Unravelling the link between sleep and mental health during the COVID-19 pandemic

The emergence of COVID-19 brought unparalleled changes in people's lifestyle, including sleep. We aimed to assess the bidirectional association between sleep quality and mental health and describe how sleep and mental health were affected in Sweden during the COVID-19 pandemic (between June 2020 and September 2021). Data were obtained from the Omtanke2020 study. Participants who completed the baseline survey and each of the 8 monthly follow-up surveys were included (N = 9035). We described the distribution of sleep and mental health in the different Swedish regions using maps and over the study period with longitudinal graphs adjusting for sex, age, recruitment type (self-recruitment or invitation), and COVID-19 status. The inner relationships between mental health, sleep and Covid infection were described through relative importance networks. Finally, we modelled how mental health affects sleep and vice versa using generalized estimating equations with different adjustments. Seasonal and north-south regional variations were found in sleep and mental health outcomes at baseline and attenuated over time. The seasonal variation of sleep and mental health correlated moderately with the incidence rate of COVID-19 in the sample. Networks indicate that the relationship between COVID-19 incidence and mental health varies over time. We observed a bidirectional relationship between sleep quality and quantity at baseline and mental health at follow-up and vice versa. Sleep quality and quantity at baseline was associated with adverse symptom trajectories of mental health at follow-up, and vice versa, during the COVID-19 pandemic. There was also a weak relationship between COVID-19 incidence, sleep, and mental health.     

The impact of the COVID-19 pandemic on mental health,associated factors and coping strategies in people living with HIV: a scoping review

Introduction

The COVID-19 pandemic and associated measures implemented by authorities have created additional stressors and increased the risk of psychological illnesses among people living with HIV (PLWH). Yet, there is no collective evidence on the mental health status of this population during the global pandemic and associated factors. This scoping review aimed to synthesize the evidence in the current literature related to the mental health outcomes and challenges faced by PLWH during the COVID-19 pandemic, identify the associated factors with psychological distress and summarize various coping strategies to ease these psychological distresses used by this population.

Methods

We conducted a scoping review following the PRISMA-ScR guideline and a literature search in four electronic databases in August 2022. Three reviewers independently screened all the search records and extracted the data from studies that met the inclusion criteria. Factors associated with worsened mental health outcomes were synthesized according to the socio-ecological framework.

Results

Among 1100 research records, 45 articles met the eligibility criteria and were included in the final review and data extraction, most of which were quantitative analyses. PLWH reported high rates of mental health problems during the pandemic. Multi-level factors were associated with increased psychological distress, including substance use, antiretroviral adherence, social support, financial hardship and economic vulnerability during the pandemic. PLWH used social media as a coping strategy to foster social support to deal with growing mental distress. Increased mental health illnesses were associated with increased substance use, it was also found associated with suboptimal medication adherence and antiretroviral therapy (ART) care engagement.

Discussion

PLWH experienced high rates of mental health illnesses, such as depression during the global COVID-19 pandemic. There is an urgent need to provide comprehensive HIV treatment and mental health services as the pandemic continues to evolve.

Conclusions

The review summarized how the mental health of PLWH was affected during the COVID-19 pandemic. Future work in the implementation of effective interventions to promote mental health in this population is needed, not only to ensure their quality of life but also to help them maintain ART adherence and healthcare during more unprecedented times.     

Changes in trends of orthopedic services due to the COVID-19 pandemic: A review

As of June 10, 2022, the World Health Organization has recorded over 532 million documented coronavirus disease 2019 (COVID-19) [(Coronavirus) SARS-CoV-2] cases and almost 6.3 million deaths worldwide, which has caused strain on medical specialties globally. The aim of this review is to explore the impact that COVID-19 has had on orthopedic practices. Providers observed a rapid decline in the number of orthopedic patients’ admissions due to cancellation of elective procedures; however, emergent cases still required treatment. Various observational studies, case reports, and clinical trials were collected through a PubMed database search. Additional sources were found through Google. The search was refined to publications in English and between the years of 2019 and 2021. The keywords used were “COVID-19” and/or “Orthopedic Injuries”. Thirty-seven studies were retained. The pandemic brought on significant changes to the mechanism of injury, number of admissions, type of injuries, and patient outcomes. Mortality rates significantly increased particularly amongst patients with hip fractures and COVID-19. Road traffic injuries remained a common cause of injury and domestic injuries became more prevalent with lockdown. Social isolation negatively affected mental health resulting in several orthopedic injuries. Telehealth services and separation for COVID-positive and COVID-negative patients benefited both patients and providers. While hospitals and medical facilities are still facing COVID-19 case surges, it is important to understand how this pandemic has impacted preparation, care, and opportunities for prevention education and ongoing care.     

