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Bulletin for 7 January 2022


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Updated difficult airway guidelines for adults and children
The American Society of Anesthesiologists has updated its difficult airway guidelines for both adult and pediatric patients and created new algorithms (algorithm 1) and infographics. (See "Management of the difficult airway for general anesthesia in adults", section on 'Importance of an algorithmic approach'.)

Bariatric surgery versus nonsurgical management of NASH in patients with obesity
Nonalcoholic steatohepatitis (NASH) is a common cause of chronic liver disease, and obesity is a major risk factor for developing NASH. The general approach to NASH in patients with obesity is lifestyle modification and weight loss; if that fails, bariatric surgery is the best alternative. (See "Outcomes of bariatric surgery", section on 'Nonalcoholic fatty liver disease'.)

Neutralization of SARS-CoV-2 variants in transplant recipients after three doses of mRNA vaccine
In transplant recipients, administration of a third COVID-19 mRNA vaccine dose has been shown to improve the immune response without causing short-term adverse events; however, data on vaccine immunogenicity against SARS-CoV-2 variants are limited. In a secondary analysis of a recent randomized trial, sera obtained from participants after receipt of the third vaccine dose had greater ability to neutralize wild-type SARS-CoV-2 and Alpha, Beta, and Delta variants when compared with sera obtained after the second dose and sera from participants who received placebo [2]. The third dose was well tolerated; no cases of rejection were reported, and graft function remained stable in all patients for three months after the third dose. These findings support administering a three-dose primary vaccine series among transplant recipients and other immunocompromised patients. (See "COVID-19: Issues related to solid organ transplantation", section on 'Vaccination'.)

Treatment of COVID-19 in outpatients at risk for severe disease (November 2021, Modified December 2021)
Nirmatrelvir-ritonavirremdesivir, and monoclonal antibody therapy active against circulating SARS-CoV-2 variants have each been demonstrated to substantially reduce hospitalization rates when given early in the course of COVID-19 [3-7]. For adult outpatients who have mild to moderate COVID-19 and risk factors for progression to severe disease, we recommend treatment with one of these agents. The choice among them depends upon availability and ease of prompt access, as well as comorbidities and other patient-specific factors. If none are feasible options, molnupiravir is an alternative, but it may not be as effective and may be teratogenic [8,9]. When supplies are limited, these treatments should be prioritized for immunocompromised individuals expected to have a suboptimal vaccine response and unvaccinated or incompletely vaccinated individuals at highest risk for severe disease (table 1) [10]. (See "COVID-19: Outpatient evaluation and management of acute illness in adults", section on 'Oral antiviral agents'.)

Placental abruption and future risk of cardiovascular disease
Accumulating data support the hypothesis that abnormalities of placental development are a harbinger of future maternal cardiovascular disease (CVD). In a meta-analysis of 11 cohort studies including over 6 million pregnancies, nearly 70,000 abruptions, and nearly 50,000 cases of CVD (including stroke), the risk of future morbidity/mortality from CVD was significantly higher among patients with abruption (17 versus 9 per 1000 births) and positively correlated with the number of abruptions [1]. Based on these and other findings, patients who have had an abruption may benefit from postpartum counseling and interventions to mitigate future CVD risk. (See "Placental abruption: Management and long-term prognosis", section on 'Long-term maternal prognosis'.) 


Cochrane Library

Intermittent prophylactic antibiotics for bronchiectasis
Overall, in adults who have frequent chest infections, long
term antibiotics given at 14day on/off intervals slightly reduces the frequency of those infections and increases antibiotic resistance. Intermittent antibiotic regimens result in little to no difference in serious adverse events. The impact of intermittent antibiotic therapy on children with bronchiectasis is unknown due to an absence of evidence, and further research is needed to establish the potential risks and benefits. Cochrane Database of Systematic Reviews – Intervention 5 January 2022

Antenatal corticosteroids prior to planned caesarean at term for improving neonatal outcomes
Evidence from one randomised controlled trial suggests that prophylactic corticosteroids before elective caesarean section at term probably reduces admission to the neonatal intensive care unit for respiratory morbidity. Cochrane Database of Systematic Reviews – Intervention 22 December 2021


Evidently Cochrane

Exercise and acute respiratory infections: might regular exercise help protect us?
Sarah Chapman looks at Cochrane evidence on whether exercise affects our susceptibility to acute respiratory infections. Evidently Cochrane 6 January 2022

Vitamin D supplements in pregnancy: what’s the latest evidence?
In this blog for pregnant women, Emily Carter, Cochrane UK Fellow and Obstetrics and Gynaecology Registrar, looks at the latest Cochrane evidence on vitamin D supplementation in pregnancy and how it may help reduce risks for mums and babies in the UK. Evidently Cochrane 6 January 2022



Effect of dexamethasone as an analgesic adjuvant to multimodal pain treatment after total knee arthroplasty: randomised clinical trial
Two doses of dexamethasone reduced morphine consumption during 48 hours after total knee arthroplasty and reduced postoperative pain. BMJ 4 January 2022

Statins do not commonly cause muscle pain and stiffness
Showing that statins rarely cause muscle symptoms is important to reassure people that statins are safe. The aches and pains are not imagined, but they are as common with placebo as with statins. Statins are not to blame for general aches and pains. These drugs need to be taken long term to reduce the risk of heart attacks or strokes. Large numbers of people think about stopping statins, or stop them, when they have muscle symptoms. The researchers hope the study will encourage people to continue taking them. BMJ 29 December 2021

Paroxysmal atrial fibrillation
What you need to know

  • More than half of patients with atrial fibrillation are either asymptomatic or have mild symptoms, and none of the classic symptoms of atrial fibrillation have high diagnostic sensitivity
  • Since paroxysmal atrial fibrillation cannot be excluded by normal 12 lead ECG or short term Holter monitoring, consider prolonged monitoring in symptomatic patients with risk factors including older age, hypertension, and comorbidities
  • Opportunistic radial pulse palpation has a sensitivity of 94% for diagnosing silent atrial fibrillation in patients aged 65 and older

BMJ 30 December 2021

Violence against women and girls has long term health consequences
The association between violence and poor physical health is often overlooked. BMJ 30 December 2021

Diagnostic reasoning in cardiovascular medicine
This article reviews the literature on the cognitive psychology of diagnostic reasoning in the context of cardiovascular disease. BMJ 6 January 2022

Prevention and non-surgical management of pelvic floor dysfunction: summary of NICE guidance
What you need to know

  • Modifications to lifestyle, such as increasing physical activity, having a healthy diet, losing weight, stopping smoking, and controlling diabetes can help prevent and treat symptoms of pelvic floor dysfunction
  • Encouraging women to start and continue training of the pelvic floor muscles in the long term can help prevent and treat symptoms
  • Pelvic floor muscle training is an effective option to treat symptoms of pelvic floor dysfunction in women with pelvic organ prolapse, urinary incontinence, and faecal incontinence

BMJ 6 January 2021 



Effect of a community-based medical oncology depression screening program on behavioral health referrals among patients with breast cancer: A randomized clinical trial
An implementation-strategy guided depression screening program compared with an educational-only strategy resulted in higher proportion of referrals to behavioral health among patients with breast cancer treated in a community setting.
JAMA 4 January 2021

Assessment of the diagnostic accuracy of baseline clinical examination and ultrasonographic imaging for the detection of lymph node metastasis in patients with high-risk cutaneous squamous cell carcinoma of the head and neck
This study found that ultrasonography had higher sensitivity than clinical examination for the detection of metastasis among patients with high-risk cutaneous SCC of the head and neck; however, ultrasonography also had a high rate of false-positive results. JAMA 29 December 2021

Comparison of drug-eluting stent with bare-metal stent in patients with symptomatic high-grade intracranial atherosclerotic stenosis : A randomized clinical trial
This trial found that, compared with bare-metal stent (BMSs), drug-eluting stent (DESs) reduced the risks of intracranial atherosclerotic stenosis (ISR) and ischemic stroke recurrence in patients with symptomatic high-grade ICAS. Further investigation into the safety and efficacy of DESs is warranted. JAMA 4 January 2022



Eltrombopag added to immunosuppression in severe Aplastic Anemia
The addition of eltrombopag to standard immunosuppressive therapy improved the rate, rapidity, and strength of hematologic response among previously untreated patients with severe aplastic anemia, without additional toxic effects. NEJM 6 January 2022

Determination of brain death
This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. NEJM 30 December 2021

Snake envenomation
In Australia, venom detection kits consisting of enzyme immunoassays are available for identifying a snake envenomation and the species of snake. However snakebite envenomation continues to be a major global health burden. NEJM 6 January 2022 


Other journals

Tracheal stenosis in prolonged mechanically ventilated patients: prevalence, risk factors, and bronchoscopic management
Tracheal stenosis is commonly observed among prolonged ventilated patients with tracheostomies, characterized by localized hypergranulation and mild to moderate airway obstruction, with interventional bronchoscopy providing satisfactory results. BMC pulmonary medicine 6 January 2021

What is the added value of CT-angiography in patients with transient ischemic attack?
More than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a short duration of symptoms and a vascular risk profile including coronary heart disease, arterial hypertension and hyperlipidaemia most likely might benefit from early CTA to streamline further diagnostics and therapy. BMC Neurology 3 January 2022

Cue-based feeding and short-term health outcomes of premature infants in newborn intensive care units: a non-randomized trial
The findings indicate that cue-based feeding is beneficial for preterm infants. Therefore, it is recommended that nurses employ cue-based feeding in the NICU. BMC Paediatrics 6 January 2022

Dual antiplatelet therapy before coronary artery bypass grafting in patients with myocardial infarction: a prospective cohort study
A 6-month follow-up showed that Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel before coronary artery bypass grafting (CABG) in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. BMC surgery 31 December 2021

Association between unmet medication needs after hospital discharge and readmission or death among acute respiratory failure survivors: the addressing post-intensive care syndrome (APICS-01) multicenter prospective cohort study
Unmet medication needs are common among survivors of acute respiratory failure shortly after discharge home. The association of unmet medication needs with 3-month readmission and mortality is complex and requires additional investigation to inform clinical trials of interventions to reduce unmet medication needs. Critical care 7 January 2021

Prone positioning during venovenous extracorporeal membrane oxygenation for acute respiratory distress syndrome: a pooled individual patient data analysis
In a large population of ARDS patients receiving venovenous extracorporeal support, the use of prone positioning during ECMO was not significantly associated with reduced ICU mortality. The impact of this procedure will have to be definitively assessed by prospective randomized controlled trials. Critical care 7 January 2021

Predictors for extubation failure in COVID-19 patients using a machine learning approach
The most important predictors for extubation failure in critically ill COVID-19 patients include ventilatory settings, inflammatory parameters, neurological status, and body mass index. Critical care 27 December 2021 _________________________________________________________________________________

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Redefining help through peer support (Lived experience narrative) Journal of psychiatric and mental health nursing 24 November 2021
The Narrative describes entering a Peer-Led Acute Alternative Service when I was amid a mental health crisis and feeling broken. Here, relationships were based on connecting with others who have experienced similar struggles, being seen as an individual rather than a patient, treated with dignity and respect, being heard, having my feelings acknowledged rather than medicated and feeling understood. This created a shift in me to a place of healing and finding meaning in my experiences of mental distress which led to me training in peer support.

