Evaluating How Mental Health Changed in Australia through the COVID-19 Pandemic: Findings from the ‘Taking the Pulse of the Nation’ (TTPN) Survey

The COVID-19 pandemic has had a significant impact on mental health at the level of the population. The current study adds to the evidence base by examining how the prevalence of psychological distress changed in Australia during the pandemic. The study also assesses the psychometric properties of a new single-item measure of mental distress included in a survey program conducted regularly throughout the pandemic. Data are from 1158 respondents in wave 13 (early July 2020) of the nationally representative Taking the Pulse of the Nation (TTPN) Survey. The questionnaire included the six-item Kessler Psychological Distress Scale (K6) and a new single-item measure of distress. Results show a significant increase in the prevalence of psychological distress in Australia, from 6.3% pre-pandemic to 17.7% in early July 2020 (unadjusted odds ratio = 3.19; 95% CI (confidence interval) = 2.51 to 4.05). The new single-item measure of distress is highly correlated with the K6. This study provides a snapshot at one point in time about how mental health worsened in Australia during the COVID-19 pandemic. However, by demonstrating the accuracy of the new single-item measure of distress, this analysis also provides a basis for further research examining the trajectories and correlates of distress in Australia across the pandemic.

The association between alcohol use disorder and suicidal ideation in a New Zealand birth cohort

Background: Alcohol use disorder is associated with increased suicide risk; however, both alcohol use disorder and suicide share risk factors which must be accounted for in order to understand this relationship. This study aimed to explore the longitudinal relationship between alcohol use disorder and suicidal ideation in adulthood, while accounting for both child background and adult covariate factors. Method: Data were collected from the Christchurch Health and Development Study, a birth cohort of 1265 children born in Christchurch (New Zealand) in mid-1977. Alcohol use disorder (operationalised as alcohol abuse and alcohol dependence) was quantified between age 18 and 40 in five data waves. The outcome measure suicidal ideation was reported over the same time periods. Childhood confounding variables were controlled for, as well as time-dynamic covariates collected in adulthood, including internalising disorders, distress due to relationship dissolutions and other substance use disorders. Results: The association between alcohol abuse and suicidal ideation was not statistically significant before or after adjusting for childhood confounding and adulthood covariate factors, when compared to no alcohol disorder. However, the association between alcohol dependence and suicidal ideation was significant both before and after adjustment (unadjusted odds ratio = 2.89, 95% confidence interval = [2.09, 3.99]; adjusted odds ratio = 1.52, 95% confidence interval = [1.04, 2.23]), when compared to no alcohol disorder. Furthermore, alcohol dependence remained significant when compared to alcohol abuse (unadjusted odds ratio = 2.33, 95% confidence interval = [1.61, 3.37]; adjusted odds ratio = 1.54, 95% confidence interval = [1.00, 2.37]). Conclusion: This analysis found an association between alcohol dependence and suicidal ideation within a New Zealand birth cohort, which persists even after adjustment for childhood confounding and adulthood covariate factors. Given the high rates of suicide and heavy drinking within the New Zealand population, any comprehensive national or regional suicide prevention plan should seek to reduce risky alcohol consumption at an individual and population level, as this represents a modifiable risk factor for suicide.

Does Media Exposure Affect the Utilization of Maternal Health Care Services? A Query from a Nationally Representative Survey of India

Maternal Health Care (MHC) is very essential for improvement in the health status of the mother and children. The present study attempts to show the role of mass media on the utilization of MHC services in India. The entire study depends on secondary data collected from the National Family Health Survey (NFHS-4, 2015-16). Initially, the data has been analyzed by some descriptive statistics and for the proper depiction of the result, binary logistic regression has been conducted. The unadjusted odds ratio (UOR) has shown media exposure positively and significantly associated with the utilization of the majority of MHC services. The adjusted odds ratio has a less effective association with the MHC services compare to the unadjusted odds ratio. Other controlling variables including maternal age, age at marriage, birth order, education, caste, religion, wealth index, place of residence, and the region has also affect the health care services.

Safety and Efficacy of Non-Vitamin K Antagonists in Atrial Fibrillation in the real world: A pooled-analysis and comparison of XANTUS and ETNA-AF-EU studies

Background: This study aims to assess the efficacy and safety of treatment with edoxaban or rivaroxaban for stroke prevention in patients with atrial fibrillation. Methods: Pooled analysis from two real-world cohorts. Efficacy outcomes were all-cause mortality, cardiovascular mortality and thromboembolic events at 1 year. Safety outcomes were assessed by major or nonmajor bleeding. Results: A total of 19876 patients were enrolled in both trials. All-cause mortality at 1 year was lower in the rivaroxaban group (118 of 6784 patients [1.7%]) than in the edoxaban group (442 of 13092 patients [3.5%]) (unadjusted odds ratio was 1.97 (95% CI, 1.61 to 2.42; P=<0.00001). Cardiovascular mortality was edoxaban (206 of 13092 patients [1.63%]) vs rivaroxaban 49 of 6784 patients [0.72%]) (unadjusted OR, 2.20; 95% CI, 1.61 to 3.00; p=<0.00001). Overall, the efficacy outcomes favoured the rivaroxaban cohort (OR 1.97, 95% CI, 1.33 to 2.91; P=0.0002), with no significant difference in ischaemic stroke between the two cohorts (unadjusted OR 1.13, 95% CI, 0.75 to 1.73; P=0.56). Overall, safety outcomes tended to occur more often in the edoxaban cohort (unadjusted OR 0.43, 95% CI, 0.20 to 0.40; P=<0.00001). Conclusion: Rivaroxaban and edoxaban seem to be effective and safe. However, real-world prospective studies evaluating safety and efficacy in certain subgroups are needed.

