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Background/Aims Post COVID-19 syndrome (PCS) is an emerging cause of morbidity and poor quality of life in COVID-19 survivors. We aimed to assess the prevalence, risk factors, outcomes, and association with disease flares of PCS in patients with autoimmune rheumatic diseases (AIRDs) and non-rheumatic autoimmune diseases (nrAIDs), both vulnerable groups understudied in the current literature using data from the 2nd COVID-19 Vaccination in Autoimmune Diseases (COVAD) global multicentre patient self-reported e-survey. Methods The survey was circulated from February to July 2022 by the international COVAD Study Group (157 collaborators from 106 countries), and demographics, comorbidities, AIRD/nrAID status, COVID-19 history, vaccination details, and PROMIS physical and mental function were recorded. PCS was defined as symptom resolution time >90 days following acute COVID-19. Predictors of PCS were analysed using regression models for the different groups. Results 7666 total respondents completed the survey. Of these, 2650 respondents with complete responses had positive COVID-19 infection, and 1677 (45.0% AIRDs, 12.5% nrAIDs, 42.5% HCs) completed the survey >90 days post acute COVID-19. Of these, 136 (8.1%) had PCS. Prevalence of PCS was higher in AIRDs (10.8%) than healthy controls HCs (5.3%) (OR: 2.1;95%CI: 1.4-3.1, p=0.002). Across the entire cohort, a higher risk of PCS was seen in women (OR: 2.9;95%CI: 1.1-7.7, p=0.037), patients with long duration of AIRDs/ nrAIDs (OR 1.01;95%CI: 1.0-1.02, p=0.016), those with comorbidities (OR: 2.8;95%CI: 1.4-5.7, p=0.005), and patients requiring oxygen supplementation for severe acute COVID-19 (OR: 3.8;95%CI: 1.1- 13.6, p=0.039). Among patients with AIRDs, comorbidities (OR 2.0;95%CI: 1.08-3.6, p=0.026), and advanced treatment (OR: 1.9;95%CI: 1.08-3.3, p=0.024), or intensive care (OR: 3.8;95%CI: 1.01-14.4, p=0.047) for severe COVID-19 were risk factors for PCS. Notably, patients who developed PCS had poorer PROMIS global physical [15 (12-17) vs 12 (9-15)] and mental health [14 (11-16) vs 11 (8-14)] scores than those without PCS. Conclusion Individuals with AIRDs have a greater risk of PCS than HCs. Associated comorbid conditions, and advanced treatment or intensive care unit admission for severe COVID-19 confer a higher risk of PCS. It is imperative to identify risk factors for PCS for immediate multidisciplinary management in anticipation of poor physical and mental health.
ABSTRACT
Introduction: Covid-19 was the cause of a pandemic that claimed thousands of human lives. The pandemic has caused health professionals mental health problems that influence emotional, psychological and social well-being, which affects the way they think, feel and act in daily life. Objective(s): To de-termine the quality of life of health personnel during the Co-vid-19 pandemic in public institutions in the city of Cuenca. Material(s) and Method(s): Descriptive, cross-sectional and observational study. The study sample was 338 health professionals belonging to the Ministry of Public Health of the Canton Cuenca, province of Azuay-Ecuador, doctors, nurses, dentists, psychologists, assistants and biochemists who work at differ-ent levels of care were included. Two WHOQOL surveys and the Lazarus and Folkman scale of coping modes were used, for the tabulation of the data the RStudio statistical program was used. Result(s): In the psychological domain, no significant destructuring was found in the personnel studied. In the field of health, it should be noted that the personnel studied reported the inability to carry out the activities they need and the diffi-culty in moving from one place to another. Conclusion(s): When investigating the relationship of health personnel with the envi-ronment, no statistically significant alteration was found, but it was evidenced that social support is a protective factor for the mental health of personnel.Copyright © 2022, Venezuelan Society of Pharmacology and Clinical and Therapeutic Pharmacology. All rights reserved.
