RESUMO
Respiratory infections are common causes of acute exacerbation of chronic obstructive lung disease (AECOPD). We explored whether the pathogens causing AECOPD and clinical features changed from before to after the coronavirus disease 2019 (COVID-19) outbreak. We reviewed the medical records of patients hospitalized with AECOPD at four university hospitals between January 2017 and December 2018 and between January 2021 and December. We evaluated 1180 patients with AECOPD for whom medication histories were available. After the outbreak, the number of patients hospitalized with AECOPD was almost 44% lower compared with before the outbreak. Patients hospitalized with AECOPD after the outbreak were younger (75 vs. 77 years, p = 0.003) and more often stayed at home (96.6% vs. 88.6%, p < 0.001) than patients of AECOPD before the outbreak. Hospital stay was longer after the outbreak than before the outbreak (10 vs. 8 days. p < 0.001). After the COVID-19 outbreak, the identification rates of S. pneumoniae (15.3 vs. 6.2%, p < 0.001) and Hemophilus influenzae (6.4 vs. 2.4%, p = 0.002) decreased, whereas the identification rates of P. aeruginosa (9.4 vs. 13.7%, p = 0.023), Klebsiella pneumoniae (5.3 vs. 9.8%, p = 0.004), and methicillin-resistant Staphylococcus aureus (1.0 vs. 2.8%, p = 0.023) increased. After the outbreak, the identification rate of influenza A decreased (10.4 vs. 1.0%, p = 0.023). After the outbreak, the number of patients hospitalized with AECOPD was lower and the identification rates of community-transmitted pathogens tended to decrease, whereas the rates of pathogens capable of chronic colonization tended to increase. During the period of large-scale viral outbreaks that require quarantine, patients with AECOPD might be given more consideration for treatment against strains that can colonize chronic respiratory disease rather than community acquired pathogens.
Assuntos
COVID-19 , Hospitalização , Doença Pulmonar Obstrutiva Crônica , Humanos , COVID-19/epidemiologia , COVID-19/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , SARS-CoV-2/isolamento & purificação , Pessoa de Meia-Idade , Pandemias , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/virologia , Progressão da Doença , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação , Streptococcus pneumoniae/patogenicidade , Haemophilus influenzae/isolamento & purificaçãoRESUMO
BACKGROUND: Prior to September 2021, 55,000-90,000 hospital inpatients in England were identified as having a potentially nosocomial SARS-CoV-2 infection. This includes cases that were likely missed due to pauci- or asymptomatic infection. Further, high numbers of healthcare workers (HCWs) are thought to have been infected, and there is evidence that some of these cases may also have been nosocomially linked, with both HCW to HCW and patient to HCW transmission being reported. From the start of the SARS-CoV-2 pandemic interventions in hospitals such as testing patients on admission and universal mask wearing were introduced to stop spread within and between patient and HCW populations, the effectiveness of which are largely unknown. MATERIALS/METHODS: Using an individual-based model of within-hospital transmission, we estimated the contribution of individual interventions (together and in combination) to the effectiveness of the overall package of interventions implemented in English hospitals during the COVID-19 pandemic. A panel of experts in infection prevention and control informed intervention choice and helped ensure the model reflected implementation in practice. Model parameters and associated uncertainty were derived using national and local data, literature review and formal elicitation of expert opinion. We simulated scenarios to explore how many nosocomial infections might have been seen in patients and HCWs if interventions had not been implemented. We simulated the time period from March-2020 to July-2022 encompassing different strains and multiple doses of vaccination. RESULTS: Modelling results suggest that in a scenario without inpatient testing, infection prevention and control measures, and reductions in occupancy and visitors, the number of patients developing a nosocomial SARS-CoV-2 infection could have been twice as high over the course of the pandemic, and over 600,000 HCWs could have been infected in the first wave alone. Isolation of symptomatic HCWs and universal masking by HCWs were the most effective interventions for preventing infections in both patient and HCW populations. Model findings suggest that collectively the interventions introduced over the SARS-CoV-2 pandemic in England averted 400,000 (240,000 - 500,000) infections in inpatients and 410,000 (370,000 - 450,000) HCW infections. CONCLUSIONS: Interventions to reduce the spread of nosocomial infections have varying impact, but the package of interventions implemented in England significantly reduced nosocomial transmission to both patients and HCWs over the SARS-CoV-2 pandemic.
