Sensitization symptoms are associated with psychological and cognitive variables in COVID-19 survivors exhibiting post-COVID pain.

OBJECTIVE: To investigate the association between demographic, clinical, psychological, cognitive, and health-related variables and the Central Sensitization Inventory (CSI) in previously hospitalized COVID-19 survivors exhibiting "de novo" post-COVID pain. METHODS: Seventy-seven (n = 77) COVID-19 survivors with "de novo" post-COVID pain completed demographic (age, height, and weight), clinical (duration and intensity of the pain), psychological (depressive/anxiety levels and sleep quality), cognitive (catastrophizing and kinesiophobia levels), and health-related quality of life variables as well as the CSI. A multivariable correlation analysis was conducted to determine the association between variables, and a stepwise multiple linear regression model was performed to identify CSI predictors. RESULTS: Patients were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Twenty-six (33.7%) individuals showed indications of sensitization-associated symptoms (CSI score ≥40 points). The CSI score was positively associated with pain intensity (r: 0.371), anxiety (r: 0.784), depressive (r: 0.709), catastrophizing (r: 0.620), and kinesiophobia (r: 0.359) levels (all, p < 0.001). The stepwise regression analysis revealed that 60.2% of CSI was explained by anxiety levels and pain intensity. CONCLUSION: This study found that psychological and cognitive variables were associated with the CSI score in previously hospitalized COVID-19 survivors with "de novo" post-COVID pain. Anxiety levels and the intensity of pain symptoms were independently associated with CSI score suggesting a significant overlap with psychological construct. The "de novo" post-COVID pain association with CSI may indicate changes in the pain processing important for managing the pain.

Prevalence of Neuropathic Component in Post-COVID Pain Symptoms in Previously Hospitalized COVID-19 Survivors.

Objectives: To investigate the prevalence of neuropathic pain symptoms and to analyze the correlation between neuropathic symptoms with pain-related, psychological, and cognitive variables in COVID-19 survivors exhibiting "de novo" post-COVID pain. Methods: Seventy-seven (n = 77) previously hospitalized COVID-19 survivors presenting with post-COVID pain completed demographic (such as age, height, and weight), pain-related (the duration and intensity of pain), psychological (depressive/anxiety levels), and cognitive (catastrophizing and kinesiophobia) variables. The Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire was also assessed. After conducting multivariable correlation analyses, a stepwise multiple linear regression model was performed to identify S-LANSS predictors. Results: Participants were assessed a mean of 6.0 (SD 0.8) months after hospital discharge. Nineteen (24.6%) exhibited neuropathic pain symptoms (S-LANSS score≥12 points). The S-LANSS score was positively associated with the duration of post-COVID pain (r: 0.262), anxiety levels (r: 0.275), and kinesiophobia level (r: 0.291) (all, P < 0.05). The stepwise regression analysis revealed that 12.8% of the S-LANSS variance was just explained by kinesiophobia. Conclusion: This study found that almost 25% of previously hospitalized COVID-19 survivors with "de novo" post-COVID pain reported a neuropathic pain component. The presence of neuropathic pain symptomatology was associated with more anxiety and kinesiophobia, but only kinesiophobia level was significantly associated explaining 12.8% of the variance of the S-LANSS score.

Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain.

BACKGROUND: Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE: The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS: A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS: 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS: The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.

Contribution of students to nursing practice settings during clinical training: Design and validation of a questionnaire.

