Existing systematic reviews have suggested mixed effects of the Covid pandemic on the mental health of children and young people. Those with pre-existing mental health and neurodevelopmental conditions have been suggested to be disproportionately affected, but this has not been meta-analysed. Most reviews of studies in clinical populations to date only include cross-sectional studies during the first lockdown or longitudinal cohorts up to early 2021, which limits our understanding of causality and long-term effects. To our knowledge, this is the first systematic review and meta-analysis to examine the longitudinal impact of the pandemic on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions.

To compare 1) mental health pre versus during Covid, and 2) mental health during Covid.

Medline, Embase, APA PsycInfo, and Global Health databases were searched up to August 2023. Longitudinal studies reporting mental health outcomes in children and young people (≤18 years old) with pre-Covid mental health and/or neurodevelopmental conditions were included. Cohorts were deemed eligible if children and young people were diagnosed using a diagnostic assessment, scored above clinical threshold on validated measures, or attended mental health services pre-Covid. Outcomes included internalising, externalising, and other symptoms. Studies were narratively synthesised by symptom category and meta-analyses performed where number of studies reporting the same outcomes were sufficient (≥5).

6,083 records were identified and 21 studies (N=2,617) were included. These widely differed in country, setting, diagnosis, outcome, and timepoints under study. The narrative synthesis highlighted mixed findings in mental health changes during the pandemic for all three symptom categories showing increases, reductions, and no changes. Only studies reporting changes in internalising symptoms pre- versus during the pandemic were in sufficient number to be amenable to meta-analysis.

Our findings suggest the pandemic’s impact on the mental health of children and young people with pre-existing mental health and neurodevelopmental conditions were complex and varied. We highlight an urgent need for longitudinal Covid research on long-term mental health outcomes in this vulnerable group. Understanding risk factors and longitudinal trajectories is warranted to guide clinical practice and policy.

None Declared

This study assesses the relationship between adverse childhood experiences (ACE) occurring before the age of 18 years and patterns of fast-food consumption and sugary beverage consumption in adulthood. The study also examines how perceived stress and socio-economic status (SES) (college educational attainment and income) in adulthood mediate this relationship.

Using data from the National Longitudinal Study of Adolescent to Adulthood Health (N 8599), multinomial logistic regression analyses were carried out to assess the association between ACE and unhealthy dietary behaviours in adulthood. Karlson–Holm–Breen mediation analysis is used to determine the mediating effects of SES and perceived stress.

Persons living in the USA in 2016–2018.

Adults (n 8599) aged 33–44 years.

The findings show an association between four or more ACE and high fast-food (relative risk ratio (RRR) = 1·436, 95 % CI = 1·040, 1·983) and high sugary beverage consumption (RRR = 1·435, 95 % CI = 1·002, 2·055). The association between ACE and high fast-food consumption is partially mediated by college educational attainment, and the association between ACE and high sugary beverage consumption is partially mediated by perceived stress and college educational attainment.

ACE can have long-term consequences for unhealthy dietary behaviours in adulthood, and this relationship is partially due to a lower likelihood of higher perceived stress and college educational attainment among ACE-exposed persons. Future research is needed to understand further the influence of ACE on dietary patterns over the life course.

As a result of the wildfire that engulfed Fort McMurray (FMM), Alberta, Canada in May 2016, over 90,000 residents were evacuated from the city. Approximately 2400 homes, or 10% of the housing stock, were destroyed in Fort McMurray. About 200,000 hectors of forest were destroyed by the fire, which reached into Saskatchewan. In the aftermath of a major disaster, a community’s infrastructure is disrupted, and psychological, economic, and environmental effects can last for many years.

Intensive research was conducted in Fort McMurray five years after the wildfire disaster to determine the prevalence of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) among residents of the community and to determine the demographic, clinical, and other risk factors of probable MDD and PTSD.

An online questionnaire administered via REDCap was used to collect data in a quantitative cross-sectional study between 24 April and 2 June 2021. Patients were asked to complete the Patient Health Questionnaire (PHQ-9) in order to assess the presence of symptoms associated with MDD. An assessment of likely PTSD in respondents was conducted using the PTSD Checklist for DSM-5 (PCL-C). In this study, descriptive, univariate, and multivariate regression analyses were conducted.