Walking on eggshells: A life defined by obsessive–compulsive personality disorder (Lived experience narrative) Journal of psychiatric and mental health nursing 27 October 2021  
The paper highlights the need for continuous, hands-on community support to those experiencing OCPD and their significant others. In order to enhance continuity of care, support is ideally centralized and provided by one keyworker who builds a strong therapeutic relationship with the person and their loved ones.

Experiences and views of carers regarding the physical health care of people with severe mental illness: An integrative thematic review of qualitative research Journal of psychiatric and mental health nursing 25 October 2021
People with severe mental illness (SMI) have high rates of physical illnesses. Informal carers are core partners in addressing these issues, however research on their views/experiences is limited and there is no systematic review published on the topic. This integrative thematic review explored the experiences and views of carers on physical health care in SMI by synthesizing the existing qualitative research findings. Carers felt that receiving practical help and a specialised role for mental health nurses would facilitate better physical health care. Lack of coordination/communication and poor service access/responsiveness were common barriers, often compounded by diagnostic overshadowing. Carers are involved in promoting healthy lifestyles, monitoring physical health and supporting access to services.

Nurses’ experiences of working in the community with adolescents who self-harm: A qualitative exploration Journal of psychiatric and mental health nursing 3 December 2021  
Nurses often work in the community with adolescents who self-harm. There is a lack of qualitative research exploring nurses’ experiences of working with adolescents who self-harm. This study aimed to gain an understanding of community nurses’ experiences of working with adolescents who self-harm. Nurses feel conflicted about working with adolescents who self-harm within the context of working with systems surrounding the adolescent. They report positive experiences, which they use to reframe their experiences and feelings of shame as a result of their emotional responses, self-care behaviours and personal and professional boundaries. Nurses working with adolescents who self-harm would benefit from training, reflective practice and self-care. CAMHS managers should encourage and invest in these areas.

The effect of a solution-oriented therapy on the depression levels and the perceived social support of depressive patients Archives of psychiatric nursing 2 January 2022  
This study was executed to evaluate the effect of the solution-oriented therapy programme on the depression levels and the perceived social support of depressive patients. The study was designed as a randomized controlled trial with a pre-test and post-test control group and repeated measures. The Solution-Oriented Therapy Programme was implemented in a total of 6 to 10 sessions with the patients of experimental group. The execution of Solution-Oriented Therapy Programme with the depressive patients should be done by the psychiatric nurses within the scope of the services that psychiatric care units serve.

The significant mediators between depression and mental health recovery among community-dwelling people with a diagnosed mental disorder Archives of psychiatric nursing 17 November 2021  
To investigate the mediating roles of community integration and positive thinking on the relationship between depression and mental health recovery among community dwelling people with mental disorders in South Korea. A cross-sectional, descriptive study was utilized. Data were collected from 167 community-dwelling people with mental disorders who did not use the day program at community mental health centers. Data were collected from November 20, 2018, to February 15, 2019. Both community integration and positive thinking were found to mediate the effects of depression on mental health recovery. The mediating effect of positive thinking was significantly greater than that of community integration. This study added evidence for a significant multiple mediating effect of community integration and positive thinking on the relationship between depression and mental health recovery in community-dwelling people with mental disorders. Although the consumer-centered recovery paradigm of people with mental health difficulties is of global importance, little research has been conducted on mental health recovery among community-dwelling people with mental disorders who do not use the day program at community mental health centers. It was found that community integration and positive thinking mediated the effects of depression on mental health recovery, with positive thinking mediating this relationship the most. Thus, these results suggest a specific direction of community mental health services to promote mental health recovery for people with mental disorders who do not have access to community mental health services.

Occupational therapy

Outcomes of assistance dog placement in the home for individuals with autism spectrum disorder and their families: A pilot study Australian occupational therapy journal 13 September 2021  
Evidence indicates that assistance dogs placed in the home are effective in supporting individuals with Autism Spectrum Disorder (ASD) by increasing social and community participation and promoting quality of life. This study aimed to examine the outcomes of assistance dog placement on quality of life, independence, and participation of families including individuals with ASD placed with an assistance dog compared to families on the waiting list for an autism assistance dog and to evaluate the feasibility of the design for future studies. These study findings add to the developing evidence about the use of assistance dogs with this population. A larger sample size may have allowed for significant associations to be detected. The methods used were feasible to be applied in a larger study. These results may assist health professionals advocate for funding for assistance dog placement to individuals with ASD and their families.

Assistance dogs in occupational therapy practice: A survey of Australian occupational therapists' experiences and recommendations American journal of occupational therapy 29 November 2021  
Assistance dogs perform multiple tasks to support people with disabilities and bring various benefits. Occupational therapists play a key role in assessing or referring clients for assistive technology, which includes assistance dogs. However, little is known about Australian occupational therapists' experiences with assistance dogs and how they perceive their roles in this area of practice. Findings indicate that occupational therapists' lack experience and knowledge of assistance dogs although they perceive assistance dogs as within the scope of occupational therapy practice. This study highlights a need for increasing professional development opportunities for occupational therapists regarding assistance dogs, including assessment and referral processes. This will be steadily more important given the increasing profile and expanding application of assistance dogs, and funding organisation requests for occupational therapists in assessing clients for assistance dogs.

Implementing an occupational therapy specific mental health intervention in a multi-professional context – the case of Balancing Everyday Life (BEL) Scandinavian journal of occupational therapy 5 November 2021  
The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned. Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.

Occupational therapy and allied health interventions to promote and support client self-advocacy: A systematic review of the literature Open journal of occupational therapy October 2021   
Despite occupational therapy’s focus on optimizing participation in society for individuals with disability, self-advocacy has only recently (2008) become an official client factor in the Occupational Therapy Practice Framework (OTPF). This study indicates that although literature on self-advocacy interventions has been published in the last 15 years, research on self-advocacy interventions in occupational therapy and other allied health disciplines is still lacking.

A gardening and woodwork group in mental health: a step towards recovery Irish journal of occupational therapy 12 November 2021  
This study aimed to evaluate the effectiveness of a woodwork and gardening group programme. The GAS allowed researchers to evaluate the efficacy of this group intervention in a recovery-oriented manner which was of inherent therapeutic value to participants and also remained in-line with occupational therapy principles. Qualitative and quantitative results indicate that the programme enabled participants’ achievement of individual recovery goals and indicate that woodwork and gardening groups should be considered when developing services for community mental health service users.

A scoping review of occupational therapy interventions in the treatment of people with substance use disorders Irish journal of occupational therapy 10 December 2021  
This study presents a synthesis of how occupational therapy interventions have been used to treat people experiencing addiction and indicates that service-users report finding occupational therapy supportive and helpful; however, there is currently limited evidence for generalisability of these findings. Further research is required to best understand how to design and tailor occupational therapy within diverse treatment settings.


A systematic scoping review of research on COVID19 impacts on eating disorders: A critical appraisal of the evidence and recommendations for the field International journal of eating disorders 2 November 2021 
Research investigating the effects of COVID-19 on eating disorders is growing rapidly. A comprehensive evaluation of this literature is needed to identify key findings and evidence gaps to better inform policy decisions related to the management of eating disorders during and after this crisis. We conducted a systematic scoping review synthesizing and appraising this literature. Evidence for COVID-19 effects is mostly limited to participant self-report or retrospective recall, cross-sectional and descriptive studies, and samples of convenience. Several novel pathways for future research that aim to better understand, monitor, and support those negatively affected by the pandemic are formulated.

Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda Lancet psychiatry 29 November 2021   
Brief psychotic episodes represent an intriguing paradox in clinical psychiatry because they elude the standard knowledge that applies to the persisting psychotic disorders such as schizophrenia. This Review describes key diagnostic considerations such as conceptual foundations, current psychiatric classification versus research-based operationalisations, epidemiology, and sociocultural variations; prognostic aspects including the risk of psychosis recurrence, types of psychotic recurrences, other clinical outcomes, prognostic factors; and therapeutic issues such as treatment guidelines and unmet need of care. The advances and challenges associated with the scientific evidence are used to set a research agenda in this area. We conclude that brief psychotic episodes can be reconceptualised within a clinical staging model to promote innovative translational research and improve our understanding and treatment of psychotic disorders.

Development and assessment of a communitybased screening tool for mental health disorders among people who inject drugs Drug and alcohol review 18 November 2021  
The prevalence of mental health disorders among people who use drugs is high and well documented. This hard-to-reach population faces a very low awareness and access to mental health care, especially in developing countries. The objectives of this study were to design and assess a quick screening tool (QST) that community-based organisations (CBO) could routinely apply to a Vietnamese population of people who inject drugs (PWID), in order to refer them appropriately to mental health specialists. The QST appeared to be both efficient and well accepted. Given the burden of mental health problems among hard-to-reach PWID in developing countries, community-based screenings such as this one could be a particularly appropriate response.

Associations of common mental disorder with alcohol use in the adult general population: a systematic review and metaanalysis Addiction 3 December 2021  
Research has shown that alcohol use and common mental disorders (CMDs) co-occur; however, little is known about how the global prevalence of alcohol use compares across different CMDs. We aimed to (i) report global associations of alcohol use (alcohol use disorder (AUD), binge drinking and consumption) comparing those with and without a CMD, (ii) examine how this differed among those with and without specific types of CMDs and (iii) examine how results may differ by study characteristics. People with common mental disorders (depression, anxiety, phobia) are twice as likely to report an alcohol use disorder than people without common mental disorders.

