Depression, anxiety and insomnia among isolated covid-19 patients: tele occupational therapy intervention vs. conventional one: a comparative study.
COVID-19 is known to cause psychological problems. Psychological rehabilitation can be performed to reduce anxiety, depression, and insomnia. Facing patients with infectious diseases can be difficult for medical staff. Therefore, this study compared the effects of psychiatric tele-rehabilitation (TR) and conventional psychiatric rehabilitation (CR) in isolated patients with COVID-19.
This randomized controlled study, conducted at a single community-based hospital, included 40 patients (24 in the psychiatric tele-rehabilitation group [TRG] and 16 in the conventional psychiatric rehabilitation group [CRG]) with COVID-19 were recruited from November 18, 2021, to April 7, 2022. Psychiatric rehabilitation is an occupation-based intervention in which patients perform meaningful activities and tasks. Patients in the TRG selected activities, received counseling, and underwent monitoring over the phone, while those in the CRG participated in face-to-face sessions. The interventions were conducted for 50 min each day during an isolation period of 7 days in both groups, and all participants received the interventions individually. The primary outcome was anxiety assessed using the Visual Analog Scale (VAS) and the Zung Self-Rating Anxiety Scale (SAS). Secondary outcomes include the Visual Analog Scale (VAS) and the Patient Health Questionnaire-9 (PHQ-9) to evaluate depression, the Multidimensional State Boredom Scale-8 (MSBS-8) to assess boredom. The Korean version of the Insomnia Severity Index (ISI-K) was used to assess the quality of sleep, and the World Health Organization Quality of Life Assessment Instrument-BRIEF (WHOQOL-BREF) was used to evaluate quality of life. Questionnaires were administered at admission, discharge, and at the 6-month follow-up.
In the time × group analysis, the SAS total score (p = .033) and the VAS score for depression (p = .012) in the CRG were significantly lower than those in the TRG at the time of discharge. The VAS score for anxiety (p = .007), total SAS score (p = .050), and VAS score for depression (p = .003) in the CRG were also significantly lower than those in the TRG at the 6-month follow-up. The PHQ-9, MSBS-8, ISI-K, and WHOQOL-BREF scores showed no significant interactions in the time × group analysis.
TR was effective in reducing anxiety and improving quality of life during hospitalization, but had no remained effects after discharge. Otherwise, CR was more effective than TR for anxiety and depression during hospitalization and had remained effects at 6-month follow-up. However, considering the characteristics of infectious conditions that involve risk in contact, TR will still play an important role, and efforts will be needed to improve the effect that remained.
The trial was registered with the Korea Clinical Trials Registry (KCT0006714, Date of registration 08/11/2021).
Jung JH
,Ko JY
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Visitor Restrictions During the COVID-19 Pandemic and Increased Falls With Harm at a Canadian Hospital: An Exploratory Study.
Falls with harms (FWH) in hospitalized patients increase costs and lengths of stay. The COVID-19 pandemic has resulted in more FWH. Additionally, the COVID-19 pandemic has resulted in increased patients in isolation with fewer visitors. Their relationship with falls has not been previously studied.
This is a retrospective, single-site, 12-month before pandemic-12-month after pandemic, observational study. Multiple logistic regression analysis was used to model FWH outcome and associations with isolation and visitor restrictions.
There were 4369 isolation events and 385 FWH among 22,505 admissions during the study period. Unadjusted analysis demonstrated a FWH risk of 1.33% (95% CI 0.99, 1.67) in those who were placed in isolation compared to 1.80% (95% CI 1.60, 2.00) in those without an isolation event ( χ2 = 4.73, P = 0.03). The FWH risk during the different visitor restriction periods was significantly higher compared to the prepandemic period ( χ2 = 20.81, P < 0.001), ranging from 1.28% (95% CI 1.06, 2.50) in the prepandemic period to 2.03% (95% 1.66, 2.40) with no visitors permitted (phase A) in the pandemic period. After adjusting for potential confounders and selection bias, only phase A visitor restrictions were associated with an increased FWH risk of 0.75% (95% CI 0.32, 1.18) compared to no visitor restrictions.
Our results suggest a moderately strong association between hospitalized patient FWH risk and severe visitor restrictions. This association was muted in phases with even minor allowances for visitation. This represents the first report of the adverse effects of visitor restriction policies on patients' FWH risks.
Shennan S
,Coyle N
,Lockwood B
,DiDiodato G
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Workplace interventions to reduce the risk of SARS-CoV-2 infection outside of healthcare settings.
Although many people infected with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) experience no or mild symptoms, some individuals can develop severe illness and may die, particularly older people and those with underlying medical problems. Providing evidence-based interventions to prevent SARS-CoV-2 infection has become more urgent with the potential psychological toll imposed by the coronavirus disease 2019 (COVID-19) pandemic. Controlling exposures to occupational hazards is the fundamental method of protecting workers. When it comes to the transmission of viruses, workplaces should first consider control measures that can potentially have the most significant impact. According to the hierarchy of controls, one should first consider elimination (and substitution), then engineering controls, administrative controls, and lastly, personal protective equipment. This is the first update of a Cochrane review published 6 May 2022, with one new study added.
