Effect of perceived discrimination on depression and suicidal ideation during the COVID-19 pandemic: A large-scale, repeated-measures study in the All of Us Research Program

ObjectiveThe COVID-19 pandemic has coincided with an increase in depressive symptoms as well as a growing awareness of health inequities and structural racism in the United States. Here, we examine the mental health impact of everyday discrimination during the pandemic in a large and diverse cohort of the All of Us Research Program. MethodsUsing repeated assessments of 62,651 participants in May to July of 2020, we fitted mixed-effects models to assess the effect of everyday discrimination on moderate to severe depression (Patient Health Questionnaire (PHQ)-9 [≥] 10) and suicidal ideation (PHQ-9 item 9 > 0), and applied inverse probability weights to account for non-random probabilities of completing the voluntary survey. ResultsEveryday discrimination was associated with increased odds of depression (adjusted odds ratio (aOR) [95% CI]: 1.21 [1.20 -1.22]) and suicidal ideation (1.17 [1.16-1.18]). For depression, the effects were larger in earlier phases of the pandemic (interaction p=8.2x10-5), which varied by main reason for discrimination and self-reported race and ethnicity. Among those who identified race or ancestry/national origin(s) as a primary reason for discrimination, Asian and Black or African American participants had 24% and 17% increase in the odds of depression in May of 2020 (1.24 [1.17-1.31] and 1.17 [1.12-1.22]), respectively, versus a 3% and 7% increase in July (1.03 [0.96-1.10] and 1.07 [1.02-1.12]). ConclusionIn this large and diverse sample, increased levels of everyday discrimination were associated with higher odds of depression, particularly during the early phase of the pandemic among participants self-identifying as Asian or Black.

Characterization and Clinical Course of 1000 Patients with COVID-19 in New York: retrospective case series

ObjectiveTo characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs). DesignRetrospective manual medical record review. SettingNewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC. ParticipantsThe first 1000 consecutive patients with laboratory-confirmed COVID-19. MethodsWe identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record. Main outcome measuresWe describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition. ResultsAmong the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital. ConclusionsHospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset.

Prevention of venous thromboembolism amongst patients in an acute tertiary referral teaching public hospital: a best practice implementation project.

BACKGROUND: Deep vein thrombosis and pulmonary embolism are known collectively as venous thromboembolism (VTE). These conditions are possible complications in hospitalized patients that can extend hospital stay, result in unplanned readmission, and are associated with long-term disability and death. Despite strong evidence, many patients do not receive optimal thromboprophylaxis. VTE prevention is a top priority in healthcare systems worldwide. AIM: The aim of the project was to establish a standardized hospital-wide VTE prevention program and to improve awareness of, and compliance with, best practice standards in the prevention of VTE. METHODS: A multidisciplinary team utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System program to facilitate the collection of pre and post implementation audit data. The Getting Research into Practice program was also used to conduct a situational analysis to identify barriers, enablers, and implementation strategies while taking into account the context in which the changes were to occur. Hospital-acquired VTE data were collected to monitor the impact, if any, on patient outcomes. The project was conducted in three different phases over a 2.5-year period in an acute care public hospital. RESULTS: A comprehensive suite of professionally crafted guidelines, tools, and resources were developed to facilitate clinician acceptance of evidence-based practices. Comparison of compliance results showed variable improvements with four audit criteria. Formalized patient risk assessment improved to 7.5% with the introduction of a new form. High-risk patients receiving appropriate prophylaxis improved to 81% in medical and 83% in surgical patients, on an existing high background compliance rate. A total of 59% of staff attended a VTE update education in-service. No patients received information about adverse VTE events prior to discharge. The hospital-acquired VTE rate decreased slightly from 0.65 to 0.52 events per 1000 overnight bed days. CONCLUSION: Overall the project achieved improvements in compliance with best practice standards. A number of delays and barriers contributed to some of the planned interventions not being fully implemented at the time of the follow-up audit. Contributing factors included the lack of electronic capabilities, some processes not being fully embedded into routine clinical workflows, lack of staff time, and identification of an additional organizational barrier relating to practical issues in providing patient education at discharge. A second action cycle is recommended in an attempt to further improve compliance, ensure intervention fidelity, and embed practices into routine daily workflows to positively impact patient and organizational outcomes.

