The COVID-19 pandemic created stressors to daily living, leading to increased mental health problems. It is important to assess the influence of COVID-19 pandemic on mental health, specifically anxiety.

The goal was to determine the prevalence and sociodemographic, clinical, and other correlates of likely Generalized Anxiety Disorder (GAD) among study subjects in Ghana.

This study employed a cross-sectional approach, using an online survey administered primarily through social media platforms. The survey questions included the GAD-7 scale, which was used to assess likely GAD in respondents. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression analysis.

Overall, 756 respondents completed the survey, mainly from Ashanti and Greater Accra, which were the hardest hit by COVID-19.

The prevalence of likely GAD in our sample was 7.6%. Gender, loss of job due to COVID-19, and seeking mental health counseling were independently associated with increased likelihood of GAD.

The findings suggest that women, those who lost their jobs due to the COVID-19 pandemic, and those who sought mental health counseling were more likely to experience moderate to high anxiety symptoms as a result of the COVID-19 pandemic. Priority must be attached to psychological support measures for members of these groups.

Although the cognitive profiles of people experiencing homelessness have been described in the literature, the neuropsychological profile of people experiencing complex homelessness has not been delineated. Complex homelessness is homelessness that continues despite the provision of bricks and mortar solutions. People experiencing complex homelessness often have an array of physical health, mental health, substance use, neurodevelopmental and neurocognitive disorders. The present study aimed to delineate the neuropsychological profile of people experiencing complex homelessness and explore the utility of neuropsychological assessment in supporting this population.

19 people experiencing complex homelessness in Sydney, Australia, were consecutively referred by specialist homelessness services for neuropsychological assessment. They underwent comprehensive assessment of intelligence, memory and executive functioning and completed questionnaires to screen for the presence of ADHD, PTSD, depression, anxiety and stress. A range of performance validity measures were included. Referrers were asked to complete questionnaires on history of childhood trauma, psychological functioning, drug and alcohol use, functional cognitive abilities, homelessness factors, personality, risk of cognitive impairment and adaptive functioning and to note existing or suspected mental health, neurodevelopmental and neurocognitive disorders. Referrers also completed a post-assessment pathways questionnaires to identify whether the neuropsychological assessment facilitated referral pathways (e.g., for government housing or financial assistance). Clinicians completed a post-assessment diagnosis survey, which was compared to the pre-assessment known or suspected diagnoses. Finally, referrers were asked to complete a satisfaction questionnaire regarding the neuropsychological assessment.

Mean (SD) WAIS-IV indexes were VCI = 81.1 (14.5), PRI = 86.1 (10.9), WMI = 80.5 (13.0), PSI = 81.6 (10.2). Mean WMS-IV Flexible (LMVR) indexes were AMI = 68.3 (19.6), VMI = 77.1 (19.3), IMI = 72.7 (17.2), and DMI = 70.5 (17.6). The majority of participants showed unusual differences between WAIS-IV and TOPF-predicted WAIS-IV scores and between WAIS-IV General Ability and WMS-IV Flexible (LMVR) scores. Demographically corrected scores on tests of executive functioning were mostly one or more standard deviations below the mean. The majority of participants screened positive on screening measures of executive dysfunction, PTSD and ADHD and had elevated self-reported psychological distress scores. At least one new diagnosis was made for nine (47%) participants, established diagnoses were confirmed for two (11%) participants, diagnoses were supported for 15 (79%) participants, tentative diagnoses were made for 16 (84%) participants, and five (26%) participants had at least one diagnosis disconfirmed/unsupported. Referrers indicated that the majority of post-assessment pathways were more accessible following the neuropsychological assessment and that they were very satisfied with the neuropsychological assessments overall.

This is one of the first studies to delineate the neuropsychological profile of people experiencing complex homelessness using robust psychometric approaches, including performance validity tests. This population experiences a high burden of cognitive impairment and associated substance use, neurodevelopmental and mental health comorbidities. Neuropsychological assessment makes referral pathways more accessible and is valued by referrers of people experiencing complex homelessness.

Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.

Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.

Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.

Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.