Impact of COVID-19 on cardiac surgical training: Our experience in the United Kingdom

The current evolving global pandemic caused by coronavirus disease-2019 (COVID-19) has dramatically impacted global health care systems, resulting in governments taking unprecedented measures to contain the spread of the infection, with adaptations by health care organizations. Research into understanding the pathophysiology behind this virus, to ascertain best medical management and treatment, has been accelerated to keep up with the rapidly evolving situation. There has been redeployment of medical and nursing staff to the frontlines and redistribution of health care resources. In addition, the cancellation of elective surgery and centralization of services to treat high-risk surgical cases will all, undeniably, have an impact on current surgical training with possible future implications. We aim to explore the impact COVID-19 is having on cardiac surgical training in the UK and what future implications this may have.     

The effect of COVID-19 pandemic on the care of fragility hip fracture patients in the United Kingdom. A case control study in a major trauma centre

IntroductionCoronavirus disease 2019 is a pandemic that forced a transformation in the services provided by the National Health Service in the United Kingdom. Fragility hip fractures account for over 65,000 cases per year in the elderly population. The study aims to assess the impact of the pandemic on fragility hip fractures.MethodsA retrospective data gather was performed to identify fragility hip fractures from the 23rd of March 2020 to the 13th of May 2020, and from the 23rd of March 2019 to the 13th of May 19. Two groups were formed and compared over their 30 day follow up.ResultsThe control group comprised of 97 patients, with a mean age of 82.1 years old (62–102 years) and M:F ratio of 38:59. The case group comprised of 102 patients, with a mean age of 82.3 years old (60–100 years) and a M:F ratio of 16:86. Significant differences between groups were identified for gender (p < 0.001), time to theatre (p = 0.002), length of stay (p < 0.001) and COVID-19 status (p = 0.001). In the Case group, association with mortality was found for male gender (p = 0.041), right side (p = 0.031) and COVID-19 positive test results (p = 0.011).ConclusionEarly surgical intervention is advocated wherever possible, and sufficient optimisation, prior to surgery whenever a COVID-19 positive patient is identified. A safe rehabilitation environment is paramount for recovery in this group of patients. Further studies are required to understand the effect of this pandemic on the fragility hip fractures.Level of evidenceLevel III: Retrospective case–control study.     

COVID-19 and education: restructuring after the pandemic

COVID-19 challenges to keep a valuable educational offer with lockdown measures and social distancing are reviewed. Scientific Societies had to think of new alternatives to maintain meetings with conversion to a virtual format and development of online resources, rapidly available and broadly accessible. Other in person activities as face-to-face clinics have been substituted by telemedicine; the same happened with surgical training in theatre, given the suspension of most of the operations. Finally, the need to share and communicate in a continuous evolving scenario, has impacted negatively the integrity of peer review process, not following the normal procedures to ensure scientific integrity and reproducibility in the earliest phases of the pandemic.     

Heterogeneity in mental health change during the COVID-19 pandemic in Germany: The role of social factors

The COVID-19 pandemic constitutes a prolonged global crisis, but its effects on mental health seem inconsistent. This inconsistency highlights the importance of considering the differential impact of the pandemic on individuals. There is some evidence that mental health trajectories are heterogeneous and that both sociodemographic and personal characteristics are associated with higher risk for mental health issues. By contrast, information on the role of social factors as potential determinants of initial reactions to the pandemic and on heterogeneous trajectories over time is lacking. We analysed seven assessments of a large-scale (N = 2203) longitudinal study across 1.5 years, beginning in March 2020. Using self-report data on mental health and life satisfaction, we applied latent change models to examine initial reactions and mean changes across the pandemic. In addition, we applied latent class growth analyses to investigate whether there were distinct groups with different patterns of change. Results showed that on average, levels of life satisfaction and anxiety decreased (d = −0.31 and d = −0.11, respectively), levels of depressive symptoms increased (d = 0.13), and stress levels remained unchanged (d = −0.01) during the first year of the pandemic. For each outcome, we identified four distinct mental health trajectories. Between 5% (for anxiety) and 11% (for life satisfaction) of the sample reported consistently high—and even increasing—impairments in mental health and well-being. The trajectories of a sizeable number of people covaried with the course of the pandemic, such that people experienced better mental health when the number of COVID cases was low and when fewer restrictions were placed on public life. Low emotional support, high instrumental support, and the tendency to compare oneself with others were associated with more mental health issues. Findings show that whereas a substantial portion of people were largely unaffected by the pandemic, some individuals experienced consistently high levels of psychological distress. Social factors appear to play a crucial role in the maintenance of well-being.     

