Addressing crises with Service Learning: Viralizing care in the face of burnout due to COVID-19

A pedagogical intervention of university Service-Learning was carried out during the first wave of the health crisis by COVID-19, of the Community Psychology professional output of a Chilean university, in charge of expert community psychologists in the topics of burnout and caregiving, as well as in the Service-Learning methodology. Based on the requirements of three community partners, as well as theoretical and empirical inputs, the need to address mental health and burnout in online teaching, teleworking and virtual interpersonal encounters was recognized, and four infographics were created with the aim of promoting a critical view of burnout, and promoting comprehensive care in these spaces during periods of confinement. Six phases of the intervention process are described and a reflection is made on the possibility of carrying out Service Learning in crisis contexts and on its contribution to address them, on the understanding and approach to burnout and care in this experience, as well as on the importance of favoring the integral learning of students, highlighting contributions from community psychology. © 2023 Pontificia Universidad Catolica de Valparaiso. All rights reserved.

The impact of COVID-19 lockdown on the health and care of children and adolescents with a childhood-onset disability

Introduction: During the initial period of COVID-19 lockdown, restriction measures modified the day-to-day life of the population. This study sought to know the impact of this period on the physical and mental health of children and young people with disabilities originating in childhood, and their families, and to describe the changes that occurred in access to education and health services. Material and methods: An observational and cross-sectional analytical study was carried out. The data were obtained by means of an electronic survey through an online platform carried out by the European Academy of Childhood Disability. The survey included questions on four thematic blocks: sociodemographic and health characteristics, impact of lock down on health and well-being, and access to education and health services. Results: One hundred and forty-five responses were obtained. 45.5% of the children and young people were totally dependent. There was an impact on their physical (54.5%), mental health (47.6%) and both (32%), higher levels of stress (68.3%), and sleep problems (41.4%), as well as a high burden in 84.8% of parents, especially in families of children with a higher level of dependency (P =.00). 55% of children and young people did not receive any treatment during this period, not even remotely. Conclusions: COVID lock down period greatly affected physical and mental health, as well as the services for children and young people with disabilities and their families. © 2022 The Author(s)

Campaña de captación (catch-up) con COVID-19 en gestantes: implementación y resultados

La vacunación frente a COVID-19 en gestantes ha demostrado ser segura y eficaz en cualquier trimestre del embarazo. A pesar de ello, a lo largo de la pandemia se han identificado mujeres reticentes a la vacunación. El objetivo es exponer la implementación y los resultados de una campaña de captación (catch-up) frente a COVID-19 en gestantes. Métodos: Se realizó la revisión de la vacunación frente a COVID-19 en las mujeres con episodios activos de gestación en OMI-AP entre el 01/01/2019 y el 10/09/2021. Las gestantes que no estaban correctamente vacunadas (ninguna dosis administrada o pauta incompleta) recibieron por correo postal una carta nominal firmada por el Servicio de Medicina Preventiva y Salud Pública (MPySP) y el Servicio de Ginecología y Obstetricia (GyO) en la que se informaba sobre su situación vacunal y la importancia de recibir las vacunas. Asimismo, se les facilitaba un teléfono de contacto para solicitar cita y un correo electrónico para solucionar dudas. Resultados: Se evaluaron 722 mujeres, de ellas, 645 (89,34%) estaban correctamente vacunadas mientras que 77 (10,66%) mostraban vacunación incorrecta. En estas 77 mujeres se encontró que 60 (77,92%) no habían recibido ninguna vacuna, 11 (14,29%) registraban pauta incompleta, 3 (3,89%) las había recibido en otra comunidad autónoma y 3 (3,89%) había cursado COVID-19 antes de la primera dosis considerándose pauta completa. Tras el envío de las cartas se consiguió que de las 60 mujeres que habían rechazado, 28 (46,67%) iniciaran pauta y de las 11 (14,29%) que solo habían recibido una primera dosis se logró que 9 (81,82%) la completasen. Por tanto, de las 71 mujeres candidatas a mejorar su estado vacunal se realizó catch-up en 37 (52,11%). Conclusiones: La presente campaña de catch-up ha sido efectiva. Estas estrategias deben considerarse para mejorar las coberturas de vacunación de este colectivo.

