Acute Health Conditions Research Articles

Medication Management and the Role of the Geriatric Pharmacist in Interdisciplinary Care Teams

Rural areas have a higher proportion of older adults aging in place. Rural areas also face structural barriers to supporting social connectedness among older adults, including transportation barriers, greater geographic distances, and access to technological connectivity. This research aims to discuss rural-specific risks of loneliness and social isolation among older adults, as well as rural/urban differences in loneliness and social isolation among older adults using the national COVID-19 Coping Study. Cross-sectional bivariate analyses highlight rural/urban differences in social activities during the pandemic. For example, rural older adults were more likely to use social media daily, compared with urban older adults (67% vs. 61%, p<0.05), but were less likely to have phone or video calls with others daily (21% vs. 26%, p<0.001). We will also share results of differences within rural older adults in loneliness, isolation, and social activities by socio-demographic characteristics in order to design targeted interventions to improve connectedness.

Source apportionment of black carbon using light absorption measurement and impact of biomass burning smoke on air quality over rural central Taiwan: A yearlong study

Biomass burning episodes are critical particulate matter (PM) issues in Taiwan. The occurrence patterns of biomass burning events through long-term PM monitoring are worth further exploration. This study monitored PM10, PM2.5, and black carbon (BC) over one year in central Taiwan. The source apportionment of BC was examined using light absorption techniques and divided into fossil fuel combustion (BCf) and biomass burning (BCb). The monitoring results showed that the annual average PM10, PM2.5, and BC mass concentrations were 45.4 μg/m3, 19.8 μg/m3, and 0.79 μg/m3, respectively, while the annual average ratio of BC/PM2.5 was 0.044. Furthermore, BCf was remarkably higher than BCb, accounting for 89% of the total BC mass. However, it was noticed that biomass burning smoke impacted the air quality by enhancing PM10, PM2.5, and BCb over monitoring location. There were 14.4% of hourly PM10 events (≥125 μg/m3) and 10.0% of hourly PM2.5 events (≥35 μg/m3) resulting from biomass burning episodes at this monitoring site in one-year observation. The hourly average PM10 and PM2.5 concentrations during these biomass burning episodes were 2.1 and 2.3 times higher than the annual average PM10 and PM2.5 concentrations. During severe biomass burning episodes, high levels of human carcinogens, such as 1, 3-butadiene, benzene, and isoprene were also observed. The results demonstrate that air quality is severely degraded during biomass burning episodes. Therefore, further research is required to understand the effects of biomass burning events on the residents' acute and chronic health conditions.

Exploring the awareness, attitudes, and actions (AAA) of UK adults at high risk of severe illness from COVID-19.

People at high risk of severe illness from COVID-19 have experienced greater restrictions during the pandemic, yet there is a paucity of research exploring their lived experience. This study explored the impact of COVID-19 on people identified as at high risk of severe illness by UK Government, and in particular, the impact of the first lockdown on access to healthcare, medications and use of technological platforms. 1038 UK adults who identified as at high risk of severe illness from COVID-19 in line with UK Government guidance or self-identified with acute or other chronic health conditions, completed the Awareness, Attitudes and Actions survey which explored the impact of COVID-19 on access to healthcare, management of long-term health condition, mental health, and health behaviours. Most participants reported feelings of vulnerability, anxiety and isolation, noticed that other people changed their behaviour towards them including a feeling of being stigmatised by people not categorised as high risk. Participants described the largely negative impact that the COVID-19 lockdown had on to health-related behaviours and access to healthcare, which had resulted in large declines in mental health and wellbeing. Participants also indicated disappointment at the UK Governments response and handling of the COVID-19 lockdown. This study provides novel evidence of the lived experience of the first COVID-19 lockdown for people identified as at high risk of severe illness. In the context of behavioural health interventions, the ubiquity of digital technologies and their adoption into day-to-day life translates into greater potential reach than traditional interventions, and consequently, greater potential for positive public health impact. Findings should be considered by policymakers and healthcare professionals to support people now and as we transition through the recovery phase with a particular emphasis on supporting mental health and changes to the management of long-term health conditions.

Higher doses of ascorbic acid may have the potential to promote nutrient delivery via intestinal paracellular absorption.