An adaptive randomized controlled trial of non-invasive respiratory strategies in acute respiratory failure patients with COVID-19

Background Both continuous positive airway pressure (CPAP) and high-flow nasal oxygenation (HFNO) have been recommended for acute respiratory failure in COVID-19. However, uncertainty exists regarding effectiveness and safety. Methods In the Recovery- Respiratory Support multi-center, three-arm, open-label, adaptive, randomized controlled trial, adult hospitalized patients with acute respiratory failure due to COVID-19, deemed suitable for treatment escalation, were randomly assigned to receive CPAP, HFNO, or conventional oxygen therapy. Comparisons were made between each intervention and conventional oxygen therapy. The primary outcome was a composite of tracheal intubation or mortality within 30-days. Results Over 13-months, 1272 participants were randomized and included in the analysis (380 (29.9%) CPAP; 417 (32.8%) HFNO; 475 (37.3%) conventional oxygen therapy). The need for tracheal intubation or mortality within 30-days was lower in the CPAP group (CPAP 137 of 377 participants (36.3%) vs conventional oxygen therapy 158 of 356 participants (44.4%); unadjusted odds ratio 0.72; 95% CI 0.53 to 0.96, P=0.03). There was no difference between HFNO and conventional oxygen therapy (HFNO 184 of 414 participants (44.4%) vs conventional oxygen therapy 166 of 368 participants (45.1%); unadjusted odds ratio 0.97; 95% CI 0.73 to 1.29, P=0.85). Conclusions CPAP, compared with conventional oxygen therapy, reduced the composite outcome of intubation or death within 30 days of randomisation in hospitalized adults with acute respiratory failure due to COVID-19. There was no effect observed, compared with conventional oxygen therapy, with the use of HFNO. (Funded by the UK National Institute for Health Research; ISRCTN 16912075).

Unidentified Persons With Disabilities in India- A Study Based on 76th Round of NSS (2018-19) Data

Background: Identification of the disabled and providing them a disability certificate is the first step for provisioning educational, employment, and other social benefits in a welfare state. Deprivation from disability certificate deprives persons with disability (PwDs) from government policy and programme. Though studies examined the extent, variation, and pattern of disability, no attempt has been made in understanding the extent and variation of unidentified PwDs in India. The study aims to examine the variation in unidentified PwDs by type of disability, state and socio-economic correlates.Data and methods: The unit data from the 76th round (schedule 26) of Nation Sample Survey, 2018 is used in analyses. A total of 1,06,894 disabled across seven types of disabilities; any disability, locomotor, visual, hearing, speech, mental retardation, mental illness, and other disability have been analysed. Descriptive statistics and logistic regression analyses are used.Results: 7 in 10 disabled person in India don’t have a disability certificate. The percentage share of PwDs with a disability certificate varies 12% among those with hearing disability to 47% with mental retardation. Unadjusted odds ratio shows that person with hearing disability (OR=0.30 CI 0.303-0.304) are less likely to hold a disability certificate compare to locomotor disability followed by mental illness (OR=0.52 CI 0.519 0520), and visual disability (OR= 0.74 CI 0.736 0.738). Person with mental retardation are two times more likely to hold the disability certificate (OR 2.05 CI 2.046 2.047) than the visual disabled. States variation in percent share of disability certificate is found to be large. The result depicts that there remains a high variation in the access of disability certificates across states in India. Conclusion: A nationwide drive to include the unidentified disabled is recommended with documentation and inclusion in the administrative processes.

Association between breastfeeding and preeclampsia in parous women: a case –control study

Background Preeclampsia is a global health problem and it is the main cause of maternal and perinatal morbidity and mortality. Breastfeeding has been reported to be associated with lower postpartum blood pressure in women with gestational hypertension. However, there is no published data on the role that breastfeeding might play in preventing preeclampsia. The aim of the current study was to investigate if breastfeeding was associated with preeclampsia in parous women. Method A case-control study was conducted in Saad Abualila Maternity Hospital in Khartoum, Sudan, from May to December 2019. The cases (n = 116) were parous women with preeclampsia. Two consecutive healthy pregnant women served as controls for each case (n = 232). The sociodemographic, medical, and obstetric histories were gathered using a questionnaire. Breastfeeding practices and duration were assessed. Results A total of 98 (84.5%) women with preeclampsia and 216 (93.1%) women in the control group had breastfed their previous children. The unadjusted odds ratio (OR) of preeclampsia (no breastfeeding vs breastfeeding) was 3.55, 95% confidence interval (CI) 1.64,7.70 and p value = 0.001 based on these numbers. After adjusting for age, parity, education level, occupation, history of preeclampsia, history of miscarriage, body mass index groups the adjusted OR was 3.19, 95% CI 1.49, 6.82 (p value = 0.006). Conclusion Breastfeeding might reduce the risk for preeclampsia. Further larger studies are required.

