COVID-19 Pandemic and Overall Mental Health of Healthcare Professionals Globally: A Meta-Review of Systematic Reviews

ObjectiveThis meta-review aimed to provide a comprehensive overview of overall mental health of healthcare professionals during the COVID-19 pandemic.MethodWe conducted a comprehensive literature search on Academic Search Premier, CINAHL, Cochrane Library, and MEDLINE. A predefined eligibility criterion was used to screen the articles. The methodology quality of eligible studies was assessed using Joanna Briggs Institute checklist for systematic reviews. The data were narratively synthesised in line with the meta-review aim.ResultForty systematic reviews (represented as K = 40), which reported data from 1,828 primary studies (N) and 3,245,768 participants, met the inclusion criteria. The findings from a pooled prevalence indicate that anxiety (16–41%, K = 30, N = 701), depression (14–37%, K = 28, N = 584), and stress/post-traumatic stress disorder (18.6–56.5%, K = 24, N = 327) were the most prevailing COVID-19 pandemic-related mental health conditions affecting healthcare workers. Other reported concerns included insomnia, burnout, fear, obsessive-compulsive disorder, somatization symptoms, phobia, substance abuse, and suicidal thoughts. Considering regions/countries, the highest anxiety was reported in the United-Kingdom [22.3, 95% Confidence Interval (CI):7–38, N = 4] compared to other countries, while the highest depression was in the Middle-East, (41, 95% CI:16–60, N = 5) and stress in the Eastern Mediterranean region (61.6, 95% CI:56.4–66.8, N = 2) compared to other regions. The most significant risk factors include female gender, younger age, being a nurse, and frontline professional. The most-reported coping strategies include individual/group psychological support, family/relative support, training/orientation, and the adequacy of personal protective equipment.ConclusionIt was concluded that healthcare professionals (nurses, doctors, allied health) have experienced various mental health issues during COVID-19 pandemic. The meta-review, therefore, recommends targeted interventions and health policies that address specific mental health issues to support health professionals worldwide during the duration of the COVID-19 pandemic and similar future health crises.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD4202126200, identifier: CRD42021262001.

Immune Dysregulation Is Associated with Neurodevelopment and Neurocognitive Performance in HIV Pediatric Populations—A Scoping Review

HIV-1 is known for its complex interaction with the dysregulated immune system and is responsible for the development of neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. Considering that HIV-1-induced immune dysregulation and its association with neurodevelopmental and neurocognitive impairments in pediatric populations are not well understood, we conducted a scoping review on this topic. The study aimed to systematically review the association of blood and cerebrospinal fluid (CSF) immune markers with neurocognitive deficits and neurodevelopmental delays in pediatric HIV populations. PubMed, Scopus, and Web of Science databases were searched using a search protocol designed specifically for this study. Studies were selected based on a set eligibility criterion. Titles, abstracts, and full texts were assessed by two independent reviewers. Data from the selected studies were extracted and analyzed by two independent reviewers. Seven studies were considered eligible for use in this context, which included four cross-sectional and three longitudinal studies. An average of 130 (±70.61) children living with HIV, 138 (±65.37) children exposed to HIV but uninfected and 90 (±86.66) HIV-negative participants were included across the seven studies. Results indicate that blood and CSF immune markers are associated with neurocognitive development/performance in pediatric HIV populations. Only seven studies met the inclusion criteria, therefore, these limited the number of significant conclusions which could have been made by using such an approach. All considered, the evidence suggests that immune dysregulation, as in the case of adult HIV populations, also has a significant association with neurocognitive performance in pediatric HIV populations.

Physical Activity in Adults With Fatigue After Cancer Treatment

Physical activity is recommended for the management of cancer-related fatigue (CRF), yet the evidence is primarily based on interventions delivered during cancer treatment, with no eligibility criterion for fatigue. There is a need to examine the quantity and quality of the existing literature on physical activity for clinically-relevant CRF that continues after cancer treatment (post-cancer fatigue). The objective of this systematic review was to summarize and evaluate the effect of physical activity on post-cancer fatigue in adults, using randomized trials where fatigue was an eligibility criterion. Studies were included if they: included adult participants with a cancer diagnosis who had completed initial cancer treatments (e.g., surgery, chemotherapy and/or radiation therapy); explicitly stated that fatigue was a participant eligibility/inclusion criterion, regardless of how this was described or assessed; involved a physical activity intervention; measured fatigue as a primary or secondary outcome. A previous systematic search was updated and electronic databases (Ovid MEDLINE(R), Ovid MEDLINE(R) and In-Process & Other Non-Indexed Citations, Embase, PsycINFO, Cochrane Database of Systematic Reviews, and CINAHL) were last searched on October 13, 2020. The risk of bias was assessed using the Cochrane Collaboration’s tool for randomized trials. A random-effects meta-analysis for the severity of fatigue across different scales at the end of the intervention was conducted. A total of 1035 participants were randomized across 19 studies. We estimate that less than 10% of the randomized trials of physical activity for CRF include people with post-cancer fatigue. The effect of physical activity on post-cancer fatigue was modest and variable (Hedge’s g -0.40; p = 0.010; 95% prediction intervals -1.41 to 0.62). Most studies had an unknown or high risk of bias, there was substantial heterogeneity between trials and evidence for the effect of physical activity on post-cancer fatigue was graded as low certainty. Including people with clinically relevant fatigue is a priority for future research in cancer survivorship. Additional transparently reported randomized clinical trials are needed to better understand the benefits of physical activity for post-cancer fatigue.