The significance of plasma ascorbic acid (AA) is underscored by its enzymatic and antioxidant properties as well as involvement in many aspects of health including the synthesis of biomolecules during acute illness, trauma and chronic health conditions. Dietary intake supports maintenance of optimal levels with supplementation at higher doses more likely pursued. Transient increased intestinal paracellular permeability following high dose AA may be utilised to enhance delivery of other micronutrients across the intestinal lumen. The potential mechanism following dietary intake however needs further study but may provide an avenue to increase small intestinal nutrient co transport and absorption, including in acute and chronic illness.

Demographics and clinical characteristics of alcohol-related admissions in a tertiary care hospital in Qatar: Does age matter?

Background: Alcohol consumption is a major cause of acute and chronic health conditions associated with comorbidities and traumatic injuries, despite its partial prohibition in some countries. Moreover, alcohol-related hospital admissions increase the burden on the healthcare system. More than 80% of the population in Qatar comprises expatriates. This study aimed to analyze the demographics and clinical characteristics of subjects with alcohol-related emergency department (ED) visits/hospitalization with respect to different age groups in a single tertiary hospital in Qatar.Methods: It is a retrospective observational study of adult patients who visited the ED at Hamad General Hospital between January 2013 and March 2015 and were screened positive for alcohol use. Collected data included sociodemographic characteristics, blood alcohol concentration (BAC), pattern of admission, previous medical history, laboratory investigations, treatment, hospital course, and mortality. Data were compared with respect to the distribution of age groups such as < 25, 25–34, 35–44, 45–54, and >55 years.Results: In total, 1506 consecutively admitted patients screened positive for alcohol use were included in the study; the majority of them were males (95.6%), non-Qatari nationals (71.1%), and aged 35–44 years (30.9%). The age groups 35–44 years and 45–54 years showed the highest median BAC ([0.24 interquartile range (IQR: 0.14–0.33)] and [0.24 (IQR: 0.13–0.33)], respectively) as compared to the other age groups (P = 0.001). The pattern of hospital admission, sociodemographic status, presence of comorbidities, laboratory investigations, and mortality showed specific age-related distribution. Particularly, young adults were more likely to have a previous ED visit due to trauma, whereas older patients’ previous hospital admissions were mostly related to various underlying comorbidities.Conclusion: This study highlighted the patterns of age and clinico-epidemiological status of patients with alcohol-attributable hospital admissions. Our study showed that alcohol consumption was higher among the working-age group. Further studies are needed to investigate changes in the alcohol consumption patterns that may help plan for allocation of health resources and prevention of alcohol-related problems.

Translational Research – Focusing on Parenting and Family Caregiving to Improve Health Outcomes of Children and Their Families

Pediatric nursing encompasses focusing on the health of children, as well as parenting and family caregiving to improve the health outcomes of children and their families. The typical challenges of parenting and family caregiving are magnified when faced with a lack of resources and support, poor health literacy, and difficulty coping with children's acute and chronic health conditions. These circumstances create challenges for parents and families through increased informational needs about caregiving for their children and learning how to provide care for children with acute and chronic health conditions, as well as when infants are hospitalized in the neonatal intensive care unit (NICU).

Productivity burden of hypertension in Japan.

In the present study, we aimed to estimate the impact of hypertension in the working-age Japanese population. We developed life table models to estimate total deaths, years of life lived, and productivity-adjusted life years lived (a newly developed metric for quantifying the burden of acute and chronic health conditions on work productivity) among Japanese individuals with hypertension aged 20-64 years, with simulated follow-up until age 65 years. Data inputs were drawn from local population statistics and published sources. Gross domestic product per person employed, a measure of labor productivity, was used to assign an economic value to each productivity-adjusted life year lived. Outcomes and costs were discounted by 2% annually. In 2017, 26.3 million Japanese individuals aged 20-64 years (37.5%) had hypertension. Of these people, 23.7% were treated and had controlled blood pressure, 23.2% were treated but had uncontrolled blood pressure, and 53.1% were untreated. During the simulated follow-up until age 65 years, 335,342 deaths (28.0% of total deaths), 1.6 million years of life (0.8% of total), 3.1 million productivity-adjusted life years (1.9% of total), and US$242.9 billion or 28.3 trillion Japanese yen of gross domestic product were lost to hypertension. Our findings highlight the considerable economic burden of hypertension in Japan, as well as the importance of effective strategies for hypertension prevention and management, which are likely to deliver a significant return on investment.

