compliance. Conclusion(s): Digital apps within PR can be useful in promoting patient self-management. However, the three issues that must be addressed and require further research are lack of internet access, poor patient digital perceptions and skill level. Reasons for this could be due to socio-economic factors, suggesting that social inequalities would need to be addressed to improve digital uptake. Some patients may require training to improve technological literacy, and overall skill set. The drop-out rate indicates that some patients had poor insight into their initial level of digital competency. Overall, a combination of traditional and digital options should be made available within the PR model to prevent exclusion, promote access to all and provide patient choice, which is paramount within healthcare. Impact: Patients within a PR cohort require more support and training in how to access and use digital technologies. Further research is required into patient digital accessibility, expectations and preferences to provide holistic and inclusive care. Funding acknowledgements: N/A

Uncoupling Molecular Testing for SARS-CoV-2 From International Supply Chains.

The rapid global rise of COVID-19 from late 2019 caught major manufacturers of RT-qPCR reagents by surprise and threw into sharp focus the heavy reliance of molecular diagnostic providers on a handful of reagent suppliers. In addition, lockdown and transport bans, necessarily imposed to contain disease spread, put pressure on global supply lines with freight volumes severely restricted. These issues were acutely felt in New Zealand, an island nation located at the end of most supply lines. This led New Zealand scientists to pose the hypothetical question: in a doomsday scenario where access to COVID-19 RT-qPCR reagents became unavailable, would New Zealand possess the expertise and infrastructure to make its own reagents onshore? In this work we describe a review of New Zealand's COVID-19 test requirements, bring together local experts and resources to make all reagents for the RT-qPCR process, and create a COVID-19 diagnostic assay referred to as HomeBrew (HB) RT-qPCR from onshore synthesized components. This one-step RT-qPCR assay was evaluated using clinical samples and shown to be comparable to a commercial COVID-19 assay. Through this work we show New Zealand has both the expertise and, with sufficient lead time and forward planning, infrastructure capacity to meet reagent supply challenges if they were ever to emerge.

Characterization of the First SARS-CoV-2 Isolates from Aotearoa New Zealand as Part of a Rapid Response to the COVID-19 Pandemic.

SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has wreaked havoc across the globe for the last two years. More than 300 million cases and over 5 million deaths later, we continue battling the first real pandemic of the 21st century. SARS-CoV-2 spread quickly, reaching most countries within the first half of 2020, and New Zealand was not an exception. Here, we describe the first isolation and characterization of SARS-CoV-2 variants during the initial virus outbreak in New Zealand. Patient-derived nasopharyngeal samples were used to inoculate Vero cells and, three to four days later, a cytopathic effect was observed in seven viral cultures. Viral growth kinetics was characterized using Vero and VeroE6/TMPRSS2 cells. The identity of the viruses was verified by RT-qPCR, Western blot, indirect immunofluorescence assays, and electron microscopy. Whole-genome sequences were analyzed using two different yet complementary deep sequencing platforms (MiSeq/Illumina and Ion PGM™/Ion Torrent™), classifying the viruses as SARS-CoV-2 B.55, B.31, B.1, or B.1.369 based on the Pango Lineage nomenclature. All seven SARS-CoV-2 isolates were susceptible to remdesivir (EC50 values from 0.83 to 2.42 µM) and ß-D-N4-hydroxycytidine (molnupiravir, EC50 values from 0.96 to 1.15 µM) but not to favipiravir (>10 µM). Interestingly, four SARS-CoV-2 isolates, carrying the D614G substitution originally associated with increased transmissibility, were more susceptible (2.4-fold) to a commercial monoclonal antibody targeting the spike glycoprotein than the wild-type viruses. Altogether, this seminal work allowed for early access to SARS-CoV-2 isolates in New Zealand, paving the way for numerous clinical and scientific research projects in the country, including the development and validation of diagnostic assays, antiviral strategies, and a national COVID-19 vaccine development program.