BACKGROUND: A validated questionnaire to measure the contributions of nursing students to clinical settings could potentially assist in the improved management of students in healthcare institutions. AIM: To develop and test the psychometric properties of the questionnaire 'Nursing Student Contributions to Clinical Settings' (CEEEC, Spanish acronym for 'Contribuciones de los Estudiantes de Enfermería a los Entornos Clínicos'). DESIGN: Instrument design and psychometric testing. PARTICIPANTS/SETTINGS: A multicentre study involving 1,098 nursing professionals from three universities and five hospitals of Spain, between January 2019 and March 2020. METHODS: The study was carried out in two phases. Phase 1 involved the questionnaire design by experts (n = 28), which required a review of the available literature, cognitive interviews and Delphi rounds, and a preliminary validity study, which included a pilot test with responses from a sample of nurses (n = 143). Phase 2 involved a formal validation with a wider sample of nurses (n = 927), including factor analysis and a study of convergent validity with the Practice Environment Scale-Nursing Work Index and Health Sciences-Evidence Based Practice. RESULTS: Experts selected 42 items on student contributions. After cognitive interviews, three items were eliminated and seven failed to reach the minimum content validity index (78%). Based on the remaining 32 items, the discrimination index of each item was calculated, and those with <0.3, eight items were sequentially eliminated. The resulting questionnaire contained 24 items grouped into a single factor, which explained 41% of the variance. The internal consistency was excellent (Cronbach's alpha: 0.94), and the convergent validity was confirmed. CONCLUSIONS: A 24-item questionnaire was designed and validated to measure the contributions of nursing students to clinical practice settings. IMPACT: Most hospitals are also teaching centres where nursing students undergo clinical practice. The application of this test will provide insight into the nursing professionals' perception of the students' role.

Knowledge of the Human Papillomavirus by Social Stratification Factors.

BACKGROUND: Social determinants of health explain most health inequities. Intermediate determinants dictate differences in the exposure and vulnerability of people based on social stratification. Vulnerable women (lower education level, older age, uninsured, etc.) have lower adherence to recommended Pap smear screening guidelines. However, a gap remains concerning the effect of social determinants on human papillomavirus (HPV) infection. OBJECTIVES: The aim of this study was to analyze the association between the level of knowledge about HPV infection and HPV vaccines with education level and residential setting among a sample of Spanish women. METHODS: A cross-sectional study at six primary care centers (Cantabria, Spain) was performed. All women >21 years consecutively attended by midwives for routine follow-up were invited to participate during the study period (2015-2016) until a convenience sample was recruited. Participants completed an anonymous questionnaire addressing sociodemographic variables (age, education level, and residential setting) and the level of knowledge regarding HPV infection, including general knowledge about infection and knowledge about the HPV vaccine. Associations between education level (primary, secondary, and university) and residential setting (urban, semiurban, and rural) with the level of knowledge of HPV infection and HPV vaccine were calculated using adjusted logistic regressions. Dose-response associations were estimated based on p-trend. RESULTS: Compared to university women, a lower education level was associated with limited or no knowledge of either HPV infection or the HPV vaccine. Women living in rural areas poorly identified "promiscuity" as a risk factor of HPV infection and "the use of condoms" as a protective factor. Moreover, living in rural areas was associated with limited or no knowledge of HPV infection and HPV vaccine. There were significant dose-response trends; those who were more educated and living in more urban areas had more knowledge about either HPV infection or the vaccine. DISCUSSION: In our sample, the level of knowledge of HPV infection and HPV vaccine was high. However, vulnerable women, defined by a lower education level and living in rural areas, presented a greater lack of knowledge regarding HPV infection and the HPV vaccine.

System-Wide Accelerated Implementation of Telemedicine in Response to COVID-19: Mixed Methods Evaluation.

BACKGROUND: As the COVID-19 pandemic disrupted medical practice, telemedicine emerged as an alternative to outpatient visits. However, it is not known how patients and physicians responded to an accelerated implementation of this model of medical care. OBJECTIVE: The aim of this study is to report the system-wide accelerated implementation of telemedicine, compare patient satisfaction between telemedicine and in-person visits, and report provider perceptions. METHODS: This study was conducted at the UC Christus Health Network, a large private academic health network in Santiago, Chile. The satisfaction of patients receiving telemedicine care in March and April 2020 was compared to those receiving in-person care during the same period (concurrent control group) as well as in March and April 2019 (retrospective control group). Patient satisfaction with in-person care was measured using the Net Promoter Score (NPS) survey. Patient satisfaction with telemedicine was assessed with an online survey assessing similar domains. Providers rated their satisfaction and responded to open-ended questions assessing challenges, strategies used to address challenges, the diagnostic process, treatment, and the patient-provider relationship. RESULTS: A total of 3962 patients receiving telemedicine, 1187 patients from the concurrent control group, and 1848 patients from the retrospective control group completed the surveys. Satisfaction was very high with both telemedicine and in-person services. Overall, 263 physicians from over 41 specialties responded to the survey. During telemedicine visits, most providers felt their clinical skills were challenged (61.8%). Female providers felt more challenged than male providers (70.7% versus 50.9%, P=.002). Surgeons, obstetricians, and gynecologists felt their clinical skills were challenged the least, compared to providers from nonsurgical specialties (P<.001). Challenges related to the delivery modality, diagnostic process, and patient-provider relationship differed by provider specialty (P=.046, P<.001, and P=.02, respectively). CONCLUSIONS: Telemedicine implemented in response to the COVID-19 pandemic produced high patient and provider satisfaction. Specialty groups perceived the impact of this new mode of clinical practice differently.