The impact and lessons learnt from the COVID-19 pandemic on a UK Burns Centre

The COVID-19 pandemic has dramatically impacted healthcare provision in the UK and burns services have had to adapt to ensure the continuity of a safe care. As we return to “normality” we reflect on lessons learnt from our response to this pandemic.A service evaluation was performed from patient notes between March 23rd and May 8th 2020 and an anonymous survey given to patients attending outpatient appointments.258 patients were referred to our burns service and 148 patients completed the survey. Eleven burns were caused by treatment or prevention of COVID-19. Patients delayed seeking medical attention due to concern of catching COVID-19 (36% adults, 8% children). There was a delay in referral of 17 patients despite them fulfilling the referral criteria. Infection rates were higher following delayed presentation (21% vs 6%). The majority of burns were managed conservatively (237/258). Dressing changes were performed at home by 32% of patients. The outreach team treated 22 patients.During the pandemic telemedicine has improved the efficiency of outpatient burn care and outreach nurses have enabled treatment of vulnerable patients. More must be done to raise public awareness of preventable causes of burn injury and to reassure them to seek help when burns occur.     

Impact of the intersection of anaesthesia and gender on burnout and mental health,illustrated by the COVID-19 pandemic

Physician burnout and poor mental health are prevalent and often stigmatised. Anaesthetists may be at particular risk and this is further increased for women anaesthetists due to biases and inequities within the specialty. However, gender-related risk factors for and experiences of burnout and poor mental health remain under-researched and under-reported. This negatively impacts individual practitioners, the anaesthesia workforce and patients and carries significant financial implications. We discuss the impact of anaesthesia and gender on burnout and mental health using the COVID-19 pandemic as an example illustrating how women and men differentially experience stressors and burnout. COVID-19 has further accentuated the gendered effects of burnout and poor mental health on anaesthetists and brought further urgency to the need to address these issues. While both personal and organisational factors contribute to burnout and poor mental health, organisational changes that recognise and acknowledge inequities are pivotal to bolster physician mental health.     

The role of emotion regulation in mental health during the COVID-19 outbreak: A 10-wave longitudinal study

The COVID-19 pandemic elicited a lot of concerns among citizens, thereby potentially compromising their well-being. This study sought to examine the role of individuals' emotion regulation styles (i.e., emotional dysregulation, emotional suppression, and emotional integration) in handling these concerns and their experiences of well-being (i.e., satisfaction with life and sleep quality) and ill-being (i.e., anxiety and depressive symptoms). The study had a unique 10-wave longitudinal design (N = 986; M_age = 41.28; 76% female) and was conducted during the outbreak of the pandemic in March–May 2020. Multilevel analyses showed, first, that weekly variation in COVID-19 related concerns related negatively to weekly variation in well-being and positively to weekly variation in ill-being. Second, at the between-person level, emotional dysregulation and suppression related positively to between-person vulnerability in ill-being and lower well-being (across all waves). Third, between-person differences in emotional dysregulation amplified the strength of the within-person association between concerns and depressive complaints and lowered life satisfaction. Unexpectedly, integrative emotion regulation amplified the strength of the within-person association between concerns and anxiety. The discussion focuses on the critical role of emotion regulation in handling the uncertainty elicited by the pandemic and provides directions for further research.     

Cardiac surgery considerations and lessons learned during the COVID-19 pandemic

The COVID-19 pandemic has transformed cardiac surgical practices. Limitations in intensive care resources and personal protective equipment have required many practices throughout the globe to pause elective operations and now slowly resume operations. However, much of cardiac surgery is not elective and patients continue to require surgery on an urgent or emergent basis during the pandemic. This continued need for providing surgical services has introduced several unique considerations ranging from how to prioritize surgery, how to ensure safety for cardiac surgical teams, and how best to resume elective operations to ensure the safety of patients. Additionally, the COVID-19 pandemic has required a careful analysis of how best to carry out heart transplantation, extra-corporeal membrane oxygenation, and congenital heart surgery. In this review, we present the many areas of multidisciplinary consideration, and the lessons learned that have allowed us to carry out cardiac surgery with excellence during the COVID-19 pandemic. As various states experience plateaus, declines, and rises in COVID-19 cases, these considerations are particularly important for cardiac surgical programs throughout the globe.     

