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1.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32999054

RESUMO

BACKGROUND: Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants. METHODS: Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020. RESULTS: Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range. CONCLUSION: An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.


Assuntos
Infecções por Coronavirus/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Coeficiente de Natalidade/tendências , Feminino , Humanos , Recém-Nascido , Irlanda/epidemiologia , Pandemias , Gravidez
2.
BMJ Glob Health ; 5(9)2020 09.
Artigo em Inglês | MEDLINE | ID: covidwho-808189

RESUMO

BACKGROUND: Aetiology of births involving very low birthweight (VLBW) and extremely low birthweight (ELBW) infants is heterogeneous and preventive strategies remain elusive. Socioenvironmental measures implemented as Ireland's response to the SARS-CoV-2 virus (COVID-19) pandemic represented a national lockdown, and have possibly influenced the health and well-being of pregnant women and unborn infants. METHODS: Regional trends of VLBW and ELBW infants in one designated health area of Ireland over two decades were analysed. Poisson regression and rate ratio analyses with 95% CI were conducted. Regional data covering most of the lockdown period of 2020 were compared with historical regional and national data and forecasted national figures for 2020. RESULTS: Poisson regression analysis found that the regional historical VLBW rate per 1000 live births for January to April, 2001-2019 was 8.18 (95% CI 7.21 to 9.29). During January to April 2020, an unusually low VLBW rate of just 2.17 per 1000 live births was observed, reflecting a rate ratio of 3.77 (95% CI 1.21 to 11.75), p=0.022, representing a 73% reduction of VLBW during the first 4 months of 2020 compared with same period for the preceding two decades. There were no ELBW infants admitted to the regional neonatal intensive care unit. National Irish VLBW rate for 2020 is forecasted to be reduced to approximate 400 per 60 000 births compared with the historical 500-600 range. CONCLUSION: An unprecedented reduction in regional births of VLBW and ELBW infants was observed in Ireland coinciding with the COVID-19 lockdown. Potential determinants of this unique temporal trend possibly reside in the summative socioenvironmental impact of the COVID-19 lockdown. Our findings, if mirrored in other regions that have adopted a lockdown, demonstrate the potential to evaluate these implicated behavioural and socioenvironmental modifiers to positively influence VLBW and ELBW rates globally.


Assuntos
Infecções por Coronavirus/epidemiologia , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Coeficiente de Natalidade/tendências , Feminino , Humanos , Recém-Nascido , Irlanda/epidemiologia , Pandemias , Gravidez
3.
Psychiatr Danub ; 32(Suppl 1): 24-28, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890357

RESUMO

BACKGROUND: Infanticide is not a new concept. It is often confused with child murder, neonaticide, filicide or even genderside. Each of these concepts has to be defined clearly in order to be understood. Through time reasons for infanticide have evolved depending on multiple factors such as culture, religion, beliefs system, or attempts to control the population. It was once seen as a moral virtue. So what has changed? SUBJECTS AND METHODS: Between January 2020 and May 2020, a literature search based on electronic bibliographic databases as well as other sources of information (grey literature) was conducted in order to investigate the most recent data on infanticide and child murder, especially the newest socio-economic and psychiatric considerations as well as the different reasons why a mother or a father ends up killing their own child and the Irish situation. RESULTS: Recent works on the subject demonstrate how some new socio economic factors and family considerations impact on infanticide. Mental illness, especially depression and psychosis, is often part of the picture and represent a very high risk factor to commit infanticide and filicide. Fathers and mothers do not proceed the same way nor for the same reasons when they kill their offspring. Neonaticide and infanticide are almost always committed by women. A recent case in Ireland (2020) proves how filicide remains an actual problem. CONCLUSIONS: Filicide is a relatively rare event, and therefore particularly impact both the public and the press when it occurs. Infanticide does not result from a unique cause, but from multiple factors (some being well known, some remaining hypothetical). Psychopathological and socio-economical parameters associated to peculiar family grounds are currently prevalent. To help and prevent infanticide, screening for psychiatric disorders and risk factors and treating or offering assistance to parents at risk should be implemented.


