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The first epidemic wave of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in Scotland resulted in high case numbers and mortality in care homes. In Lothian, over one-third of care homes reported an outbreak, while there was limited testing of hospital patients discharged to care homes. To investigate patients discharged from hospitals as a source of SARS-CoV-2 introduction into care homes during the first epidemic wave. A clinical review was performed for all patients discharges from hospitals to care homes from 1st March 2020 to 31st May 2020. Episodes were ruled out based on coronavirus disease 2019 (COVID-19) test history, clinical assessment at discharge, whole-genome sequencing (WGS) data and an infectious period of 14 days. Clinical samples were processed for WGS, and consensus genomes generated were used for analysis using Cluster Investigation and Virus Epidemiological Tool software. Patient timelines were obtained using electronic hospital records. In total, 787 patients discharged from hospitals to care homes were identified. Of these, 776 (99%) were ruled out for subsequent introduction of SARS-CoV-2 into care homes. However, for 10 episodes, the results were inconclusive as there was low genomic diversity in consensus genomes or no sequencing data were available. Only one discharge episode had a genomic, time and location link to positive cases during hospital admission, leading to 10 positive cases in their care home. The majority of patients discharged from hospitals were ruled out for introduction of SARS-CoV-2 into care homes, highlighting the importance of screening all new admissions when faced with a novel emerging virus and no available vaccine. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was threefold: 1) to describe spiritual well-being (existential and religious well-being) in adolescents with inflammatory bowel disease (IBD) versus healthy peers; 2) to examine associations of spiritual well-being with mental health outcomes (emotional functioning and depressive symptoms); and 3) to assess the differential impact of existential versus religious well-being on mental health. METHODS: A total of 155 adolescents aged 11-19 years from a children's hospital and a university hospital filled out questionnaires including the Spiritual Well-Being Scale, the Children's Depression Inventory-Short Form, and the Pediatric Quality of Life Inventory. Covariates in multivariable models included demographics, disease status, and interactions. RESULTS: Participants' mean (SD) age was 15.1 (2.0) years; 80 (52%) were male; and 121 (78%) were of white ethnicity. Levels of existential and religious well-being were similar between adolescents with IBD and healthy peers. In multivariable analyses, existential well-being was associated with mental health (partial R(2) change = .08-.11, p < .01) above and beyond other characteristics (total R(2) = .23, p < .01). Presence of disease moderated both the relationship between existential well-being and emotional functioning and that between religious well-being and depressive symptoms: that is, the relationships were stronger in adolescents with IBD as compared with healthy peers. Religious well-being was only marginally significantly associated with mental health after controlling for other factors. CONCLUSIONS: Although both healthy adolescents and those with IBD had high levels of spiritual well-being, having IBD moderated the relationship between spiritual well-being and mental health. Meaning/purpose was related to mental health more than was connectedness to the sacred. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine variables associated with adolescent girls' perceptions of the timing of their first consensual intercourse. METHODS: One hundred seventy-four primarily African-American adolescent girls, aged 12 to 15 years participated in a 3-year longitudinal study of psychosexual development. Seventy-three percent reported being sexually experienced by the end of the study. They were asked whether they believed their age of initiation was 'too young,' 'too old,' or 'just right.' A generalized estimating equation (GEE) model was used to evaluate predictors of perception of timing of first consensual intercourse. RESULTS: Ninety-nine (78%) said that they were 'too young' and 28 (22%) said that their age had been 'just right.' The results of the final GEE model indicated that variables associated with perceiving age of first consensual intercourse as 'just right' included younger chronological age, an older age of first consensual intercourse, endorsement of being 'in love' as a reason for first consensual intercourse, greater indirect parental monitoring (vs. 'none' or 'direct parental monitoring'), and a higher level of education for mothers. CONCLUSIONS: Most of these adolescents thought their age of initiation was too young. Factors associated with perceiving the timing of consensual intercourse as 'just right' are similar to those reported in the literature to be associated with delaying the initiation of consensual intercourse. [ABSTRACT FROM AUTHOR]

Study Objective: Oral contraceptive pills (OCs) are a commonly prescribed method of birth control for sexually experienced adolescents. The purpose of the current study was to describe anticipated parental involvement and adolescent compliance with pill taking, and to describe experiences with a 20-mcg OC regarding satisfaction and side effects after six cycles.Design: Anticipated parental involvement and anticipated compliance, and experiences with an OC, were assessed at baseline, and after the first and sixth cycles during a clinical trial of oral contraceptives, which required parental consent.Setting: Three adolescent medicine clinics in New York, NY; Cincinnati, OH; and San Juan, Puerto Rico.Participants: The sample consisted of 43 female adolescents with a mean age of 17 years.Results: The majority of adolescents living with a parent anticipated parental involvement, and few adolescents anticipated difficulties with consistent pill taking. For two side effects (weight and mood changes), more than 30% of the adolescents anticipated the occurrence or worsening of side effects. However, few adolescents actually experienced increases in any of the nine side effects assessed. Ninety-seven percent of adolescents in this trial reported being satisfied with a 20-mcg OC.Conclusions: Health care providers can assess adolescents'' anticipated difficulties with compliance with daily pill taking, and desire for help from their parents. This information can be incorporated into counseling to promote consistent and correct use. [Copyright &y& Elsevier]