Bioequivalence study of a new formulation of paracetamol/ibuprofen during the COVID-19 pandemic

Objective: To determine the bioequivalence of two oral formulations of paracetamol 500 mg/ibuprofen 200 mg. Tolerability of both formulations of paracetamol/ ibuprofen were evaluated descriptively. Material and/or methods: Twenty-four healthy volunteers were enrolled at this random, single-dose, crossover, two-period design, open-label, bioequivalence study. After overnight fasting, two formulations (test and reference) of paracetamol/ibuprofen (paracetamol 500 mg/ ibuprofen 200-mg film coated tablets), were administered as a single dose on two treatment days separated by a 72 h (minimum) washout period. After dosing, blood samples were drawn for a period of 12 h. Pharmacokinetic parameters were determined from plasma concentrations for both formulations. The coronavirus disease 2019 (COVID-19) pandemic was declared a public health emergency of international concern by the WHO. Extraordinary safety measures were implemented at different levels that intended to preserve the clinical trial activities as far as possible, protecting the safety and preserving the traceability while no vaccine was available. These measures, locally, consisted of: information about the importance of the measures, PCR test for COVID-19 at the screening visit (if IgG serology was positive) and PCR test at every period of admission to Trials Unit, the subject came into the Unit only after a negative result. Results: The highest effort made to assure the safety of participants led to a regular development of the study, with only two cases excluded primarily and one excluded after the first dose administration. Regarding pharmacokinetics, the results found for Paracetamol: Ln (Cmax) ng/ml Ratio 92.83% (CI90: 83.73%-102.94%);Ln (AUClast) h∗ng/ml Ratio: 96.14% (CI90: 93.24%-99.13%);for Ibuprofen: Ln (Cmax) ng/ml Ratio: 93.78% (CI90: 85.43-102.96%), Ln (AUClast) h∗ng/ml Ratio: 96.06% (CI90: 93.75%-98.42%). No drug-related safety concerns appeared. Conclusions: The clinical development of the BE clinical trial was made available by the extraordinary safety measures adopted. The pharmacokinetics results comply with the regulatory requirements for bioequivalence. No significant findings concerning safety were found.

Clinical Presentation and Outcome of COVID-19 in a Latin American Versus Spanish Population: Matched Case-Control Study.

INTRODUCTION: Increased mortality has been reported in the Latin American population. The objective is to compare the clinical characteristics and outcome of Latin American and Spanish populations in a cohort of patients hospitalized with COVID-19 during the first year of the pandemic. METHODS: We retrospectively analysed all the Latin American patients (born in South or Central America) hospitalized in our centre from February 2020 to February 2021 and compared them with an age- and gender-matched group of Spanish subjects. Variables included were demographics, co-morbidities, clinical and analytical parameters at admission and treatment received. The primary outcomes were ICU admission and mortality at 60 days. A conditional regression analysis was performed to evaluate the independent baseline predictors of both outcomes. RESULTS: From the 3216 patients in the whole cohort, 216 pairs of case-controls (Latin American and Spanish patients, respectively) with same age and gender were analysed. COPD was more frequent in the Spanish group, while HIV was more prevalent in the Latin American group. Other co-morbidities showed no significant difference. Both groups presented with similar numbers of days from symptom onset, but the Latin American population had a higher respiratory rate (21 vs. 20 bpm, P = 0.041), CRP (9.13 vs. 6.22 mg/dl, P = 0.001), ferritin (571 vs. 383 ng/ml, P = 0.012) and procalcitonin (0.10 vs. 0.07 ng/ml, P = 0.020) at admission and lower cycle threshold of PCR (27 vs. 28.8, P = 0.045). While ICU admission and IVM were higher in the Latin American group (17.1% vs. 13% and 9.7% vs. 5.1%, respectively), this was not statistically significant. Latin American patients received remdesivir and anti-inflammatory therapies more often, and no difference in the 60-day mortality rate was found (3.2% for both groups). CONCLUSION: Latin American patients with COVID-19 have more severe disease than Spanish patients, requiring ICU admission, antiviral and anti-inflammatory therapies more frequently. However, the mortality rate was similar in both groups.

COVID-19 vaccine mandates: what are the current European public perspectives?