Assuntos
COVID-19 , Infecção Hospitalar , Pessoal de Saúde , SARS-CoV-2 , Humanos , COVID-19/transmissão , COVID-19/prevenção & controle , COVID-19/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Inglaterra/epidemiologia , Simulação por Computador , Controle de Infecções/métodos , Medicina Estatal , Máscaras/estatística & dados numéricosRESUMO
BACKGROUND: Lockdowns have been implemented to limit the number of hospitalisations and deaths during the first wave of 2019 coronavirus disease. These measures may have affected differently death characteristics, such age and sex. France was one of the hardest hit countries in Europe with a decreasing east-west gradient in excess mortality. This study aimed at describing the evolution of age at death quantiles during the lockdown in spring 2020 (17 March-11 May 2020) in the French metropolitan regions focusing on 3 representatives of the epidemic variations in the country: Bretagne, Ile-de-France (IDF) and Bourgogne-Franche-Comté (BFC). METHODS: Data were extracted from the French public mortality database from 1 January 2011 to 31 August 2020. The age distribution of mortality observed during the lockdown period (based on each decile, plus quantiles 1, 5, 95 and 99) was compared with the expected one using Bayesian non-parametric quantile regression. RESULTS: During the lockdown, 5457, 5917 and 22 346 deaths were reported in Bretagne, BFC and IDF, respectively. An excess mortality from + 3% in Bretagne to + 102% in IDF was observed during lockdown compared to the 3 previous years. Lockdown led to an important increase in the first quantiles of age at death, irrespective of the region, while the increase was more gradual for older age groups. It corresponded to fewer young people, mainly males, dying during the lockdown, with an increase in the age at death in the first quantile of about 7 years across regions. In females, a less significant shift in the first quantiles and a greater heterogeneity between regions were shown. A greater shift was observed in eastern region and IDF, which may also represent excess mortality among the elderly. CONCLUSIONS: This study focused on the innovative outcome of the age distribution at death. It shows the first quantiles of age at death increased differentially according to sex during the lockdown period, overall shift seems to depend on prior epidemic intensity before lockdown and complements studies on excess mortality during lockdowns.
Assuntos
COVID-19 , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , França/epidemiologia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Adulto , Adolescente , Adulto Jovem , Idoso de 80 Anos ou mais , Lactente , Criança , Pré-Escolar , Quarentena , Distribuição por Idade , Mortalidade/tendências , Recém-Nascido , Fatores Etários , Teorema de Bayes , Controle de Doenças Transmissíveis/métodos , SARS-CoV-2RESUMO
BACKGROUND: Increased working from home has imposed new challenges on public service employees, while also granting opportunities for job crafting. Grounding on the Job Demands-Resources model and Hobfoll's Conservation of Resources theory this exploratory research aims to investigate the work-nonwork balance of employees one and a half years after the outbreak of the COVID-19 pandemic. Therefore, the research focus lies on employees' job crafting strategies to optimize their working from home experience concerning boundary management and energy resource management. METHODS: Twelve semi-structured telephone interviews were conducted with public service employees from different sectors in Germany. The experiences were content analyzed using the software MaxQDA and inductive and deductive categories were derived. RESULTS: Boundary management comprised different strategies such as communicative (e.g., negotiating work time), physical (e.g., going to the garden), temporal (e.g., logging off in between the work day) and behavioral (e.g., prioritizing tasks) strategies. The job crafting strategies regarding energy management included preventing exhaustion (e.g. taking breaks), healthy cooking and energy management in case of sickness (e.g. deciding on sick leave). CONCLUSIONS: This qualitative case study enriches research on job crafting by offering insights on boundary tactics and energy resources management strategies for remote working during the COVID-19 pandemic. The results point out different starting points for employees and decision makers, how a work-nonwork balance, energy management and thus employees' wellbeing may be increased when working from home in the future. TRIAL REGISTRATION: The study design and methodology were approved by the Ethics Committee of the University of Cologne and the study was prospectively registered (Ref No. 21-1417_1).