Gender differences in clinical and psychological variables associated with the burden of headache in tension-type headache.

Our aim was to assess gender differences in variables associated with the emotional and physical burdens of tension-type headache (TTH). Participants with TTH diagnosed according to the ICHD-III were recruited from three university-based hospitals (in Spain, Italy, Denmark) between January 2015 and June 2017. The physical/emotional headache burden was assessed with the Headache Disability Inventory (HDI-P/HDI-E, respectively). Headache features were collected with a four-week diary. Sleep quality was assessed with Pittsburgh Sleep Quality Index. The Hospital Anxiety and Depression Scale evaluated anxiety and depressive symptom levels. Trait and state anxiety levels were evaluated with the State-Trait Anxiety Inventory. Two hundred and twelve (28% men) participants (aged 41-48 years old) participated. Multiple regression models revealed that sleep quality explained 36.7% of the variance of HDI-E and 31.1% of the variance of HDI-P in men, whereas headache intensity, depressive levels, and younger age explained 37.5% of the variance of HDI-E and 32.8% of the variance of HDI-P in women (all p < .001). This study observed gender differences in variables associated with headache burden in TTH. Management of men with TTH should focus on interventions targeting sleep quality, whereas the management of women with TTH should combine psychological approaches and interventions targeting pain mechanisms.

Prevalence and factors associated with overweight and obesity among Spanish students attending special education schools.

BACKGROUND: Some studies suggest that children and adolescents with intellectual disability (ID) are at elevated risk of obesity. The objective was to determine the prevalence of and factors associated with overweight and obesity among students attending special education schools in Cantabria, Spain. METHODS: Cross-sectional design. A sample of n = 220 students with intellectual disability attending seven special education schools was selected using convenience sampling. Body mass index was classified into four categories according to the International Obesity Task Force (IOTF) criteria: underweight; normal weight; overweight; obesity. RESULTS: The prevalence of overweight/obesity was 40.9% (95% CI: 34.6-47.5). Obesity was more frequent among females (26.0%) than males (9.8%), with an OR = 3.23 (95% CI: 1.53-6.85). Participants with Down syndrome showed an increased risk of obesity compared to other conditions (p = .005). CONCLUSIONS: The prevalence of overweight/obesity among children, adolescents and young adults with intellectual disability was remarkably high, with females in general and students of both sexes with Down syndrome at particularly high risk.

Perspectives of Victims of Gender Violence.

The purpose of the current study was to explore the experiences of women who have been affected by violence and received mental health care. A qualitative phenomenological design was used with in-depth interviews and personal letters in a sample of 29 women from a public mental health center of Madrid, Spain, who were affected by physical, mental, and/or sexual abuse. The analysis revealed three themes: (1) Living With Fear; (2) Feeling Guilty; and (3) Experiencing the Imposition of So-Called "Womanly Duties" (i.e., being a maid, babysitter, and/or sexual slave). The current study highlights the importance of developing educational programs for the prevention of abuse. [Journal of Psychosocial Nursing and Mental Health Services, 58(6), 30-39.].

