Pandemic Isolation / Loneliness

This forum is to discuss general things concerning TSOI.
trader32176
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

“Just stay at home” was lonely and terrifying

11/5/20


https://www.bmj.com/content/371/bmj.m3807


Lisa Jensen describes how covid-19 has affected her and how important empathy is as she faces the long term effects.

I became sick with covid-19 on 7 March. I was told to stay at home unless I became very unwell. Those words might seem straightforward, but following them proved to be terrifying, lonely, and confusing.

Feeling like a check box

I was left on my own to manage shortness of breath, chest pain, fever, intermittently low oxygen, tachycardia, dizziness, brain fog, headache, sore throat, rash, back pain, and a myriad of other symptoms.

My doctor’s only efforts to reach out came in the form of two identical emails, stating that they hoped my symptoms were “continuing to improve,” despite me letting them know that I was only getting worse. I felt like a box to check off. Not like a person grappling with an unknown and potentially serious illness. I called my doctor several times during the worst weeks. The conversations always ended in the same place: “There is nothing we can do for you. Just stay home.” It wasn’t the lack of treatment options or information that troubled me most in these conversations. It was the lack of empathy. I never felt heard.

Finding others

I started to research my symptoms and read everything I could find on potentially relevant conditions. I also kept a detailed log, tracking more than 30 symptoms I was experiencing and just as many potential triggers. The most useful support and information came from a covid-19 support group. I spent countless hours comparing my symptoms and triggers with those experienced by other members of the group. We still compare notes on how best to manage ongoing symptoms. Based on this shared learning, I have made many lifestyle adjustments that have helped me tremendously.

Most people in the support group have also experienced some degree of doubt or dismissal from doctors. This can be especially difficult for those of us who never received a positive nasal swab because we either were tested too late or were never tested at all. This is notably common among those of us who got sick early in the pandemic. Believing and acknowledging symptoms is important even without that positive test result.

The importance of empathy


It is widely acknowledged that physical health is worsened by isolation and anxiety. Empathic acknowledgment of symptoms is imperative when there are still so many unknowns. A doctor’s empathy may not cure covid-19, but lack of empathy can cause genuine harm.

Six months have passed, and I am still not fully recovered. I let my doctor know that I am still struggling, but I haven’t heard back. I understand that this is a new disease and therefore my doctors might not have the answers, but I still wish I felt heard. For now, I have given up on turning to my doctor for help and am opting not to seek more appointments with specialists. Instead, I’m sitting back and learning from the experiences of others in my support group. Having the support of this group makes the uncertainty—and my ongoing symptoms—more manageable.

What you need to know

Showing you care, by listening attentively, expressing empathy, and periodically checking is even more important when there are so many unknowns

Stay open and curious to symptoms of covid-19. You can learn from patients with this new illness

Finding support from others going through the same experience is invaluable

Education in practice

How can you support someone with the long-term effects of covid-19?

When could you contact someone who has had covid-19 to check in on them?

What advice can you give a patient recovering from covid-19 while we learn about the long-term effects?

Additional information for doctors and patients

Covid-19 support group https://www.wearebodypolitic.com/covid19.

Newsletter for Covid-19 long haulers -lisajensen.substack.com
trader32176
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Re: Pandemic Isolation / Loneliness

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Covid-19 self-isolation fines 'tend not to work'

11/4/20


https://www.bbc.com/news/uk-wales-54796292


Fining people for breaking self-isolation "tends not to work," according to a government adviser.

Ann John said support, such as the new £500 payment for low earners, was more effective than "punitive measures."

The Welsh Government has announced a new legal requirement for people told to self-isolate by contact tracers.

First Minister Mark Drakeford said fines would be used "when we've run out of everything else".

The Welsh Government has not yet said how much the fines will be.

In England, refusing to self-isolate can lead to a fine of up to £10,000.

What are the rules around self-isolation?
Potato buyer handed fine for Covid rule breach
'Carrot as well as stick' to enforce covid rules

A study cited by the UK government's scientific advisory group Sage has suggested only about 20% of people in England with symptoms fully follow self-isolation guidance.

Officials believe compliance in Wales is similar.

Prof John, an independent member of the Welsh Government's technical advisory cell (TAC) which advises it on coronavirus, said compliance was low because isolation was "a hard thing to do".

"What we're seeing when we do surveys with people is that actually people want to comply, people want to do the right thing.

"For a lot of people when they're told to isolate, it's the first time it's happened.

"And for many it's the first time they've given it any real thought."

She welcomed the government's announcement that people on low incomes would receive a £500 payment when told to isolate, but said the amount should remain under review.

"I think it's a really hugely positive step to recognise the challenges that people have financially.

"There hasn't always been that recognition that people in insecure employment or in zero-hour contracts, that those choices can be harder for them to make than other sectors of society.

"So I think we've got to welcome that and then review it."

Prof John, who chairs TAC's behavioural insights subgroup and also sits on the UK government's scientific pandemic influenza group on behaviours (SPI-B), is sceptical about the impact fines have.

"There's not a lot of evidence that enforcement works, there really, really isn't," she said.

"There is some evidence about legislation, but enforcement and fines tend not to work, people become very avoidant.

"I think what's better is that if we create those environments, messaging, so that people are supported in making their choices.

"We need to make sure that people know what's available in terms of support to them for their mental health, support to them for the practicalities like how do they get food, how do they get their medication, and financial support."