Analysis of COVID-19 infection and mortality among patients with psychiatric disorders, 2020 JAMA network open 23 November 2021
Results of the current study suggest that many patients with major psychiatric disorders demonstrate a lower rate of positive COVID-19 test during the 2020 pandemic than the general population. These rates may be influenced by a more limited exposure to SARS-CoV-2 due to social isolation. This study also found that the patients with major psychiatric disorders are more likely to have comorbidities associated with worse COVID-19 outcomes. Finally, patients with schizophrenia had higher mortality rates for COVID-19, independent of those comorbidities. This study’s findings suggest the need to foster recognition of pandemic risks on specific groups of patients with psychiatric conditions, and may drive alternative approaches to COVID-19 disease testing and interventions to improve clinical outcomes.

Therapists’ emotional state after sessions in which suicidality is addressed: need for improved management of suicidal tendencies in patients with borderline personality pathology BMC psychiatry 23 November 2021
Two different therapist responses were identified after sessions in which young female patients with BPD or subthreshold BPD talked about their suicidal ideation or about a more concrete suicide plan. Therapists showed an emotional response pattern consisting firstly of arousal and negative affect (“distress”) and secondly of arousal and positive affect (“eustress”). These two types of arousal are distinguished by being angry, uncertain and afraid versus feeling pleased and definite. First of all, this implies that patient suicidality does not always have to be emotionally burdening for therapists and moreover, that clinicians need to feel definite and self-effective which in turn enables the mastery of a challenging situation. If therapists become aware of their “suicidality-countertransference” and their anxiety about patient suicide contained, this can on one hand enable a good therapy process and outcome (including prevent discontinuation of the therapeutic process) and on the other hand lead to clinicians’ well-being. Conducting further research on how therapists’ mental health can be preserved seems necessary in order to ensure appropriate and good care for patients with suicidal tendencies.

Psilocybin therapy increases cognitive and neural flexibility in patients with major depressive disorder Translational psychiatry 8 November 2021  
Psilocybin has shown promise for the treatment of mood disorders, which are often accompanied by cognitive dysfunction including cognitive rigidity. Recent studies have proposed neuropsychoplastogenic effects as mechanisms underlying the enduring therapeutic effects of psilocybin. In an open-label study of 24 patients with major depressive disorder, we tested the enduring effects of psilocybin therapy on cognitive flexibility (perseverative errors on a set-shifting task), neural flexibility (dynamics of functional connectivity or dFC via functional magnetic resonance imaging), and neurometabolite concentrations (via magnetic resonance spectroscopy) in brain regions supporting cognitive flexibility and implicated in acute psilocybin effects (e.g., the anterior cingulate cortex, or ACC). Psilocybin therapy increased cognitive flexibility for at least 4 weeks post-treatment, though these improvements were not correlated with the previously reported antidepressant effects. One week after psilocybin therapy, glutamate and N-acetylaspartate concentrations were decreased in the ACC, and dFC was increased between the ACC and the posterior cingulate cortex (PCC). Surprisingly, greater increases in dFC between the ACC and PCC were associated with less improvement in cognitive flexibility after psilocybin therapy. Connectome-based predictive modeling demonstrated that baseline dFC emanating from the ACC predicted improvements in cognitive flexibility. In these models, greater baseline dFC was associated with better baseline cognitive flexibility but less improvement in cognitive flexibility. These findings suggest a nuanced relationship between cognitive and neural flexibility. Whereas some enduring increases in neural dynamics may allow for shifting out of a maladaptively rigid state, larger persisting increases in neural dynamics may be of less benefit to psilocybin therapy.

Optimal dose of aripiprazole for augmentation therapy of antidepressant-refractory depression: preliminary findings based on a systematic review and dose–effect meta-analysis British journal of psychiatry 15 November 2021  
Low-dose aripiprazole as augmentation treatment might achieve the optimal balance between efficacy, tolerability and acceptability in the acute treatment of antidepressant-refractory depression. However, the small number of included studies and the overall moderate to high risk of bias seriously compromise the reliability of the results. Further research is required to investigate the benefits of low versus high dose.

Borderline personality disorder and ageing: myths and realities Current opinion in psychiatry January 2022  
Although mental health issues in ageing individuals have been receiving more attention, borderline personality disorder (BPD) in older adults and the elderly has been relatively neglected. This article aims to review the current state of knowledge about BPD in these age groups. Studies have consistently reported decreasing prevalence rates of BPD among ageing individuals. This may be attributed to the ageing process itself and/or different clinical features due to which meeting the diagnostic criteria for BPD becomes more difficult. Ageing individuals with BPD often present in a way that makes them look 'atypical' compared to younger individuals with the same condition. In particular, this pertains to somewhat attenuated and less overt manifestations of impulsivity. However, the basic pattern of overall symptoms instability continues to characterize ageing individuals with BPD, in addition to depressive symptoms, feeling of emptiness, anger, unstable interpersonal relationships, turbulent responses when needs are not met, various somatic complaints and other symptoms. Clinicians should be aware of different clinical features of BPD as patients get older. Diagnostic criteria for BPD may need to be revised to reflect this reality, allow accurate diagnosis and minimize the risk of overlooking BPD in ageing individuals.

Microbiota-targeted interventions for mental health Current opinion in psychiatry January 2022 
The gut microbiota has emerged as a key conduit in mental health and is a promising target for interventions. This review provides an update on recent advances in using microbiota-targeted approaches for the management of mental health. Although the current literature preliminarily supports targeting the microbiota to manage mental health and use as adjuvant therapies for certain brain disorders, large gaps remain and especially data including clinical cohorts remains scarce. Research studies including larger cohorts, well-characterized clinical populations and defined duration and dosage of the intervention are required to develop evidence-based guidelines for microbiota-targeted strategies.

Sociodemographic and cultural determinants of mood disorders Current opinion in psychiatry January 2022 
Recent evidence on sociodemographic determinants of mood disorders confirms associations derived from existing literature. There is also new and emerging evidence on how quality of sleep, diet and the environment influence risk of mood disorders. Culture and ethnicity, depending on context, may contribute to both vulnerability and resilience. Socioeconomic deprivation may be the final common pathway through which several sociodemographic and cultural determinants of mood disorders act.

A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders Acta Psychiatrica Scandinavica 30 November 2021  
The authors aimed to examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.

Parsing the network mechanisms of electroconvulsive therapy Biological psychiatry 19 November 2021 
Electroconvulsive therapy is one of the oldest and most effective forms of neurostimulation, where electrical current is used to elicit brief, generalized seizures under general anesthesia. When electrodes are positioned to target fronto-temporal cortex, ECT is arguably the most effective treatment for severe major depression, with response rates and times superior to other available antidepressant therapies. Neuroimaging research has been pivotal in improving the field’s mechanistic understanding of ECT, with a growing number of MRI studies demonstrating hippocampal plasticity after ECT, in line with evidence of upregulated neurotrophic processes in the hippocampus in animal models. However, the precise roles of the hippocampus and other brain regions in antidepressant response to ECT remain unclear. Seizure physiology may also play a role in antidepressant response to ECT, as indicated by early PET/SPECT and EEG research, and corroborated by recent ECT-MRI studies. In this review, we discuss the evidence supporting neuroplasticity in the hippocampus and other brain regions during and after ECT, and their associations with antidepressant response. We also offer a mechanistic, circuit-level model which proposes that core mechanisms of antidepressant response to ECT involve thalamocortical and cerebellar networks that are active during seizure generalization and termination over repeated ECT sessions, and their interactions with corticolimbic circuits that are dysfunctional prior to treatment and targeted with the electrical stimulus.

Treatment of electroconvulsive therapy-emergent hypomania and mania: A systematic review of the literature Journal of clinical psychiatry 16 November 2021 
Electroconvulsive therapy (ECT)-emergent hypomania/mania is a clinically significant problem that has lacked evidence-based guidelines for effective management. The aim of this systematic literature review is to compile the current published literature on treating ECT-emergent hypomania/mania to help guide treatment course in patients with unipolar and bipolar depression. The available data are insufficient to support definitive conclusions; however, potential treatment guidelines are suggested within the review to providers based on the limited data available.

Motivational coaching augmentation of exercise intervention for early psychotic disorders: A randomised controlled trial Australian and New Zealand journal of psychiatry 27 November 2021 
Exercise offers improvement to physical and mental health symptoms as well and cognitive function in patients with psychosis. However, patients with psychosis are often less ready to benefit from exercise intervention because of the difficulties in motivation. This study aimed to examine the effectiveness of adjunctive motivational coaching on exercise intervention in women with psychosis in Hong Kong. Motivational coaching may augment the effects of exercise interventions, as reflected by higher physical activity participation. Motivational coaching augmentation has the potential to further improve exercise intervention outcomes.


Cognitive behavioral group treatment for low self-esteem in psychosis: a proof of concept study BMC psychiatry 12 November 2021 
This pilot study demonstrates the feasibility and treatment potential of a self-esteem group treatment provided by a psychiatry nurse and graduate psychologist in a patient population that receives little psychological treatment. Results suggest that this easily accessible intervention may be effective in improving self-esteem and reducing depression symptoms.

The effectiveness of psychological support interventions for those exposed to mass infectious disease outbreaks: a systematic review BMC psychiatry 24 November 2021  
Despite benefits from psychological interventions in managing anxiety and depression for all those exposed to mass infectious disease outbreaks, the evidence is limited. The review highlights the need for further research including complex intervention trials, studies involving representative study populations, studies to investigate whether interventions used in other large-scale disasters are effective when used during a pandemic such as COVID-19, and to explore whether any organisations already offer any psychological interventions, and to formally evaluate these. Research is needed now to inform the development and implementation of effective psychological interventions for all those exposed to mass infectious disease outbreaks to ensure we are adequately prepared. Intervention development, piloting, evaluating, reporting and implementation should follow recommended guidance for complex interventions.

Mindfulness-based approaches for COVID-19 mental health in working from home International journal of mental health and addiction 3 November 2021  
The novel coronavirus (COVID-19) pandemic spread rapidly since it was first identified in December 2019. A nation-level lockdown has been implemented in many countries, affecting workers of all sectors and forcing many to work from home. In this commentary, we discuss mental health difficulties that working from home might cause on non-key workers, based on research in New Ways of Working (NWW) and telecommuting. Moreover, we propose the use of mindfulness-based approaches to protect workforce from the potential negative impacts of working from home.