Out of 249 people who accessed the survey link, 186 completed it (74.7% response rate). There was a median age of 42 among the subscribers. A majority of the sample consisted of 159 (85.5%) females; 98 (52.7%) over the age of 40; 136 (71%) in a relationship; and 175 (94.1%) employed. Our study sample had an overall prevalence of 45.0% (76) of MDD symptoms. The multivariate logistic regression model revealed four variables that were independently associated with MDD symptoms, including being unemployed, diagnosed with MDD, taking sedative-hypnotics, and willingness to receive mental health counseling. A total of 39.6% of our respondents (65) reported having likely PTSD. Three independent variables: received a mental health depression diagnosis from a health professional, would like to receive mental health counseling, and have only limited or no support from familycontributed significantly to the model for predicting likely PTSD among respondents while controlling the other factors in the regression model.

The findings of this study indicate that unemployment, the use of sleeping pills, the presence of a previous depression diagnosis, and the willingness to seek mental health counseling are significant factors associated with the increase in the prevalence of MDD and PTSD following wildfires. Support from family members may prevent these conditions from developing.

None Declared

As a result of the floods in Fort McMurray (FMM) and the surrounding area in 2020, more than $228 million in insured damage was sustained, over 1200 structures were damaged, and more than 13,000 people were evacuated from their homes.

The aim of the study was to determine the prevalence of post-traumatic stress disorder (PTSD)-like symptoms among the population of FMM one year after the flood in 2020 and the risk predictors associated with such symptoms.

In order to collect sociodemographic, clinical, and flood-related information from residents of FMM via REDCap, an online quantitative cross-sectional survey was administered between April 24 and June 02, 2021. Respondents were assessed for probable PTSD using the PTSD Checklist for DSM-5 (PCL-C).

An overall response rate of 74.7% was achieved among 186 of 249 respondents. The prevalence of likely post-traumatic stress disorder was 39.6% (65). There was a significantly increased likelihood of developing PTSD symptoms in respondents with a history of depression (OR= 5.71; 95% CI: 1.68 - 19.36). As well, disaster responders experiencing limited and no family support after the disaster were more likely to report PTSD symptoms (OR= 2.87; 95% CI: 1.02 - 8.05) and (OR= 2.87; 95% CI: 1.06 - 7.74), respectively.

As a result of our study, we found that those who had a history of depression and had sought health counseling were significantly more likely to develop PTSD symptoms following flooding, while those with family support were less likely to suffer from PTSD symptoms. There is a need for further studies to investigate the relationship between the need for counseling and the presentation of potential symptoms of post-traumatic stress disorder.

None Declared

To examine the perspectives of caregivers that are not part of the antibiotic stewardship program (ASP) leadership team (eg, physicians, nurses, and clinical pharmacists), but who interact with ASPs in their role as frontline healthcare workers.

Qualitative semistructured interviews.

The study was conducted in 2 large national healthcare systems including 7 hospitals in the Veterans’ Health Administration and 4 hospitals in Intermountain Healthcare.

We interviewed 157 participants. The current analysis includes 123 nonsteward clinicians: 47 physicians, 26 pharmacists, 29 nurses, and 21 hospital leaders.

Interviewers utilized a semistructured interview guide based on the Consolidated Framework for Implementation Research (CFIR), which was tailored to the participant’s role in the hospital as it related to ASPs. Qualitative analysis was conducted using a codebook based on the CFIR.

We identified 4 primary perspectives regarding ASPs. (1) Non-ASP pharmacists considered antibiotic stewardship activities to be a high priority despite the added burden to work duties: (2) Nurses acknowledged limited understanding of ASP activities or involvement with these programs; (3) Physicians criticized ASPs for their restrictions on clinical autonomy and questioned the ability of antibiotic stewards to make recommendations without the full clinical picture; And (4) hospital leaders expressed support for ASPs and recognized the unique challenges faced by non-ASP clinical staff.

Further understanding these differing perspectives of ASP implementation will inform possible ways to improve ASP implementation across clinical roles.

To identify the clinical characteristics, treatment, and prognosis of relapsing polychondritis patients with airway involvement.

Twenty-eight patients with relapsing polychondritis, hospitalised in the First Hospital of Shanxi Medical University between April 2011 and April 2021, were retrospectively analysed.