760 Prevalence of eligibility criteria for prolonged dual antithrombotic therapy in patients with PEGASUS and COMPASS phenotypes: insights from the start-antiplatelet registry

Aims After 1 year of dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS), clinicians face the dilemma of choosing between prolonged DAPT with aspirin and ticagrelor 60 mg twice daily (PEGASUS strategy) or aspirin and rivaroxaban 2.5 mg twice daily (COMPASS strategy). In recent years, there has been a widespread discussion about the optimal duration of DAPT and the best combination of drugs. To analyse the prevalence and clinical implications of the eligibility criteria for prolonged dual antithrombotic therapy with ticagrelor 60 mg twice daily and/or rivaroxaban 2.5 mg twice daily in a contemporary real-world ACS registry. Methods and results Patients from the START-ANTIPLATELET registry (NCT02219984) were stratified according to the eligibility criteria of the PEGASUS and COMPASS studies to investigate the proportion of patients eligible for prolonged dual antithrombotic therapy at discharge and after 1-year of DAPT. Net adverse clinical events (NACE), defined as all-cause death, myocardial infarction, stroke, and major bleeding, at 1 year were also evaluated and compared among groups. 1844 were considered for the analysis at baseline. Out of 849 event-free patients continually receiving dual antiplatelet therapy for at least 1 year, 577 (68%) and 583 (68.7%) met at least one eligibility criterion for ticagrelor and rivaroxaban, respectively. In the PEGASUS-like patients, age was the most common criterion (71% of cases). The presence ≥2 cardiovascular risk factors was the most common eligibility criterion in the COMPASS-like patients (80.8%). At 1-year follow-up, 211 (11.4%) and 119 (6.5%) patients experienced NACE and MACE, respectively. The incidence of NACEs was higher in the PEGASUS-only group (15.4% vs. 8.4%; P = 0.008) and numerically higher in the COMPASS-only group (10.9% vs. 8.4%; P = 0.299). Conclusions In a contemporary real-world ACS cohort, approximately two-thirds of patients that complete 1-year DAPT met the eligibility criteria for ticagrelor 60 mg twice daily or rivaroxaban 2.5 mg twice daily, showing a higher risk of NACEs.

473. Clinical Outcomes of a Pediatric COVID Monoclonal Antibody Program based at an Urban Academic Center

Background Growing clinical evidence in adults has demonstrated use of COVID monoclonal antibody (mAB) therapy results in a reduction of hospitalization and/or emergency room (ER) visits with the greatest benefit following early administration. While the FDA has authorized use of mAB therapy in children ages 12-17 years, clinical outcomes in this population have yet to be described. This study aims to assess the pediatric clinical experience in a low social economic setting. Methods Retrospective study conducted among children and adolescents who tested positive for SARS-CoV-2 from 12/1/2020 to 6/1/2021, met ≥ 1 eligibility criterion based on pre-determined institutional guidelines. Individuals were identified by patient-level data linked to pharmacy and medical claims with ICD-10 codes for COVID-19. Electronic medical records were reviewed for demographic characteristics, comorbidities, time to receipt of mAB therapy from positive test, adverse effects, and clinical outcomes. Primary clinical end point was hospitalization and/or medical visit at 28 days. Descriptive summary statistics were used for the entire cohort. Results Overall, 17 met eligibility criteria. Thirteen patients with a mean age of 16 years, received casirivimab and imdevimab mAB therapy: 4 declined treatment. Among the treated patients, 61.5% (n=8) were male, 38.6% (n=5) Hispanic/Latino; 38.6% (n=5) non-Hispanic Black; 7.7% (n=1) White. Seven out of 12 had a BMI ≥ 95th% for gender and age. Eight patients (61.5%) met ≥ 1 criteria with obesity (n=8) as the most common factor followed by immunocompromised state (n=6, 46.2%) tied with neurodevelopmental disorder (n=6, 46.2%). Median time from positive test to mAB therapy was 2 days [IQR:1-3]. One patient had a severe adverse event. Overall, none required hospitalization/ER visit with COVID like symptoms. Demographics and Results Table The table describes the pediatric patients and clinical outcome of receiving monoclonal antibody treatment for COVID-19. Conclusion Though limited by numbers, our findings may suggest a role of mAB therapy in children and adolescents in our setting. With increasing rates of SARS-CoV-2 in this age group coupled with vaccine hesitancy, mAB therapy may serve as an important outpatient intervention with a need for further studies to assess clinical benefit and establish optimal, cost-effective, practice guidelines for these highly vulnerable patients. Disclosures All Authors: No reported disclosures

Non-Ceruloplasmin Copper as a Stratification Biomarker of Alzheimer’s Disease Patients: How to Measure and Use It