Assuntos
Homicídio , Infanticídio , Criança , Pai , Feminino , Humanos , Lactente , Irlanda , Masculino , Mães
4.
Artigo em Inglês | MEDLINE | ID: mdl-32942698

RESUMO

This study outlines the impact of COVID-19 on paediatric emergency department (ED) utilisation and assesses the extent of healthcare avoidance during each stage of the public health response strategy. Records from five EDs and one urgent care centre in Ireland, representing approximately 48% of national annual public paediatric ED attendances, are analysed to determine changes in characteristics of attendance during the three month period following the first reported COVID-19 case in Ireland, with reference to specific national public health stages. ED attendance reduced by 27-62% across all categories of diagnosis in the Delay phase and remained significantly below prior year levels as the country began Phase One of Reopening, with an incident rate ratio (IRR) of 0.58. The decrease was predominantly attributable to reduced attendance for injury and viral/viral induced conditions resulting from changed living conditions imposed by the public health response. However, attendance for complex chronic conditions also reduced and had yet to return to pre-COVID levels as reopening began. Attendances referred by general practitioners (GPs) dropped by 13 percentage points in the Delay phase and remained at that level. While changes in living conditions explain much of the decrease in overall attendance and in GP referrals, reduced attendance for complex chronic conditions may indicate avoidance behaviour and continued surveillance is necessary.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus , Criança , Medicina Geral , Humanos , Irlanda , Pandemias , Encaminhamento e Consulta/estatística & dados numéricos
5.
Trials ; 21(1): 758, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883328

RESUMO

OBJECTIVES: Tocilizumab is a humanized monoclonal antibody which targets and inhibits interleukin-6 (IL-6) and has demonstrated efficacy in treating diseases associated with hyper-inflammation. Data are suggestive of tocilizumab as a potential treatment for patients with COVID-19 infection. The aim of this study is to determine the safety and efficacy of standard dose versus low dose tocilizumab in adults with severe, non-critical, PCR-confirmed COVID-19 infection with evidence of progressive decline in respiratory function and evolving systemic inflammation on time to intubation, non-invasive ventilation and/or all-cause mortality. TRIAL DESIGN: This trial is a phase 2, open label, two-stage, multicentre, randomised trial. PARTICIPANTS: Adult subjects with severe, non-critical, PCR-confirmed COVID-19 infection with evidence of progressive decline in respiratory function and evolving systemic inflammation requiring admission to hospital at St. Vincent's University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. Inclusion criteria Aged 18 years or older. Confirmed SARS-CoV2 infection (as defined by positive PCR). Evidence of hyper inflammatory state as evidenced by at least three of the following: Documented temperature >38°C in the past 48 hours, IL6 >40 pg/ml, or in its absence D-dimer >1.5 µgFEU /ml, Elevated CRP (>100mg/L) and/or a three-fold increase since presentation, Elevated ferritin X5 ULN, Elevated LDH (above the ULN), Elevated fibrinogen (above the ULN). Pulmonary infiltrates on chest imaging. Moderate to severe respiratory failure as defined by PaO2/FiO2≤300mmHg. INTERVENTION AND COMPARATOR: Intervention for participants in this trial is SOC plus Tocilizumab compared to SOC alone (comparator). For Stage 1, following randomisation, subjects will receive either (Arm 1) SOC alone or (Arm 2) SOC plus Tocilizumab (standard single dose - 8mg/kg, infused over 60 minutes. Once stage 1 has fully recruited, subsequent participants will be enrolled directly into Stage 2 and receive either (Arm 1) SOC plus Tocilizumab (standard single dose - 8mg/kg, infused over 60 minutes or (Arm 2) SOC plus Tocilizumab (standard single dose - 4mg/kg, infused over 60 minutes). MAIN OUTCOMES: The primary endpoint for this study is the time to a composite primary endpoint of progression to intubation and ventilation, non-invasive ventilation or death within 28 days post randomisation. RANDOMISATION: Eligible patients will be randomised (1:1) using a central register. Randomisation will be performed through an interactive, web-based electronic data capturing database. In stage 1, eligible participants will be randomised (1:1) to (Arm 1) SOC alone or to (Arm 2) SOC with single dose (8mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes. In stage 2, eligible participants will be randomised (1:1) to receive either (Arm 1) single, standard dose (8mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes or (Arm 2) reduced dose (4mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes. BLINDING: This study is open label. The study will not be blinded to investigators, subjects, or medical or nursing staff. The trial statistician will be blinded for data analysis and will be kept unaware of treatment group assignments. To facilitate this, the randomisation schedule will be drawn up by an independent statistician and objective criteria were defined for the primary outcome to minimize potential bias. NUMBERS TO BE RANDOMISED: In stage 1, 90 subjects will be randomised 1:1, 45 to SOC and 45 subjects to SOC plus Tocilizumab (8mg/kg, infused over 60 minutes). In stage 2, sample size calculation for the dose evaluation stage will use data generated from stage 1 using the same primary endpoint as in stage 1. TRIAL STATUS: The COVIRL002 trial (Protocol version 1.4, 13th May 2020) commenced in May 2020 at St. Vincent's University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. Recruitment is proceeding with the aim to achieve the target sample size on or before April 2021. TRIAL REGISTRATION: COVIRL002 was registered 25 June 2020 under EudraCT number: 2020-001767-86 and Protocol identification: UCDCRC/20/02. FULL PROTOCOL: The full protocol for COVIRL002 is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Betacoronavirus/patogenicidade , Ensaios Clínicos Fase II como Assunto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Progressão da Doença , Interações entre Hospedeiro e Microrganismos , Humanos , Intubação Intratraqueal , Irlanda , Estudos Multicêntricos como Assunto , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
6.
Evid Based Dent ; 21(3): 96-97, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32978539

