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IntroductionCoronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term.MethodsThis article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions.ResultsSuccessful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe.DiscussionThe Alzheimer's Association Global Consortium harmonized methodology is proposed as a model to study long-term neurocognitive sequelae of SARS-CoV-2 infection.Key pointsThe following review describes what is known so far in terms of molecular and epidemiological links among COVID-19, the brain, neurological symptoms, and AD and related dementias (ADRD)The primary objective of this large-scale collaboration is to clarify the pathogenesis of ADRD and to advance our understanding of the impact of a neurotropic virus on the long-term risk of cognitive decline and other CNS sequelae. No available evidence supports the notion that cognitive impairment after SARS-CoV-2 infection is a form of dementia (ADRD or otherwise). The longitudinal methodologies espoused by the consortium are intended to provide data to answer this question as clearly as possible controlling for possible confounders. Our specific hypothesis is that SARS-CoV-2 triggers ADRD-like pathology following the extended olfactory cortical network (EOCN) in older individuals with specific genetic susceptibility.The proposed harmonization strategies and flexible study designs offer the possibility to include large samples of under-represented racial and ethnic groups, creating a rich set of harmonized cohorts for future studies of the pathophysiology, determinants, long-term consequences, and trends in cognitive aging, ADRD, and vascular disease.We provide a framework for current and future studies to be carried out within the Consortium. and offers a "green paper" to the research community with a very broad, global base of support, on tools suitable for low- and middle-income countries aimed to compare and combine future longitudinal data on the topic.The Consortium proposes a combination of design and statistical methods as a means of approaching causal inference of the COVID-19 neuropsychiatric sequelae. We expect that deep phenotyping of neuropsychiatric sequelae may provide a series of candidate syndromes with phenomenological and biological characterization that can be further explored. By generating high-quality harmonized data across sites we aim to capture both descriptive and, where possible, causal associations.

Aim: In 2016 NICE updated its guidance, extending the age to which early intervention in psychosis (EIP) services treat patients following their first episode of psychosis, to 65 years, from the previous cut‐off of 35 years. The aim of this service evaluation was to identify differences in the demographic details, diagnoses, and treatments between patients below and above 35 years to identify any unmet needs in the latter age category. Methods: A total of 100 patients from the caseload were randomly selected, with 50 from each age group, to analyse in further detail. Descriptive statistics was predominantly used due to the relatively small sample size. Results: The over 35 s were predominantly female (62%), whilst the under 35 s were predominantly male (66%). There was a statistically significantly higher rate of substance misuse in the under 35 s. Whilst schizophrenia was the most common diagnosis in both groups, higher rates of delusional disorders and psychosis NOS were observed in the over 35 s. In both age groups, a median of two different medications was used per patient. However, amongst the over 35 s there is less use of psychological therapy and of support, time and recovery workers (STR workers). Conclusion: There are distinct differences between the two age groups including demographic and diagnostic features. Being historically youth based, EIP services needs to ensure that treatments offered are tailored to meet the need of the older age demographic who have different needs. [ABSTRACT FROM AUTHOR]

Background: In the densely populated slums of Kolkata, informal healthcare providers' (IHP) diarrhea-related knowledge and rationality of practices should be improved to reduce risk of adverse outcome, expenditure, and antimicrobial resistance.Methods: A multicomponent intervention was conducted among 140 representative IHPs in the slums of 8 wards in Kolkata to assess its impact on their diarrhea-related knowledge and practice. Six intervention modules in local languages were provided (1 per month) with baseline (N = 140) and postintervention (N = 124) evaluation.Results: Mean overall (61.1 to 69.3; P < .0001) and domain-specific knowledge scores for etiology/spread (5.4 to 8.1; P < .0001), management (6.4 to 7.2; P < .0001), and oral rehydration solution ([ORS] 5.7 to 6.5; P < .0001) increased significantly (at α = 0.05) after intervention and were well retained. Impact on knowledge regarding etiology/spread (adjusted odds ratio [aOR] = 5.6; P < .0001), cholera (aOR = 2.0; P = .0041), management (aOR = 3.1; P < .0001), ORS (aOR = 2.3; P = .0008), and overall (aOR = 4.3; P < .0001) were significant. Intervention worked better for IHPs who practiced for ≥10 years (aOR = 3.2; P < .0001), untrained IHPs (aOR = 4.8; P < .0001), and pharmacists (aOR = 8.3; P < .0001). Irrational practices like empirical antibiotic use for every cholera case (aOR = 0.3; P < .0001) and investigation for every diarrhea case (aOR = 0.4; P = .0003) were reduced. Rationality of testing (aOR = 4.2; P < .0001) and antibiotic use (aOR = 1.8; P = .0487) improved.Conclusions: Multicomponent educational intervention resulted in sustainable improvement in diarrhea-related knowledge and practices among IHPs in slums of Kolkata. Policy implications should be advocated along with implementation and scale-up. [ABSTRACT FROM AUTHOR]