First Minister Mark Drakeford told BBC Wales Live fines would be a last resort.

"The main thing we use is the power of persuasion and the power of asking people to do the right thing.

"And for most people that works.

"There is a small minority of people who deliberately and knowingly break the rules and put themselves and others at risk.

"It's inevitable we have to have some penalty for people doing that, but it's not where we go to first.

"It's where we go to when we've run out of everything else."

Plaid Cymru's health spokesman Rhun ap Iorwerth said financial support of "up to £800" should be available.

"We wish to avoid fines and that is why we believe that those asked to self-isolate must be supported - including financially where that's needed.

The Welsh Conservatives have questioned why the £500 payments were not brought in sooner.

There are already fines in place in Wales for people who breach other coronavirus regulations.

People can be given a fixed penalty notice "for most types of breaches" and fined £60 for the first offence.

That fine is increased to £120 for a second offence and continues to double for repeated offences, up to a maximum of £1,920.

If prosecuted, however, a court can impose an unlimited fine.
trader32176
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Re: Pandemic Isolation / Loneliness

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StopCovidNI Q&A: How Northern Ireland's contact tracing app works

11/5/20


https://www.bbc.com/news/uk-northern-ireland-54797603


Northern Ireland's StopCovidNI contact tracing app has now been downloaded more than half a million times since its launch in July.

The software has notified more than 22,500 users they must self-isolate for 14 days
- prompted when a close contact submits a positive test - according to Northern Ireland's health department.

However, despite the app's uptake, questions remain about its reliability and users' privacy.

BBC News NI answers some of the most common questions about the app.

How does the StopCovidNI app work?

When someone adds a positive test into the app, a notification is triggered for other users who are deemed to be at risk of exposure.

This "close-contact alert" is defined as a person - or their mobile phone, at least - that has been within two metres of the infected person's device for at least 15 minutes.

The person who receives the alert is not told when or where the exposure occurred, but it will have been in the previous 14 days.

The app then tells the user to self-isolate for 14 days and provides information such as how to book a test if symptoms develop.

In a new version of the app, due to be released at the end of November, users will be given the date when their contact occurred and when their isolation period can end.

Health Minister Robin Swann said this would limit the amount of time people were being forced to stay away from work and education.

The "greater precision" on self-isolation periods would not compromise anonymity, added Mr Swann.

Do I need to download local apps in the Republic of Ireland and Great Britain if I travel?


As of Thursday 5 November, no.

Previously, Northern Ireland's app linked to those used in the Republic of Ireland, Scotland and Jersey.

England, Wales and Gibraltar have now been linked, with each app communicating anonymously to push exposure notifications to affected users.

Indeed, some of the 500,000 downloads of the Northern Ireland app may be users from outside who have not needed it.

However, NI's Department of Health says people should download the app of the country in which they live, as this will be integrated with the country's test registries should they need to enter a positive test.

It also said that there have been "11,000 diagnosis exchanges between Northern Ireland the Republic of Ireland".

Can police issue fines to those who do not self-isolate because of the app?

Since March, the police in Northern Ireland have issued 47 fines of £1,000 to people found to be in breach of orders to self-isolate.

However, the Department of Health says the StopCovidNI app is confidential, and neither knows who has received an alert, nor tracks their location.

"There is no possible personal information that could be shared from the app with the police," says a department spokesperson.

Does the app record information when I walk past someone in the street?

To an extent, yes, but not every encounter will be deemed sufficiently at risk to result in an exposure notification.

This notification will happen when the app recognises the user has been within two metres for 15 minutes or longer of someone who later enters a positive test result.

Does the app recognise walls?

The app does not recognise obstacles such as walls or screens, meaning it cannot take into account safety measures installed in the likes of workplaces, restaurants or hotels.
If I take precautions, such as using personal protective equipment (PPE), can I ignore app notifications?

The app does not tell the user from where or when the exposure notification originates, but it will have been in the previous 14 days.

During periods when people can use appropriate PPE or screens, for instance at work, "you are advised to deactivate the app for as long as you are protected by these measures", says the Department of Health.

This can be done by using a pause function in the "tracing active" panel of the app.

What about QR codes from pubs and restaurants - can they register if I have breached the app's self-isolation order?

Many establishments such as pubs and cafes have encouraged people to scan QR codes to help log information in case it is needed for contact tracing.

However, the app does not use data gathered from QR codes and the Department of Health warns the technology is not secure.

Officials say such codes can be used to hack smartphones, so the department decided not to incorporate them in the app, said a spokesperson.

What are 'key matches'?

Once the app is installed, a section in your phone settings - "exposure notifications" or "exposure logs" - will list a number of "key matches".

This is a record of the times your app has communicated with other devices via Bluetooth; be it a few people at work or potentially hundreds in a shopping centre.

The keys contain anonymous information and are discarded after 14 days.

Their purpose is to allow the software to notify the user if they were in close contact with someone who later registers a positive Covid-19 test.

If this happens, an exposure notification is triggered and the app will change to reflect the new advice to self-isolate.

How does this differ from other forms of contact tracing?

The app is an alert system for devices that have been in close proximity; however, it is not the only way you may be informed you are at risk and must self-isolate.

When someone receives a positive Covid-19 test they will receive a text message from contact tracers working for the Public Health Agency (PHA).