The article aims to elaborate on European policy choices for the prevention of SARS­CoV­2 contagion, with a close focus on the rules and regulations enacted in Italy so far. European states have ruled out generalized vaccination mandates but have so far preferred to exert a form of "moral suasion", through the introduction of a digital certificate which can only be granted to those who are vaccinated, cured of COVID-19 or tested negative through an antigen test in the previous 48 hours. Italy has applied this tool, dubbed "Green Pass", very rigorously: many daily activities, including going to work, are only allowed for those who have the certificate. A one-year Green Pass is issued after vaccination, although data show that vaccine protection may subside gradually over about six months; the cost of the antigen tests every 48 hours is to be borne by the patient. Testing the unvaccinated is essential to contain the spread of the infection, but it would have been more logical to mandate that all the unvaccinated undergo regular testing (for example every ten days), instead of imposing a test every 48 hours only to be allowed to engage in some activities. The authors stress that in order to minimize the risk of future possible pandemics, prevention strategies are needed, and poor countries need to be enabled to vaccinate their populations in order to prevent new variants from developing. The pledges made by world leaders in that regard during the recent G20 summit must therefore be honored, for the sake of global health that never in our lifetime has been so threatened.

Substance abuse in times of COVID-19 pandemic: a "perfect storm" for substance use disorder and mental health?

ABSTRACT: Our lives and communities have been besieged by COVID-19 for almost two years, and society and its functioning have been turned upside down and upset, through limitations and restrictions aimed at stemming the spread of the SARS-CoV-2 virus. Severe levels of anxiety, distress and uncertainty have taken a huge toll on our daily lives from the social, professional and emotional perspectives, but it is still rather unclear how serious an impact the emergency has had on a class of particularly vulnerable individuals: those with substance abuse issues. Particularly, we would like to draw attention to a uniquely troublesome development: forced isolation resulting from pandemic-related restrictions and how it has impacted drug users and their efforts to achieve recovery.

Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19.

BACKGROUND: The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality. METHODS: Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality. RESULTS: In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days). CONCLUSIONS: Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms.

Increasing diversion of prescribed benzodiazepines and Z-drugs to new psychoactive substances.

ABSTRACT: Over the last few years reports have indicated an increase in the number, type and availability of new psychoactive substances belonging to the benzodiazepine class. These molecules may pose high risks to users, since the majority have never undergone clinical trials or tests so their pharmacology and toxicology is largely unknown. However the new drug scenario emerging from the COVID-19 global pandemic seems to play a role in increasing the diversion of prescribed benzodiazepines and Z-drug. A brief presentation of this phenomenon is hereby presented. The awareness and response activities at national and international levels related to this issue should be enforced.

Perinatal and post-partum infections in times of Coronavirus: Are compliance with cautionary measures and safety protocols key factors in staving off litigation?

Several factors have been associated with increased risk of maternal and fetal peripartum and postpartum infections, including pre-existing maternal conditions (e.g. malnutrition, diabetes, obesity, severe anaemia, bacterial vaginosis, and group B streptococcus infections) and unexpected or iatrogenic conditions during labour and childbirth, such as prolonged rupture of membranes (PROM) multiple vaginal examinations, manual removal of the placenta, and cesarean section. As such, the strategies to reduce maternal and fetal infections and their short- and long-term complications have been largely directed at preventive measures where such risk factors exist. In many cases of maternal and fetal infections, medical negligence may have played a role. In fact, a given infection may not have been detected during examinations, or proper treatment may not have been implemented in a timely fashion. In fact, some infections may become more severe if they are not properly treated as quickly as possible. The Authors have aimed to shed a light on the most common, and feared, childbirth-related infections, by means of a wide-ranging analysis of medical databases (Scopus, Pubmed, Embase, Research Gate, Web of Science), legal archives (Justia, Leagle, Lexis, Casetext) and recommendations issued by medical and scientific institutions (United Nations, World Health Organization, Centers for Disease Control and Prevention, National Health Service, etc…), spanning the 2004-2020 period. The inability on the part of physicians to thoroughly document the appropriateness of their interventions and the compliance with guidelines and best practices often results in claims being filed by damaged patients and/or their legal heirs. Litigation is typically complex in such cases, and likely to result in substantial compensatory damages being awarded to damaged patients. Currently, a higher standard for cautionary rules should be applied by practitioners and medical facilities to minimize the risk of claims being filed, particularly in tort courts. As a matter of fact, the current global setting of Covid-19 pandemic crisis has engendered unique conditions. Hence, specifically targeted measures are needed in maternity centers in order to stave off the contagion of healthy patients, while at the same time providing the best possible care for Covid-19 positive parturients and their newborns. Compliance with directives and regulations issued by health care authorities, aimed at the implementation of adequate diagnostic pathways, isolation protocols and protection requirements, is undoubtedly crucial for preventing malpractice allegations and liability.