Sputum Microbiome Dynamics in Chronic Obstructive Pulmonary Disease Patients during an Exacerbation Event and Post-Stabilization.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects up to 65 million people worldwide, and COPD exacerbation causes tissue damage and subsequent loss of lung function. It is a multifactorial event in which respiratory infections are involved, but little is known about its dynamics. OBJECTIVES: The objective of our study was to determine the microbiome composition during an exacerbation event and post-stabilization. METHODS: We conducted an observational analytical study of a cohort of 55 COPD patients in which 2 sputum samples (the first taken during an exacerbation event and the second during clinical post-stabilization) were submitted to 16s RNA ribosomal analysis by Illumina Miseq Next Generation Sequencing (NGS). The presence of respiratory viruses was also determined. RESULTS: Our study found a stable microbiome composition in the post-stabilization sputum samples of COPD patients, and 4 additional microbiomes in samples taken during the exacerbation, 3 of which showed a marked dysbiosis by Haemophilus, Pseudomonas, and Serratia. The fourth exacerbation microbiome had a very similar composition to post-stabilization samples, but some pathogens such as Moraxella and respiratory viruses were also found. CONCLUSIONS: Our study reveals the main protagonists involved in lung microbiome dynamics during an exacerbation event and post-stabilization in COPD patients by NGS analysis.

Female Family Caregivers' Experiences During Nursing Home Admission: A Phenomenological Qualitative Study.

The experience of nursing home (NH) admission has a significant impact on older adults and their relatives. The aim of the current study is to describe the life experiences of female family caregivers (N = 20) after long-stay NH admission of their relative. A qualitative phenomenological approach was followed with purposeful sampling. Data were collected over 18 months using unstructured interviews, letters, and diaries and were analyzed using systematic text condensation analysis. Three themes emerged: The Value of Experience: Deciding on Admission and Defending One's Criteria; Living on Two Sides of the Same Coin; and Maintaining Contact. Results provide insight into female caregivers' experiences of NH admission, which may improve relationships established between female family caregivers and NH staff and help inform the decision-making process. [Journal of Gerontological Nursing, 45(6), 33-43.].

Active Trigger Points Are Associated With Anxiety and Widespread Pressure Pain Sensitivity in Women, but not Men, With Tension Type Headache.

BACKGROUND: A better understanding of gender differences can assist clinicians in further developing therapeutic programs in tension type headache (TTH). OBJECTIVE: To evaluate gender differences in the presence of trigger points (TrPs) in the head, neck, and shoulder muscles and their relationship with headache features, pressure pain sensitivity, and anxiety in people with TTH. METHODS: Two hundred and ten (59 men, 151 women) patients with TTH participated. TrPs were bilaterally explored in the temporalis, masseter, suboccipital, upper trapezius, splenius capitis, and sternocleidomastoid muscles. Headache features were collected using a 4-week headache diary. Trait and state anxiety levels were assessed using the State-Trait Anxiety Inventory. Pressure pain thresholds (PPTs) over the temporalis, C5/C6 joint, second metacarpal, and tibialis anterior were assessed. RESULTS: Women with TTH exhibited a significantly higher number of total (P = 0.027) and active (P = 0.030), but similar number of latent (P = 0.461), TrPs than men with TTH. Active TrPs in the temporalis, suboccipital, and splenius capitis muscles were the most prevalent in both men and women with TTH. The number of active TrPs was associated with anxiety levels (r = 0.217; P = 0.045) in women, but not in men (P = 0.453): the higher the number of active TrPs, the more the trait levels of anxiety. Women exhibited lower PPTs than men (all, P < 0.001). In men, the number of active, but not latent, TrPs was negatively associated with localized PPTs (all, P < 0.05), whereas in women, the number of active and latent TrPs was negatively associated with PPTs in all points (all, P < 0.01): the higher the number of TrPs, the lower the widespread PPTs. CONCLUSIONS: This study described gender differences in the presence of TrPs in TTH. Women with TTH showed lower PPTs than men. The association between TrPs, anxiety levels, and pressure pain hyperalgesia seems to be more pronounced in women than in men with TTH.

Prevalence of high-risk HPV genotypes, categorised by their quadrivalent and nine-valent HPV vaccination coverage, and the genotype association with high-grade lesions.