This will ask the individual to submit the details of people with whom they came into close contact in recent days.

These people will then receive a text from "HSCTracing" with the instruction to self-isolate for 14 days.

This process is separate and different from the app.

It is possible that someone will receive both the text as well as an app notification, if they were in close proximity to the positive case.

Does the app drain my phone battery?

Having Bluetooth switched on will always increase battery usage, however, the Department of Health insists it uses a low-energy 'Bluetooth LE' setting to limit this.

For the technology to be fully effective, Bluetooth needs to be on for as long as possible. However, as above, it can be switched off when the user is assured they are in a safe setting or using PPE.

Can anyone 'prank' the app by entering a positive test?


Only the user can enter a positive test result into the app. This will not be done by health or testing staff.

If the user tests positive they receive an SMS text from "HSCResult". This will include a six-digit authorisation code that lasts for 24 hours.

This needs to be entered into the test section of the app.

What next for the app?

Northern Ireland was the first of the UK nations to introduce a Covid-19 tracing app and the quick roll-out of such technology posed challenges with operability and privacy concerns.

The total number of downloads represents a high uptake of the Northern Ireland app in just over four months.

From October, the app has been available to 11 to 17-year-olds.

Another future development in the app could arise from the planned greater contact tracing cooperation with other European countries.

The Department of Health said the code has over a billion combinations.
trader32176
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

Veterans grapple with increased isolation amid coronavirus pandemic

Calls to the Veterans Crisis Line have doubled during the pandemic


11/8/20

https://www.denverpost.com/2020/11/08/v ... isolation/


Army veteran Ashley Wallis spent years learning to overcome an inclination to isolate, a symptom of post traumatic stress disorder she faced after her service from 2002 to 2005.

Wallis, 36, of Firestone, worries about the toll the pandemic will take on veterans’ mental health. With the coronavirus continuing to spread and public health orders asking people to stay home as much as possible, she worries veterans may fall into old habits.

“A lot of veterans rely on that in-person group therapy and socialization to have that sense of community,” Wallis said. “Not having that right now has been a big strain. Many veterans are reverting back to staying inside, because that’s a safe thing that we are supposed to be doing. We fought hard to get out more and not let those symptoms of PTSD affect our lives. Now that’s what we have to do, so it’s easy to slip back into those negative coping mechanisms.”

Wallis works for Mental Health Partners, a behavioral health center with offices in Longmont and Boulder. Her work during the pandemic has sought to emphasize that while connection is different in the era of a global pandemic, veterans are not alone.

“There are options for community engagement,” Wallis said. “We would love to see them.”

In an article she wrote for Mental Health Partner’s website, Wallis said she worked to overcome her negative coping mechanisms, including isolation and a propensity to “avoid people to the extreme,” she wrote. Wallis had reached a place where she enjoyed being around people, but the pandemic brought out some regression, she said. She stopped making phone calls and leaving her house.

Calls to the Veterans Crisis Line have doubled during the pandemic, Wallis said. What concerns her most, she said, is the ones not calling.

With the number of coronavirus cases continuing to climb, veterans have faced not just isolation, but job loss and homelessness. In a time when getting connected to resources can be paramount to quality of life, the virus has left them adrift in a world of largely virtual communication.

For Vietnam veteran Tom Daschofsky, it’s been tough not being able to connect with his fellow veterans like normal.

Daschofsky, of Berthoud, was 19 when he served in the Marine Corps. Now 71, Daschofsky is the commander of Longmont American Legion Post 32. Over Friday night dinners and Sunday morning breakfasts, he used to have the chance to build camaraderie with his fellow veterans.

“That’s important to veterans,” Daschofsky said. “You forget about all that comradeship that you had back when you were in service, versus now. It’s good to be able to meet veterans who were also in the same situation that you were. We need to pass this down to the younger generation.”

Those meals and chances to socialize have been brought to a grinding halt by the coronavirus pandemic. The conditions have presented many challenges for veterans and the American Legion.

“It’s tough all around,” he said. “It’s a bad deal. It forces us to have to cut back.”

Normally a hub of activity, the American Legion, which is limited to 25% capacity, hasn’t been able to proceed with regular activities. There’s no more sitting together around plates of food. Parade planning and community engagement projects like passing out six scholarships to youth have been limited to no contact. This year’s Veterans Day parade was among the community events canceled.

The number of coronavirus cases has yet to see a decline in Boulder County. On Friday, the county moved to a more restrictive Safer at Home Level 3 in an effort to curb the fast-spreading, contagious respiratory illness. A record daily high of 292 cases was recorded in Boulder County on Thursday.

Daschofsky has been a commander for six years and part of the American Legion for the last 22 years. He knows the 300 members well, but his own health concerns following a heart attack in March have forced him to be extra-cautious.

“That’s affected my ability to interact closely with a lot of them,” he said. “I’ve had to social distance and try and maintain a safe distance.”

A growing need


This year has been challenging for veterans and nonveterans alike. Unemployment rates have skyrocketed, and social service organizations, such as Longmont’s OUR Center, are seeing some families facing job loss and homelessness for the first time, with demand for rent and utility assistance increasing by 300%.

Karen Townsend, a veterans service officer for the Boulder County Area Agency on Aging, said she hears panic in the voices of some of the veterans she helps obtain access to benefits. She works with 15 to 25 contacts each day and is seeing three to four new people each day.