Effect of mindfulness on psychological distress and well-being of children and adolescents: a meta-analysis Mindfulness 26 November 2021  
Mindfulness-based interventions (MBIs) are being increasingly used toward improving mental health. Previous studies reached inconsistent conclusions regarding the effects of MBIs on the well-being and psychological distress of children and adolescents. Therefore, we conducted a meta-analysis summarizing the effects of MBIs on the well-being and psychological distress (i.e., anxiety, depression, and stress) of children and adolescents. Our results confirmed MBI to be an alternative intervention for reducing psychological distress among both children and adolescents. The development and application of a shorter MBI, adapted for adolescents, could be addressed in future studies.

Overoptimistic literature and methodological biases favoring cognitive behavioral therapy for the prevention of psychosis Schizophrenia bulletin 10 November 2021  
Indicated prevention in young people at Clinical High Risk for Psychosis (CHR-P) originated in Australia more than 20 years ago and subsequently impacted national and international clinical guidelines and diagnostic manuals. While the most recent umbrella reviews (reviews of meta-analyses) demonstrated substantial achievements in detection and prognostic assessment of young CHR-P individuals, the most updated network meta-analysis found no robust evidence to favor cognitive behavioral therapy (CBT) compared with the control condition (ie, needs-based interventions). An independent pairwise meta-analysis by the Cochrane group corroborated these findings, concluding “there was no convincing unbiased, high-quality evidence” that any type of intervention is more effective than needs-based interventions (two other pairwise meta-analyses were published, but either used older data than the network and Cochrane meta-analyses or were discussed elsewhere, with significant concerns in regard to study inclusion). Overall, these studies cautioned that uncertainty of evidence is high for CBT in preventing psychosis among CHR-P individuals.

Recovering from intimate partner violence through strengths and empowerment: Findings from a randomized clinical Journal of clinical psychiatry 23 November 2021 
Recovering from Intimate Partner Violence through Strengths and Empowerment (RISE) is a brief, variable-length (1–6 sessions), modular, individualized psychosocial counseling intervention for women experiencing intimate partner violence (IPV). Pilot findings demonstrated the potential helpfulness, acceptability, and feasibility of RISE; however, a randomized clinical trial (RCT) is needed to support program effectiveness. Results indicate the effectiveness of RISE in enhancing psychosocial well-being, especially empowerment and self-efficacy, among women experiencing IPV, for whom accessible health care–based interventions are needed.

Social Work

 What support do young people affected by adverse childhood experiences need? BMJ 15 November 2021 
Adverse childhood experiences include physical or sexual abuse, neglect, and living in a household with domestic violence or substance misuse. A key public health priority is to reduce the longlasting and negative impact of these experiences on someone’s mental and physical health. Researchers reviewed evidence from 20 UK qualitative studies published since 2008. The studies explored the views of young people on their support needs, and included people who had been exposed to adverse childhood experiences when they were between the ages of 3 and 18. They may not have accessed services until later. People were looking for emotional and practical support to fill the gaps left by their childhood experiences. They valued service providers who displayed empathy, were non-judgmental, and were active listeners. Supportive relationships, especially with adults, were a key factor in feeling understood. The synthesised findings were grouped into three themes, according to the types of services needed, and how best they could be delivered.

Factors influencing elevated mortality rates of patients with schizophrenia hospitalized with COVID Community mental health journal 20 November 2021 
Work completed since the pandemic began has repeatedly demonstrated elevated mortality rates in people with schizophrenia hospitalized with COVID. They are a vulnerable group due to multiple issues—for example high co-morbidity rates of medical illness, often impaired insight and judgment, barriers to obtaining health care, and trouble understanding and implementing preventive measures. The objective of this study was to evaluate if a diagnosis of schizophrenia in the context of COVID-19 requiring hospitalization increased the risk for people with a diagnosis of schizophrenia to be intubated, admitted to the ICU or die when compared to people hospitalized with COVID-19 who did not have schizophrenia. This was accomplished by doing a retrospective chart review of 123 people with schizophrenia and matched controls. Although we found elevated rates of these outcomes in the patients with schizophrenia, our analysis attributed these differences to congregate living, rather than the illness itself.


SEMINAR - Talking Point: Dual diagnosis of mental illness and substance use disorder: an underappreciated determinant of health disparities  
Presenter: Dr Jesse Young PhD MPH BSc, 17th November 2021 
This seminar presents findings from Dr Young's program of work which has applied unique data linkage methodology to quantify health and health service use outcomes associated with dual diagnosis. An overview of the Australian arm of the multinational International Naturalistic Cohort Study on ADHD and substance use disorders, a large prospective cohort study in progress, will be provided. Opportunities for evidence-based policy reform are discussed.

WEB REPORT - New release from the Australian Institute of Health and Welfare: Mental health services in Australia 
Mental health services in Australia (MHSA) provides a picture of the national response of the health and welfare service system to the mental health care needs of Australians. MHSA is updated progressively throughout each year as data becomes available.

Bulletin for December 2021

The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians BMC Public Health 23 November 2021 
The Driving Change program appears to be effective in improving employment outcomes for those who gained a licence. Clients from regional areas were more likely to gain a licence compared to those in urban settings, and were predominantly young and unemployed, often a hard to reach cohort. Future licensing programs being delivered in regional areas need integrated pathways into employment opportunities to provide holistic services that address the social and economic challenges faced by Aboriginal and Torres Strait Islander Australians.

Key demographic and mental disorder diagnostic differences between Australian First Nations and non-First Nations clinic-referred children and adolescents assessed in a culturally appropriate and safe way ANZ journal of psychiatry 7 December 2021 
Key known risk factors for oppositional defiant disorder can be identified early and holistically managed in First Nations young people. This will prevent oppositional defiant disorder decreasing their access to mental health services and increasing their involvement in the criminal justice system. In addition, the resilience building aspects of oppositional defiant disorder that may enhance self-respect need to be nurtured.

Psychiatric disorders and offending in an Australian birth cohort: Overrepresentation in the health and criminal justice systems for Indigenous Australians ANZ journal of psychiatry 9 December 2021
Indigenous Australians were significantly overrepresented in court finalisations and psychiatric diagnoses. Indigenous Australians with a psychiatric diagnosis were at highest risk of experiencing a court appearance, emphasising the importance of culturally appropriate mental health responses being embedded into the criminal justice system.

Does community cultural connectedness reduce the influence of area disadvantage on Aboriginal & Torres Strait Islander young peoples' suicide? ANZ journal of public health 45(6) 2021 
Cultural connectedness indicators were associated with lower Aboriginal and Torres Strait Islander young peoples' suicide rates in communities experiencing the most disadvantage. Implications for public health: This provides initial evidence for trialling and evaluating interventions using cultural practices and engagement to mitigate against the impacts of community risk factors on Aboriginal and Torres Islander suicide.

Markers of chronic disease risk in a cohort of Aboriginal children: findings from the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) ANZ journal of public health 45(6) 2021  
Dyslipidaemia and elevated HbA1c prevalence was low in the cohort, increasing with high BMI. Overweight and obesity were common, which increase the risk of developing chronic disease later in life. Findings indicate few Aboriginal children have dyslipidaemia and hyperglycaemia, supporting screening for chronic disease risk factors from 18 years of age. Opportunities to reduce overweight and obesity among children should be considered to decrease the future risk of chronic disease.

A discourse analysis of the Aboriginal and Torres Strait Islander COVID-19 policy response ANZ journal of public health 45(6) 2021  
The policy response perpetuates an ongoing paternalistic discourse where Aboriginal and Torres Strait Islander people must be controlled for the sake of their health, informed by notions of Indigeneity as deficient. This stands in contrast with the work of community-controlled health organisations, advocacy by Aboriginal and Torres Strait Islander people for and against restrictions, and examples of communities protecting themselves. Unilateral government intervention creates limiting discourses of Aboriginal and Torres Strait Islander people. In contrast, ongoing COVID-19 responses can build on the strengths of and work done by Aboriginal and Torres Strait Islander families, leaders, and communities.

Risk of severe illness from COVID-19 among Aboriginal and Torres Strait Islander adults: the construct of ‘vulnerable populations’ obscures the root causes of health inequities ANZ journal of public health 45(6) 2021  
Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID-19 illness. Indigeneity itself is not a ‘risk’ factor and must be viewed in the wider context of inequities that impact health. Multi-sectoral responses are required to improve health during and after the COVID-19 pandemic that: enable self-determination; improve incomes, safety, food security and culturally-safe healthcare; and address discrimination and trauma.

Central Australian Aboriginal women's placental and neonatal outcomes following maternal smokeless tobacco, cigarette or no tobacco use ANZ journal of public health 25 November 2021  
This research is the first to demonstrate that the maternal use of Australian Nicotiana spp. (pituri) as smokeless tobacco may negatively impact placental and neonatal outcomes. Maternal smokeless tobacco use is a potential source of placental and foetal nicotine exposure. Maternal antenatal screening should be expanded to capture a broader range of tobacco and nicotine products, and appropriate cessation support is required.

Changes in cancer incidence and survival among Aboriginal and Torres Strait Islander children in Australia,1997–2016 Paediatric blood and cancer 15 December 2021 
Improvements in identification, particularly in urban areas, most likely accounts for the greater increase in cancer incidence rates among Aboriginal and Torres Strait Islander children. Examination of data on stage at diagnosis and treatment may provide important insights into survival for children with solid tumours.

A community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia BMC health services research 20 October 2021
This is the first multi-site effort in northern Australia to strengthen primordial and primary prevention of RHD. Community-led programs are central to the overarching strategy to eliminate RHD. Future implementation should support culturally safe relationships which build the social capital required to address social determinants of health and enable holistic ways to support sustainable individual and community-level actions. Government and services must collaborate with communities to address systemic, structural issues limiting the capacity of Aboriginal peoples to eliminate RHD.

COVID-19 misunderstandings cleared up
(Central Land Council - poster) 
This factsheet provides answers to some common misunderstandings about the COVID-19 pandemic and the vaccinations available.

Head to health ( Department of health – website) 
Head to Health is an online resource which aims to help Aboriginal and Torres Strait Islander people find digital social and emotional wellbeing resources and health services from Australia’s most trusted mental health organisations.