To assess the benefits and harms of interventions in non-healthcare-related workplaces aimed at reducing the risk of SARS-CoV-2 infection compared to other interventions or no intervention.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science Core Collections, Cochrane COVID-19 Study Register, World Health Organization (WHO) COVID-19 Global literature on coronavirus disease, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform, and medRxiv to 13 April 2023.
We included randomised controlled trials (RCTs) and non-randomised studies of interventions. We included adult workers, both those who come into close contact with clients or customers (e.g. public-facing employees, such as cashiers or taxi drivers), and those who do not, but who could be infected by coworkers. We excluded studies involving healthcare workers. We included any intervention to prevent or reduce workers' exposure to SARS-CoV-2 in the workplace, defining categories of intervention according to the hierarchy of hazard controls (i.e. elimination; engineering controls; administrative controls; personal protective equipment).
We used standard Cochrane methods. Our primary outcomes were incidence rate of SARS-CoV-2 infection (or other respiratory viruses), SARS-CoV-2-related mortality, adverse events, and absenteeism from work. Our secondary outcomes were all-cause mortality, quality of life, hospitalisation, and uptake, acceptability, or adherence to strategies. We used the Cochrane RoB 2 tool to assess risk of bias, and GRADE methods to evaluate the certainty of evidence for each outcome.
We identified 2 studies including a total of 16,014 participants. Elimination-of-exposure interventions We included one study examining an intervention that focused on elimination of hazards, which was an open-label, cluster-randomised, non-inferiority trial, conducted in England in 2021. The study compared standard 10-day self-isolation after contact with an infected person to a new strategy of daily rapid antigen testing and staying at work if the test is negative (test-based attendance). The trialists hypothesised that this would lead to a similar rate of infections, but lower COVID-related absence. Staff (N = 11,798) working at 76 schools were assigned to standard isolation, and staff (N = 12,229) working at 86 schools were assigned to the test-based attendance strategy. The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of symptomatic polymerase chain reaction (PCR)-positive SARS-CoV-2 infection (rate ratio (RR) 1.28, 95% confidence interval (CI) 0.74 to 2.21; 1 study; very low-certainty evidence). The results between test-based attendance and standard 10-day self-isolation were inconclusive for the rate of any PCR-positive SARS-CoV-2 infection (RR 1.35, 95% CI 0.82 to 2.21; 1 study; very low-certainty evidence). COVID-related absenteeism rates were 3704 absence days in 566,502 days-at-risk (6.5 per 1000 working days) in the control group and 2932 per 539,805 days-at-risk (5.4 per 1000 working days) in the intervention group (RR 0.83, 95% CI 0.55 to 1.25). We downgraded the certainty of the evidence to low due to imprecision. Uptake of the intervention was 71% in the intervention group, but not reported for the control intervention. The trial did not measure our other outcomes of SARS-CoV-2-related mortality, adverse events, all-cause mortality, quality of life, or hospitalisation. We found seven ongoing studies using elimination-of-hazard strategies, six RCTs and one non-randomised trial. Administrative control interventions We found one ongoing RCT that aims to evaluate the efficacy of the Bacillus Calmette-Guérin (BCG) vaccine in preventing COVID-19 infection and reducing disease severity. Combinations of eligible interventions We included one non-randomised study examining a combination of elimination of hazards, administrative controls, and personal protective equipment. The study was conducted in two large retail companies in Italy in 2020. The study compared a safety operating protocol, measurement of body temperature and oxygen saturation upon entry, and a SARS-CoV-2 test strategy with a minimum activity protocol. Both groups received protective equipment. All employees working at the companies during the study period were included: 1987 in the intervention company and 1798 in the control company. The study did not report an outcome of interest for this systematic review. Other intervention categories We did not find any studies in this category.
We are uncertain whether a test-based attendance policy affects rates of PCR-positive SARS-CoV-2 infection (any infection; symptomatic infection) compared to standard 10-day self-isolation amongst school and college staff. A test-based attendance policy may result in little to no difference in absenteeism rates compared to standard 10-day self-isolation. The non-randomised study included in our updated search did not report any outcome of interest for this Cochrane review. As a large part of the population is exposed in the case of a pandemic, an apparently small relative effect that would not be worthwhile from the individual perspective may still affect many people, and thus become an important absolute effect from the enterprise or societal perspective. The included RCT did not report on any of our other primary outcomes (i.e. SARS-CoV-2-related mortality and adverse events). We identified no completed studies on any other interventions specified in this review; however, eight eligible studies are ongoing. More controlled studies are needed on testing and isolation strategies, and working from home, as these have important implications for work organisations.
Constantin AM
,Noertjojo K
,Sommer I
,Pizarro AB
,Persad E
,Durao S
,Nussbaumer-Streit B
,McElvenny DM
,Rhodes S
,Martin C
,Sampson O
,Jørgensen KJ
,Bruschettini M
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《Cochrane Database of Systematic Reviews》