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Introduction: The COVID 19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. Specifically, it has created a global context likely to increase eating disorders' (Eds') risk and symptoms and to decrease factors that protect against EDs. Previous studies have highlighted a link between mentalizing deficits and clinical problems. This study aims to compare Covid-Period vs. NON-Covid Period adolescent patients affected by Anorexia Nervosa (AN) considering their psychopathological symptoms and their mentalizing capabilities. Method(s): 206 female adolescents (aged between 12 and 17 years) affected by AN were recruited from the Service for Eating Disorders at S. Gerardo Hospital in Monza. Exclusion criteria were the presence of intellectual disabilities and neurological disorders. The first group of 94 subjects was recruited between September 2018 and February 2020 (NON-Covid Period), and the second group of 112 individuals was recruited between August 2020 and May 2022 (Covid Period). The following instruments were administrated: EDI-3 (Eating Disorders Inventory-3) was used to provide a standardized clinical evaluation of symptomatology associated with eating disorders;SCL-90R (Symptom Checklist 90- Revised) was used to assess psychological problems and psychopathological symptoms;Reflective Functioning Questionnaire (RFQ) was used to assess mentalizing skills, considering that Reflective functioning (RF) is the operationalization of the mental processes underlying the capacity to mentalize. Result(s): A preliminary analysis of data showed worse values in primary and composites scales of EDI-3, higher levels of general psychopathological suffering (SCL-90 composite scales) and more marked levels of hypo-mentalization (RFQ-u) in the Covid-Period subjects: the differences were statistically significant. Conclusion(s): Although these results are still preliminary, it is possible to hypothesize a correlation between marked levels of hypo-mentalization and higher rates of psychopathological suffering and a worse clinical pattern of Anorexia Nervosa. It is also possible to hypothesize that a preventive intervention to strengthen the reflexive functions may result protective factor against the onset of more severe clinical manifestations and comorbidities;mentalizing abilities could be an important target for therapeutic interventions. Further research should be conducted on larger samples and with a new assessment after treatment interventions.
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COVID-19 affects not only somatic, but also psychological functions of a person. Cognitive disorder appears to be one of the most striking, although it is very inconsistent and there is a considerable interindividual variability in the cognitive impairment of different patients. The symptoms of cognitive disorder and fatigue syndrome are strongly intertwined with each other. The condition is often described as "brain fog". In most cases, it has a reversible character of a type of a mild disorder of cognitive functions. The causes are discussed - primarily inflammation, but also factors of a psychosocial nature.Copyright © 2023, Czech Medical Association J.E. Purkyne. All rights reserved.
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Background: Virtual Reality (VR) is increasingly considered a valuable therapy tool for managing behavioural and psychological symptoms (BPSDs) and quality of life (QoL) in dementia (Parsons, 2013). However, rigorous studies are still needed to evaluate its impact in acute care settings (Appel, 2021). This study evaluated the impact of VR-therapy on managing BPSDs, falls, and length of stay (LoS) and QoL for inpatients with dementia admitted to an acute care hospital. Method(s): An open longitudinal interventional randomized controlled trial was conducted between April 2019 and March 2020 (ClinicalTrials.gov, ID:NCT03941119). A total of 69 participants (age >=65, diagnosis of dementia, did not meet exclusion criteria) (Figure 1) who were randomly assigned either followed standard of care (Control Arm, n = 35 or received VR-therapy every 1-3 days (Intervention Arm, n = 34) (Figure 2). VR-therapy entailed watching 360-degree-VR-films on a HMD for up to 20 minutes (Figures 3 and 4). Instances of daily BPSDs documented in EMR nursing notes were categorized based on the Neuropsychiatric Inventory (NPI). QoL measures included the Quality of Life in Late-Stage Dementia scale (QUALID) and semi-structured interviews conducted at scheduled visits. Structured observations (including the standardized "ObsRVR" tool) and interviews were used to measure treatment feasibility (Figure 5). Result(s): VR-therapy had a statistically significant effect (p =.014) in reducing aggressivity (i.e., physical aggression and loud vociferation). A sentiment analysis of patient responses to the semi-structured interviews on QoL revealed a statistically significant impact of VR therapy (p =.013). No statistically significant impact of VR therapy was found for other BPSDs (e.g., apathy), falls, or LoS or QoL as measured by the QUALID. VR-therapy was overall an acceptable and enjoyable experience for participants and no adverse events occurred as a result of VR-therapy. Conclusion(s): Immersive VR-therapy appears to have an effect on aggressive behaviours and QoL in acute care patients with dementia. Although the RCT was stopped before reaching the intended sample size due to COVID-19 restrictions, trends in the results are promising. We suggest conducting future trials with larger samples and, in some cases, more sensitive data collection instruments. Copyright © 2022 the Alzheimer's Association.