The website brings together a wide range of digital information resources, as well as:

  • apps and online programs
  • online forums
  • phone, chat and email services
  • mental health websites.

This online resource can help individuals:

  • improve their own sense of wellbeing
  • look for help with something that is bothering them
  • help someone they care about.

The website also includes a section for health professionals, where they can find videos, webinars and other reference materials to help communicate with, and support their patients.

Racism in health: Key Thinkers Forum videos
This is a series of video presentations given at the Key Thinkers Forum (KTF) about Racism in Health
The KTF was hosted by Poche Indigenous Health Network and facilitated by Professor Tom Calma AO. The forum was held online due to COVID-19 and the presentations were recorded.

Cracks in the ice – Information and resources about ice for Aboriginal and Torres Strait Islanders 
Cracks in the Ice is the first national website providing trusted, evidence-based, and up-to-date resources about crystal methamphetamine (‘ice’) for Aboriginal and Torres Strait Islander peoples. The content of the website aims to support and empower communities who are working to address ice use and related harms

This video aims to encourage Aboriginal and Torres Strait Islander communities to protect their families by getting a COVID-19 test if they feel unwell.

Regional insights for Ingidenous communities (AIHW)  
The Regional Insights for Indigenous Communities (RIFIC) website brings together a range of regional statistics about the health and wellbeing of Aboriginal and Torres Strait Islander people and their communities. The aim of the website is to provide access to data at a local level, to help communities set their priorities and participate in joint planning with government and service providers.

Hep B story App 
The Hep B Story App is a visual, interactive app designed for patients living with chronic hepatitis B (hep B) and their families. It tells the story of the hep B virus, how you get it, what happens over time, how you know you have it as well as details about immunisation and treatment. It also features a separate women’s business section discussing mother to child transmission and ways to prevent it.

AIMhi mental health and wellbeing app now available for smart phones 
The Aboriginal and Islander Mental health initiative (AIMhi) Stay Strong app is a colourful, user-friendly digital mental health tool developed by Menzies with Australian First Nations people.

Indigenous governance toolkit 
The Indigenous Governance Toolkit is an online resource developed for Indigenous nations, communities, individuals and organisations searching for information to build their governance. It covers all the basics – your rules, values, culture, membership, leadership, and decision making – and has many examples of ideas that work from other groups, tools to help you get started, and useful guidance to sustain your efforts.


Better Indigenous Genetic Health Services project Policy Brief  
The findings of the BIG Health Services project highlight the need for a systematic approach to increasing the benefits of clinical genetic services for Aboriginal and Torres Strait Islander people.

Annual update on the implementation of The Roadmap to Close the Gap for Vision
The tenth Annual Update on the Implementation of The Roadmap to Close the Gap for Vision shows over the past year continued good progress in the implementation of the Roadmap’s recommendations and the provision of eye services to Aboriginal and Torres Strait Islander peoples.

Profiling excellence Indigenous knowledge translation 
The #LowitjaKT series of four articles are bound together in this e-publication report, which was produced in collaboration with Croakey Health Media and aims to provide several examples of Indigenous knowledge translation in practice.

SA Rural Aboriginal Health Workforce Plan
The SA Rural Aboriginal Health Workforce Plan has been developed by the SA Rural Aboriginal Health Working Group, chaired by Sharon Perkins, Director of Aboriginal Health, Riverland Mallee Coorong Local Health Network under the leadership of the Rural Health Workforce Strategy Steering Committee, chaired by Dr Hendrika Meyer, Chief Clinical Advisor, Rural Support Service.

National Aboriginal and Torres Strait Islander Health Plan 2021–2031
The National Aboriginal and Torres Strait Islander Health Plan 2021–2031 is the new national policy to improve health and wellbeing outcomes for Aboriginal and Torres Strait Islander people over the next 10 years.

Bulletin for 15 January 2021


No party, no drugs? Use of stimulants, dissociative drugs, and GHB/GBL during the early COVID-19 pandemic International journal of drug policy 5 January 2021 
The early stage of the COVID-19 pandemic was associated with major changes in the use of “party drugs”. Those who increased their level of drug use and perceived it as a coping strategy in particular might be targeted with adaptive preventive and therapeutic measures.

The health impact of smokeless tobacco products: a systematic review Harm reduction journal 4 December 2021 
Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.

Examining the attitudes of non-psychiatric practicing healthcare workers towards patients with alcohol problems in general hospital setting Substance abuse: research and treatment 8 January 2022 
Doctors and nurses demonstrated low levels of therapeutic commitments towards patients with problematic alcohol-use thereby necessitating the introduction of in-house programmes to educate, empower and emphasise the importance of therapeutic contact with patients for alcohol intervention. Scientific significance: The prompt identification and treatment of patients with alcohol problems are contingent on the workers’ attitudes towards them. This study’s results should spark a nation-wide interest to improve the training and recognition of such patients and providing adequate educational resources.

Revision of the Australian guidelines to reduce health risks from drinking alcohol MJA 29 November 2021 

  • Guideline 1: To reduce the risk of harm from alcohol‐related disease or injury, healthy men and women should drink no more than ten standard drinks a week and no more than four standard drinks on any one day. The less you drink, the lower your risk of harm from alcohol.
  • Guideline 2: To reduce the risk of injury and other harms to health, children and people under 18 years of age should not drink alcohol.
  • Guideline 3: To prevent harm from alcohol to their unborn child, women who are pregnant or planning a pregnancy should not drink alcohol. For women who are breastfeeding, not drinking alcohol is safest for their baby. 

Changes as result of the guideline: The recommended limit for healthy adults changed from two standard drinks per day (effectively 14 per week) to ten per week. The new guideline states that the less you drink, the lower your risk of harm from alcohol. The recommended maximum on any one day remains four drinks (clarified from previously “per drinking occasion”). Guidance is clearer for pregnancy and breastfeeding, and for people aged less than 18 years, recommending not drinking.

“Looking after yourself is self-respect”: The limits and possibilities of men’s care on a night out Contemporary drug problems 49(1) 2022
Notions of masculinity have played a central role in social and cultural research on men’s drinking events. Within this context, masculinity is regularly called on to explain the problematic disparities that mark men’s alcohol consumption, including men’s disproportionate involvement in drinking and a range of alcohol-related harms. More recently, however, researchers have begun to emphasize men’s drinking events as sites of care and support, leading some to suggest that men’s drinking masculinities are evolving in affirmative and health promoting ways.

Cannabis legalization and detection of Tetrahydrocannabinol in injured drivers NEJM 13 January 2022
After cannabis legalization, the prevalence of moderately injured drivers with a THC level of at least 2 ng per millilitre in participating British Columbia trauma centres more than doubled. The increase was largest among older drivers and male drivers.

Exposure to parental alcohol use is associated with adolescent drinking even when accounting for alcohol exposure of best friend and peers Alcohol and alcoholism 24 December 2021 
Throughout early adolescence, parental alcohol exposure matters for their offspring’s alcohol use, independently of whether peers or their best friend expose them to alcohol or not. Parental alcohol exposure should be considered in prevention efforts to further decrease the number of adolescents that engage in early alcohol use and binge drinking.

Tobacco use during pregnancy Addiction 5 January 2022
There is insufficient evidence regarding the efficacy and safety of smoking cessation pharmacotherapies when used during pregnancy, although in some countries nicotine replacement therapy is recommended for pregnant women who have been unable to quit without non-pharmacological assistance. E-cigarettes are increasingly being used as a smoking cessation aid in the general population of smokers, but more research is needed to determine if e-cigarettes are a safe and effective treatment option for pregnant women.

Longer-term impacts of trading restrictions on alcohol-related violence: insights from New South Wales, Australia Addiction 2 December 2022
Some of the initial reduction in assault in
Kings Cross (KX) and the CBD of Sydney, Australia, previously attributed to the February 2014 introduction of lockout laws may have been a response to publicity surrounding recent deaths connected with alcohol-related violence.

Changes in and correlates of Australian public attitudes toward illicit drug use Drug and alcohol review 28 December 2021
There is strong support for legalising use of cannabis. There is little support for legalising use of ecstasy and cocaine but growing public support for a less punitive approach to those who use these drugs. There is little public support for a change in the current approach to heroin and methamphetamine.

A quantitative analysis of MDMA seized at New South Wales music festivals over the 2019/2020 season: Form, purity, dose and adulterants Drug and alcohol review 28 December 2021 
Dangerous MDMA adulterants or new psychoactive substances in tablet, capsule, powder or crystal forms (whether misrepresented as MDMA or not) were unlikely to be in circulation during the study period. Harm reduction messaging should inform that a key risk-factor for MDMA-related harm is the high and wide variation of purity and dose across forms. Market changes may have occurred since COVID-19, but continued monitoring will ensure messaging remains current.

Investigating the impact of COVID-19 on performance and image enhancing drug use Harm reduction journal 4 December 2021
This study contributes to the emerging literature of the impact of the COVID-19 pandemic on substance use, specifically performance and image enhancing drug (PIED) use among men. The results suggest that the pandemic did influence the choice of PIEDs that participants consumed, although there was little disruption to patterns of exercise, an important aspect of PIED use. Of the men who did cease use completely, the majority reported little issue with post-cycle therapy (PCT) access; those who reported difficulty accessing PCT compounds indicated experience some mental health concerns related to ceasing their PIED use. Clinicians and those who come into contact with this group should be alert for any negative physical or mental health concerns resulting from disrupted or ceased PIED use.

The hazardous (mis)perception of Self-estimated Alcohol intoxication and Fitness to drivE—an avoidable health risk: the SAFE randomised trial Harm reduction journal 7 December 2021  
Social drinkers are commonly unaware of exceeding the legal driving limit when consuming alcohol. Self-estimating alcohol intoxication can be improved through awareness. Dedicated awareness programs, social media campaigns and government advice communications should be utilised to address this avoidable hazard.

Protective factors for decreasing nicotine, alcohol, and cannabis use among adolescents with a history of adverse childhood experiences (ACEs) International journal of mental health and addiction 9 January 2022
Adolescents who have experienced adversity have an increased likelihood of using substances. This study examined if individual-, family-, school-, and community-level protective factors were associated with a decreased likelihood of substance use.