Like Daschofsky and Wallis, Townsend worries about veterans being further isolated by the conditions of the pandemic.

“Veterans tend to be isolated anyways,” she said. “It’s one thing to be isolated because you want to be, but forced isolation is very intense.”

Townsend said in her communication with veterans she hears how isolation has been compounded with fears about the virus, a contentious presidential election and job loss.

The Wounded Warrior Project, a nonprofit veterans service organization, released the results of its 11th annual membership poll in September. The poll was sent to members in May and asked how the pandemic had impacted their lives.

The survey showed that more than half of the 28,282 post-9/11 veterans expressed that their mental health had worsened with social distancing, while 49% said their physical health had worsened with social distancing. The survey also showed that 60% agreed with a statement that they felt more disconnected from their family, friends or community. Roughly half said Veterans Affairs had provided them with information on how to continue medical care, and 41% said they had experienced challenges with unemployment, due to the pandemic.

Daniel Savage, a regional veterans employment representative with the Colorado Department of Labor and Employment said he’s seen a larger than average number of veterans in need of job assistance. While Savage’s office is based out of Denver, his job is to work with the Boulder County community to help people facing unemployment find jobs.

“We’ve seen a real increase in the number of vets coming into the system,” Savage said. “What we are seeing more is folks that have lost jobs without the promise of rehire.”

Savage said that since March he has seen a 15 to 20% increase in the number of veterans looking for work in Boulder County. Savage said a number of veterans who were dependent on part-time work in service jobs to supplement their Social Security have been hit hardest.

“We’ve seen an increase in that population (60s to 70s), because Social Security is not cutting it,” Savage said.

Younger veterans, such as those 18 to 24, who served but have no other job history, are also struggling to find work, he said.

Nationally veteran unemployment peaked at 11.8% in April, with the rate improving in August to 6.6%, according to an article in the Colorado Business Review. By comparison, nonveterans saw an unemployment peak in April of 14.8%, with that number dropping to 8.5% in August.

A new helping hand

At a site on Anderson Street is a model tiny home. It’s an indication of the work already underway by an organization new to Longmont: The Veterans Community Project. The nonprofit’s goal is to eliminate veteran homelessness and is based in Kansas City, Mo. Longmont marks the first expansion site of the nonprofit, according to Sean Anderson, the Longmont branch’s director of Veteran Support Services.

In the months ahead, the roughly 1½-acre dirt patch on Anderson Street will be transformed into a community of tiny homes, created to provide homeless veterans with a place to live and a network of resources to help them.

Anderson is working with 27 veterans to help them find housing. Of those, roughly 20 veterans are from Boulder County, and 17 of them are unemployed. Anderson approximated that 10 of those veterans were unemployed as a direct result of the coronavirus. The nonprofit also provides rental assistance, emergency hotel stays, assistance in transportation and helping people find gainful employment.

“With the high COVID numbers and the way that all the services seem to be taxed right now, as far as homelessness is concerned, people are wondering if the help is coming and how timely it will be to receive that funding,” Anderson said. “Since March, we have seen more veterans.”

Anderson attributes some of that to fixed monthly incomes that don’t rise with the cost of living.

“There’s probably more veterans now experiencing homelessness, because their monthly incomes don’t rise with that,” Anderson said. “Certainly with the senior population, you’re seeing kind of a homelessness crisis in Boulder County.”

Anderson also homed in on the loss of human connection that is being felt by veterans. With doctor’s appointments and case management largely done over the phone or computer, veterans aren’t getting the same connection as a face-to-face interaction.

“When you lose that primary case manager at the Veterans Affairs or you stop seeing them in person you aren’t able to explain yourself as well because you’re doing it over the phone and doing it through a Zoom meeting,” Anderson said. “You’re not getting the same level of care. I try to spend as much time with veterans in the field as I can.”

Looking to the future


With social interaction limited, Townsend said she believes the best way the community can give back to veterans right now is to remind them that help is still there.

“We have to remind them about the online opportunities,” she said. “There are writing classes, outdoor activities and online groups that meet, etc.”

Wallis encouraged veterans to get involved in the Veterans Smokepit hosted by Northern Colorado Veteran Resource Center. People can join by contacting TJ Cruz, who helps to facilitate the conversation. His contact info is: tj.cruz@nocovrc.com.

Wallis reiterated that veterans aren’t alone, and she encouraged them TO reach out to the resources in their community.

“Connection is the most important thing we can have,” she said. “When we’re serving we have our brothers and sisters (serving around us). Not being able to engage can really damage mental health. Having these options here, we are happy to listen and talk to everybody.”
Looking to the future
trader32176
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

Social distancing is increasing feelings of loneliness in older population

11/9/20


https://www.news-medical.net/news/20201 ... ation.aspx


Social distancing introduced in response to COVID-19 is increasing feelings of loneliness in Scotland's older population and impacting their wellbeing, according to a new University of Stirling study.

The research has identified a link between increases in loneliness in over 60s and the worsening of wellbeing and health. Increasing loneliness due to social distancing was associated with a smaller social network, lower perceived social support and a decrease in wellbeing, the study found.

The findings emerge from research launched under the Scottish Government's Chief Scientist Office Rapid Research in COVID-19 programme in May. Professor Anna Whittaker, of the University's Faculty of Health Sciences and Sport, led the work and hopes it will help to inform decision-making on the virus and support post-pandemic recovery strategies.