RESUMO

Design A single-blinded, randomised controlled trial. The experimental group received 24 personalised text messages each week, disseminating tailored preventive advice using the multifactorial model for individual caries risk assessment: Cariogram. The same frequency of text messaging was delivered to the control group; however, these were non-personalised messages and did not factor the Cariogram.Sample selection One hundred and ninety-one participants were assessed for eligibility by eight calibrated, volunteer dental practitioners in County Cork, Ireland. Six different inclusion criteria were detailed, including the requirement for medical card holders, serving as an indicator for economically underprivileged status. Other criteria included: aged between 19-70 years; competent with text messaging services; have a minimum of 20 teeth present; not pregnant; and prepared to give consent. Failure to return a baseline food diary or possess a mobile phone saw the exclusion of 20 participants. Following stratified and blocked randomisation, 85 and 86 participants were allocated in the test and control group, respectively. The study received ethical approval by the Clinical Research Ethics Committee of the Cork Teaching Hospitals.Data analysis One hundred and eleven participants attended the follow-up examination, 26 weeks after randomisation, where the 'chance of avoiding new cavities' was determined as a numerical index for caries risk. The secondary aim was to measure individual changes to seven Cariogram risk factors between the baseline assessment and the re-examination. The ANCOVA intention-to-threat (ITT) protocol and the per-protocol method were adhered to for analyses of outcome measures. Statistical analysis was performed using SAS 9.4, in adherence to a pre-defined significance level of 5% (two-sided).Results Both analytic techniques confirmed no statistically significant difference (p >0.05) between the groups regarding the 'chance of avoiding new cavities'. Of the risk parameters assessed, only saliva secretion demonstrated a positive effect in the intervention group (p = 0.036, OR = 0.3, 95% CI = 0.1, 0.9). Predictive modelling techniques were not reliable due to the limited sample size of per-protocol analysis.Conclusions The failure to conclude statistical significance between the groups validates the null hypothesis. Accordingly, no difference can be established between the personalised nor non-personalised mobile text messaging intervention on the caries risk of underprivileged adults in Ireland. The authors address the value of further studies exploring the potential for caries risk reduction through mobile phone communications.