: Alzheimer’s disease (AD) is a type of dementia very common in the elderly. A growing body of recent evidence has linked AD pathogenesis to copper (Cu) dysmetabolism in the body. In fact, a subset of patients affected either by AD or by its prodromal form known as Mild Cognitive Impairment (MCI) have been observed to be unable to maintain a proper balance of Cu metabolism and distribution and are characterized by the presence in their serum of increased levels of Cu not bound to ceruloplasmin (non-ceruloplasmin Cu). Since serum non-ceruloplasmin Cu is a biomark- er of Wilson's disease (WD), a well-known condition of Cu-driven toxicosis, in this review, we pro- pose that in close analogy with WD, the assessment of non-ceruloplasmin Cu levels can be exploit- ed as a cost-effective stratification and susceptibility/risk biomarker for the identification of some AD/MCI individuals. The approach can also be used as an eligibility criterion for clinical trials aim- ing at investigating Cu-related interventions against AD/MCI.

Potential surrogates for performance status and survival in metastatic non-small cell lung cancer (NSCLC).

170 Background: Performance status (PS), a physician-based, subjective assessment of a patient’s symptoms and ambulatory state, is an eligibility criterion for most clinical trials and a key clinical decision tool for treatment of NSCLC. Methods: Patients with metastatic NSCLC were asked to participate in a prospective, observational study of potential prognostic factors that includes demographics, laboratory, patient reported outcomes (PROs) by the patient reported outcomes measurement information system (PROMIS), PS reported by patient, PS assessed by physician, FitBit tracker (includes steps, distance, heart rate (HR), calories, METs), physical challenge and proteomics (Veristratâ). Correlation and regression analyses were performed for the initial 55 patients enrolled prior to COVID restrictions. Tracker data was collected and averaged over the first 7 days with wear > 500 minutes/day. Other data were collected at baseline. Results: We enrolled 55 patients with metastatic NSCLC. There were 35 females and 20 males with a median age of 67 years. A majority of patients were never (38%, n = 21) or former smokers (40%, n = 22); adenocarcinoma (83%, n = 83%) was the most common histology. 30% (n = 17) patients were 2nd or greater line of therapy. 52 were included for survival analysis and 21 expired with median survival 226 days (149, NA). There were minimal gender related differences in the study population except a higher incidence of adenocarcinoma in women (94% vs 65%, p = 0.012 and longer FiTBit assessed daily “very active minutes” (defined as METs > = 6) in men compared to women (4.21 vs 0.43, p = 0.036). Patient- and physician assessed PS were not statistically different, although patients tended underestimated their PS relative to physicians. Physician assessed PS, patient assessed PS, two-minute walk distance, proteomics by Veristratâ, total daily steps, total daily distance covered, and heart rate/activity mismatch were independent predictors of survival. Age, gender, smoking, BMI, histology, and various CBC-based indices were not prognostic. Conclusions: Patient- and physician-assessment of PS do not always match, many alternate measures to PS are prognostic of survival and tracker-based methods are objective and feasible in clinical practice.

Drug sentencing in Brazil: factors influencing sentencing outcomes in the criminal courts of Recife/PE

Purpose This paper aims to examine sentencing decisions for drug-trafficking offences in the criminal courts of the city of Recife to address a gap in quantitative research on drug sentencing and incarceration in Brazil. Design/methodology/approach Using original data obtained from the Court of Justice for Pernambuco, the research used multivariate regression analysis to investigate the effect of case processing, offender, and offence characteristics on sentence length. Findings A key finding of the research is the influence of two legal factors on sentence length: admitting to a drug-trafficking offence and being categorized as “mitigated trafficking”. Results also indicate that first-time defendants were more likely to be categorized as mitigated trafficking, stressing the importance of criminal history on predicting sentencing outcomes. “Mitigated trafficking” is a distinct category of drug-trafficking created by the Drug Law nº. 11.343 (2006) to protect defendants considered novices in the illicit drug market from receiving longer imprisonment sentences. Practical implications The findings suggest that the policy strategy of having a legal distinction for a specific type of defendant appears to be effective in impacting sentence length for drug-trafficking convictions. Future research could explore how similar strategies could be adopted to influence sentencing for other vulnerable groups. However, focussing on a defendant records or prior convictions as an eligibility criterion could disproportionately impact defendants who are caught in a cycle of re-offending for socio-economic reasons or a need to finance a substance use disorder. Originality/value This research address a gap in quantitative sentencing research in Brazil and contributes to the broader literature by presenting results that are aligned with previous studies conducted in North America.

Best Practices of Principals to Increase Attendance in Low-Socioeconomic Status Rural High Schools

Securing attendance is challenging at rural high schools with a high percentage of students from low-socioeconomic states (low-SES) households. Best practices of principals to achieve high annual attendance rates (> 90%) were studied. Interviews were held with principals from 8 of 12 high schools across rural West Virginia that met the eligibility criterion of 100% enrollment of low-SES students. Six best practices emerged. Rural schools striving to increase attendance could reduce student absenteeism by implementing best practices suggested.