Previous studies have demonstrated the negative impacts of social isolation and loneliness. This is a key issue for older adults who may be more likely to have few social contacts. We know that social distancing guidelines introduced in response to COVID-19 have restricted social activity engagement and impacted vulnerable groups, including older adults.

Our study, which involved a survey of more than 1,400 older people, examined the impact of social distancing during the pandemic on social activity, loneliness and wellbeing. The majority of survey participants reported that social distancing has made them experience more loneliness, social contact with fewer people, and less social contact overall.

" We found that a larger social network and better perceived social support seems to be protective against loneliness and poorer health and wellbeing, due to social distancing. This underlines the importance of addressing loneliness and social contact in older adults, but particularly during pandemics or situations where the risk of isolation is high."

- Professor Anna Whittaker, Faculty of Health Sciences, University of Stirling

Of the 1,429 survey participants, 84 percent were aged 60 or over and had an average social network of five people. On average, the participants socialised five days per week, for more than 6.6 hours per week. Fifty-six percent reported that social distancing regulations made them experience more loneliness - with scores that were significantly higher than reported norms; the same quality of perceived support; but social contact with fewer people and less social contact overall.

Greater loneliness was significantly associated with a smaller social network, lower perceived social support, and a decrease in social support frequency, quality, and amount - and a worsening of wellbeing and health.

Physical activity

Using the same survey data, the research also considered the impact of social distancing on physical activity. The majority of participants reported continuing to meet physical activity guidelines during lockdown - with 35 percent moderately active and 41 percent highly active. Walking was the greatest contributor to total physical activity, with just over a quarter (26.4%) walking more than before lockdown. Those living in rural areas reported greater volumes of physical activity.

Forty percent of people said they were walking less, compared to before lockdown, and a similar proportion were engaging in less moderate physical activity. Those who reported in engaging in lower physical activity had poorer wellbeing.

Individuals who reported no change in moderate physical activity were the most active pre-lockdown and those who reported no change in walking had significantly higher levels of total physical activity pre-lockdown.

Professor Whittaker said: "Physical activity engagement during lockdown varied and this study indicates a positive link with wellbeing - supporting the notion that physical activity should be considered an important contributor in recovery strategies targeted at older adults as we emerge from the pandemic.

"There appears to be a relationship between pre-lockdown physical activity and physical activity changes due to lockdown. This may be of significance in the context of trying to get older adults to maintain or increase physical activity, where appropriate, as we emerge from this pandemic, given our understanding of the benefits of physical activity in this age group.

"Additionally, irrespective of pre-lockdown physical activity, older adults should continue to be encouraged to be active, and particularly to engage in some sort of strength and balance training - such as tai chi, yoga, or weights - which was very low in the sample but is vital for maintaining balance and physical function. Just 12 percent of the sample met the physical activity guidelines, which indicate strength training should be undertaken at least twice per week."

The results will be presented as part of the Scottish Physical Activity Research Connections digital conference, which begins later this week.

Source:

University of Stirling
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

Stay-at-home orders during COVID-19 pandemic may have a dangerous side effect

11/9/20


https://www.news-medical.net/news/20201 ... ffect.aspx


The social isolation brought on by stay-at-home orders (SAHO) issued in the early phase of the Coronavirus Disease 2019 (COVID-19) pandemic may have a deadly and dangerous side effect: an increase in intentional penetrating injuries, especially firearm violence, that has remained at high levels even as stay-at-home orders have subsided and as COVID-19 cases are on an upswing. Philadelphia-area researchers released these findings in an "article in press" published on the Journal of the American College of Surgeons website in advance of print.

Jose L. Pascual, MD, PhD, FACS, and colleagues at the University of Pennsylvania in Philadelphia report that while emergency department (ED) visits fell drastically during stay-at-home orders, visits for intentional injuries reached historic highs and have stayed there since. As of October 19, Philadelphia has experienced 386 homicides, a 39 percent increase over the same time last year, reported KYW/AM Newsradio.

" We are now looking at the fact that even though main emergency department admissions have pretty much settled back to numbers pre-COVID--including trauma admissions, falls, motor-vehicle and motorcycle collisions, pedestrian accidents--and elective operations have mostly returned to normal, penetrating injury still remains high."

- Dr. Jose L. Pascual, MD, PhD, FACS, University of Pennsylvania in Philadelphia

Importantly, he noted the same demographic--young African-American men--has been disproportionately impacted by these injuries, before as well as after statewide SAHO were eased.

The study evaluated trauma and emergency ED visits to the University of Pennsylvania Presbyterian Medical Center between February 1 and May 30, 2020, using the March 16 start of SAHO in Philadelphia as a demarcation of before and after periods. Penn Presbyterian is one of four adult level 1 trauma centers in Philadelphia and serves West Philadelphia and its western suburbs.

The analysis found significant differences in trauma trends in three key demographics between post- and pre-SAHO: a higher proportion of men presenting for trauma, with men accounting for 64.4 percent of cases before SAHO and 72.1 percent after (p=0.019); more younger patients presenting, with the mean patient age of 47.4 (range 22.1 years) before and 42.9 (range 20.3 years) after (p=0.009); and a higher proportion of non-white trauma patients, accounting for 69.5 percent before and 77.7 percent after (p=0.008). Specifically, the proportion of visits for gunshot wounds nearly doubled, from 12.6 to 22.9 percent (p<0.0001).