Assuntos
COVID-19 , Pesquisa Qualitativa , Humanos , COVID-19/epidemiologia , Masculino , Adulto , Feminino , Alemanha , Pessoa de Meia-Idade , Teletrabalho , Entrevistas como Assunto , Setor Público , SARS-CoV-2RESUMO
BACKGROUND: Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany. METHODS: Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions. RESULTS: Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students). CONCLUSIONS: Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.
Assuntos
Adaptação Psicológica , COVID-19 , Tocologia , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Alemanha/epidemiologia , Feminino , Estudos Transversais , Adulto , Estudantes de Enfermagem/psicologia , SARS-CoV-2 , Pandemias , Inquéritos e Questionários , Adulto Jovem , Estresse Psicológico/epidemiologia , Masculino , Capacidades de EnfrentamentoRESUMO
BACKGROUND: The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders' behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care. METHODS: We tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale's internal consistency through Cronbach's alpha, and associations between leadership scales and staff outcomes through odds ratios. RESULTS: There were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) "task-oriented leadership" and (2) "person-oriented leadership", and select staff outcomes of (3) "commitment to sustaining change" and (4) "performance self-evaluation". Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes. CONCLUSION: The CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.
Assuntos
COVID-19 , Liderança , Atenção Primária à Saúde , Humanos , COVID-19/epidemiologia , Atenção Primária à Saúde/organização & administração , Ontário , Feminino , Masculino , Adulto , Inquéritos e Questionários , SARS-CoV-2 , Pandemias , Pessoa de Meia-Idade , Pessoal de Saúde/psicologiaRESUMO
BACKGROUND: Stroke is among the top contributors to disability and can impact an individual's cognition, physical functioning, and mental health. Since the COVID-19 pandemic, several community-based organizations have started delivering stroke programs virtually. However, participants' experiences in these programs remain understudied, and evidence-based guidelines to inform and optimize virtual stroke program development and delivery are lacking. Thus, this study aimed to describe the perspectives and experiences of individuals with stroke who participated in virtual community-based organization stroke programs, including perceived access and participation facilitators and barriers and suggestions for improving these programs. METHODS: A qualitative descriptive design was used to gather participant experiences through semi-structured interviews. Audio-recorded interviews were conducted on Zoom and transcribed verbatim. Adult participants who had experienced a stroke and attended at least one Canadian virtual community-based organization stroke program were recruited. Data were analyzed using inductive thematic analysis. RESULTS: Twelve participants (32-69 years, 2-23 years post-stroke, eight women and four men) participated in this study. Five themes were identified: (1) motives to join virtual community-based organization stroke programs, including gaining peer connections, knowledge and information; (2) perceived barriers to accessing and participating in virtual community-based organization stroke programs, including technology inequities, difficulties navigating technology, and inadequate facilitation; (3) perceived facilitators to accessing and participating in virtual community-based organization stroke programs, including remote access, virtual platform features and program leader characteristics/skills; (4) unmet needs during virtual community-based organization stroke programs, including in-person connection and individualized support; and (5) suggestions and preferences for improving virtual community-based organization stroke programs, including program facilitation, content and format. CONCLUSIONS: Study findings highlight opportunities to improve virtual community-based organization stroke programs to optimize participant experiences and outcomes. Addressing the barriers and suggestions identified in this study may improve virtual community-based organization stroke programs' access and quality.
