This is the accepted version of the paper.This version of the publication may differ from the final published version. Abstract Aims: This review explores the quality of life of adult congenital heart disease patients and the relationship between disease severity and quality of life. Methods: We searched seven electronic databases and the bibliography of articles. The 31 selected studies fulfilled the following criteria: adult population; quantitative; assessment of quality of life and/or impact of disease severity on quality of life using validated measures; English language. Data extraction forms were used to summarise the results. Results: There are evident methodological limitations within the reviewed studies such as heterogeneous populations, designs, and quality of life conceptualisations and measurements. Despite these problems, findings suggest that the quality of life of adult congenital heart disease patients is compromised in the physical domain compared with their healthy counterparts, whereas no differences were found in relation to the psychosocial and environmental/occupational domain. Some severity variables appear to be significant correlates of quality of life and could be considered in a future standardised classification of disease severity. Conclusion: The methodological limitations of past research in relation to the definition and measurement of quality of life, the study designs, and disease severity classifications need to be addressed in future studies in order to provide robust evidence and valid conclusions in this area of study. This will enable the development of targeted interventions for the improvement of quality of life in the adult population of congenital heart disease patients. Permanent repository linkKeywords: Quality of life; congenital heart disease; adult; adults with congenital heart disease; GUCH; severity Received: 16 October 2012; Accepted: 9 December 2012 A PPROXIMATELY EIGHT IN 1000 CHILDREN ARE born with congenital heart disease, with approximately two-thirds requiring treatment. Owing to advances in treatment, ,90% are now expected to survive into adulthood compared with 20% 50 years ago.1 This has resulted in an estimated current population of 135,000 adult congenital heart patients in England. 2 Traditionally, the outcome in congenital heart disease has been measured in terms of mortality and functional status. There is an increasing recognition that reliance on clinical measures in determining outcomes is not sufficient as it fails to capture the patients' perspective. 3 Consequently, interest has turned to examining the quality of life of adult congenital heart disease patients. Although a universally accepted definition of quality of life does not exist, it is usefully conceptualised in three broad domains, namely, physical, psychosocial, and environmental.Research suggests that adult patients with congenital heart disease, like other patients with chronic conditions, are faced with physical health issues and psychosocial challenges. 4 A clear perspective o...

Aims and objectivesThis study aimed to examine the psychosocial impact and identify risk factors for poor psychosocial outcomes in healthcare professionals during the Coronavirus disease 2019 (COVID‐19) pandemic in Cyprus.BackgroundHealthcare professionals are in the forefront of the COVID‐19 pandemic facing an unprecedented global health crisis, which can have consequences on their psychosocial health. There is a need to identify risk factors for poor psychosocial outcomes to inform the design of tailored psychological interventions.DesignCross‐sectional online study.MethodsA total of 1071 healthcare professionals completed self‐report questionnaires. Measures included sociodemographic information, COVID‐19‐related characteristics, quality of life (Brief World Health Organization Quality of Life; WHOQOL‐Bref), anxiety (Generalized Anxiety Disorder‐7; GAD‐7), depression (Patient Health Questionnaire‐8; PHQ‐8), occupational burnout (Copenhagen Burnout Inventory; CBI), and coping (Brief Coping Orientation to Problems Experienced; Brief COPE). This article follows the STROBE reporting guidelines.ResultsThe prevalence of moderate to severe anxiety and clinically significant depression was 27.6% and 26.8%, respectively. Significant risk factors for poor psychological outcomes included being female, being a nurse or doctor (vs non‐medical professional), working in frontline units (inpatient, intensive care), perceptions of inadequate workplace preparation to deal with the pandemic, and using avoidance coping. Depression and occupational burnout were significant risk factors for poor quality of life.ConclusionThe findings suggest several individual, psychosocial, and organisational risk factors for the adverse psychological outcomes observed in healthcare professionals during the COVID‐19 pandemic.Relevance to clinical practiceThis study highlights the urgent need for screening for anxiety and depression and psychological interventions to combat an imminent mental health crisis in healthcare professionals during the COVID‐19 pandemic. Pandemic response protocols and public health initiatives aiming to improve and prevent mental health problems in healthcare professionals during the current and future health crises, need to account for the various factors at play.

This is the accepted version of the paper.This version of the publication may differ from the final published version. Tel No: +44 207 040 5767, Fax No: +44 207 0408750 Email: Stanton.newman.1@city.ac.uk Word Count: 3,215(excluding title page, abstract, key questions, references, figures, tables). Permanent repository linkKey Words: Adult Congenital Heart Disease, Cognition, Neuropsychological assessment, Mood 3 ABSTRACT ObjectiveA cross-sectional study assessed cognitive function in a sample of Adult Congenital Heart Disease patients, within the Functioning in Adult Congenital Heart Disease study London. The association between cognitive functioning and disease complexity was examined. MethodsThree hundred and ten patients participated. Patients were classified into four structural complexity groups (Tetralogy of Fallot, Transposition of the Great Arteries, Single Ventricle and Simple conditions). Each participant underwent neuropsychological assessment to evaluate cognitive function (memory, executive function) and completed questionnaires to assess depression and anxiety. ResultsForty one percent of the sample showed impaired performance (>1.5 SD below the normative mean) on at least 3 tests of cognitive function compared to established normative data. This was higher than the 8% that would be expected in a normal population. The sample exhibited significant deficits in divided attention, motor function and executive functioning. There was a significant group difference in divided attention (F=5.01, p=.002) and mean total composite score (F=5.19, p=.002) between different structural complexity groups with the Simple group displaying better cognitive function. ConclusionThe results indicate that many Adult Congenital Heart Disease patients display impaired cognitive function relative to a healthy population, which differs in relation to disease complexity. These findings may have implications for clinical decision making in this group of patients during childhood. Possible mechanisms underlying these deficits and how they may be 4 reduced or prevented are discussed; however further work is needed to draw conclusive judgments.