Assuntos
Telefone Celular , Cárie Dentária , Envio de Mensagens de Texto , Adulto , Idoso , Cárie Dentária/prevenção & controle , Odontólogos , Feminino , Humanos , Irlanda , Pessoa de Meia-Idade , Gravidez , Papel Profissional , Método Simples-Cego , Adulto Jovem
7.
Trials ; 21(1): 758, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: covidwho-745011

RESUMO

OBJECTIVES: Tocilizumab is a humanized monoclonal antibody which targets and inhibits interleukin-6 (IL-6) and has demonstrated efficacy in treating diseases associated with hyper-inflammation. Data are suggestive of tocilizumab as a potential treatment for patients with COVID-19 infection. The aim of this study is to determine the safety and efficacy of standard dose versus low dose tocilizumab in adults with severe, non-critical, PCR-confirmed COVID-19 infection with evidence of progressive decline in respiratory function and evolving systemic inflammation on time to intubation, non-invasive ventilation and/or all-cause mortality. TRIAL DESIGN: This trial is a phase 2, open label, two-stage, multicentre, randomised trial. PARTICIPANTS: Adult subjects with severe, non-critical, PCR-confirmed COVID-19 infection with evidence of progressive decline in respiratory function and evolving systemic inflammation requiring admission to hospital at St. Vincent's University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. Inclusion criteria Aged 18 years or older. Confirmed SARS-CoV2 infection (as defined by positive PCR). Evidence of hyper inflammatory state as evidenced by at least three of the following: Documented temperature >38°C in the past 48 hours, IL6 >40 pg/ml, or in its absence D-dimer >1.5 µgFEU /ml, Elevated CRP (>100mg/L) and/or a three-fold increase since presentation, Elevated ferritin X5 ULN, Elevated LDH (above the ULN), Elevated fibrinogen (above the ULN). Pulmonary infiltrates on chest imaging. Moderate to severe respiratory failure as defined by PaO2/FiO2≤300mmHg. INTERVENTION AND COMPARATOR: Intervention for participants in this trial is SOC plus Tocilizumab compared to SOC alone (comparator). For Stage 1, following randomisation, subjects will receive either (Arm 1) SOC alone or (Arm 2) SOC plus Tocilizumab (standard single dose - 8mg/kg, infused over 60 minutes. Once stage 1 has fully recruited, subsequent participants will be enrolled directly into Stage 2 and receive either (Arm 1) SOC plus Tocilizumab (standard single dose - 8mg/kg, infused over 60 minutes or (Arm 2) SOC plus Tocilizumab (standard single dose - 4mg/kg, infused over 60 minutes). MAIN OUTCOMES: The primary endpoint for this study is the time to a composite primary endpoint of progression to intubation and ventilation, non-invasive ventilation or death within 28 days post randomisation. RANDOMISATION: Eligible patients will be randomised (1:1) using a central register. Randomisation will be performed through an interactive, web-based electronic data capturing database. In stage 1, eligible participants will be randomised (1:1) to (Arm 1) SOC alone or to (Arm 2) SOC with single dose (8mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes. In stage 2, eligible participants will be randomised (1:1) to receive either (Arm 1) single, standard dose (8mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes or (Arm 2) reduced dose (4mg/kg, maximum 800mg) intravenous tocilizumab infused over 60 minutes. BLINDING: This study is open label. The study will not be blinded to investigators, subjects, or medical or nursing staff. The trial statistician will be blinded for data analysis and will be kept unaware of treatment group assignments. To facilitate this, the randomisation schedule will be drawn up by an independent statistician and objective criteria were defined for the primary outcome to minimize potential bias. NUMBERS TO BE RANDOMISED: In stage 1, 90 subjects will be randomised 1:1, 45 to SOC and 45 subjects to SOC plus Tocilizumab (8mg/kg, infused over 60 minutes). In stage 2, sample size calculation for the dose evaluation stage will use data generated from stage 1 using the same primary endpoint as in stage 1. TRIAL STATUS: The COVIRL002 trial (Protocol version 1.4, 13th May 2020) commenced in May 2020 at St. Vincent's University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland. Recruitment is proceeding with the aim to achieve the target sample size on or before April 2021. TRIAL REGISTRATION: COVIRL002 was registered 25 June 2020 under EudraCT number: 2020-001767-86 and Protocol identification: UCDCRC/20/02. FULL PROTOCOL: The full protocol for COVIRL002 is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2).


