Background: delirium affects up to 40% of older hospitalised patients, but there has been no systematic review focussing on risk factors for incident delirium in older medical inpatients. We aimed to synthesise data on risk factors for incident delirium and where possible conduct meta-analysis of these.Methods: PubMed and Web of Science databases were searched (January 1987–August 2013). Studies were quality rated using the Newcastle-Ottawa Scale. We used the Mantel–Haenszel and inverse variance method to estimate the pooled odds ratio (OR) or mean difference for individual risk factors.Results: eleven articles met inclusion criteria and were included for review. Total study population 2338 (411 patients with delirium/1927 controls). The commonest factors significantly associated with delirium were dementia, older age, co-morbid illness, severity of medical illness, infection, ‘high-risk’ medication use, diminished activities of daily living, immobility, sensory impairment, urinary catheterisation, urea and electrolyte imbalance and malnutrition. In pooled analyses, dementia (OR 6.62; 95% CI (confidence interval) 4.30, 10.19), illness severity (APACHE II) (MD (mean difference) 3.91; 95% CI 2.22, 5.59), visual impairment (OR 1.89; 95% CI 1.03, 3.47), urinary catheterisation (OR 3.16; 95% CI 1.26, 7.92), low albumin level (MD −3.14; 95% CI −5.99, −0.29) and length of hospital stay (OR 4.85; 95% CI 2.20, 7.50) were statistically significantly associated with delirium.Conclusion: we identified risk factors consistently associated with incident delirium following admission. These factors help to highlight older acute medical inpatients at risk of developing delirium during their hospital stay.

AimsFrontline health care workers exposed to COVID-19 patients could be at increased risk of developing psychological issues. The study aimed to estimate the prevalence of mental health-related problems, specifically depression, anxiety, post-traumatic stress disorder (PTSD), and insomnia among health care professionals during the COVID-19 pandemic in Bangladesh and to compare these between medical and allied health care professionals.MethodThis cross-sectional survey was conducted using Google Form then subsequent telephone interview between June and August 2020. Using random sampling, a total of 479 health care professionals participated in the study. We collected data on demographics. Anxiety and depression were measured using 4 items Patient Health Questionnaire-4 (PHQ-4), PTSD was measured using 4 items Primary Care (PC)-PTSD-Screen, and insomnia was measured by using a 7-item Insomnia Severity Index (ISI). A multivariable logistic regression analysis was performed to assess risk factors associated with mental health symptoms.ResultOverall, 17.6% of frontline health workers had symptoms of anxiety, 15.5% had depression symptoms, 7.6% had PTSD symptoms and 5.9% had symptoms of insomnia. Compared to allied health professionals (n = 113, 24%), doctors (n = 366, 76%) had significantly higher prevalence of anxiety: 21.1% vs 06%, (OR = 4.19; 95% CI = 1.88–9.35; p-value <0.001); depression: 18% vs 6.8%, (OR = 2.99; 95% CI = 1.40–6.42; p-value 0.005); PTSD: 9.4% vs 1.7%, (OR = 5.96; 95% CI = 1.41–25.11; p-value 0.015) and insomnia: 7.4% vs 0.9%, (OR = 9.22; 95% CI = 1.24–68.4; p-value 0.03). Logistic regression analysis showed that pre-existing medical illness has significantly more risks of developing symptoms of anxiety (adjusted OR = 2.85; 95% CI = 1.71–4.76; p-value <0.001) and depression (OR = 2.29; 95% CI = 1.39–3.77; p-value 0.001). Having a postgraduate degree (adjusted OR = 6.13; 95% CI = 1.28–29.28; p-value 0.023) and working in secondary care setting (adjusted OR = 3.08; 95% CI = 1.18–8.02; p value 0.021) have significant predictors of developing anxiety symptoms among health workers. Those who had worked more than 6 weeks in COVID-19 dedicated hospitals had risk of developing symptoms of PSTD (OR = 2.83; 95% CI = 1.35–5.93; p value 0.006) and insomnia (OR = 2.63; 95% CI = 1.15–6.02; p value 0.022).ConclusionOur study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers (particularly among doctors) during the COVID-19 pandemic. There is an urgent need to address the mental health needs of frontline health workers.Funding: Medical Research Council, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.

The Covid-19 pandemic and associated lockdown has disrupted mental well-being of individual. A number of studies provide evidence that lockdown is associated with higher level of stress and anxiety that contribute to deteriorating mental wellbeing of individuals. The general conclusion of those studies is unidirectional meaning more lockdown days lead to more deterioration of mental health. However, resilience argument state that if people get more time with families and loved ones, their resilience level will improve and as a result mental wellbeing improves as well. As lockdown brings the opportunity to spend more time with families, this study hypothesise that mental health gets affected at the early days of lockdown but starts to improve at a later stage. Using data from UK household longitudinal data and adopting appropriate statistical tests, this study finds that the relationship between lockdown days and mental health is U-shaped, meaning that mental health becomes worse in the early days of lockdown but improves at a later stage. We have found that mental health starts improving after 54 days since the start of lockdown for the full sample. The results also indicate that females adopt much quicker that males. The average time females take to recover is 34.4 days whereas males take 75 days to recover.

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This study aimed to estimate the prevalence of depression, anxiety, post-traumatic stress disorder, and insomnia symptoms among frontline health workers during the corona virus disease 19 (COVID-19) pandemic in Bangladesh and to compare these between medical and allied health workers. We conducted a cross-sectional survey between June and August 2020. A total of 479 health care professionals participated in the study. Anxiety and depression were measured using Patient Health Questionnaire-4 (PHQ-4), post-traumatic stress disorder (PTSD) was measured by primary care post-traumatic stress disorder score (PC-PTSD score), and insomnia was measured by Insomnia Severity Index (ISI). We performed logistic regression to assess risk factors associated with psychological symptoms. Overall, prevalence of anxiety, depression, PTSD and insomnia symptoms were 17.6%, 15.5%, 7.6% and 5.9%, respectively. Compared to allied health workers, doctors had significantly higher prevalence of symptoms of anxiety: doctor versus allied health care worker; 21.1% vs 06%, (OR= 4.19; 95% CI= 1.88-9.35; p <0.001); depression: 18% vs 6.8%, (OR= 2.99; 95% CI= 1.40-6.42; p 0.005); PTSD: 9.4% vs 1.7%, (OR= 5.96; 95% CI= 1.41-25.11; p 0.015) and insomnia: 7.4% vs 0.9%, (OR= 9.22; 95% CI= 1.24-68.4; p 0.03),respectively. The logistic regression analysis showed pre-existing medical illness as a predictor of anxiety (OR= 2.85; 95% CI= 1.71-4.76; p <0.001) and depressive symptoms (OR= 2.29; 95% CI= 1.39-3.77; p 0.001). Working more than 6(six) weeks in COVID-19 dedicated hospitals was significantly associated with PSTD symptoms (OR= 2.83; 95% CI= 1.35-5.93; p 0.006) and insomnia (OR= 2.63; 95% CI= 1.15-6.02; p 0.022). Our study demonstrated a high prevalence of symptoms of depression, anxiety, PTSD, and insomnia among Bangladeshi frontline health workers during the COVID-19 pandemic. BSMMU J 2021; 14 (COVID -19 Supplement): 22-29