In the majority of low- and middle-income countries, mental healthcare is delivered by primary care workers. Often, they are the only contact for patients and their families. Although their knowledge base can be limited, they are expected to manage complex cases with few resources. The authors describe their experience of partnership with mental health centres set up by the Nigeria Health Care Project, and training their primary care workers based on the World Health Organization's Mental Health Gap Action Programme. Although the programme was very effective in helping to upskill their knowledge and experience, a need for continued professional development was highlighted. Based on their feedback, multiple evidence-based options are explored, including the use of remote learning and social media (increased significantly around the world because of the COVID-19 pandemic), to help primary care workers improve their knowledge base and maintain their competencies with the limited resources available. [ABSTRACT FROM AUTHOR]

Mental health remains largely neglected in most low and middle income countries. There is undoubted need to build resources and consolidate training for staff, which is relevant to the mental health needs of the communities in Africa and practically feasible. In this study we present descriptive statistics of diagnostic categories in the patient group attending the outpatient clinics of Edawu---a community mental health center in rural Nigeria. The data shows disproportionately low numbers of clinical contacts for depression. The possible reasons are discussed and strategies including the use of the World Health Organization (WHO) mhGAP Intervention Guide are suggested for the way forward. The study also emphasizes on the potential of the mhGAP intervention guide not only as a tool of assessment and delivery of mental health services but also as a possible instrument of research with available resources. [ABSTRACT FROM AUTHOR]

Aim: The present study aimed to determine the influence of demographic and clinical features on the likelihood of patients being discharge to primary vs secondary care. The overarching aim of this service evaluation is to assess factors affecting discharge and determine important modulators of discharge destination to inform care planning in services. Method: Clinical and demographic data were extracted from patient notes of those discharged from the Psychosis Intervention and Early Recovery (PIER) service in Leicestershire between January 2005 and December 2013. A total of 508 records were analysed and logistic regression was used to assess the impact of diagnostic, demographic and other clinical factors on the discharge destination of patients. Results: Of the 508 patients, 241 (47.44%) had been discharged to primary care and 267 (52.55%) to secondary psychiatric services. The factors which increased the likelihood of patients being discharged to secondary care were diagnoses of enduring psychoses, being referred from inpatient services and longer time spent with the PIER team. Conclusions: Diagnosis and duration of treatment were significant predictors of discharge destination. Patients with diagnoses of enduring psychotic illness, were more likely to be discharged to a secondary psychiatric service irrespective of gender, ethnicity and geographical location. These data may suggest the possibility to predict the discharge destination when patients are taken on to the caseload of an early intervention in psychosis (EIP) team and have important implications for psychoeducation, preparing the patient for future after EIP and distribution of resources. [ABSTRACT FROM AUTHOR]

BackgroundMethodResultsDiscussionIt was considered useful to describe service-users’ and staff’s experience of Adventure Therapy (AT) in an Early Intervention for Psychosis (EIP) service, exploring the impact on personal wellbeing and feasibility of use.Focus groups were conducted with 14 participants, immediately following, and three months after a four day hiking trip. Transcripts were analysed using inductive thematic analysis. Questionnaires were administered pre and post trip to describe service-users’ physical activity, recovery and personal goals.A majority of participants reported progress towards personal goals on the AT trip and improvements in confidence and connectedness. Questionnaire items did not show improvements in physical activity and recovery measures at 3- and 6-month follow-up. Four key themes emerged from the focus groups. The themes centred around the social experience of being in relation to others and a more personal emotional experience: (a) social connectedness, (b) challenging perceptions of self-capabilities, (c) positive reaction to new experiences and (d) motivation for more.AT was positively experienced by both staff and service-users. Key areas of benefit were recognised and considered for utilisation in services in different ways. Further studies are warranted exploring maintaining and supporting benefits gained following AT. [ABSTRACT FROM AUTHOR]