Assuntos
Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Anti-Inflamatórios/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Betacoronavirus/patogenicidade , Ensaios Clínicos Fase II como Assunto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Progressão da Doença , Interações entre Hospedeiro e Microrganismos , Humanos , Intubação Intratraqueal , Irlanda , Estudos Multicêntricos como Assunto , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Respiração Artificial , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
8.
Ann Fam Med ; 18(5): 461-462, 2020 09.
Artigo em Inglês | MEDLINE | ID: covidwho-768776

RESUMO

Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, 2 family physicians on different continents reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care. Although technology enables physicians to stay in touch with patients verbally, we have lost the ability to physically touch. Traditionally, touch is central to medical practice, physical examination guides diagnosis and informs management. But the silent language of touch fulfills a deeper symbolic function, enabling physicians to acknowledge patient concerns in a tangible way. Touch expresses healing, extending beyond skin-to-skin contact to express humanity, caring, and connection. As we adapt to novel technologies, we wonder how, as family physicians, we will adapt our clinical acumen to extend our ability to connect with patients.


Assuntos
Medicina de Família e Comunidade , Relações Médico-Paciente , Telemedicina , Canadá , Humanos , Irlanda , Tato
9.
Artigo em Inglês | MEDLINE | ID: covidwho-750685

RESUMO

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Geriatria/métodos , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Inglaterra , Alemanha , Humanos , Irlanda , Jornais como Assunto , Pandemias , Escócia , Mídias Sociais , País de Gales
10.
Artigo em Inglês | MEDLINE | ID: mdl-32899652

RESUMO

Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Geriatria/métodos , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Inglaterra , Alemanha , Humanos , Irlanda , Jornais como Assunto , Pandemias , Escócia , Mídias Sociais , País de Gales
11.
Artigo em Inglês | MEDLINE | ID: mdl-32992809

RESUMO

This study is an overview of the current and future trajectory, as well as the impact of the novel Coronavirus (COVID-19) in the world and selected countries including the state of Kuwait. The selected countries were divided into two groups: Group A (China, Switzerland, and Ireland) and Group B (USA, Brazil, and India) based on their outbreak containment of this virus. Then, the actual data for each country were fitted to a regression model utilizing the excel solver software to assess the current and future trajectory of novel COVID-19 and its impact. In addition, the data were fitted using the Susceptible-Infected-Recovered (SIR) Model. The Group A trajectory showed an "S" shape trend that suited a logistic function with r2 > 0.97, which is an indication of the outbreak control. The SIR models for the countries in this group showed that they passed the expected 99% end of pandemic dates. Group B, however, exhibited a continuous increase of the total COVID-19 new cases, that best suited an exponential growth model with r2 > 0.97, which meant that the outbreak is still uncontrolled. The SIR models for the countries in this group showed that they are still relatively far away from reaching the expected 97% end of pandemic dates. The maximum death percentage varied from 3.3% (India) to 7.2% with USA recording the highest death percentage, which is virtually equal to the maximum death percentage of the world (7.3%). The power of the exponential model determines the severity of the country's trajectory that ranged from 11 to 19 with the USA and Brazil having the highest values. The maximum impact of this COVID-19 pandemic occurred during the uncontrolled stage (2), which mainly depended on the deceptive stage (1). Further, some novel potential containment strategies are discussed. Results from both models showed that the Group A countries contained the outbreak, whereas the Group B countries still have not reached this stage yet. Early measures and containment strategies are imperative in suppressing the spread of COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Global , Pneumonia Viral/epidemiologia , Betacoronavirus , Brasil , China , Humanos , Índia , Irlanda , Kuweit , Pandemias , Suíça , Estados Unidos
12.
Ann Fam Med ; 18(5): 461-462, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928765