Naturopathic community clinics: an international cross-sectional survey

BackgroundGlobally, naturopathic practitioners offer services in 98 countries, reaching every world region and providing care to diverse populations for a range of acute and chronic health conditions. Community clinics provide free or low-cost healthcare services and play a key role in providing necessary primary healthcare for underprivileged or marginalized populations. However, the reach and impact of naturopathic community clinics (NCCs) has not yet been examined. The aim of this study was to identify the characteristics of NCCs around the world, determine the types of services they offer and provide insight into the populations being served.MethodsTwo online cross-sectional surveys were administered using purposive and snowball sampling. A 6-item screening survey was administered first to identify clinics and institutions who fit the criteria for NCC services, followed by a 40-item follow-up survey. Descriptive analysis was conducted using frequencies and means.ResultsThe screening survey returned a total of 37 responses from six world regions. Of those respondents who indicated involvement in NCCs, 74% went on to complete the follow-up survey. The majority of the responding NCCs were located in North America (50%), followed by Western Pacific (17%), Europe (10%), Asia (13%), Latin America (7%) and Africa (3%). The vast majority (71%) of the NCCs that have been in operation for more than 10 years are located in North America, while 43% of the NCCs that have been operational less than 5 years are in the Western Pacific Region. 80% of the responding NCCs were affiliated with a naturopathic school. The majority of respondents (76%) mentioned that they aim to serve underserved and/or marginalized populations, with 34% indicating that their target population is low-income families, 21% focusing on serving immigrants and refugees, 21% on serving people experiencing homelessness, 14% on serving Indigenous peoples, 14% on serving those with specific gender differences, 10% on serving seniors and 10% on serving drug users.ConclusionThe naturopathic profession offers free or significantly low-cost naturopathic services through community clinics around the world. The findings of this survey provide insight into the important role of the naturopathic profession in primary health care and provide rationale for exploring this topic in greater detail.

The age profile of life satisfaction after age 65 in the U.S.

Although income and wealth are frequently used as indicators of well-being, they are increasingly augmented with subjective measures such as life satisfaction to capture broader dimensions of the well-being of individuals. Based on large surveys of individuals, life satisfaction in cross-section often is found to increase with age beyond retirement into advanced old age. It may seem puzzling that average life satisfaction does not decline at older ages because older individuals are more likely to experience chronic or acute health conditions, or the loss of a spouse. Accordingly, this empirical pattern has been called the “paradox of well-being.” We examine the age profile of life satisfaction of the U.S. population age 65 or older in the Health and Retirement Study (HRS), and find that in cross-section it increases between age 65 and 71 and is flat thereafter; but based on the longitudinal dimension of the HRS, life satisfaction significantly declines with age and the rate of decline accelerates with age. We reconcile the cross-section and longitudinal measurements by showing that both differential mortality and differential non-response bias the cross-sectional age profile upward: individuals with higher life satisfaction and in better health tend to live longer, and, among survivors, individuals with higher life satisfaction are more likely to remain in the survey, masking the decline in life satisfaction experienced by individuals as they age. We conclude that the optimistic view about increasing life satisfaction at older ages based on cross-sectional data is not warranted.

Mental health emergencies and COVID-19: the impact of 'lockdown' in the East Midlands of the UK.

The most immediate response of the research community to COVID-19 has been a focus on understanding the effects, treatment and prevention of infection. Of equal and ongoing importance is elucidating the impact of mitigation measures, such as lockdown, on the well-being of societies. Research about mental health and lockdown in the UK has predominately involved large surveys that are likely to encounter self-selection bias. Further, self-reporting does not constitute a clinical judgement. To (a) compare the age, gender and ethnicity of patients experiencing mental health emergencies prior compared with during lockdown, (b) determine whether the nature of mental health emergencies has changed during compared with before lockdown, (c) explore the utility of emergency medical service data for identifying vulnerability to mental health emergencies in real time during a pandemic. A total of 32 401 clinical records of ambulance paramedics attending mental health emergencies in the East Midlands of the UK between 23 March and 31 July 2020 and the same period in 2019 were analysed using binary logistic regression. People of younger age, male gender and South Asian and Black ethnicity are particularly vulnerable to acute mental health conditions during lockdown. Patients with acute cases of anxiety have increased during lockdown whereas suicide and intentional drug overdose have decreased. Self-reported data may underrepresent the true impact of lockdown on male mental health and ethnic minority groups. Emergency medical data can be used to identify vulnerable communities in the context of the extraordinary circumstances surrounding the current pandemic, as well as under more ordinary circumstances.

