COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is highly transmissible, with a high mortality in vulnerable individuals and no known disease-specific treatment or vaccine. [1] On 11 March 2020, the World Health Organization (WHO) declared the COVID-19 outbreak to be a pandemic, making global recommendations to reduce transmission, prepare and be ready. [2] As anticipated, it continued to spread and is now prevalent in South Africa (SA) and other African countries, [1] putting healthcare systems under severe pressure.Healthcare workers (HCWs) are the most important resource in both the COVID-19 response and in maintaining essential services. [3] HCW motivation and empathy are critical to effective and compassionate healthcare. Mental health conditions may compromise work performance and increase risk of burnout, absenteeism and resignations. [4,5] Fatigue, emotional exhaustion or poor concentration are likely to increase clinical error, including breaches in infection control, impacting on patient care and staff infections. Protecting the mental health and wellbeing of HCWs is therefore of paramount importance during an infectious disease outbreak.Such outbreaks cause high levels of psychosocial stress, [6] related to uncertainty regarding risk of infection and prognosis, loss of loved ones, and the social impact of measures instituted to contain the spread of disease. Being at the frontline in disease detection and management, HCWs are vulnerable, exposed to infection, high workloads and difficult working conditions. Resource constraints, including shortages of personal protective equipment (PPE), limit individual capacity to provide appropriate patient care and heighten the mental health risk. Being quarantined appears to convey particular stress. [7] The Gauteng Province Department of Health's research and evaluation workstream therefore requested evidence-based recommendations regarding the potential impact of the COVID-19 pandemic on the mental health of HCWs and their protection. This article describes the process behind, and builds upon, a presentation made to the senior leadership of the Gauteng Department of Health's COVID-19 response team in April 2020, for which we sought to answer two questions: (i) what may be expected regarding the psychological impact of the COVID-19 outbreak on HCWs; and (ii) what interventions could be considered in order to protect and support the mental health and wellbeing of HCWs during the crisis. MethodsWe conducted a rapid scoping review of published literature on mental health of HCWs exposed to infectious disease outbreaks. Literature search and study selectionTo gain an understanding of the topic, we conducted a preliminary search and screen of the PubMed and Cochrane databases on 7 and 8 April 2020, respectively, using terms (healthcare workers OR medical doctors OR nurses OR community health workers) AND This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

There are significant challenges in studying people with intellectual disabilities and considerable difficulties in instituting phenylalanine-restricted diet in this population. However, if attempted, there are potential benefits to quality of life for the individuals with PKU and their carers.

We aimed to examine the relationship between physical activity (PA) and change in body weight and cardiorespiratory fitness (CRF) in severely obese men and women. Thirty-five subjects (10 men, body mass index 43.2 ± 5.1 kg/m2) who participated in a 10-month lifestyle treatment programme were included. The PA duration correlated only with weight change for men (r = −0.69, P = .027 versus r = −0.19, P = .372 for women). Conversely, the PA intensity correlated only with CRF for women (r = 0.61, P = .003 versus r = 0.39, P = .340 for men). PA explained 55.8 and 5.6% of weight change for men and women, respectively, whereas the corresponding explained variances for CRF were 15.6 and 36.7%. We conclude that PA was associated with change in body weight and CRF; however, there was a trend towards a gender specific effect between severely obese men and women.

The level of expressed emotion (EE) in 32 relationships between relatives and schizophrenic patients was assessed on three separate occasions over five years. EE was high on all three occasions in 25% of relatives, low on all three in 38%, and fluctuating in 38%; that is, in the majority of relatives (63%) the level of EE was stable over time. Three relatives who had previously shown high EE had evidence of dementia at the time of the third assessment, and showed low EE. Fourteen patients relapsed at least once over five years; patients who relapsed were evenly spread throughout those living in a home in which EE was consistently high, consistently low, or fluctuating. However, patients living in low-EE homes who did relapse did so significantly less often than those who relapsed and were living in homes in which EE was high or fluctuating. At the time of relapse, EE was not consistently high, and some patients in consistently high-EE homes did not relapse at all over five years.

Obstetric histories of 54 schizophrenic patients and 114 siblings were obtained from their mothers and scored using the Obstetric Complications Scale. There were no statistically significant difference in the proportion of schizophrenic patients (35%) and siblings (29%) who had at least one definite obstetric complication. There was no evidence that schizophrenic patients with a history of obstetric complications were less likely to have a first-degree relative with a history of psychiatric illness leading to in-patient care. Schizophrenic patients with a history of obstetric complications were more likely to have drug-induced Parkinsonism. There was a trend for tardive dyskinesia to be more common in those schizophrenic patients with no obstetric complications but a family history of schizophrenia.

Of all known schizophrenics living in Nithsdale, south-west Scotland, 146 (88%) were examined for the presence of the three principal movement disorders secondary to antipsychotic medication, namely akathisia, tardive dyskinesia and Parkinsonism. Of these, 18% had akathisia, 5% pseudoakathisia, 29% tardive dyskinesia, 8% persistent tardive dyskinesia, and 27% Parkinsonism. No movement disorder was seen in 445, 36% had one and 20% had more than one movement disorder. Plasma neuroleptic levels at the time of clinical assessment were measured by the radioreceptor technique. Correlations between dose and plasma level were low; the ratio of mean plasma concentration to mean dose was greatest with fluphenazine decanoate and lowest for sulpiride. The concentration:dose ratio was higher in the elderly. There was no relationship between neuroleptic levels and akathisia, Parkinsonism or tardive dyskinesia. Additional psychotropic medication influenced neuroleptic levels. In 9% of patients receiving oral antipsychotic medication, no drug was detected in plasma.

It is unknown how changes in physical activity may affect changes in quality of life (QoL) outcomes during lifestyle interventions for severely obese adults. The purpose of this study was to examine associations in the patterns of change between objectively assessed physical activity as the independent variable and physical, mental, and obesity-specific QoL and life satisfaction as the dependent variables during a two-year lifestyle intervention. Forty-nine severely obese adults (37 women; 43.6 ± 9.4 years; body mass index 42.1 ± 6.0 kg/m2) participated in the study. Assessments were conducted four times using Medical Outcomes Study Short-Form 36 Health Survey (SF-36), Obesity-Related Problems (OP) scale, a single item on life satisfaction, and accelerometers. The physical component summary (PCS) score and the mental component summary (MCS) score were used as SF-36 outcomes. Associations were determined using linear regression analyses and reported as standardized coefficients (stand. coeff.). Change in physical activity was independently associated with change in PCS (stand. coeff. = 0.35, P = .033), MCS (stand. coeff. = 0.51, P = .001), OP (stand. coeff. = −0.31,  P = .018), and life satisfaction (stand. coeff. = 0.39, P = .004) after adjustment for gender, age, and change in body mass index.

Some people with phenylketonuria who were born before screening began were never treated and are still alive. Here we report that far fewer people with untreated phenylketonuria were detected than are thought to exist (about 2000). The majority of those traced had high support needs, challenging behaviour and other symptoms of phenylketonuria. No significant differences were found between those who had or had not tried the phenylalanine-restricted diet. A randomised controlled trial is required to examine the effect of trying the low-phenylalanine diet for people with untreated phenylketonuria.