The impact of COVID-19 pandemic on family caregivers' mental health: a rapid systematic review of the current evidence

BACKGROUND AND AIM OF THE WORK

Older adults, especially in isolation and with cognitive decline/dementia, can become more anxious and stressed during the quarantine. All these symptoms negatively affect the psycho-physical health of their caregivers. This study aimed to synthesize the current evidence on the impact of the COVID-19 pandemic on caregivers' mental health.

METHODS

A rapid systematic review was conducted using the following databases: Pubmed/Medline, CINAHL, Scopus, and PsycInfo (PROSPERO registration number: CRD42020215485). The 'PRISMA' flow chart guided the selection of articles. The search was entirely performed up to September 15th, 2021.

RESULTS

The narrative synthesis has brought out two main themes that represent the current debate in literature: "Family caregivers COVID-19 related stress", and "(Mal)adaptive strategies to the "new" normality".

CONCLUSIONS

This study provides an evidence synthesis of the negative mental health impact experienced by caregivers of older adults during the COVID-19 pandemic.

Maternal mortality in the covid-19 pandemic: findings from a rapid systematic review

Background

The COVID-19 pandemic is having significant direct and associated effects on many health outcomes, including maternal mortality. As a useful marker of healthcare system functionality, trends in maternal mortality provide a lens to gauge impact and inform mitigation strategies.

Objective

To report the findings of a rapid systematic review of studies on levels of maternal mortality before and during the COVID-19 pandemic.

Methods

We systematically searched for studies on the 1st March 2021 in MEDLINE and Embase, with additional studies identified through MedRxiv and searches of key websites. We included studies that reported levels of mortality in pregnant and postpartum women in time-periods pre- and during the COVID-19 pandemic. The maternal mortality ratio was calculated for each study as well as the excess mortality.

Results

The search yielded 3411 references, of which five studies were included in the review alongside two studies identified from grey literature searches. Five studies used data from national health information systems or death registries (Mexico, Peru, Uganda, South Africa, and Kenya), and two studies from India were record reviews from health facilities. There were increased levels of maternal mortality documented in all studies; however, there was only statistical evidence for a difference in maternal mortality in the COVID-19 era for four of these. Excess maternal mortality ranged from 8.5% in Kenya to 61.5% in Uganda.

Conclusions

Measuring maternal mortality in pandemics presents many challenges, but also essential opportunities to understand and ameliorate adverse impact both for women and their newborns. Our systematic review shows a dearth of studies giving reliable information on levels of maternal mortality, and we call for increased and more systematic reporting of this largely preventable outcome. The findings help to highlight four measurement-related issues which are priorities for continuing research and development.

The Impact of COVID-19 School Closure on Child and Adolescent Health: A Rapid Systematic Review

School closures during pandemics raise important concerns for children and adolescents. Our aim is synthesizing available data on the impact of school closure during the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent health globally. We conducted a rapid systematic review by searching PubMed, Embase, and Google Scholar for any study published between January and September 2020. We included a total of ten primary studies. COVID-19-related school closure was associated with a significant decline in the number of hospital admissions and pediatric emergency department visits. However, a number of children and adolescents lost access to school-based healthcare services, special services for children with disabilities, and nutrition programs. A greater risk of widening educational disparities due to lack of support and resources for remote learning were also reported among poorer families and children with disabilities. School closure also contributed to increased anxiety and loneliness in young people and child stress, sadness, frustration, indiscipline, and hyperactivity. The longer the duration of school closure and reduction of daily physical activity, the higher was the predicted increase of Body Mass Index and childhood obesity prevalence. There is a need to identify children and adolescents at higher risk of learning and mental health impairments and support them during school closures.

The current status of studies of human exposure assessment of microplastics and their health effects: a rapid systematic review

This rapid systematic review aims to summarize studies of human exposure to microplastics (MPs) and their health effects. For the systematic literature review, we separately searched for review articles and original articles published from 2000 to 2019 in the PubMed, NDSL, KMBASE, and Cochrane databases. A total of 276 review articles and 475 original articles were independently evaluated and eligibility of each article was assessed by two researchers. Finally, 8 review articles and 13 original articles were selected for analysis. There was no standardized methodology for determining human exposure to MPs. Therefore, the size, shape, color, and chemical composition of MPs were considered as factors that affected human exposure to MP. We ascertained that human exposure to MPs occurs through two major routes: inhalation and ingestion. The general population can be exposed to MPs through the food chain, food, and mineral water. Thus, there are multiple scenarios for the exposure process. The only exposure marker in humans is the detection and measurement of MPs in feces. Health effects of human exposure to MPs include respiratory effects from inhalation, digestive effects from ingestion, oxidative stress, and cancer. However, there are few studies of the effects of MP exposure in the general population. Based on a systematic review, we propose a standardized methodology to identify various exposure scenarios to facilitate studies of human exposure to MPs and their health effects.

Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis

This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians' chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada's single payer system ought to be maintained and strengthened, but not through privatization.

Profound health-care discrimination experienced by transgender people: rapid systematic review

Transgender people experience interpersonal and structural barriers which prevent them from accessing culturally and medically competent health care. This rapid systematic review examined the prevalence of health-care discrimination among transgender people in the U.S. and drew comparisons with sexual minority samples and the general U.S. population. Eight primary studies with 35 prevalence estimates were analyzed. Transgender populations experience profound rates of discrimination within the U.S. health-care system. Compared to sexual minorities, transgender participants appear to be more compromised in their access to health care. Service providers must change structural inequities which contribute to transgender people's invisibility.