Associations between Natural Resource Extraction and Incidence of Acute and Chronic Health Conditions: Evidence from Tanzania.

Natural resource extraction projects are often accompanied by complex environmental and social-ecological changes. In this paper, we evaluated the association between commodity extraction and the incidence of diseases. We retrieved council (district)-level outpatient data from all public and private health facilities from the District Health Information System (DHIS2). We combined this information with population data from the 2012 national population census and a geocoded list of resource extraction projects from the Geological Survey of Tanzania (GST). We used Poisson regression with random effects and cluster-robust standard errors to estimate the district-level associations between the presence of three types of commodity extraction (metals, gemstone, and construction materials) and the total number of patients in each disease category in each year. Metal extraction was associated with reduced incidence of several diseases, including chronic diseases (IRR = 0.61, CI: 0.47–0.80), mental health disorders (IRR = 0.66, CI: 0.47–0.92), and undernutrition (IRR = 0.69, CI: 0.55–0.88). Extraction of construction materials was associated with an increased incidence of chronic diseases (IRR = 1.47, CI: 1.15–1.87). This study found that the presence of natural resources commodity extraction is significantly associated with changes in disease-specific patient volumes reported in Tanzania’s DHIS2. These associations differed substantially between commodities, with the most protective effects shown from metal extraction.

Foundation doctor preparedness for treating mental health conditions: results from a national survey

AimsPrevious research suggests the prevalence of mental health conditions among medical inpatients may be as high as 38%. Anecdotally, junior doctors report lacking the confidence, knowledge and skills to assess and treat patients with psychiatric conditions. Identifying this unmet need offers potential to improve standards of care and achieve parity of esteem between psychiatric and medical conditions within the general hospital. Aims:To assess self-reported preparedness of newly-qualified Foundation Doctors to care for patients with acute or chronic psychiatric symptoms in comparison to physical health conditions.MethodIn September of each year (2017, 2018, 2019), a survey was cascaded to all incoming Foundation Year 1 Doctors. For each respective year there were 1673, 961 &amp; 1301 respondents. Respondents were asked to rate their agreement with statements on a Likert scale. Statements pertaining to mental health included “a) I am competent in acute mental health care provision, b) I am competent in chronic mental health care provision” and “I feel confident in prescribing the following drugs; c) drugs for mental health problems”. Comparison statements assessed confidence caring for medically unwell patients, performing practical procedures and prescribing drugs for physical health conditions.ResultPreparedness for acute and chronic mental health were lower than both physical health comparison items; preparedness to care for patients with critical illness (acute: r = 0.794, p &lt; 0.001, chronic: r = 0.556, p &lt; 0.001) and preparedness to perform practical procedures (acute: r = 0.724, p &lt; 0.001, chronic: r = 0.433, p &lt; 0.001).Confidence prescribing mental health drugs was lower than all other comparison items (simple analgesia: r = 0.854, bronchodilators: r = 0.789, antimicrobials: r = 0.772, inhaled steroids: r = 0.720, intravenous fluids: r = 0.702, oral anti-diabetics: r = 0.611, anticoagulants: r = 0.515, narcotics: r = 0.514, insulin: r = 0.206; p &lt; 0.001)ConclusionThese results identify a disparity in foundation doctors’ self-reported preparedness to treat acute and chronic mental health conditions and prescribe psychotropic medications, compared to a variety of physical health domains. To our knowledge this is the first large-scale study to empirically test a potential discrepancy between newly-qualified doctors’ preparedness to treat patients’ mental and physical health needs. Medical school education and foundation training may therefore present a fruitful opportunity to improve care for patients with psychiatric conditions within general hospital settings.