Assuntos
COVID-19 , Pesquisa Qualitativa , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Acidente Vascular Cerebral/psicologia , COVID-19/epidemiologia , Canadá , SARS-CoV-2 , Telemedicina/métodosRESUMO
BACKGROUND: SARS-CoV-2 mRNA vaccines are highly immunogenic in people living with HIV (PLWH) on effective antiretroviral therapy (ART). However, whether viro-immunologic parameters or other factors affect immune responses to vaccination is debated. This study aimed to develop a machine learning-based model able to predict the humoral response to mRNA vaccines in PLWH and to assess the impact of demographic and clinical variables on antibody production over time. METHODS: Different machine learning algorithms have been compared in the setting of a longitudinal observational study involving 497 PLWH, after primary and booster SARS-CoV-2 mRNA vaccination. Both Generalized Linear Models and non-linear Models (Tree Regression and Random Forest) were trained and tested. RESULTS: Non-linear algorithms showed better ability to predict vaccine-elicited humoral responses. The best-performing Random Forest model identified a few variables as more influential, within 39 clinical, demographic, and immunological factors. In particular, previous SARS-CoV-2 infection, BMI, CD4 T-cell count and CD4/CD8 ratio were positively associated with the primary cycle immunogenicity, yet their predictive value diminished with the administration of booster doses. CONCLUSIONS: In the present work we have built a non-linear Random Forest model capable of accurately predicting humoral responses to SARS-CoV-2 mRNA vaccination, and identifying relevant factors that influence the vaccine response in PLWH. In clinical contexts, the application of this model provides promising opportunities for predicting individual vaccine responses, thus facilitating the development of vaccination strategies tailored for PLWH.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Infecções por HIV , Imunidade Humoral , Imunização Secundária , Aprendizado de Máquina , SARS-CoV-2 , Humanos , Masculino , Feminino , Infecções por HIV/imunologia , Pessoa de Meia-Idade , COVID-19/imunologia , COVID-19/prevenção & controle , SARS-CoV-2/imunologia , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Vacinação , Adulto , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Vacinas de mRNA , Estudos Longitudinais , RNA Mensageiro/genética , RNA Mensageiro/metabolismoRESUMO
BACKGROUND: The COVID-19 pandemic has presented multiple psychological challenges for healthcare workers, such as anxiety, depression, burnout, and substance use disorders. In this research, we investigate the different ways Romanian physicians dealt with the difficult period of the COVID-19 pandemic. We also analyze how positive and negative stress-reducing strategies, as well as demographic variables, affect their psychological resilience and quality of life. Our goal is to provide a comprehensive overview of how physicians coped with the unprecedented global health challenges. METHODS: We carried out a national cross-sectional study of 265 physicians in Romania between January 2021 and January 2022 using a web-based questionnaire. The study employed a web-based questionnaire to assess coping mechanisms using the COPE inventory, resilience through the Connor-Davidson Resilience Scale 25 (CD-RISC 25), and quality of life via the WHOQOL-BREF scale. The COPE inventory, consisting of 60 items across 15 subscales, categorizes coping strategies into problem-focused, emotion-focused, and dysfunctional types, with each item rated on a 4-point scale. The CD-RISC 25 measures resilience on a 5-point Likert scale, with total scores ranging from 0 to 100. WHOQOL-BREF assesses quality of life through 26 items in 4 domains: physical, mental, social relations, and environmental, scored from 1 to 5 and converted to a 0-100 scale for domain scores. Univariate and multivariate linear regression models were employed to discern the intricate relationships between coping strategies, resilience levels, quality of life dimensions, and pertinent demographic factors. RESULTS: The average CD-RISC score among participants was 66.2. The mean scores for the values for the QOL subscales were 64.0 for physical well-being, 61.7 for psychological well-being, 61.2 for social relationships, and 64.7 for environment. Individuals tend to use problem-focused and emotion-focused coping more than dysfunctional mechanisms, according to the COPE inventory. Problem-focused and emotion-focused coping are positively correlated with resilience, while dysfunctional coping is negatively correlated. Resilience is significantly influenced by gender and professional status, with males and senior specialists reporting higher levels while younger physicians and residents reporting lower levels. CONCLUSIONS: Our data points to specific protective characteristics and some detrimental factors on physicians' resilience and quality of life during the pandemic.