Country participation in the WHO Framework Convention on Tobacco Control Health Warnings Database Tobacco use insights 3 December 2021 
While sharing was evident from the database, there remains a need for more countries to upload the pictorials to the database. There is also a need to expand the database to include alternative tobacco products, such as waterpipe tobacco and e-cigarettes.

Police discretion in encounters with people who use drugs: operationalizing the theory of planned behaviour Harm reduction journal 16 December 2021 
The Theory of Planned Behavior (TPB) offers untapped potential to better understand and modify police practices. In designing interventions to improve the health outcomes of police encounters with people who use drugs (PWUD), further research should validate instruments that measure the relationship between these variables and discretionary intentions, and that measure role-relevant police stigma towards PWUD.

Comparison of cardiovascular safety for smoking cessation pharmacotherapies in a population-based cohort in Australia JAMA 30 November 2021
The finding of this cohort study that varenicline and nicotine replacement therapy (NRT) patch use have similar risk of major adverse cardiovascular events (MACE) suggests that varenicline, the most efficacious smoking cessation pharmacotherapy, may be prescribed instead of NRT patches without increasing risk of major cardiovascular events. Further large-scale studies of the cardiovascular safety of varenicline and NRT relative to bupropion are needed.

Impacts of changes in alcohol consumption patterns during the first 2020 COVID-19 restrictions for people with and without mental health and neurodevelopmental conditions: A cross sectional study in 13 countries International journal of drug policy 8 December 2021
Among people with mental health/developmental conditions (MHDCS), reduced alcohol consumption was associated with better mental health, while the negative effects of increased drinking were more pronounced when compared to people without MHDCS. When supporting people in reducing alcohol consumption during uncertain times, people with MHDCS may need additional support, alongside those experiencing greater levels of distress.

Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework Tobacco control 11 January 2022
While fragments of good practices were widespread across the reviewed PSMs, only a few included a ‘critical mass’ of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.

Early life adversity and increased antisocial and depressive tendencies in young adults with family histories of alcohol and other substance use disorders: Findings from the Family Health Patterns project Addictive behaviors reports 21 December 2021 
These results suggest that early life adversity (ELA) is linked to increased antisocial and depressive tendencies observed in FH+ persons.

Addressing injecting related risks among people who inject both opioids and stimulants: Findings from an Australian survey of people who inject drugs Addictive behaviors reports 11 December 2021
The findings of increased injecting and broader harms associated with injecting both stimulants and opioids are important for tailoring harm reduction and intervention designs for people who use both opioid and stimulant drugs, including prioritizing peer-based approaches.

Association of e-cigarette use with discontinuation of cigarette smoking among adult smokers who were initially never planning to quit JAMA 28 December 2021
In this cohort study, daily e-cigarette use was associated with greater odds of cigarette discontinuation among smokers who initially had no plans to ever quit smoking. These findings support the consideration of smokers who are not planning to quit when evaluating the risk-benefit potential of e-cigarettes for smoking cessation in the population.

Information-seeking behaviours in Australian sexual minority men engaged in chemsex Addictive behaviors reports 11 December 2021
Engagement with health professionals and harm-reduction information is limited in this population, despite high risk and potentially significant adverse health outcomes. Results suggest that new and combined approaches are necessary to reach this population, including peer support networks, anonymous personal advice and changing community attitudes towards chemsex.

Did the under-reporting of meth/amphetamine use increase in a general population survey in Australia as negative media coverage increased? Addiction 20 December 2021 
In Australia, the actual prevalence of lifetime meth/amphetamine use may be two to four times higher than that estimated in the most recent national household surveys (2019). The level of under-reporting is strongly associated with increasing negative attitudes towards methylamphetamine and d-amphetamine use over the same period.

Heated tobacco products for smoking cessation and reducing smoking prevalence Cochrane Database of Systematic Reviews – Intervention 6 January 2022
No studies reported on cigarette smoking cessation, so the effectiveness of heated tobacco for this purpose remains uncertain. There was insufficient evidence for differences in risk of adverse or serious adverse events between people randomised to switch to heated tobacco, smoke cigarettes, or attempt tobacco abstinence in the short
term. There was moderatecertainty evidence that heated tobacco users have lower exposure to toxicants/carcinogens than cigarette smokers and very low to moderatecertainty evidence of higher exposure than those attempting abstinence from  all tobacco. Independently funded research on the effectiveness and safety of HTPs is needed. The rate of decline in cigarette sales accelerated after the introduction of heated tobacco to market in Japan but, as data were observational, it is possible other factors caused these changes. Moreover, falls in cigarette sales may not translate to declining smoking prevalence, and changes in Japan may not generalise elsewhere. To clarify the impact of rising heated tobacco use on smoking prevalence, there is a need for timeseries studies that examine this association.

Drug checking services for people who use drugs: a systematic review Addiction 12 December 2021 
Drug checking services appear to influence behavioural intentions and the behaviour of people who use drugs, particularly when results from drug checking ser-vices are unexpected or drugs of concern. Monitoring of drug markets by drug checking services is well established in Europe, and increasingly in North America. Concerns about drug contents and negative health consequences facilitate the use of drug checking ser-vices; lack of concern; trust in drug sellers; lack of accessibility of drug checking services; and legal and privacy concerns are barriers to use.

Lockdown and licensed premises: COVID-19 lessons for alcohol policy Drug and alcohol review 13 December 2021 
COVID-19 gave rise to both restrictions on premises and relaxations of licensing, with initial reductions in alcohol-related ambulance callouts, a rise in home drinking and diverse impacts on businesses. Policies which may protect on-trade businesses, while reshaping the night-time economy away from alcohol-related harms, could offer a ‘win–win’ for policymakers and health advocates.

Reactions on Twitter towards Australia’s proposed import restriction on nicotine vaping products: a thematic analysis Australian and New Zealand journal of public health 45(6) 2021 
Tweets predominately objected to the policy announcement. Approximately three-quarters of tweets that cited potential adverse consequences of the policy mentioned smoking relapse as their primary concern. Implications for public health: User-generated content on Twitter was primarily used to lobby against the proposed policy, which was subsequently amended.

The risk of being culpable for or involved in a road crash after using cannabis: A systematic review and meta-analyses Drug science, policy and law 13 December 2021 
It is evident that the risks from driving after using cannabis are much lower than from other behaviours such as drink-driving, speeding or using mobile phones while driving. With the medical and recreational use of cannabis becoming more prevalent, the removal of cannabis-presence driving offences should be considered (while impairment-based offences would remain).

Side-loading prevalence and intoxication in the night-time economy Addictive behaviors reports 31 December 2021 
The author’s results suggest that side-loading might not be used as a method for drinkers to enhance intoxication, but instead as a means of sustaining a target level of intoxication during an evening.

Should e-cigarettes be licensed as medicines? BMJ “Head to head’ 12 January 2022 
As the UK announces support for medicinal licensing of e-cigarettes, Nicholas S Hopkinson argues that this will give doctors another means to help smokers quit. But Jørgen Vestbo, Andrew Bush, and Jonathan Grigg say that its benefit is unproved and that harms are likely.

Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway Drug and alcohol dependence 1 February 2022 
The author’s findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.

Online resources
National AOD WFD Strategy - Stakeholder Consultation
The National AOD Workforce Development Strategy is being revised. Contribute a submission to share your views & experiences to inform the revised Strategy

Tobacco: preventing uptake, promoting quitting and treating dependence (NICE guidelines - UK)
This guideline covers support to stop smoking for everyone aged 12 and over, and help to reduce people's harm from smoking if they are not ready to stop in one go. It also covers ways to prevent children, young people and young adults aged 24 and under from taking up smoking. The guideline brings together and updates all NICE's previous guidelines on using tobacco, including smokeless tobacco. It covers nicotine replacement therapy and e-cigarettes to help people stop smoking or reduce their harm from smoking. It does not cover using tobacco products such as ‘heat not burn’ tobacco.

The alcohol 'problem' podcast UK 
The Alcohol Problem Podcast aims to explore the nature of problem drinking with Dr James Morris ( Research Fellow at London South Bank University) and a range of guests

Trends in drug-related hospitalisations in South Australia, 1999-2020

There were 5,157 hospitalisations with a drug related principal diagnosis in South Australia in 2019-20, equivalent to 0.66% of all hospitalisations in South Australia. This is equivalent to 316 hospitalisations per 100,000 people, which was a significant increase from 2018-19.

Trends in drug-related-hospitalisations in Australia, 2019-20 (NDARC) 
There were 62,757 drug-related hospitalisations (excluding alcohol and tobacco) among Australians in 2019-20, equivalent to 0.56% of all hospitalisations in Australia.

Australian Drug Trends 2021: Key findings from the National Ecstasy and Related Drugs Reporting System (EDRS) interviews (NDARC)
Data were collected in 2021 from April-August. Interviews in 2020 and 2021 were delivered face-to-face as well as via telephone, due to COVID-19 restrictions being imposed in various jurisdictions throughout the data collection period. This methodological change should be factored into all comparisons of data from the 2020 and 2021 sample relative to previous years.

South Australian Drug Trends 2021: Key Findings from the Ecstasy and Related Drugs Reporting System (EDRS) Interviews (NDARC) 
Data were collected in 2021 from April-July. Interviews were delivered face-to-face as well as via telephone, due to COVID-19 restrictions being imposed throughout the data collection period. This methodological change, which also impacted interview modality in 2020, should be factored into all comparisons of data from the 2020 and 2021 sample, relative to previous years.

South Australian Drug Trends 2021: Key Findings from the Illicit Drug Reporting System (IDRS) Interviews (NDARC)
Data were collected in 2021 from June-July. Interviews in 2020 and 2021 were delivered face-to-face as well as via telephone, due to COVID-19 restrictions being imposed throughout the data collection period. This methodological change should be factored into all comparisons of data from the 2020 and 2021 sample relative to previous years

No escape: How alcohol advertising preys on children and vulnerable people (Alcohol Health Alliance UK) 
Prevalence of alcohol marketing helps to normalise – and often glamourise – alcohol and creates a culture where alcohol is seen as an ‘essential part’ of everyday life.

Specialist homelessness services annual report 2020–21 (AIHW) 
The specialist homelessness services web report is an annual report summarising data from the Specialist Homelessness Services Collection (SHSC). It describes the characteristics of clients of specialist homelessness services, the services requested, outcomes achieved, and unmet requests for services.