Extended medical preparticipation screening as a useful option for injury prevention in professional sports

Preparticipation screening is important in order to make a statement about an athlete's health. The evaluation includes both an internal medicine/cardiology and an orthopaedic section. In professional team sports, players have to undergo medical screening on an annual basis to obtain their license and be cleared for play. Screening delivers information about the acute health condition of the athlete but only gives an indirect statement on his/her functional status and performance. This gap has been tried to be closed with functional, sports-specific performance testing in the past few years. In the event of future injury, the collected data can be used as a baseline level to monitor the progress in an athlete's rehabilitation process. This provides a huge advantage in the return-to-play diagnosis. Based on the assumption that only a healthy player can perform to the best of his or her ability, we have extended our medical screening for a professional basketball team. Since the 2012/2013 season, a test battery was added with a view to basketball-specific conditioning. The collected data was prospectively correlated to injury occurrence. Seventy-one players were tested in 5 different categories. We have documented 142 injuries which lead to a downtime of 23 days (range 1-347 days). The injuries mainly involved the lower extremity, in particular the ankle, the knee and the thigh muscles. There was a clear trend indicating that players performing weaker in the agility tests sustained more injuries (r = 0.34, p = 0.029). Athletes who performed worse in the Yo-Yo test suffered from significantly more thigh muscle injuries (r = 0.266, p = 0.012). Pre-participation screening is a useful tool in injury prevention, which helps to detect injuries or chronic stress complaints, especially in, but not limited to professional sports. Adding sports-specific performance testing may reveal potential deficits in agility and endurance which could lead to an increased injury risk. In addition, it allows to obtain baseline data which could be used to show the progress in rehabilitation in the event of an injury.

Intoxication of Cypermethrin on Binding Site of Human Oxyhaemoglobin

Pesticide exposure can occur by several routes in the same individual due to multiple uses, and there is likely to be additive toxicity in human. Cypermethrin a synthetic pyrethroid can produce a variety of acute health conditions and also carries several ecological risks. Hemoglobin is the protein that transports oxygen in the blood. Any change in heamoglobin may direct or indirect effect the human body. In this work, we report computational prediction of binding of cypermethrin pesticides on human oxyhaemoglobin [using Molegro Virtual Docker (MVD)] and evaluating the computational prediction on binding of human oxyhaemoglobin with cypermethrin pesticide and evaluate the Mole Dock Score, RMSD, affinity, interacting residues of receptor human oxyhaemoglobin, number of H-bond interaction, docking score and intracting interaction of residues. The energy bound conformation with lower value of selected ligand shows hydrogen bonding and electrostatic interactions. The binding affinity of cypermethrin pesticides is found to be -35.7414 KJ/mol, and bind with two hydrogen bonds with tyrosine 35 and serine 133. Frequent alterations in the expression of amino acid due to pesticide interaction with oxyhemoglobin may lead to produce carcinogenic cells in human beings.

Exploratory Factor Analysis for Identifying Comorbidities as Risk Factors Among Patients with Cied

Abstract The emergence of SARS-CoV-2 affected care both for acute and chronic health conditions. Majority of the patients with cardiac implantable electronic devices (CIEDs) have multiple comorbidities, which can influence their response to COVID-19. An online survey consisting of 45 multiple-choice question was designed for CIED patients assessing comorbidities and overall health condition during September -December 2020. A multivariate analysis based on principal axis factoring (PAF) was performed on the eligible 184 survey response. Three factors were identified. Ten-year survival rates were calculated with Charlson Comorbidity Index. The extracted factors explained 66.1% of the cumulative variance and were consistent with medical literature data.