Assuntos
Adaptação Psicológica , COVID-19 , Médicos , Qualidade de Vida , Resiliência Psicológica , SARS-CoV-2 , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Qualidade de Vida/psicologia , Romênia , Masculino , Feminino , Estudos Transversais , Médicos/psicologia , Adulto , Pessoa de Meia-Idade , Inquéritos e Questionários , Esgotamento Profissional/psicologia , Esgotamento Profissional/epidemiologia , Pandemias , Capacidades de EnfrentamentoRESUMO
BACKGROUND: The COVID-19 pandemic has prompted a rapid shift to online teaching, placing unprecedented demands on educators' physical and mental well-being. However, the relationship between English as a Foreign Language (EFL) teachers' physical activity, emotion regulation, and competence for online teaching remains underexplored. OBJECTIVES: This study aimed to investigate the interplay between EFL teachers' physical activity, emotion regulation strategies, and competence for online teaching. RESULTS: Structural equation modeling revealed significant direct and indirect effects, indicating that physical activity positively influences emotion regulation, which, in turn, enhances teachers' competence for online instruction. Furthermore, emotion regulation was found to mediate the relationship between physical activity and online teaching competence. CONCLUSIONS: These findings underscore the importance of promoting physical activity among EFL teachers as a means to enhance their emotion regulation skills and competence for online teaching, particularly in the context of the COVID-19 pandemic. IMPLICATIONS: The study highlights the need for targeted interventions aimed at supporting EFL teachers' well-being and professional development, with implications for educational policies, teacher training programs, and institutional support structures in the digital learning landscape.
Assuntos
COVID-19 , Educação a Distância , Regulação Emocional , Exercício Físico , Humanos , Masculino , Feminino , Adulto , COVID-19/psicologia , Exercício Físico/psicologia , Competência Profissional , Modelos Estruturais , Multilinguismo , Professores Escolares/psicologia , Pessoa de Meia-Idade , SARS-CoV-2RESUMO
SARS-CoV-2 vaccines have been used worldwide to combat COVID-19 pandemic. To elucidate the factors that determine the longevity of spike (S)-specific antibodies, we traced the characteristics of S-specific T cell clonotypes together with their epitopes and anti-S antibody titers before and after BNT162b2 vaccination over time. T cell receptor (TCR) αß sequences and mRNA expression of the S-responded T cells were investigated using single-cell TCR- and RNA-sequencing. Highly expanded 199 TCR clonotypes upon stimulation with S peptide pools were reconstituted into a reporter T cell line for the determination of epitopes and restricting HLAs. Among them, we could determine 78 S epitopes, most of which were conserved in variants of concern (VOCs). After the 2nd vaccination, T cell clonotypes highly responsive to recall S stimulation were polarized to follicular helper T (Tfh)-like cells in donors exhibiting sustained anti-S antibody titers (designated as 'sustainers'), but not in 'decliners'. Even before vaccination, S-reactive CD4+ T cell clonotypes did exist, most of which cross-reacted with environmental or symbiotic microbes. However, these clonotypes contracted after vaccination. Conversely, S-reactive clonotypes dominated after vaccination were undetectable in pre-vaccinated T cell pool, suggesting that highly responding S-reactive T cells were established by vaccination from rare clonotypes. These results suggest that de novo acquisition of memory Tfh-like cells upon vaccination may contribute to the longevity of anti-S antibody titers.
Assuntos
Anticorpos Antivirais , Vacina BNT162 , Vacinas contra COVID-19 , COVID-19 , SARS-CoV-2 , Glicoproteína da Espícula de Coronavírus , Vacinação , Humanos , Anticorpos Antivirais/imunologia , Anticorpos Antivirais/sangue , Glicoproteína da Espícula de Coronavírus/imunologia , SARS-CoV-2/imunologia , COVID-19/imunologia , COVID-19/prevenção & controle , Vacina BNT162/imunologia , Vacina BNT162/administração & dosagem , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/administração & dosagem , Feminino , Masculino , Epitopos de Linfócito T/imunologia , Adulto , Linfócitos T Auxiliares-Indutores/imunologia , Pessoa de Meia-IdadeRESUMO
The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.