BACKGROUND: The new nine-valent vaccine against human papillomavirus (HPV) includes the four HPV genotypes (6, 11, 16, and 18) that are targeted by the older quadrivalent HPV vaccine, plus five additional oncogenic types (31, 33, 45, 52, and 58) remain significantly associated with high grade lesions. We aimed to determine the prevalence of high-risk HPV genotypes in unvaccinated subjects and the association of these genotypes with the incidence of high-grade lesions. We also assessed which, if either, of these two HPV vaccines could have prevented these cases. METHODS: This cross-sectional study, conducted from 4 January 2010 to 30 December 2011, was composed of 595 women attending the Hospital General Universitario de Elche (Spain) gynaecology department who were positively screened for opportunistic cervical cancer by pap smears and HPV detection during a routine gynaecological health check. The pap smear results were classified using the Bethesda system. HPV genotyping was performed with the Linear Array HPV genotyping test, and viruses were classified by the International Agency for Research on Cancer assessment of HPV carcinogenicity. Odds ratios (ORs) with their 95% confidence intervals (95% CI) were estimated by logistic regression, adjusting for age and immigrant status. The prevented fraction among those exposed (PFe-adjusted) was determined as a measure of impact. RESULTS: At least one of the additional five high-risk HPV genotypes present in the nine-valent HPV vaccine was detected in 20.5% of subjects. After excluding women with genotype 16 and/or 18 co-infection, high-risk genotypes (31, 33, 45, 52, and 58) were associated with a higher risk of intraepithelial lesion or malignancy: adjusted OR = 3.51 (95% CI, 1.29-9.56), PFe-adjusted = 0.72 (95% CI, 0.22-0.90). Genotypes that are still non-vaccine-targeted were detected in 17.98% of the women, but these were not significantly associated with high-grade lesions. CONCLUSION: The greater protection of the nine-valent HPV vaccine is likely to have a positive impact because, in the absence of genotype 16 or 18 infection, these five genotypes on their own remained significantly associated with high-grade lesions.

Living with a peripherally inserted central catheter: the perspective of cancer outpatients-a qualitative study.

PURPOSE: The aim of this study was to describe the experience of using a peripherally inserted central catheter (PICC) in cancer sufferers receiving outpatient treatment. METHODS: A qualitative, phenomenological study was performed. Purposeful sampling methods were used. Data collection methods included semi-structured interviews and researcher field notes. Thematic analysis was used to analyze data. The study was conducted following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Eighteen patients (61% women, mean age 58 years) participated. They spent a mean duration of 155 days with the line in place. Two themes were identified with different subgroups. The theme "Living with a PICC line," including the subthemes "Benefits" and "Disadvantages," displays how the implantation is experienced by patients in a dichotomous manner. This highlighted both the beneficial and negative aspects of the implantation. The second theme was "Adapting to life with the catheter" and comprised three subthemes: "Advantages," "Lifestyle modifications," and "Overall assessment of the peripherally inserted central catheter," which shows how patients gradually accept the catheter by adapting their lifestyle. CONCLUSIONS: Over time, most patients considered having a PICC line to be a positive experience that they would recommend to other patients, as they found that it did not alter their quality of life. These results can be applied in Oncology Units for developing specific protocols for patients.

Does Jacobson's relaxation technique reduce consumption of psychotropic and analgesic drugs in cancer patients? A multicenter pre-post intervention study.

BACKGROUND: Cancer patients often suffer from emotional distress as a result of the oncological process. The purpose of our study was to determine whether practice of Jacobson's relaxation technique reduced consumption of psychotropic and analgesic drugs in a sample of cancer patients. METHODS: This was a multicenter pre-post intervention design. Participants were 272 patients aged over 18 years attending 10 Spanish public hospitals with oncological pathologies and anxiety symptoms. The intervention consisted of a protocol of abbreviated progressive muscle relaxation training developed by Bernstein and Borkovec. This was followed up by telephone calls over a 1-month period. The intervention was performed between November 2014 and October 2015. Sociodemographic variables related to the oncological process, mental health variables, and intervention characteristics were measured. RESULTS: A reduction in the consumption of psychotropic and analgesic drugs was observed throughout the follow-up period. Improvement was observed throughout the 4-week follow-up for all the parameters assessed: anxiety, relaxation, concentration, and mastery of the relaxation technique. CONCLUSIONS: The practice of abbreviated Jacobson's relaxation technique can help to decrease the consumption of psychotropic and analgesic drugs. Patients experienced positive changes in all the evaluated parameters, at least during the 1-month follow-up. To confirm these findings, additional long-term studies are needed that include control groups. TRIAL REGISTRATION: ISRCTN 81335752 , DOI 10.1186/ISRCTN81335752 17. Date of registration: 22/11/2016 (retrospectively registered).