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In the elderly, it is necessary to take into account the changes in physical, mental, and social functions related to aging. In general, after assessing the general condition of the elderly, necessary life support should be provided, and long-term follow-up should be conducted. When introducing cancer drug therapy, there are times when standard treatment is deemed difficult to implement. The actual practice is to assess the general condition of the patient, determine the risk for each patient, and adjust the intensity of treatment as necessary. In addition to side effect management, support for maintaining nutritional status, physical activity, and social activity, as well as decision-making support, are considered important. Specifically, a multidisciplinary approach should be taken, and the use of home medical care, home nursing care, and nursing care insurance should be devised. In addition, the cancer consultation service should be used, and social support systems for medical expenses should be widely publicized. Cancer drug therapy is now available on an outpatient clinic, and oral drugs, molecular targeted drugs, and immune checkpoint inhibitors can be selected, making it essential to understand and respond to the situation appropriately at home. Online medical care is attracting attention due to the impact of Covid-19 infection, and information sharing between oncologists and visiting physicians, as well as in multidisciplinary collaboration, is necessary. For this purpose, not only telephone support but also various ICT devices are expected to be utilized. With the reform of the all-generation security system underway in Japan, there is a need to develop a system that can make effective use of limited medical resources.
ABSTRACT
Risk communication related to treatments was particularly challenging during the COVID-19 pandemic and became more complicated with the advent of vaccines. The miraculous speed with which the vaccines were developed and authorized was a key element in getting out of the emergency because it limited the circulation of the virus and consequently slowed down the onset of worrying variants. However, it was also the object of attack for all vaccine detractors, who considered development times too fast to guarantee safety. Cases of thrombotic syndrome with thrombocytopenia (TTS) generated a risk signal for the Vaxzevria vaccine, later confirmed by regulatory agencies, which fuelled the fear of the vaccine in the population and resulted in a rather widespread vaccination hesitancy. All this has been favoured by the large use of social media, where news (fake or not) circulates uncontrollably by the rampant populist and conspiracy sentiment in many Western countries and, in general, by the lack of trust in governments. In this context, the set up of a correct communication, which can effectively support a vaccination campaign that never before in history is a priority like in this moment, has become a particularly difficult challenge. To set up an effective communication strategy, it is first of all important to understand the mental shortcuts that underlie vaccination hesitancy. The population generally relies on heuristics to process risk information. These are mental processes that allow you to make quick decisions when dealing with large volumes of information. For example, people's overestimation of an unlikely outcome ('compression') can make it difficult to communicate the actual size of an extremely rare event like TTS. Likewise, a serious but rare event such as TTS can carry more weight in the decision when it is highly publicized ('availability'). Some people tend to anticipate negative emotions in the face of a decision and therefore avoid that path ('anticipated regret'), and this can limit the acceptance of the vaccine and impact on the desire of a healthcare professional to recommend the Vaxzevria vaccine. In relation to this, people may prefer to accept an outcome that comes from doing nothing (not getting vaccinated) rather than an outcome that comes from doing something (getting vaccinated) ('omission bias') or avoid taking risks when the outcome is uncertain ('aversion to ambiguity'). The heuristics is based on values that determine people's thinking, feelings and actions towards risk. The relevant values for the approximate hesitation can be self-determination, fairness, harm minimization and justice. With these principles in mind, an effective communication strategy that supports the vaccination campaign must have the support of health professionals and regulatory authorities. Communication must be written and verbal and where possible use graphic tools that help understanding in the less educated population groups. It must be frequent and transparent so that the population feels part of the decisions made and the reasons behind these decisions. Vaccination should be promoted but not be over-reassuring, always communicating elements of uncertainty. The channels through which information is conveyed must be as diversified as possible. False or misleading information must be identified early and debunked. Communication should be prioritized in certain key groups such as healthcare professionals. It is important that the messages are conveyed by vaccine experts rather than politicians. Finally, it is advisable to consider monitoring the effects of communication by identifying parameters that can detect changes in behaviour and that allow adjustments to be made in the strategy, when necessary.