The COVID-19 pandemic and its consequences for chronic pain: a narrative review

The COVID-19 pandemic transformed everyday life, but the implications were most impactful for vulnerable populations, including patients with chronic pain. Moreover, persistent pain is increasingly recognised as a key manifestation of long COVID. This narrative review explores the consequences of the COVID-19 pandemic for chronic pain. Publications were identified related to the COVID-19 pandemic influence on the burden of chronic pain, development of new-onset pain because of long COVID with proposed mechanisms and COVID-19 vaccines and pain interventions. Broadly, mechanisms underlying pain due to SARS-CoV-2 infection could be caused by ‘systemic inflammatory-immune mechanisms’, ‘direct neuropathic mechanisms’ or ‘secondary mechanisms due to the viral infection or treatment’. Existing chronic pain populations were variably impacted and social determinants of health appeared to influence the degree of effect. SARS-CoV-2 infection increased the absolute numbers of patients with pain and headache. In the acute phase, headache as a presenting symptom predicted a milder course. New-onset chronic pain was reportedly common and likely involves multiple mechanisms; however, its prevalence decreases over time and symptoms appear to fluctuate. Patients requiring intensive support were particularly susceptible to long COVID symptoms. Some evidence suggests steroid exposure (often used for pain interventions) may affect vaccine efficacy, but there is no evidence of clinical repercussions to date. Although existing chronic pain management could help with symptomatic relief, there is a need to advance research focusing on mechanism-based treatments within the domain of multidisciplinary care.     

The influence of the COVID-19 pandemic on lung cancer surgery in Queensland

Background

The coronavirus disease-19 (COVID-19) pandemic poses unprecedented challenges to global healthcare. The contemporary influence of COVID-19 on the delivery of lung cancer surgery has not been examined in Queensland.

Methods

We performed a retrospective registry analysis of the Queensland Cardiac Outcomes Registry (QCOR), thoracic database examining all adult lung cancer resections across Queensland from 1/1/2016 to 30/4/2022. We compared the data prior to, and after, the introduction of COVID-restrictions.

Results

There were 1207 patients. Mean age at surgery was 66 years and 1115 (92%) lobectomies were performed. We demonstrated a significant delay from time of diagnosis to surgery from 80 to 96 days (P < 0.0005), after introducing COVID-restrictions. The number of surgeries performed per month decreased after the pandemic and has not recovered (P = 0.012). 2022 saw a sharp reduction in cases with 49 surgeries, compared to 71 in 2019 for the same period.

Conclusion

Restrictions were associated with a significant increase in pathological upstaging, greatest immediately after the introduction of COVID-restrictions (IRR 1.71, CI 0.93–2.94, P = 0.05). COVID-19 delayed the access to surgery, reduced surgical capacity and consequently resulted in pathological upstaging throughout Queensland.     

The Impact of COVID-19 on Plastic Surgery Training in the United Kingdom,Canada and Australia—A Cross-Sectional Study

Background Surgical trainees worldwide have been thrust into a period of uncertainty, with respect to the implications COVID-19 pandemic will have on their roles, training, and future career prospects. It is currently unclear how plastic surgery trainees are being affected by COVID-19. This study examined the experience of plastic surgery trainees in Canada, the UK, and Australia to determine trainee roles during the early COVID-19 emergency response and how training changed during this time. Methods A cross-sectional survey-based study was designed for plastic surgery trainees in the UK, Canada and Australia. In total, 110 trainees responded to the survey. Statistical tests were conducted to determine differences in responses, based on year of training and country of residence. Results In total, 9.7% (10/103) of respondents reported being deployed to cover another service. There was a significant difference between redeployment based on country ( p = 0.001). Within the UK group, 28.9% of respondents were redeployed. For trainees not deployed, 95.5% (85/89) reported that there has been a reduction in operative volume. Ninety-seven (94.1%) respondents reported that there were ongoing teaching activities offered by their program. The majority of trainees (66.4%) were concerned about their training. There was a significant difference between overall concern and country ( p < 0.05). Conclusion In these unprecedented times, training programs in plastic surgery should be aware of the major impact that COVID-19 has had on trainees and will have on their training. The majority of plastic surgery trainees have experienced a reduction in surgical exposure but have maintained some form of regular teaching.