Assuntos
COVID-19 , Tomada de Decisões , Pandemias , Humanos , COVID-19/prevenção & controle , Brasil/epidemiologia , SARS-CoV-2 , Saúde Pública , Medicina Baseada em EvidênciasRESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) results in several complications and mortality in intensive care unit (ICU) patients. Limited studies have investigated the effect of enteral nutrition (EN) on the survival of COVID-19 patients in the ICU. The aim of this study was to investigate the association of EN with biochemical and pathological indices associated with mortality in ICU patients with COVID-19. METHODS: This case-control study was conducted on 240 patients with COVID-19 hospitalized in the ICU including 120 eventual nonsurvived as the cases and 120 survived patients as the controls. All of the patients received EN as a high protein high volume or standard formula. Data on general information, anthropometric measurements, and the results of lab tests were collected. RESULTS: The recovered patients received significantly more high protein (60.8% vs. 39.6%, p = .004) and high volume (61.6% vs. 42.3%, p = .005) formula compared to the nonsurvived group. Mortality was inversely associated with high volume (odds ratio [OR]: 0.45 confidence interval [CI]95%, p = .008) and high protein (OR: 0.42 CI95%, p = .003) formula. The results remained significant after adjusting for age and sex. Further adjustment for underlying diseases, smoking, body mass index, and the acute physiology and chronic health evaluation II (APACHE II) score did not change the results. CONCLUSION: The findings of the study showed that there was a significant inverse association between mortality and high volume and high protein formula in patients with COVID-19. Further investigation is warranted.
Assuntos
COVID-19 , Nutrição Enteral , Unidades de Terapia Intensiva , SARS-CoV-2 , Humanos , COVID-19/mortalidade , COVID-19/terapia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Idoso , Unidades de Terapia Intensiva/estatística & dados numéricos , Estado Terminal/mortalidade , AdultoRESUMO
Although research has confirmed that the first COVID-19-related lockdown has increased stress and mental health problems in children, less is known about the longer-term effects of the pandemic on children's COVID-related future anxiety (CRFA). Because of CRFA's potentially debilitating effects, risk and resilience factors against this anxiety were investigated. To this end, n = 140 children (49% female) in 3rd and 4th grade classrooms in Germany were asked to perform a working memory task and to self-report about their CRFA and emotion regulation in December 2020 and in May 2021. More maladaptive emotion regulation in December 2020 contributed to the explanation of a high CRFA score in May 2021, whereas a better performance on working memory updating contributed a lower CRFA score later when controls were in place. These results were confirmed when children's CRFA in December 2020 was included in the prediction of their later CRFA. They suggest that maladaptive strategies of emotion regulation, such as rumination, may explain higher or increasing levels of CRFA, whereas efficient working memory updating may be an indicator of processing information in a way which shields children from CRFA-related thoughts. The concepts underlying these variables should be included in prevention and intervention efforts.
Assuntos
Ansiedade , COVID-19 , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Alemanha/epidemiologia , Feminino , Criança , Masculino , Ansiedade/epidemiologia , Ansiedade/psicologia , Instituições Acadêmicas , SARS-CoV-2/isolamento & purificação , Estudos Longitudinais , Pandemias , Memória de Curto Prazo , Regulação EmocionalRESUMO
The widespread evolution of phenotypic resistance in clinical isolates over the years, coupled with the COVID-19 pandemic onset, has exacerbated the global challenge of antimicrobial resistance. This study aimed to explore changes in bacterial infection patterns and antimicrobial resistance during the COVID-19 pandemic. This study involved the periods before and during COVID-19: the pre-pandemic and pandemic eras. The surveillance results of bacterial isolates causing infections in cancer patients at an Egyptian tertiary oncology hospital were retrieved. The Vitek®2 or Phoenix systems were utilized for species identification and susceptibility testing. Statistical analyses were performed comparing microbiological trends before and during the pandemic. Out of 2856 bacterial isolates, Gram-negative bacteria (GNB) predominated (69.7%), and Gram-positive bacteria (GPB) comprised 30.3% of isolates. No significant change was found in GNB prevalence during the pandemic (P = 0.159). Elevated rates of Klebsiella and Pseudomonas species were demonstrated during the pandemic, as was a decrease in E. coli and Acinetobacter species (P < 0.001, 0.018, < 0.001, and 0.046, respectively) in hematological patients. In surgical patients, Enterobacteriaceae significantly increased (P = 0.012), while non-fermenters significantly decreased (P = 0.007). GPB species from either hematological or surgical wards exhibited no notable changes during the pandemic. GNB resistance increased in hematological patients to carbapenems, amikacin, and tigecycline and decreased in surgical patients to amikacin and cefoxitin (P < 0.001, 0.010, < 0.001, < 0.001, and 0.016, respectively). The study highlights notable shifts in the microbial landscape during the COVID-19 pandemic, particularly in the prevalence and resistance patterns of GNB in hematological and surgical wards.