A systematic review of randomized controlled trials examining the effectiveness of saffron (Crocus sativus L.) on psychological and behavioral outcomes.

BACKGROUND: Throughout the past three decades, increased scientific attention has been given to examining saffron's (Crocus sativus L.) use as a potential therapeutic or preventive agent for a number of health conditions, including cancer, cardiovascular disease, and depression. OBJECTIVE: The purpose of this systematic review is to examine and categorize the current state of scientific evidence from randomized controlled trials (RCTs) regarding the efficacy of saffron on psychological/behavioral outcomes. SEARCH STRATEGY: Electronic and non-electronic systematic searches were conducted to identify all relevant human clinical research on saffron. The search strategy was extensive and was designed according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)." Reference lists of articles that met the inclusion criteria were searched. Only English language studies were reviewed. INCLUSION CRITERIA: Saffron trials in combination with other substances and saffron safety studies were considered, in accordance with the PRISMA statement. Included studies must have a control group. Included studies must measure a physiological and/or a behavioral outcome. DATA EXTRACTION AND ANALYSIS: The methodological quality of all included studies was independently evaluated by two reviewers using the Jadad score. Mean scores and P-values of measures were compared both inter- and intra-study for each parameter (i.e., depression). RESULTS: Twelve studies met our inclusion criteria. These studies examined the effects of saffron on psychological/behavioral outcomes of: major depressive disorder (n=6), premenstrual syndrome (n = 1), sexual dysfunction and infertility (n=4), and weight loss/snacking behaviors (n=1). The data from these studies support the efficacy of saffron as compared to placebo in improving the following conditions: depressive symptoms (compared to anti-depressants and placebo), premenstrual symptoms, and sexual dysfunction. In addition, saffron use was also effective in reducing excessive snacking behavior. CONCLUSION: Findings from initial clinical trials suggest that saffron may improve the symptoms and the effects of depression, premenstrual syndrome, sexual dysfunction and infertility, and excessive snacking behaviors. Larger multi-site clinical trials are needed to extend these preliminary findings.

A systematic review of randomized controlled trials examining the effectiveness of saffron (Crocus sativus L.) on psychological and behavioral outcomes / 中西医结合学报

<p><b>BACKGROUND</b>Throughout the past three decades, increased scientific attention has been given to examining saffron's (Crocus sativus L.) use as a potential therapeutic or preventive agent for a number of health conditions, including cancer, cardiovascular disease, and depression.</p><p><b>OBJECTIVE</b>The purpose of this systematic review is to examine and categorize the current state of scientific evidence from randomized controlled trials (RCTs) regarding the efficacy of saffron on psychological/behavioral outcomes.</p><p><b>SEARCH STRATEGY</b>Electronic and non-electronic systematic searches were conducted to identify all relevant human clinical research on saffron. The search strategy was extensive and was designed according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)." Reference lists of articles that met the inclusion criteria were searched. Only English language studies were reviewed.</p><p><b>INCLUSION CRITERIA</b>Saffron trials in combination with other substances and saffron safety studies were considered, in accordance with the PRISMA statement. Included studies must have a control group. Included studies must measure a physiological and/or a behavioral outcome.</p><p><b>DATA EXTRACTION AND ANALYSIS</b>The methodological quality of all included studies was independently evaluated by two reviewers using the Jadad score. Mean scores and P-values of measures were compared both inter- and intra-study for each parameter (i.e., depression).</p><p><b>RESULTS</b>Twelve studies met our inclusion criteria. These studies examined the effects of saffron on psychological/behavioral outcomes of: major depressive disorder (n=6), premenstrual syndrome (n = 1), sexual dysfunction and infertility (n=4), and weight loss/snacking behaviors (n=1). The data from these studies support the efficacy of saffron as compared to placebo in improving the following conditions: depressive symptoms (compared to anti-depressants and placebo), premenstrual symptoms, and sexual dysfunction. In addition, saffron use was also effective in reducing excessive snacking behavior.</p><p><b>CONCLUSION</b>Findings from initial clinical trials suggest that saffron may improve the symptoms and the effects of depression, premenstrual syndrome, sexual dysfunction and infertility, and excessive snacking behaviors. Larger multi-site clinical trials are needed to extend these preliminary findings.</p>

Adolescent cardiovascular risk factors: A follow-up study.