"The demographic that was most evidently involved here was the young black male, which is a demographic that was seen before in that violent injury category," Dr. Pascual said. "Therefore it appeared that either the pandemic or the stay-at-home order, or both, may have had a direct result in augmenting the existing urban violent reality for that demographic."

To get a more historical perspective on the impact of SAHO, Dr. Pascual and colleagues compared trauma injuries for the March 16 to May 30 period for 2016 through 2019. Up until March 16, trends of violent injuries were similar in 2020 to previous years, but Dr. Pascual noted, "After March 16, 2020, they were truly different, in that numbers for gunshot wounds increased by nearly 40 percent compared with the average of previous years."

During the COVID-19 surge earlier this year, Penn Presbyterian implemented a host of recommendations to maintain its emergency department, including World Health Organization guidelines and the American College of Surgeons guidance statement on maintaining emergency care, released April 7. Before that, Dr. Pascual said they were relying on "hearsay" from physicians in Milan, the United Kingdom, and Hong Kong for COVID-patient-care early on in the pandemic.

"We had to make emergency decisions on how to put personal protective equipment (PPE) on the providers and how to separate the patients from each other in the trauma bay, which was as important when PPE was not readily available," he said. The ACS statement helped in that regard. "Although I have to say," Dr. Pascual added, "that the concurrent presence of both the pandemic and the endemic penetrating trauma did not get really defined or explained by any plan."

The findings raise a host of questions about urban firearm violence as COVID-19 cases rise. Dr. Pascual notes, "How do we rid ourselves, as an urban center, as a trauma center, as a country of this very devastating change in trauma mechanism and in trauma distributions across a given demographic that is most at risk and most suffering from it? I'm very worried that this is not a story that is done. Although cases may rise in the weeks or months ahead, the numbers for COVID-19 and for trauma overall--pre- and post-COVID-19--have for at least a brief time settled, but the numbers for violent injury have not."

Study coauthors are Hatem O. Abdallah, BS, and Cindy Zhao, BS, of the University of Pennsylvania Perelman School of Medicine; Elinore Kaufman, MD, Justin Hatchimonji, MD, and Robert A. Swendiman, MD, of the department of surgery at Perelman School of Medicine; and Lewis J. Kaplan, MD, Mark Seamon, MD, FACS., and William Schwab, MD, of the division of traumatology, surgical care, and emergency surgery at Penn Presbyterian Medical Center.

Dr. Pascual, an associate professor of surgery and a neurosurgery at the University of Pennsylvania Perelman School of Medicine, disclosed serving as a consultant to Pfizer and Grifols. He is a council member of the Society of Critical Care Medicine and chairs the Quality and Patient Safety Committee of the Eastern Association for the Surgery of Trauma.

Source:

American College of Surgeons
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Re: Pandemic Isolation / Loneliness

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New project aims to decrease social isolation, loneliness and suicide risk among older adults

11/9/20


https://www.news-medical.net/news/20201 ... dults.aspx


With a $1.3 million grant from the U.S. Department of Health and Human Services (DHHS) researchers are developing and evaluating the Belonging and Empathy, With Intentional Targeted Helping (BE WITH) project, which is designed to reduce social isolation, loneliness and elevated suicide risk in racially diverse older adults, the demographic hardest hit by COVID-19.

Georgia State University associate professor Laura Shannonhouse, doctoral student Mary Chase Mize and Matthew Fullen from Virginia Tech are evaluating the effectiveness of the training program for nutrition service volunteers who work with old adults in six metro Atlanta counties.

The researchers hope to demonstrate that BE WITH should be added to the National Council on Aging's registry of programs, a necessary step that allows states to access federal Title IIID funds to equip their networks with suicide prevention resources.

Their grant work builds off a previous DHHS-funded research grant Shannonhouse led in metro Atlanta before and during the COVID-19 pandemic. Her team tracked more than 51 suicide interventions led by nutrition service volunteers just before the pandemic. They learned these volunteers acquired suicide intervention skills and used them.


" Nutrition service volunteers are often a life connection for homebound older adults and are uniquely positioned to offer life-assisting interventions when needed."

- Laura Shannonhouse, Associate Professor, Georgia State University

In addition to the BE WITH project's development and evaluation, the grant funding supports the research team's efforts to evaluate COVID-19's impact on mental health in older adults. They have already found older adult suicide desire has increased in the wake of the pandemic with some participants. They are examining thwarted belongingness and perceived burdensomeness, which together summarize suicide desire, and are arguably exacerbated by COVID-19. The physical distancing interventions needed to protect older adults are isolating, and COVID-19 ethical treatment guidelines tend to prioritize care for younger patients.

Shannonhouse and her colleagues will evaluate nutrition service volunteers' responding behaviors with at-risk older adults in real time - such as empathic connections and suicide intervention over time - and these behaviors' potential benefits on reduced depression, anxiety, suicidal desire, suicide behaviors, and increased social support and well-being among older adults.

"We hope to demonstrate how nutrition services can decrease social isolation, loneliness and elevated suicide risk among older adults by equipping volunteers to be with them during COVID-19 and beyond," Shannonhouse said.