Assuntos
Antibacterianos , COVID-19 , Farmacorresistência Bacteriana , SARS-CoV-2 , Centros de Atenção Terciária , Humanos , COVID-19/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Egito/epidemiologia , Antibacterianos/farmacologia , SARS-CoV-2/efeitos dos fármacos , Neoplasias , Testes de Sensibilidade Microbiana , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/tratamento farmacológico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Bactérias/classificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Institutos de Câncer , PandemiasRESUMO
Health sciences library public services underwent profound changes due to the COVID-19 pandemic. Circulation, reference services, instruction, interlibrary loan, and programming were all significantly affected. Libraries adapted by moving to virtual services, featuring online workshops, video consultations, and digital information sharing. Reference services moved to virtual consultations for a streamlined experience, and instruction transitioned to interactive video tutorials. Interlibrary loan services saw a decrease in print material lending but an increase in electronic subscriptions. Library programming shifted from in-person to virtual, focusing on wellness activities. This post-pandemic transformation underscores the importance of ongoing adaptation to meet changing user needs.
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COVID-19 , Bibliotecas Médicas , Pandemias , SARS-CoV-2 , COVID-19/epidemiologia , Bibliotecas Médicas/organização & administração , Humanos , Estados UnidosRESUMO
An ambitious U.S. project aims to sample more than 50 animal species to clarify how the COVID-19 virus moves between people and wildlife.
Assuntos
Animais Selvagens , COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/virologia , Animais , Animais Selvagens/virologia , Humanos , Estados Unidos/epidemiologiaRESUMO
Global health faces the triple challenge of preparing for future pandemics while responding to current ones in the midst of a climate crisis. In this commentary, we discuss the heightened focus on pandemic preparedness after the COVID-19 pandemic and the risks that this may pose to addressing the elimination of AIDS, tuberculosis, hepatitis and malaria, established in the Sustainable Development Goals as target 3.3. Considering their interconnections with the climate crisis and advocating for global health justice, we identify impasses that such a dispute over priorities can imply, and comment on four fronts of actions that could contribute convergently to both agendas as well as to facing the consequences of climate change to health: strengthening health systems, global commitment to equitable access to strategic medicines, addressing social inequalities and joining efforts for health and climate justice We conclude that addressing these fronts safeguards the health rights of the most vulnerable to existing epidemics while enhancing readiness for future pandemics. Moreover, solutions must transcend technocratic approaches, necessitating the confrontation of inequalities perpetuated by systems of power and privilege fueling both health and climate crises. Ultimately, health justice should guide responses to this intricate triple global health challenge.
Assuntos
COVID-19 , Mudança Climática , Saúde Global , Pandemias , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Justiça SocialRESUMO
As the mankind counters the ongoing COVID-19 pandemic by the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), it simultaneously witnesses the emergence of mpox virus (MPXV) that signals at global spread and could potentially lead to another pandemic. Although MPXV has existed for more than 50 years now with most of the human cases being reported from the endemic West and Central African regions, the disease is recently being reported in non-endemic regions too that affect more than 50 countries. Controlling the spread of MPXV is important due to its potential danger of a global spread, causing severe morbidity and mortality. The article highlights the transmission dynamics, zoonosis potential, complication and mitigation strategies for MPXV infection, and concludes with suggested 'one health' approach for better management, control and prevention. Bibliometric analyses of the data extend the understanding and provide leads on the research trends, the global spread, and the need to revamp the critical research and healthcare interventions. Globally published mpox-related literature does not align well with endemic areas/regions of occurrence which should ideally have been the scenario. Such demographic and geographic gaps between the location of the research work and the endemic epicentres of the disease need to be bridged for greater and effective translation of the research outputs to pubic healthcare systems, it is suggested.