Health Related Quality of Life of Children with Sickle Cell Anemia and Their Parents; Quantitative Study in Albaha; Saudi Arabia

Aims: To gain a better understanding of the quality of life (QoL) of children and impact of this disease on parents QoL.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: The study was conducted in King Fahd Hospital, Albaha city, Albaha, Saudi Arabia, between March2020 and February 2021.&#x0D; Methodology: We included 95 responses. Two different tools were used for the purpose of this study. PedsQL™ Sickle Cell Disease Module was used to measure health-related quality of life (HRQoL) in healthy children and adolescents and those with acute and chronic health conditions. Moreover, PedsQL™ Family Information Form was completed by caregivers. Median and interquartile range were used for numerical variables since they were skewed. Bivariate analyses were carried out using non-parametrical tests and Pearson correlation. The prediction of QoL was accomplished through multivariate analysis.&#x0D; Results: A total of (95) responses were analyzed. Female respondents were 52.6%. The age median was 12 (IQR=10-14). Mothers represented the most frequent informant 46.3% in this current study. Significant association was found between QoL and certain independent factors, some of which is parental level of education (P&lt; .001) and marital support (P&lt; .001).&#x0D; Conclusion: Sickle cell disease (SCD) is a major condition accounts for a huge burden on variable levels. This study reported that low QoL among children affected by SCD. Higher education and current marital status of the parents were significantly associated with high QoL in SCD patients. Number of workdays affected due to child health was significantly correlated with low QoL.

FACTORS AFFECTING ADHERENCE TO MEDICAL APPOINTMENT AMONG HYPERTENSIVE PATIENTS OF PUBLIC HEALTH FACILITIES IN PUNJAB, INDIA

Objective: Objective: Regular visit to health facilities is important for hypertension control. Under India Hypertension Control Initiative, hypertensive patients are enrolled in public hospitals and provided with patient-specific monthly medication for regular treatment at home and advised to return to the health facility after a month. However, at least 50% -60% of registered patients were not visiting the health facility for 3 to 6 months following their last visits. This article aims to document the major reasons for missed appointments and to characterize the patient and health system barriers. Design and method: We used a telephonic interview for collecting information from the patients who missed the appointments for more than 3 consecutive months. Out of 300 randomly selected patients, 206 were interviewed with a pre-structured questionnaire to explore patients’ experiences along with medical record reviews from the patient database. Interviews were conducted during the last quarter of 2019 and analyzed in both descriptive statistics and textual descriptions. Results: Not feeling sick or not experiencing any bodily symptoms due to hypertension (18.4%) followed by far distance between the health facility and the patient's home (16.5%) were the major reasons reported by the patients. Among other reasons, lack of proper instructions/guidance from the facility (11%), acute health conditions of patients (6%) and long waiting time at the public health facilities (5%) are also documented as the reasons for poor follow up. These factors cumulatively shifting a patient towards private sectors as 54% patients who were continuing their treatment are preferring private sectors. Conclusions: The results suggest the need for a more patient-centric care model such as guiding the patient properly at the health facility, saving patients time in the clinic, personalized care for acutely ill and aged patient and addressing the distance barriers between a patient's home and the health facility. Further, introducing reminder system by means of phone calls/SMS/visit may help to retain the higher follow-up of the patient.

Should Strengthening Bonds Be a Public Health Priority?

Abstract. Background: Previous research demonstrates the importance of close relationships on our physical health. However, to what extent the quality of our social relationships impacts our health, relative to other important health behaviors (e.g., smoking, drinking alcohol, and physical exercise), is less clear. Aims: Our goal was to use a nationally representative sample of Canadian adults to assess the relative importance of the quality of one’s social relationships (close emotional bonds and negative social interactions), relative to important health behaviors on physical health outcomes previously linked to social relationship quality. Method: Data ( N = 25,113) came from the Canadian Community Health Survey in 2012, a cross-sectional survey administered by Statistics Canada (2013) . The predictor variables were the presence of close emotional bonds, negative social relationships, type of smoker, type of drinker, and weekly hours of physical activity. The outcome variables were a current or previous diagnosis of high blood pressure, cancer, stroke, reports of current illness or injury, pain, and self-reported physical health. Results: Using regressions, we found that negative social interactions were more important than other health behaviors in relation to current injury/illness and pain. Physical activity was most strongly related to self-rated health, followed by negative social interactions and then close emotional bonds. Alcohol consumption was more related to the prevalence of stroke. Conclusions: Our findings suggest that negative social interactions may be more related to acute or minor physical health conditions, but social relationships may not be more strongly related to more chronic, life-threatening health conditions than other health behaviors.