Source:


Georgia State University
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Re: Pandemic Isolation / Loneliness

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Loneliness levels highest in the 20s and lowest in the 60s, finds study

11/10/20


https://www.news-medical.net/news/20201 ... study.aspx


Loneliness is a prevalent and serious public health problem impacting health, well-being and longevity. Seeking to develop effective interventions, researchers at University of California San Diego School of Medicine examined the psychological and environmental factors that lead to patterns of loneliness in different age groups.

Researchers used a web-based survey of 2,843 participants, ages 20 to 69 years, from across the United States.

The study, published in the November 10, 2020 online edition of the Journal of Clinical Psychiatry, found that levels of loneliness were highest in the 20s and lowest in the 60s, with another peak in the mid-40s.

"What we found was a range of predictors of loneliness across the lifespan," said corresponding senior author Dilip V. Jeste, MD, senior associate dean for Healthy Aging and Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine.

The researchers noted that lower levels of empathy and compassion, smaller social networks, not having a spouse or a partner and greater sleep disturbances were consistent predictors of loneliness across all decades. Lower social self-efficacy -; or the ability to reflect confidence in exerting control over one's own motivation, behavior and social environment -; and higher anxiety were associated with worse loneliness in all age decades, except the 60s.

Loneliness was also associated with a lower level of decisiveness in the 50s.

The study confirmed previous reports of a strong inverse association between loneliness and wisdom, especially the pro-social behaviors component (empathy and compassion).

" Compassion seems to reduce the level of loneliness at all ages, probably by enabling individuals to accurately perceive and interpret others' emotions along with helpful behavior toward others, and thereby increasing their own social self-efficacy and social networks."

- Dilip V. Jeste, MD, Senior Associate Dean for Healthy Aging and Distinguished Professor of Psychiatry and Neurosciences at UC San Diego School of Medicine

The survey suggested that people in their 20s were dealing with high stress and pressure while trying to establish a career and find a life partner.

"A lot of people in this decade are also constantly comparing themselves on social media and are concerned about how many likes and followers they have," said Tanya Nguyen, PhD, first author of the study and assistant clinical professor in the Department of Psychiatry at UC San Diego School of Medicine. "The lower level of self-efficacy may lead to greater loneliness."

People in their 40s start to experience physical challenges and health issues, such as high blood pressure and diabetes.

"Individuals may start to lose loved ones close to them and their children are growing up and are becoming more independent. This greatly impacts self-purpose and may cause a shift in self-identify, resulting in increased loneliness," said Nguyen.

Jeste said the findings are especially relevant during the COVID-19 global pandemic.

"We want to understand what strategies may be effective in reducing loneliness during this challenging time," said Jeste. "Loneliness is worsened by the physical distancing that is necessary to stop the spread of the pandemic."

Nguyen said intervention and prevention efforts should consider stage-of-life issues. "There is a need for a personalized and nuanced prioritizing of prevention targets in different groups of people," said Jeste.
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Re: Pandemic Isolation / Loneliness

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Exercise classes decrease loneliness and social isolation in older adults

11/12/20


https://www.news-medical.net/news/20201 ... dults.aspx


Older adults who joined group exercise classes experienced decreased loneliness and social isolation
, according to a new Cedars-Sinai study conducted before the COVID-19 pandemic. The classes have continued virtually since March, and early results suggest the online versions are also effective.

Seniors face increased risk for developing serious health issues or even death if they lack social connections or feel alone. Loneliness is connected to higher rates of depression, anxiety and suicide. Experts say social isolation can have the same impact on an older person's health as smoking 15 cigarettes a day.

Both loneliness and social isolation are widespread issues in the U.S.
, where more than a third of adults 45 and older feel lonely and nearly a quarter of those 65 and older are socially isolated, according to the National Academies of Sciences, Engineering, and Medicine. But few studies have examined the most effective ways to improve social connectedness among seniors.

" As the demographics of our country shift, more people are living alone than ever before. The number of adults over the age of 65 in the U.S. is expected to reach more than 70 million by 2030 – double what it is now. We need sustainable ways to help this burgeoning population thrive as they age, or there will be widespread consequences."

- Allison Moser Mays, MD, study's lead author, Cedars-Sinai geriatrician

Mays and her co-investigators partnered with local community groups to enroll participants in evidence-based exercise and health management classes for people over 50 at nine sites in Los Angeles neighborhoods with a known concentration of low-income older adults. All locations – which included libraries, senior centers and recreation centers – were accessible for those with mobility limitations and had access to parking and public transit.

The study tracked 382 participants ages 52 to 104 from July 2018 through March 2020, when the pandemic forced the classes to move online. Some people were referred by their Cedars-Sinai physician during an office visit. Others found the program through community outreach.

All participants met with a health coach who assessed their needs and helped them select one of four courses, which research has shown improve other aspects of health: Arthritis Exercise, EnhancedFitness, Tai Chi for Arthritis, and Chronic Disease Self-Management. The three exercise classes proved the most popular, and individuals had to attend at least one session to be included in the study.

Participants completed questionnaires about their social connections and loneliness prior to starting their course and after six months. At the end of that period, investigators found a 6.9% decrease in loneliness and a 3.3% improvement in social connectedness, after adjusting for age, gender and other characteristics. The study was published in the American Journal of Geriatric Psychiatry.