PURPOSE: To assess the outcomes of a school nurse referral to a family physician for adolescents identified with elevated cholesterol or blood pressure risk factors. METHOD: Telephone survey interviews were used to collect quantitative and qualitative data. FINDINGS: Data were collected on 178 adolescents through parent and adolescent interviews over a 3-month period. The main theme reported for not complying with the follow-up referral was that respondents did not perceive it as necessary or urgent. Of the approximately 60% who reportedly went to the physician, 58% had further tests, 10% were referred to specialists, and 3% were prescribed medications. Eating and exercise changes were reported by those who went for follow-up. CONCLUSION: Adolescent health-seeking behaviors can be influenced positively by school programs that involve families in discussion, nurses in risk identification, and referrals to physicians for follow-up.

Building a more resilient haitian state

Ce rapport évalue les plans et politiques passés et actuels visant à améliorer la prestation de services publics en Haïti et, en s'appuyant sur cette évaluation, il fournit des recommandations sur la façon dont ces plans et politiques pourraient être améliorées. Le rapport met l'accent sur l'établissement de priorités pour les années à venir et propose des mesures qui pourraient produire des améliorations palpables dans la fourniture de services publics pendant cette période. Il est destiné au gouvernement d'Haïti pour l'élaboration de plans détaillés pour les réformes politiques et institutionnelles, ainsi qu'à la communauté internationale dans sa détermination de la façon de soutenir les efforts du gouvernement.

Prevalence of cardiovascular risk factors in grade nine students.

BACKGROUND: The Niagara Schools' Healthy Heart Program (NSHHP) is a health education and intervention program offered to students enrolled in a grade nine physical education course. The program involves completion of a family history and a self-report lifestyle survey, measurements of height, weight, blood pressure, and random total cholesterol levels, a heart education class, and CPR training. PURPOSE: The purpose of this study was to report the prevalence of cardiovascular risk for adolescents enrolled in the program. METHODS: A secondary analysis was conducted using data collected by the NSHHP staff to determine the prevalence of cardiovascular risk factors in grade nine students for the school year 2006. Specific risk factors studied were smoking, body mass index, total cholesterol level and blood pressure. RESULTS: A total of 3,639 students from 30 schools participated. Almost 14% of students had at least one cardiovascular risk factor. Body mass index was found to be the highest risk factor (13.7%) and total random cholesterol level (5%) was found to be the lowest risk factor in this sample. There were differences in prevalence rates between male and female students for all risk factors except elevated blood pressure. Five per cent of the students were referred to a family physician for follow-up, mostly for high cholesterol readings. CONCLUSIONS: The findings suggest that adolescents do have cardiovascular risk factors and prevention could be targeted to this population. These risk factors were already established by the time the students reached adolescence. The findings support conducting early prevention with younger children and adolescents.

Effects of benzodiazepines on explicit memory in a paediatric surgery setting.

RATIONALE: Many laboratory-based studies indicate that benzodiazepines impair explicit memory performance, increase sedation, and impair attention. OBJECTIVES: The present study was designed to extend prior lab-based findings to an applied setting in which the amnestic effects of benzodiazepines may be beneficial for users. In addition, the study extended the previous adult-focused research by examining the cognitive effects of benzodiazepines in children. METHODS: The present study examined the use of a specific benzodiazepine (midazolam) as a premedicant among 40 children aged 4-6 years old having ear tube (myringotomy) surgery, who were randomly assigned to receive midazolam or placebo. RESULTS: Consistent with previous studies, the results indicated that midazolam causes significant amnesia on a cued recall task. In addition, free recall for post-drug events were also impaired by midazolam relative to placebo, indicating that benzodiazepine-induced amnesia occurs even for highly salient information. CONCLUSIONS: Overall, it appears that benzodiazepines do impair memory in a pediatric population. This amnesia was not secondary to the inattention and sedation also caused by midazolam administration. The theoretical and clinical implications of these findings are discussed, as are potential future studies.