Fifty per cent of relapsing polychondritis patients with airway involvement had a lower risk of ear and ocular involvement. Relapsing polychondritis patients with airway involvement had a longer time-to-diagnosis (p < 0.001), a poorer outcome following glucocorticoid combined with immunosuppressant treatment (p = 0.004), and a higher recurrence rate than those without airway involvement (p = 0.004). The rates of positive findings on chest computed tomography and bronchoscopy in relapsing polychondritis patients with airway involvement were 88.9 per cent and 85.7 per cent, respectively. Laryngoscopy analysis showed that 66.7 per cent of relapsing polychondritis patients had varying degrees of mucosal lesions.

For relapsing polychondritis patients with airway involvement, drug treatment should be combined with local airway management.

To examine how individual steward characteristics (eg, steward role, sex, and specialized training) are associated with their views of antimicrobial stewardship program (ASP) implementation at their institution.

Descriptive survey from a mixed-methods study.

Two large national healthcare systems; the Veterans’ Health Administration (VA) (n = 134 hospitals) and Intermountain Healthcare (IHC; n = 20 hospitals).

We sent the survey to 329 antibiotic stewards serving in 154 hospitals; 152 were physicians and 177 were pharmacists. In total, 118 pharmacists and 64 physicians from 126 hospitals responded.

The survey was grounded in constructs of the Consolidated Framework for Implementation Research, and it assessed stewards’ views on the development and implementation of antibiotic stewardship programs (ASPs) at their institutions We then examined differences in stewards’ views by demographic factors.

Regardless of individual factors, stewards agreed that the ASP added value to their institution and was advantageous to patient care. Stewards also reported high levels of collegiality and self-efficacy. Stewards who had specialized training or those volunteered for the role were less likely to think that the ASP was implemented due to a mandate. Similarly volunteers and those with specialized training felt that they had authority in the antibiotic decisions made in their facility.

Given the importance of ASPs, it may be beneficial for healthcare institutions to recruit and train individuals with a true interest in stewardship.

The coronavirus disease 2019 (COVID-19) pandemic represents an unprecedented threat to mental health. Herein, we assessed the impact of COVID-19 on subthreshold depressive symptoms and identified potential mitigating factors.

Participants were from Depression Cohort in China (ChiCTR registry number 1900022145). Adults (n = 1722) with subthreshold depressive symptoms were enrolled between March and October 2019 in a 6-month, community-based interventional study that aimed to prevent clinical depression using psychoeducation. A total of 1506 participants completed the study in Shenzhen, China: 726 participants, who completed the study between March 2019 and January 2020 (i.e. before COVID-19), comprised the ‘wave 1’ group; 780 participants, who were enrolled before COVID-19 and completed the 6-month endpoint assessment during COVID-19, comprised ‘wave 2’. Symptoms of depression, anxiety and insomnia were assessed at baseline and endpoint (i.e. 6-month follow-up) using the Patient Health Questionnaire-9 (PHQ-9), Generalised Anxiety Disorder-7 (GAD-7) and Insomnia Severity Index (ISI), respectively. Measures of resilience and regular exercise were assessed at baseline. We compared the mental health outcomes between wave 1 and wave 2 groups. We additionally investigated how mental health outcomes changed across disparate stages of the COVID-19 pandemic in China, i.e. peak (7–13 February), post-peak (14–27 February), remission plateau (28 February−present).

COVID-19 increased the risk for three mental outcomes: (1) depression (odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.04–1.62); (2) anxiety (OR = 1.47, 95% CI: 1.16–1.88) and (3) insomnia (OR = 1.37, 95% CI: 1.07–1.77). The highest proportion of probable depression and anxiety was observed post-peak, with 52.9% and 41.4%, respectively. Greater baseline resilience scores had a protective effect on the three main outcomes (depression: OR = 0.26, 95% CI: 0.19–0.37; anxiety: OR = 1.22, 95% CI: 0.14–0.33 and insomnia: OR = 0.18, 95% CI: 0.11–0.28). Furthermore, regular physical activity mitigated the risk for depression (OR = 0.79, 95% CI: 0.79–0.99).

The COVID-19 pandemic exerted a highly significant and negative impact on symptoms of depression, anxiety and insomnia. Mental health outcomes fluctuated as a function of the duration of the pandemic and were alleviated to some extent with the observed decline in community-based transmission. Augmenting resiliency and regular exercise provide an opportunity to mitigate the risk for mental health symptoms during this severe public health crisis.