RESUMO

Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, 2 family physicians on different continents reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care. Although technology enables physicians to stay in touch with patients verbally, we have lost the ability to physically touch. Traditionally, touch is central to medical practice, physical examination guides diagnosis and informs management. But the silent language of touch fulfills a deeper symbolic function, enabling physicians to acknowledge patient concerns in a tangible way. Touch expresses healing, extending beyond skin-to-skin contact to express humanity, caring, and connection. As we adapt to novel technologies, we wonder how, as family physicians, we will adapt our clinical acumen to extend our ability to connect with patients.


Assuntos
Medicina de Família e Comunidade , Relações Médico-Paciente , Telemedicina , Canadá , Humanos , Irlanda , Tato
13.
Ir Med J ; 113(6): 100, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32816435

RESUMO

The Covid-19 pandemic has brought unprecedented pressure to healthcare systems worldwide, resulting in significant and precipitous changes in demand, burden and method of delivery. The psychosocial impact of this crisis is likely to increase over the course of the pandemic, peak later than medical cases and endure for longer thereby significantly exceeding medical morbidity. It will have far reaching impact on the individual, their family and their care providers. Frontline healthcare workers and those with pre-existing mental health difficulties are recognised at increased risk. Now that the initial surge has been expertly curtailed, it is essential that urgent consideration is now directed towards the mental health implications of the current outbreak and ensure that we are as ready for the increased MH needs of the community as we were for the intensive medical care.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Saúde Mental , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Betacoronavirus , Comorbidade , Família/psicologia , Pessoal de Saúde/psicologia , Humanos , Irlanda/epidemiologia , Transtornos Mentais/epidemiologia , Angústia Psicológica , Populações Vulneráveis/psicologia
17.
BMJ Open ; 10(8): e039851, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32788191

RESUMO

INTRODUCTION: The COVID-19 pandemic is putting an unprecedented strain on healthcare systems globally. The psychological impact on frontline doctors of dealing with the COVID-19 pandemic is currently unknown. This longitudinal professional survey aims to understand the evolving and cumulative effects of working during the COVID-19 outbreak on the psychological well-being of doctors working in emergency departments (ED), intensive care units (ICU) and anaesthetics during the pandemic. METHODS AND ANALYSIS: This study is a longitudinal questionnaire-based study with three predefined time points spanning the acceleration, peak and deceleration phases of the COVID-19 pandemic.The primary outcomes are psychological distress and post-trauma stress as measured by the General Health Questionnaire-12 (GHQ-12) and Impact of Events Scale-Revised (IES-R). Data related to personal and professional characteristics will also be collected. Questionnaires will be administered prospectively to all doctors working in ED, ICU and anaesthetics in the UK and Ireland via existing research networks during the sampling period. Data from the questionnaires will be analysed to assess the prevalence and degree of psychological distress and trauma, and the nature of the relationship between personal and professional characteristics and the primary outcomes. Data will be described, analysed and disseminated at each time point; however, the primary endpoint will be psychological distress and trauma at the final time point. ETHICS AND DISSEMINATION: Ethical approval was obtained from the University of Bath, UK (ref: 4421), and Children's Health Ireland at Crumlin, Ethics Committee. Regulatory approval from the Health Regulation Authority (UK), Health and Care Research Wales (IRAS: 281944).This study is limited by the fact that it focuses on doctors only and is survey based without further qualitative interviews of participants. It is expected this study will provide clear evidence of the psychological impact of COVID-19 on doctors and will allow present and future planning to mitigate against any psychological impact. TRIAL REGISTRATION NUMBER: ISRCTN10666798.