"These classes had already been shown to reduce the risk of falls in seniors, and this was the first demonstration that they also reduce social isolation, to the best of our knowledge," Mays said.

The Leveraging Exercise to Age in Place (LEAP) classes have been supported by a three-year grant from the AARP Foundation. Cedars-Sinai has adopted the successful programming under the Community Engagement Department.

"The results of this study are very exciting because we've provided a model that other health systems can easily replicate by integrating evidence-based programs in the community with their organizations. They don't need to reinvent the wheel," said senior study author Sonja Rosen, MD, chief of Geriatric Medicine at Cedars-Sinai. "The health coach is the key ingredient because they make sure that nobody falls through the cracks."

The health coach has been especially crucial since the pandemic began when classes moved online and participants sometimes have needed help figuring out how to log on to the platform. That effort has been paying off.

Of the 59 participants who continued with the virtual workouts, there has not been a statistically significant change in loneliness or social isolation one month after stay at home orders began, according to data Mays presented over the weekend at the Gerontological Society of America's annual meeting. The investigators will analyze further data as the classes continue. They're also piloting another program that pairs older adults with younger participants for one-on-one workout sessions online.

"Cedars-Sinai treats more patients over the age of 80 than any other academic health system in the country," Rosen said. "We're really at the epicenter of this growing population of older adults and figuring out the best ways to care for them so they can successfully age in place."

Rosen said efforts like the LEAP program helped Cedars-Sinai earn its designation as an Age-Friendly Health System Committed to Care Excellence earlier this year. The distinction, which highlights care tailored to older adults, is part of a national initiative of The John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.
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Re: Pandemic Isolation / Loneliness

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COVID-19 loneliness study reveals significant depressive symptoms in 80% of young adults

11/16/20


https://www.news-medical.net/news/20201 ... dults.aspx


A new national survey, looking at how the COVID-19 pandemic has impacted young US adults' loneliness, reveals "significant depressive symptoms" in 80% of participants.

Over 1,000 Americans aged 18-35 took part in the online anonymous questionnaire, which also asked the subjects to report on their anxiety and substance use.

The analyzed findings, published in the peer-reviewed Journal of Psychoactive Drugs, show that "alarming" levels of loneliness are associated with significant mental health issues, as approximately 61% of respondents reporting moderate (45%) to severe (17%) anxiety.

Meanwhile, 30% of interviewees disclosed harmful levels of drinking. And, although only 22% of the respondents reported using drugs, 38% of these reported severe drug use.

Therefore, a response with mental health care provision is "imperative", lead author Professor Viviana Horigian, from the University of Miami, states.


" The convergence of the COVID-19 pandemic and the loneliness and addiction epidemics in the US is here to stay.

These young adults are the future of our nation's social fabric. They need to be given access to psychological help, coupled with the development and dissemination of brief online contact-based interventions that encourage healthy lifestyles.

Addressing mental health and substance use problems in young adults, both during and after the COVID-19 pandemic, is an imperative."

- Professor Viviana Horigian, University of Miami

And co-author Renae Schmidt adds: "As we invest in developing the sense of cohesion and social connectedness in these generations, we can address social and physical resiliency in our communities at large.

"Students need sustaining online delivery of [relevant] coursework, increasing counseling services, and deploying outreach through telehealth services. For young adults not engaged in school, aggressive patient outreach by primary care physicians should be used to ensure screening and intervention, also via telehealth. Access to psychological help coupled with the development and dissemination of brief online contact-based interventions that encourage healthy lifestyles."

The online, 126-item, survey was carried out between April 22 and May 11. 1,008 participants took part, with the average age 28 and 86% being over 23.

Each symptom (loneliness, anxiety, depression, alcohol use, drug use) was measured against internationally recognized scoring systems.

To examine the associations between loneliness and the mental health conditions highlighted, the researchers used a model which looked at the direct effects of both loneliness and social connectedness on depression, anxiety, alcohol use, and drug use. They also looked at the indirect effects of loneliness and social connectedness on alcohol and drug use working through anxiety and depression. In addition, they characterized relationships in pre-COVID and post-COVID behaviors and psychosocial symptomatology.

The results show that most participants who reported an increase in feelings of loneliness also indicated an increase in drinking (58%), drug use (56%), anxiety (76%), and depression (78%), and a decrease in feelings of connectedness (58%).

Looking at general increases of mental health issues or substance use due to the pandemic, most issues were recorded by participants as rising, with their feelings of loneliness going up by 65%, lack of connectedness 53%, alcohol use 48%, drug use 44%, anxiety 62%, and depression 64%.

Overall, an "alarming" 49% of respondents reported a great degree of loneliness.

Most respondents (80%) reported drinking alcohol, with 30% revealing harmful and dependent levels of drinking. 19% of respondents reported binge drinking at least weekly and 44% reported binging at least monthly.

The team hopes that the results will now be used to guide intervention efforts.

"Social prescribing, which draws from and promotes usage of community resources, also shows promise of improving social and psychological wellbeing," Professor Horigian adds.

"This could be positioned to then encourage service to others, bringing social comfort and reward as a result of connecting with others in need.

"These efforts, and others, can help to alleviate the problems of loneliness and its manifestations; yet it may take an integrated, multi-faceted, and concerted approach, rooted, and supported by mental health prevention and wellbeing promotion boosted by workforce development and research on intervention development, to readdress these trajectories."
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