Youth detention population in Australia 2021 (AIHW) 
This report presents information on the youth detention population in Australia from June 2017 to June 2021. Among the 819 young people in detention on an average night in the June quarter 2021, most were male (91%), aged 10–17 (83%) and unsentenced (72%). Half (50%) were Aboriginal and Torres Strait Islander. Over the 4-year period, the numbers fluctuated across quarters, decreasing overall, from 958 in the June quarter 2017

Study on smoke-free environments and advertising of tobacco and related products - Final report (Publications Office of the European Union)
Executive summary 

This study examined two important aspects of tobacco control: on the one hand, advertising, promotion and sponsorship and on the other, smoke-free environments.

Submission to the UN Special Rapporteur on Extreme Poverty and Human Rights: Barriers to accessing social protection faced by people who use drugs (The International Drug Policy Consortium) 
‘Marginalising the most marginalised’: Gathering evidence on how the welfare stare discriminates against people who use drugs. All persons are entitled to basic social protection by the state, including health care, education, and a secure income when they are sick, disabled, retired, or simply have no job. However, people who use drugs are often discriminated against when they try to access the services to which they should be entitled – with devastating consequences for their life, health, and well-being. Drawing on desk research and on a survey of the IDPC membership, this IDPC submission provides an overview of the main mays in which this discrimination is operated.

Webinars (pre-recorded)

Alcohol use among women: trends, social practices and co-designed solutions (NDARC)
This webinar discussed findings from recent studies on alcohol use among women in Australia.

The safety of pharmaceutical drugs of dependence in pregnancy (NDARC)
This seminar examines the emerging research on the safety of pharmaceutical drugs of dependence in pregnancy.

Connect & learn: Social connection, pain and opioid use: the OP-ALMA Social Prescribing Project at Turning Point (Turning Point) 
For many older adults living with chronic pain, dependence on opioid medications can develop over time, underpinned by social and psychological factors that perpetuate pain. This project aims to explore the role of social prescribing in addressing loneliness and social connection in older adults living with pain. The pilot program tested a novel way of delivering social prescribing, with linkage to online connections during COVID-19. The webinar focus’ on key takeaways for frontline clinicians working in AOD and community health services who may want to test social prescribing in their own services.

Talking Point: Dual diagnosis of mental illness and substance use disorder: an underappreciated determinant of health disparities (Turning Point)
Treatment and health outcomes experienced by people with dual diagnosis is an internationally recognised evidence gap. Despite emerging international evidence that people with dual diagnosis experience substantial health disparities, robust evidence on the treatment and health outcomes for people with dual diagnosis in Australia remains scarce. Furthermore, despite decades of calls to action and the promotion of Australia's 'no wrong door' policy, our capacity to identify and treat dual diagnosis in the Australian health system remains suboptimal.

Updated 14 January 2022

Update to living WHO guideline on drugs for covid-19
The latest version of this WHO living guidance provides (a) a strong recommendation for the use of baricitinib as an alternative to interleukin-6 (IL-6) receptor blockers, in combination with corticosteroids, in patients with severe or critical covid-19; (b) a conditional recommendation against the use of ruxolitinib and tofacitinib for patients with severe or critical covid-19; (c) a conditional recommendation for the use of sotrovimab in patients with non-severe covid-19, restricted to those at highest risk of hospitalisation. BMJ 13 January 2022

Intrauterine fetal demise in the third trimester of pregnancy associated with mild infection with the SARS-CoV-2 Delta variant without protection from vaccination
SARS-CoV-2 has a higher infection rate in pregnant women than age-matched adults. With increased infectivity and transmissibility, the Delta variant is predominant worldwide. Here, the authors describe intrauterine fetal demise in an unvaccinated women with mild symptoms of SARS-CoV-2 Delta variant infection. Histology and elevated proinflammatory responses of the placenta suggest that fetal demise was associated with placental malperfusion due to Delta variant infection. This study suggests that the Delta variant can cause severe morbidity and mortality to fetuses. Vaccination should continve to be advocated and will likely continue to reduce SARS-CoV-2 infection risks for pregnant women and their fetuses. Journal of infectious diseases 13 January 2022

SARS-CoV-2 placentitis associated with B.1.617.2 (Delta) variant and fetal distress or demise
There is limited information on the specific impact of maternal infection with the SARS-CoV-2 B.1.617.2 (Delta) variant on pregnancy outcomes. The authors present two cases of intrauterine fetal demise and one case of severe fetal distress in the setting of maternal infection with Delta-variant SARS-CoV-2. In all cases, fetal demise or distress occurred within 14 days of COVID-19 diagnosis. Evaluation revealed maternal viremia, high nasopharyngeal viral load, evidence of placental infection with Delta-variant SARS-CoV-2, and hallmark features of SARS-CoV-2 placentitis. They suggest that Delta-variant SARS-CoV-2 infection during pregnancy warrants vigilance for placental dysfunction and fetal compromise regardless of disease severity. Journal of infectious diseases 13 January 2022

Development and validation of a novel at-home smell assessment
The findings of this diagnostic study suggest that NASAL-7 and NASAL-3, inexpensive and brief patient-reported assessments, can be used to identify individuals with OD. As the burden of COVID-19–associated OD increases, these assessments may prove beneficial as screening and diagnostic tools. Future work will explore whether the NASAL assessments are sensitive to change and how much of a change is clinically important. JAMA 13 January 2022

Audio interview: Covid-19 takeaways at podcast 100
In this audio interview conducted on January 11, 2022, the editors discuss what we’ve learned through 2 years of Covid-19 and 100 podcast episodes, as well as a new study of vaccine effectiveness in adolescents. NEJM 13 January 2022

Comparative effectiveness of BNT162b2 and mRNA-1273 vaccines in U.S. veterans
The 24-week risk of Covid-19 outcomes was low after vaccination with mRNA-1273 or BNT162b2, although risks were lower with mRNA-1273 than with BNT162b2. This pattern was consistent across periods marked by alpha- and delta-variant predominance. NEJM 13 January 2022

Indirect effects of the covid-19 pandemic on childhood infection in England: population based observational study
During the covid-19 pandemic, a range of behavioural changes (adoption of non-pharmacological interventions) and societal strategies (school closures, lockdowns, and restricted travel) were used to reduce transmission of SARS-CoV-2, which also reduced admissions for common and severe childhood infections. Continued monitoring of these infections is required as social restrictions evolve. BMJ 12 January 2022

Covid-19 control measures and common paediatric infections
Hospital admissions fell substantially, probably reflecting a real decrease in non-covid infections. BMJ 12 January 2022

Duration of protection against mild and severe disease by Covid-19 vaccines
We observed limited waning in vaccine effectiveness against Covid-19–related hospitalization and death at 20 weeks or more after vaccination with two doses of the ChAdOx1-S or BNT162b2 vaccine. Waning was greater in older adults and in those in a clinical risk group. NEJM 12 January 2022

Effectiveness of BNT162b2 vaccine against critical Covid-19 in adolescents
Among hospitalized adolescent patients, two doses of the BNT162b2 vaccine were highly effective against Covid-19–related hospitalization and ICU admission or the receipt of life support. NEJM 12 January 2022

Assessment of functional mobility after COVID-19 in adults aged 50 years or older in the Canadian longitudinal study on aging
This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization. JAMA 12 January 2022

Relationship between anxiety, depression and susceptibility to SARS-CoV-2 infection: proof of concept
The author’s findings offer early support for the hypothesis that psychological factors may influence susceptibility to SARS-CoV-2 infection. Journal of infectious diseases 12 January 2022

Rapid cytokine release assays for analysis of SARS-CoV-2-specific T cells in whole blood
Cytokine release assays for the monitoring of T cell memory in whole blood may be useful for evaluation of complications following unverified past COVID-19 and for long-term assessment of vaccine-induced T cell immunity. Journal of infectious diseases 12 January 2022

Human research study of particulate propagation distance from human respiratory function
The experimental study indicates that 3ft [0.914m] physical distancing with face coverings is equally as effective at reducing aerosol/droplet exposure as 6ft [1.829m] with no face covering. Journal of infectious diseases 12 January 2022

COVID-19 cluster linked to aerosol transmission of SARS-CoV-2 via floor drains
SARS-CoV-2 transmission possibly occurs between different floors of an apartment building through aerosol transmission via non-functioning drain traps. Journal of infectious diseases 12 January 2022

Outcomes of SARS-CoV-2–positive youths tested in emergency departments : The Global PERN–COVID-19 Study
In this study, approximately 3% of SARS-CoV-2–positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions. JAMA 11 January 2022

Antibody response to a fourth messenger RNA COVID-19 vaccine dose in kidney transplant recipients: A case series
A fourth dose of mRNA vaccine (BNT162b2 [Pfizer], n = 34; mRNA-1273 [Moderna], n = 58) was given to 92 kidney transplant recipients from 3 independent French university hospitals (Strasbourg, Lyon, and Nantes) who had antispike IgG titers less than 143 BAU/mL 1 month after a third dose. All had measurements of antispike IgG titers 2 to 6 weeks later (median, 29 days [interquartile range, 26 to 34 days]). Annals of internal medicine 11 January 2022

Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study
For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. The Lancet regional health -Europe 10 January 2022

Association of a third dose of BNT162b2 vaccine with incidence of SARS-CoV-2 infection among health care workers in Israel
Among health care workers at a single center in Israel who were previously vaccinated with a 2-dose series of BNT162b2, administration of a booster dose compared with not receiving one was associated with a significantly lower rate of SARS-CoV-2 infection over a median of 39 days of follow-up. Ongoing surveillance is required to assess durability of the findings. JAMA 10 January 2022

Trajectory of Viral RNA load among persons with incident SARS-CoV-2 G614 infection (Wuhan Strain) in association with COVID-19 symptom onset and severity
This cohort study suggests that having incident SARS-CoV-2 G614 infection was associated with a rapid viral load peak followed by slower decay. COVID-19 symptom onset generally coincided with peak viral load, which correlated positively with symptom severity. This longitudinal evaluation of the SARS-CoV-2 G614 with frequent molecular testing serves as a reference for comparing emergent viral lineages to inform clinical trial designs and public health strategies to contain the spread of the virus. JAMA 10 January 2022