Assuntos
Infecções por Coronavirus/terapia , Corpo Clínico Hospitalar/psicologia , Pneumonia Viral/terapia , Estresse Psicológico/epidemiologia , Serviço Hospitalar de Anestesia/organização & administração , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência/organização & administração , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/estatística & dados numéricos , Unidades de Terapia Intensiva/organização & administração , Irlanda/epidemiologia , Estudos Longitudinais , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Prevalência , Projetos de Pesquisa , Autorrelato , Inquéritos e Questionários , Reino Unido/epidemiologia
18.
Lancet Child Adolesc Health ; 4(10): 740-749, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32861271

RESUMO

BACKGROUND: Despite the availability of continuous conventional electroencephalography (cEEG), accurate diagnosis of neonatal seizures is challenging in clinical practice. Algorithms for decision support in the recognition of neonatal seizures could improve detection. We aimed to assess the diagnostic accuracy of an automated seizure detection algorithm called Algorithm for Neonatal Seizure Recognition (ANSeR). METHODS: This multicentre, randomised, two-arm, parallel, controlled trial was done in eight neonatal centres across Ireland, the Netherlands, Sweden, and the UK. Neonates with a corrected gestational age between 36 and 44 weeks with, or at significant risk of, seizures requiring EEG monitoring, received cEEG plus ANSeR linked to the EEG monitor displaying a seizure probability trend in real time (algorithm group) or cEEG monitoring alone (non-algorithm group). The primary outcome was diagnostic accuracy (sensitivity, specificity, and false detection rate) of health-care professionals to identify neonates with electrographic seizures and seizure hours with and without the support of the ANSeR algorithm. Neonates with data on the outcome of interest were included in the analysis. This study is registered with ClinicalTrials.gov, NCT02431780. FINDINGS: Between Feb 13, 2015, and Feb 7, 2017, 132 neonates were randomly assigned to the algorithm group and 132 to the non-algorithm group. Six neonates were excluded (four from the algorithm group and two from the non-algorithm group). Electrographic seizures were present in 32 (25·0%) of 128 neonates in the algorithm group and 38 (29·2%) of 130 neonates in the non-algorithm group. For recognition of neonates with electrographic seizures, sensitivity was 81·3% (95% CI 66·7-93·3) in the algorithm group and 89·5% (78·4-97·5) in the non-algorithm group; specificity was 84·4% (95% CI 76·9-91·0) in the algorithm group and 89·1% (82·5-94·7) in the non-algorithm group; and the false detection rate was 36·6% (95% CI 22·7-52·1) in the algorithm group and 22·7% (11·6-35·9) in the non-algorithm group. We identified 659 h in which seizures occurred (seizure hours): 268 h in the algorithm versus 391 h in the non-algorithm group. The percentage of seizure hours correctly identified was higher in the algorithm group than in the non-algorithm group (177 [66·0%; 95% CI 53·8-77·3] of 268 h vs 177 [45·3%; 34·5-58·3] of 391 h; difference 20·8% [3·6-37·1]). No significant differences were seen in the percentage of neonates with seizures given at least one inappropriate antiseizure medication (37·5% [95% CI 25·0 to 56·3] vs 31·6% [21·1 to 47·4]; difference 5·9% [-14·0 to 26·3]). INTERPRETATION: ANSeR, a machine-learning algorithm, is safe and able to accurately detect neonatal seizures. Although the algorithm did not enhance identification of individual neonates with seizures beyond conventional EEG, recognition of seizure hours was improved with use of ANSeR. The benefit might be greater in less experienced centres, but further study is required. FUNDING: Wellcome Trust, Science Foundation Ireland, and Nihon Kohden.