A brief report of the prevalence of chronic and acute health conditions among blind American adults

BackgroundPrior research demonstrates disparities in the prevalence of certain chronic and acute health conditions among persons who are blind (PWB) compared to non-blind persons, such as diabetes and infectious diseases. However, a comprehensive understanding of the prevalence of chronic and acute health conditions among PWB is currently lacking. ObjectiveThe present study addressed this gap by examining the prevalence of chronic and acute conditions among blind persons, and examining differences by gender. MethodsThe present study surveyed 410 PWB residing in the U.S. about their health conditions and activities. Lifetime prevalence for eight chronic and six acute health conditions were estimated separately for men and women. Engagement in physical activity, regular use of medication, and satisfaction with health were also estimated. ResultsWe found that men more often reported their health conditions interfered with daily activities compared to women, as well as higher prevalence of stroke and arthritis compared to women. ConclusionThe current study contributes information that is vital to understanding the burden of specific health conditions on this population and necessary to understand the extent to which this burden disproportionately affects PWB.

Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study

SummaryBackgroundThere are concerns that the response to the COVID-19 pandemic in the UK might have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We aimed to ascertain what has happened to general practice contacts for acute physical and mental health outcomes during the pandemic.MethodsUsing de-identified electronic health records from the Clinical Research Practice Datalink (CPRD) Aurum (covering 13% of the UK population), between 2017 and 2020, we calculated weekly primary care contacts for selected acute physical and mental health conditions: anxiety, depression, self-harm (fatal and non-fatal), severe mental illness, eating disorder, obsessive-compulsive disorder, acute alcohol-related events, asthma exacerbation, chronic obstructive pulmonary disease exacerbation, acute cardiovascular events (cerebrovascular accident, heart failure, myocardial infarction, transient ischaemic attacks, unstable angina, and venous thromboembolism), and diabetic emergency. Primary care contacts included remote and face-to-face consultations, diagnoses from hospital discharge letters, and secondary care referrals, and conditions were identified through primary care records for diagnoses, symptoms, and prescribing. Our overall study population included individuals aged 11 years or older who had at least 1 year of registration with practices contributing to CPRD Aurum in the specified period, but denominator populations varied depending on the condition being analysed. We used an interrupted time-series analysis to formally quantify changes in conditions after the introduction of population-wide restrictions (defined as March 29, 2020) compared with the period before their introduction (defined as Jan 1, 2017 to March 7, 2020), with data excluded for an adjustment-to-restrictions period (March 8–28).FindingsThe overall population included 9 863 903 individuals on Jan 1, 2017, and increased to 10 226 939 by Jan 1, 2020. Primary care contacts for almost all conditions dropped considerably after the introduction of population-wide restrictions. The largest reductions were observed for contacts for diabetic emergencies (odds ratio 0·35 [95% CI 0·25–0·50]), depression (0·53 [0·52–0·53]), and self-harm (0·56 [0·54–0·58]). In the interrupted time-series analysis, with the exception of acute alcohol-related events (0·98 [0·89–1·10]), there was evidence of a reduction in contacts for all conditions (anxiety 0·67 [0·66–0·67], eating disorders 0·62 [0·59–0·66], obsessive-compulsive disorder [0·69 [0·64–0·74]], self-harm 0·56 [0·54–0·58], severe mental illness 0·80 [0·78–0·83], stroke 0·59 [0·56–0·62], transient ischaemic attack 0·63 [0·58–0·67], heart failure 0·62 [0·60–0·64], myocardial infarction 0·72 [0·68–0·77], unstable angina 0·72 [0·60–0·87], venous thromboembolism 0·94 [0·90–0·99], and asthma exacerbation 0·88 [0·86–0·90]). By July, 2020, except for unstable angina and acute alcohol-related events, contacts for all conditions had not recovered to pre-lockdown levels.InterpretationThere were substantial reductions in primary care contacts for acute physical and mental conditions following the introduction of restrictions, with limited recovery by July, 2020. Further research is needed to ascertain whether these reductions reflect changes in disease frequency or missed opportunities for care. Maintaining health-care access should be a key priority in future public health planning, including further restrictions. The conditions we studied are sufficiently severe that any unmet need will have substantial ramifications for the people with the conditions as well as health-care provision.FundingWellcome Trust Senior Fellowship, Health Data Research UK.