To evaluate the effect of ERAS bundle implementation on surgical duration, blood loss, length of stay (LOS), 30-day readmission, complication rates as well as opiates prescribing pattern at discharge in patients undergoing hysterectomy. Retrospective chart review including all hysterectomies performed one year before and one year after the implementation of the ERAS bundle. Teaching county hospital in Texas. All patients undergoing hysterectomy from 1/1/17-12/31/18. ERAS components included: 1- Preoperative carbohydrate loading, Preemptive anesthesia, 2- Intraoperative fluid and narcotic restriction and regional anesthesia, 3- Postoperative early feeding and ambulation. 474 patients were included in the study, 51% before and 49% after ERAS. Route of surgery included 36% vaginal, 33 % laparoscopic and 30% open hysterectomy. Patient characteristics were similar between groups. Surgical outcomes as well as opioid prescription at discharge measured in Morphine Milli-Equivalents (MME) were recorded and compared before and after the intervention. After ERAS implementation, more regional blocks were performed in open hysterectomies: 6% vs 20%, p<0.001 and successful intraoperative fluid restriction was achieved in laparoscopic and open hysterectomies (p=0.045, p<0.001respectively). LOS was significantly shorter after ERAS in all categories of hysterectomies (P<0.01). Same day discharge increased from 16% in vaginal and laparoscopic hysterectomies to 40% and 38% respectively. No significant difference in surgical duration, blood loss, postoperative complications, emergency room (ER) visits and readmissions was noted between groups, however, opioid prescription at the time of discharge decreased significantly from 150 to 123 MME, p<0.01, 174 to 130 MME, p<0.001, 188 to 147 MME (p<0.003) in vaginal, laparoscopic and abdominal hysterectomies respectively. ERAS implementation in a safety net teaching hospital was associated with decreased LOS with no increase in complications, ER visits or readmissions in hysterectomy cases while decreasing opioid prescription at the time of discharge. [ABSTRACT FROM AUTHOR]

Background: Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD.Methods: We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible.Results: 7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples.Limitations: Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms.Conclusions: Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state. [ABSTRACT FROM AUTHOR]

The increased scientific interest in the Arctic due to climate change and potential oil and gas development has resulted in numerous surveys of Arctic marine fish communities since the mid-2000s. Surveys have been conducted in nearly all Arctic marine fish habitats: from lagoons, beaches and across the continental shelf and slope. This provides an opportunity only recently available to study Arctic fish communities across a spectrum of habitats. We examined fish survey data from lagoon, beach, nearshore benthic, shelf pelagic and shelf benthic habitats in the western Beaufort Sea and Chukchi Sea. Specifically, we compare and contrast relative fish abundance and length (a proxy for age) among habitats and seas. We also examined ichthyoplankton presence/absence and abundance of dominant taxa in the shelf habitat. Our synthesis revealed more similarities than differences between the two seas. For example, our results show that the nearshore habitat is utilized by forage fish across age classes, and is also a nursery area for other species. Our results also indicated that some species may be expanding their range to the north, for example, Chinook Salmon. In addition, we documented the presence of commercially important taxa such as Walleye Pollock and flatfishes (Pleuronectidae). Our synthesis of information on relative abundance and age allowed us to propose detailed conceptual models for the life history distribution of key gadids in Arctic food webs: Arctic and Saffron Cod. Finally, we identify research gaps, such as the need for surveys of the surface waters of the Beaufort Sea, surveys of the lagoons of the Chukchi Sea, and winter season surveys in all areas. We recommend field studies on fish life history that sample multiple age classes in multiple habitats throughout the year to confirm, resolve and interpret the patterns in fish habitat use that we observed. [ABSTRACT FROM AUTHOR]

We aimed to understand the differences in the burden of chronic heart failure (HF) among patients from Shanghai compared with those from the rest of China (RoC). We analyzed 1500 PRFs (Shanghai, n=300; RoC, n=1200) and 933 PSCs (Shanghai, n=179; RoC, n=754). [Extracted from the article]

Impact of depression and anxiety on work productivity has been well studied, however, the impact of comorbid depression and anxiety in migraine patients is not well understood. The objective of this real-world study was to examine the impact of co-morbid depression and/or anxiety on work productivity in adult migraine patients in the US. Depression/anxiety was derived from the EQ-5D domain, and patients were categorized as experiencing none, slight, or moderate-to-severe (moderate+) depression/anxiety. [Extracted from the article]

Depression and anxiety are often comorbid with migraine, and are associated with negative outcomes, including reduced quality of life and increased overall disease burden. The objective of this study was to examine the impact of comorbid depression and/or anxiety on migraine-specific health-related quality of life (HRQoL) outcomes in the real world from a patient perspective. Patients with migraine and depression/anxiety experienced significantly worse migraine-specific HRQoL and general quality of life, based on the MSQ, MIDAS, and EQ-5D, that worsens with increasing number of headache days. [Extracted from the article]