Effects of COVID-19 stay-at- home orders on physical activity in people with obesity

Background: Individuals may experience reduced physical activity (PA) levels during stay-at- home orders in response to COVID-19. While reduced PA negatively affects all populations, those with overweight/obesity may be disproportionately affected. Also, differences between men and women may exist. The aim of this study was to examine changes in PA levels during COVID-19 between individuals with normal weight and overweight/obesity, and the influence of gender in this relationship. Methods: An electronic survey was distributed in Brazil between May 5th -17th 2020. Participants (N = 1828 ≥18 y) were invited through social media to answer a structured questionnaire using Google Forms. The online assessment included questions pertaining to physical activity type and frequency, overall health status, weight, and height. Binary logistic regression was used to analyze the relationship between overweight/obesity (body mass index ≥ 25 kg/m2), the impact COVID-19 on PA level, and the influence of gender. Results: Compared to normal weight individuals, those with overweight/ obesity were more likely to engage in lower intensity activities (p < 0.001). There were significant associations between those with overweight/obesity and PA levels when compared with normal weight individuals when adjusted for age, education level, social isolation, and pre-pandemic physical activity levels (p < 0.017). Conclusions: There is an association between body weight and changes in PA levels during the COVID-19 pandemic. Individuals with overweight/obesity were more likely to have lower PA levels during COVID-19 pandemic, independent of their gender.

“All Zoomed Out”: Strategies for Addressing Zoom Fatigue in the Age of COVID-19

The COVID-19 pandemic has impacted institutions of higher education, and as a result, many educators are now experiencing Zoom fatigue. Institutions of higher education have moved to online or remote learning and are integrating web conferencing tools such as Zoom, WebEx, and Adobe Connect for course delivery. Many educators have reported an overutilization of technology, which has resulted in technostress. Technostress has been shown to affect physical and mental health. As more institutions of higher education move to remote learning, it will require a collective response from educators and from colleges and universities. The purpose of this article is to explore how the technostress model can be used as the framework to provide strategies to recognize and address Zoom fatigue. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Relapsing Klebsiella pneumoniae meningitis in a patient with COVID-19.

Klebsiella pneumoniae is a common cause of potentially life-threatening infection. This report describes a relapsing healthcare-associated Klebsiella pneumoniae meningitis in a 60-year-old patient who had SARS-CoV-2 infection. During their initial admission for COVID-19 pneumonitis and treatment with corticosteroids, the patient developed signs and symptoms suggestive of bacterial meningitis. Blood and cerebrospinal fluid cultures confirmed Klebsiella pneumoniae as the causative organism. The patient was treated with a prolonged course of high-dose meropenem and made an apparent recovery. Four days after hospital discharge, the patient re-presented critically unwell. Klebsiella pneumoniae was once again isolated from cerebrospinal fluid. During their second admission, the patient deteriorated despite antimicrobial treatment, and life-sustaining therapies were withdrawn. This case highlights that all COVID-19 patients receiving immunosuppressive therapy should be monitored for potential opportunistic infection. Prompt recognition and early antimicrobial therapy are key to improving patient outcomes.

Rapid Response to SARS-CoV-2 in Aotearoa New Zealand: Implementation of a Diagnostic Test and Characterization of the First COVID-19 Cases in the South Island.

It has been 20 months since we first heard of SARS-CoV-2, the novel coronavirus detected in the Hubei province, China, in December 2019, responsible for the ongoing COVID-19 pandemic. Since then, a myriad of studies aimed at understanding and controlling SARS-CoV-2 have been published at a pace that has outshined the original effort to combat HIV during the beginning of the AIDS epidemic. This massive response started by developing strategies to not only diagnose individual SARS-CoV-2 infections but to monitor the transmission, evolution, and global spread of this new virus. We currently have hundreds of commercial diagnostic tests; however, that was not the case in early 2020, when just a handful of protocols were available, and few whole-genome SARS-CoV-2 sequences had been described. It was mid-January 2020 when several District Health Boards across New Zealand started planning the implementation of diagnostic testing for this emerging virus. Here, we describe our experience implementing a molecular test to detect SARS-CoV-2 infection, adapting the RT-qPCR assay to be used in a random-access platform (Hologic Panther Fusion® System) in a clinical laboratory, and characterizing the first whole-genome SARS-CoV-2 sequences obtained in the South Island, right at the beginning of the SARS-CoV-2 outbreak in New Zealand. We expect that this work will help us and others prepare for the unequivocal risk of similar viral outbreaks in the future.