Assuntos
Algoritmos , Eletroencefalografia/métodos , Aprendizado de Máquina/estatística & dados numéricos , Monitorização Fisiológica/métodos , Convulsões/diagnóstico , Eletroencefalografia/normas , Humanos , Lactente , Terapia Intensiva Neonatal , Irlanda , Monitorização Fisiológica/normas , Países Baixos , Convulsões/prevenção & controle , Suécia , Reino Unido
19.
Ann R Coll Surg Engl ; 102(8): 625-631, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32777931

RESUMO

INTRODUCTION: Healthcare faces growing challenges. With reports of diminishing research output from the UK and Ireland in the leading surgical journals, this study aimed to ascertain whether this trend had been echoed in the trauma and orthopaedic literature. MATERIALS AND METHODS: Citable research output from the 10 globally leading trauma and orthopaedic journals was analysed from five individual years, over a 20-year period, to ascertain trends in absolute output, geographical mix, and level of evidence. RESULTS: The overall number of published articles fell by 14.5%. North America saw the greatest decline (-8.0%), followed by Japan (-5.6%) and Europe (-3.3%). The UK and Ireland (+2.9%) and the rest of the world (+13.9%) saw rising output. A decline in lower (levels IV and V) and a rise in higher (levels I, II and III) quality evidence was observed. The UK and Ireland had a greater proportion of higher-quality studies than North America and Japan, but lower than Europe and the rest of the world. The impact factor of the leading journal rose from 4.47 to 7.01. DISCUSSION: The research landscape has evolved, with leading journals placing greater emphasis on higher-quality evidence. UK and Irish research output remains stable, contributing 14% of the most highly cited publications in 2018, and challenging North America's dominance with a greater proportion of level I and II evidence in the leading journals. CONCLUSION: With the growing emergence of Europe and the rest of the world, UK and Irish authors must build upon the region's output despite political challenges such as Brexit. Increasing international collaboration will continue to play an important role.


Assuntos
Fator de Impacto de Revistas , Cirurgiões Ortopédicos/estatística & dados numéricos , Editoração/estatística & dados numéricos , Pesquisa Biomédica/estatística & dados numéricos , Humanos , Irlanda , Reino Unido
20.
Sci Total Environ ; 746: 141116, 2020 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758987

RESUMO

Intensification of the food production system to meet increased global demand for food has led to veterinary pharmaceuticals becoming a critical component in animal husbandry. Anticoccidials are a group of veterinary products used to control coccidiosis in food-producing animals, with primary prophylactic use in poultry production. Excretion in manure and subsequent land-spreading provides a potential pathway to groundwater. Information on the fate and occurrence of these compounds in groundwater is scant, therefore these substances are potential emerging organic contaminants of concern. A study was carried out to investigate the occurrence of anticoccidial compounds in groundwater throughout the Republic of Ireland. Twenty-six anticoccidials (6 ionophores and 20 synthetic anticoccidials) were analysed at 109 sites (63 boreholes and 46 springs) during November and December 2018. Sites were categorised and selected based on the following source and pathway factors: (a) the presence/absence of poultry activity (b) predominant aquifer category and (c) predominant groundwater vulnerability, within the zone of contribution (ZOC) for each site. Seven anticoccidials, including four ionophores (lasalocid, monensin, narasin and salinomycin) and three synthetic anticoccidials (amprolium, diclazuril and nicarbazin), were detected at 24% of sites at concentrations ranging from 1 to 386 ng L-1. Monensin and amprolium were the two most frequently detected compounds, detected at 15% and 7% of sites, respectively. Multivariate statistical analysis has shown that source factors are the most significant drivers of the occurrence of anticoccidials, with no definitive relationships between occurrence and pathway factors. The study found that the detection of anticoccidial compounds is 6.5 times more likely when poultry activity is present within the ZOC of a sampling point, compared to the absence of poultry activity. This work presents the first detections of these contaminants in Irish groundwater and it contributes to broadening our understanding of the environmental occurrence and fate of anticoccidial veterinary products.


Assuntos
Coccidiostáticos , Água Subterrânea , Doenças das Aves Domésticas , Drogas Veterinárias , Animais , Galinhas , Irlanda
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