School learning format and children’s behavioral health during the COVID-19 pandemic
In this cohort study, parents reported that their children’s behaviors at home were worse during remote learning than during in-person learning. Although our analyses accounted for all between-child factors, they did not account for all time-varying factors that might explain children’s learning format and parents’ perception of their well-being at any given time. Therefore, results should not be interpreted to mean that remote learning caused worse behavioral health; rather, the results illustrate that parents perceived their children’s behaviors as having shifted systematically through the COVID-19 pandemic’s educational interruptions. The ongoing and ever-changing public health situation means that clinicians and others working directly with children and families should address not only the likely academic consequences of the COVID-19 pandemic, but also its consequences for children’s social, emotional, and behavioral well-being. JAMA 10 January 2022

Mortality among Care Home Residents in England during the first and second waves of the COVID-19 pandemic: an observational study of 4.3 million adults over the age of 65
COVID-19 has had a disproportionate impact on the mortality of care home residents in England compared to older residents of private homes, but only in the first wave. This may be explained by a degree of acquired immunity, improved protective measures or changes in the underlying frailty of the populations. The care home population should be prioritised for measures aimed at controlling COVID-19. The Lancet regional health Europe 8 January 2022

Atorvastatin versus placebo in patients with covid-19 in intensive care: randomized controlled trial
In adults with covid-19 admitted to the ICU, atorvastatin was not associated with a significant reduction in the composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or all cause mortality compared with placebo. Treatment was, however, found to be safe. As the overall event rates were lower than expected, a clinically important treatment effect cannot be excluded. BMJ 7 January 2022

Receipt of COVID-19 vaccine during pregnancy and preterm or small-for-gestational-age at birth — Eight integrated health care organizations, United States, December 15, 2020–July 22, 2021
These data support the safety of COVID-19 vaccination during pregnancy. CDC recommends COVID-19 vaccination for women who are pregnant, recently pregnant, who are trying to become pregnant now, or who might become pregnant in the future. CDC Mortality and morbidity weekly report 7 January 2022

False-positive results in Rapid Antigen Tests for SARS-CoV-2
The overall rate of false-positive results among the total rapid antigen test screens for SARS-CoV-2 was very low, consistent with other, smaller studies.3 The cluster of false-positive results from 1 batch was likely the result of manufacturing issues rather than implementation. These results inform the discussion of whether rapid antigen tests will result in too many false-positives that could overwhelm PCR testing capacity in other settings. JAMA 7 January 2022

SARS-CoV-2 antibody response to 2 or 3 doses of the BNT162b2 vaccine in patients treated with anticancer agents
The results of this cohort study appear to support the use of a third vaccine dose among patients with active cancer treatment for solid tumors. JAMA 7 January 2021

Comprehensive chemosensory psychophysical evaluation of self-reported gustatory dysfunction in patients with long-term COVID-19 : A cross-sectional study
It is widely believed that self-reported loss of taste can be an indirect consequence of retronasal olfactory dysfunction; indeed, the author’s study found that even when specifically asked about basic tastes, more than half of patients self-reporting an altered taste perception exhibited a normal gustatory function, while most of them had an olfactory impairment. However, 42% were found to have true hypogeusia. Following evaluation of the scores in relation to age, still 29% exhibited hypogeusia, which has largely been overlooked to date. While olfactory training may help the former group, additional strategies may be needed for those with gustatory impairment. JAMA 6 January 2022

Audio interview: Covid-19 — The outlook in Europe
In this audio interview conducted on January 4, 2022, the editors are joined by Berlin virologist Christian Drosten to discuss the situation in Europe, along with a new study of vaccine effectiveness against transmission of SARS-CoV-2. NEJM 6 January 2022

Evaluation of the BNT162b2 Covid-19 Vaccine in children 5 to 11 years of age
A Covid-19 vaccination regimen consisting of two 10-μg doses of BNT162b2 administered 21 days apart was found to be safe, immunogenic, and efficacious in children 5 to 11 years of age. NEJM 6 January 2022

VITT and second doses of Covid-19 vaccine
None of the 40 patients had any relapse of symptoms or severe adverse reactions after receiving the second dose of vaccine, regardless of the vaccine received. Although the mechanism of VITT is still not known,4 the absence of relapse suggests that the phenomenon is not related to the immune response to the spike protein. NEJM 6 January 2022

Lack of evidence of significant homology of SARS-CoV-2 spike sequences to myocarditis-associated antigens
The author’s results do not support the notion that increased occurrence of myocarditis after SARS-CoV-2-spike vaccination is mediated by a cross-reactive adaptive immune response. EBioMedicine 5 January 2021

Lack of evidence of significant homology of SARS-CoV-2 spike sequences to myocarditis-associated antigens
The author’s results do not support the notion that increased occurrence of myocarditis after SARS-CoV-2-spike vaccination is mediated by a cross-reactive adaptive immune response. EBioMedicine 5 January 2021

CRISPRi links COVID-19 GWAS loci to LZTFL1 and RAVER1
Patients with risk alleles of rs11385942 and rs74956615 may be susceptible to critical illness in COVID-19 in part through weakened airway viral clearance via LZTFL1-mediated ciliogenesis and diminished antiviral immune response via the MDA5/RAVER1 pathway, respectively.  EBioMedicine 5 January 2021

Effect of Covid-19 vaccination on transmission of Alpha and Delta variants
Vaccination was associated with a smaller reduction in transmission of the delta variant than of the alpha variant, and the effects of vaccination decreased over time. PCR Ct values at diagnosis of the index patient only partially explained decreased transmission.
NEJM 5 January 2022

Effect of influenza vaccination on risk of COVID-19 – A prospective cohort study of 46,000 health care workers
The purpose of this study was to assess if influenza vaccination has an impact on the risk of COVID-19. A cohort of 46,112 health care workers were tested for antibodies against SARS-CoV-2 and filled in a survey on COVID-19 symptoms, hospitalization, and influenza vaccination. The RR of hospitalization due to SARS-CoV-2 for influenza vaccinated compared with unvaccinated participants was 1.00 for the seasonal vaccination in 2019/2020 (CI 0.56-1.78, p=1.00). Likewise, no clinical effect of influenza vaccination on development of antibodies against SARS-CoV-2 was found. The present findings indicate that influenza vaccination does not affect the risk of SARS-CoV-2 infection or COVID-19. Journal of infectious diseases 5 January 2022

Association of birth during the COVID-19 Pandemic with neurodevelopmental status at 6 months in infants with and without In utero exposure to maternal SARS-CoV-2 infection
In this study, birth during the pandemic, but not in utero exposure to maternal SARS-CoV-2 infection, was associated with differences in neurodevelopment at age 6 months. These early findings support the need for long-term monitoring of children born during the COVID-19 pandemic. JAMA 4 January 2022

Feasibility of SARS-CoV-2 surveillance testing among children and childcare workers at German day care centers : A nonrandomized controlled trial
In this nonrandomized controlled trial, surveillance for SARS-CoV-2 in 9 German day care centers was feasible and well accepted. Mathematical modeling estimated that testing can minimize the spread of SARS-CoV-2 in day care centers. These findings enable setup of surveillance programs to maintain institutional childcare. JAMA 4 January 2022

Who should get the scarce ICU bed? The US public’s view on triage in the time of COVID-19
Respondents favoured giving the last ICU bed available to the patient with the highest probability of surviving COVID-19. Public opinion suggests a simple guideline for physician choices based on likelihood of survival as opposed to the number of life-years saved. There was heterogeneity among respondents of different age groups for allocating the last ICU bed, as well as to the importance of the patient having an Alzheimer’s-like disability (where religion of the respondent is important) and the gender of the patient (where the gender and racial identity are important). Emergency medicine journal 3 January 2021

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis—implications for public health communications in Australia
Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor’s recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates. BMJ open 3 January 2022

Serum levels of pro-inflammatory lipid mediators and specialised pro-resolving molecules are increased in SARS-CoV-2 patients and correlate with markers of the adaptive immune response
SARS-COV-2 infection was associated with increased levels of specialised pro-resolution molecules and other pro- and anti-inflammatory bioactive lipids, supporting the future investigation of the underlying enzymatic pathways, which may inform the development of novel treatments. Journal of infectious diseases 3 January 2022

Lung function decline in relation to COVID-19 in the general population: a matched cohort study with pre-pandemic assessment of lung function
COVID-19 related decline of dynamic lung volumes in the general population not requiring hospitalization were small but measurableJournal of infectious diseases 3 January 2022

SARS-CoV-2 variant exposures elicit antibody responses with differential cross-neutralization of established and emerging strains including Delta and Omicron
The wide spectrum of SARS-CoV-2 variants with phenotypes impacting transmission and antibody sensitivity necessitates investigation of the immune response to different spike protein versions. Here, we compare the neutralization of variants of concern, including B.1.617.2 (Delta) and B.1.1.529 (Omicron) in sera from individuals exposed to variant infection, vaccination, or both. We demonstrate that neutralizing antibody responses are strongest against variants sharing certain spike mutations with the immunizing exposure. We also observe that exposure to multiple spike variants increases the breadth of variant cross-neutralization. These findings contribute to understanding relationships between exposures and antibody responses and may inform booster vaccination strategies.
Journal of infectious diseases 3 January 2022

Comparison of patient characteristics and in-hospital mortality between patients with COVID-19 in 2020 and those with influenza in 2017–2020: a multicenter, retrospective cohort study in Japan
Patients hospitalised with COVID-19 in Japan were more likely to die than those with influenza. However, this was mainly driven by findings in older people, and there was no difference once mechanical ventilation was started. The Lancet regional health – Western Pacific 2 January 2022

The benefits, costs and feasibility of a low incidence COVID-19 strategy
In the summer of 2021, European governments removed most NPIs after experiencing prolonged second and third waves of the COVID-19 pandemic. Most countries failed to achieve immunization rates high enough to avoid resurgence of the virus. Public health strategies for autumn and winter 2021 have ranged from countries aiming at low incidence by re-introducing NPIs to accepting high incidence levels. However, such high incidence strategies almost certainly lead to the very consequences that they seek to avoid: restrictions that harm people and economies. At high incidence, the important pandemic containment measure ‘test-trace-isolate-support’ becomes inefficient. At that point, the spread of SARS-CoV-2 and its numerous harmful consequences can likely only be controlled through restrictions. We argue that all European countries need to pursue a low incidence strategy in a coordinated manner. Such an endeavour can only be successful if it is built on open communication and trust. The Lancet regional health – Europe 2 January 2022