Perceptions of COVID–19-related Risks and Deaths Among Health Care Professionals During COVID-19 Pandemic in Pakistan: A Cross-sectional Study

COVID-19 is an established challenge to the health care professionals (HCPs) having physical, emotional, and psychological repercussions. We determine the perceptions of Pakistani HCPs regarding the risks and deaths related to COVID-19. A cross-sectional study was conducted among HCPs throughout Pakistan from 16th February 2021 to 6th March 2021 by disseminating an online Google questionnaire via all possible social media platforms including WhatsApp, Facebook, Twitter, and emails. Out of total of 462 HCPs, 33.55% tested COVID-19 positive and 49.43% had received their first dose of COVID-19 vaccine. The proportion of HCPs worried about contracting COVID-19 was 46.97%. A total of 69.48% mentioned that doctors are at a higher risk of dying from COVID-19 infection compared to the general population. In a dichotomous analysis done for risk perception, 72.06% of doctors reported a high-risk perception of contracting COVID-19 in hospital settings. The main reasons identified to be associated with higher mortality amongst the HCPs, specifically doctors, included comorbidities (47.26%), working in high-risk wards (24.02%) and lack of adequate personal protective equipment (PPE) (28.72%). Using univariate and multivariate regression the HCPs tested positive rated two-fold high risk while performing professional duty during COVID-19 pandemic [unadjusted odds ratio (OR) (95% confidence interval (CI)): 2.23 (1.24–4.02), P = .007; adjusted OR (95% CI) 2.27 (1.22–4.19), P = .009]. In conclusion, Pakistani HCPs have significant COVID–19-related concerns and anxieties. The doctors perceived to be at a higher risk of dying with COVID-19, due to a variety of personal and professional reasons.

Does pre-existent physical inactivity have a role in the severity of COVID-19?

Background and Aims: Physical inactivity is considered an important lifestyle factor for overweight and cardiovascular disease. We aimed to investigate the association between pre-existent physical inactivity and the risk of severe coronavirus disease 2019 (COVID-19). Methods: We included 164 (61.8 ± 13.6 years) patients with COVID-19 who were admitted between 15 February and 14 March 2020 in this retrospective study. We evaluated the association between pre-existent physical inactivity and severe COVID-19 using a logistic regression model. Results: Of 164 eligible patients with COVID-19, 103 (62.8%) were reported to be physically inactive. Univariable logistic regression analysis showed that physical inactivity was associated with an increased risk of severe COVID-19 [unadjusted odds ratio (OR) 6.53, 95% confidence interval (CI) 1.88–22.62]. In the multivariable regression analysis, physical inactivity remained significantly associated with an increased risk of severe COVID-19 (adjusted OR 4.12, 95% CI 1.12–15.14) after adjustment for age, sex, stroke, and overweight. Conclusion: Our data showed that pre-existent physical inactivity was associated with an increased risk of experiencing severe COVID-19. Our findings indicate that people should be encouraged to keep physically active to be at a lower risk of experiencing a severe illness when COVID-19 infection seems unpredicted. The reviews of this paper are available via the supplemental material section.

Visual Impairment at Age 85 Predicts Subsequent Cognitive Decline at Age 90

Although the impact of visual impairment (VI) upon functional status and mortality among older people is recognized, its relationship to cognitive function is unclear. We examined the association between VI and subsequent cognitive decline from age 85-90 among subjects from the Jerusalem Longitudinal Study (1990-2020), which follows a representative study sample born 1920-21. Assessment at age 85 (2005) and age 90 (2010) included Snellen visual testing and Mini Mental State Examination (MMSE) for 488 subjects. VI was defined as corrected best eye vision ≤ 40/60. Dementia was defined as MMSE ≤24/30, after visually-dependent items (drawing, writing, reading) were excluded from the MMSE, and the score (maximum=27) was corrected to a maximum of 30 by multiplying by a factor of 1.111. At age 85 frequency of VI was 40.1% (198/488) and 86.9% (424/488) of subjects were non-demented (MMSE ≥24/30). Between ages 85-90 the mean decline in MMSE among all subjects with VI vs. non-VI was 5.2±7.7 vs. 3.9±6.7 (p=0.053), among non-demented subjects was 5.2±7.8 vs. 3.5±6.3 (p=0.002), and the transition to dementia was 34% vs. 20% (p=0.004) respectively. In logistic regression analysis among non-demented subjects at age 85, the unadjusted odds ratio (OR) for transition to dementia by age 90 associated with VI at age 85 was OR 1.95, 95%CI 1.24-3.06, p&lt;0.01, and after adjusting for gender, years of education, depression and diabetes, the adjusted OR was 1.74, 95%CI 1.09-2.76, p&lt;0.05. In conclusion, visual impairment at age 85 is independently associated with subsequent cognitive decline and the development of dementia.