Gender differences in variables associated with sleep quality in chronic tension type headache.

We aimed to evaluate gender differences in the relationships between headache features, sleep quality, anxiety, depressive symptoms, and burden of headache in 193 patients (73 percent women) with chronic tension type headache (CTTH). Sleep quality was assessed with the Pittsburgh Sleep Quality Index. Headache features were collected with a four-week diary. The Hospital Anxiety and Depression Scale was used to assess anxiety/depressive symptoms. Headache Disability Inventory was used to evaluate the burden of headache. In men with CTTH, sleep quality was positive correlated with headache frequency (r = 0.310; p = .018), emotional (r = 0.518; p < .001) and physical (r = 0.468; p < .001) burden of headache, and depressive symptoms (r = 0.564; p < .001). In women, positive correlations were observed between sleep quality and headache intensity (r = 0.282; p < .001), headache frequency (r = 0.195; p = .021), emotional burden (r = 0.249; p = .004), and depressive symptoms (r = 0.382; p < .001). The results of stepwise regression analyses revealed that depressive symptoms and emotional burden of headache explained 37.2 percent of the variance in sleep quality in men (p < .001), whereas depressive symptoms and headache intensity explained 17.4 percent of the variance in sleep quality in women (p < .001) with CTTH. Gender differences associated with poor sleep should be considered for proper management of individuals with CTTH.

The experience of being a psychiatric nurse in South Africa: A qualitative systematic review.

PURPOSE: The purpose of the study was to summarize the experiences of African psychiatric nurses in their workplace by examining the findings of existing qualitative studies. METHODS: Eleven studies published in English, Portuguese, and Spanish, between 1998 and 2016, which explored psychiatric nurses' experiences in Africa, were included. FINDINGS: After meta-aggregation, five key findings were identified: 1) organization and management, 2) perceptions of professional safety and insecurity, 3) relationship with the patient, 4) emotional experiences and 5) recommendations for improvement. DISCUSSION: The findings in this study highlight the stressful nature of the work climate of the psychiatric nurse in South Africa. More focus on improving working conditions and providing support is necessary to increase the quality of care for psychiatric mental health patients and their nurse providers.

Environmental Sustainability and Physicochemical Property Screening of Chitin and Chitin-Glucan from 22 Fungal Species.

Thanks to its biobased character with embedded biogenic carbon, chitin can aid in the transition to a sustainable circular economy by replacing fossil carbon from the geosphere. However, meeting current demands for material availability and environmental sustainability requires alternative methods limiting conventional chemical and energy-consuming chitin extraction from crustaceans. To assist future chitinous bioproduct development, this work analyzes the physicochemical properties and potential environmental sustainability of fungal chitin-glucan complexes. A conventional isolation procedure using sodium hydroxide, a weak acid, and short reaction times are applied to the fruiting body of 22 fungal species. Besides, the valorization of underutilized waste streams including Agaricus bisporus and Agaricus brunnescens stipes is investigated. The carbohydrate analysis renders chitin fractions in the range of 9.5-63.5 wt %, while yields vary from 4.2 to 29.9%, and the N-acetylation degree in found in between 53.0 and 98.7%. The sustainability of the process is analyzed using life cycle assessment (LCA), providing impact quantification for global warming potential, terrestrial acidification, freshwater eutrophication, and water use. With 87.5-589.3 kg·CO2-equiv per kilo, potentially lower global warming potential values in comparison to crustacean chitin are achieved. The crystallinity degree ranged from 28 to 78%, while the apparent chitin crystalline size (L020) is between 2.3 and 5.4 nm. Ten of the species yield α-chitin coexisting with semicrystalline glucans. Zwitterionic properties are observed in aqueous solutions, shifting from cationic to anionic at pH 4.5. With its renewable carbon content, fungal chitin is an environmentally sustainable alternative for high-value applications due to its balance of minimal treatment, low carbon footprint, material renewability, ease of isolation, thermal stability, zwitterionic behavior, biodegradability, and noncytotoxicity.

Coping with the hospital environment during the COVID-19 pandemic: A qualitative study of the survivors' perspective during their stay at the ICU and inpatient ward.

The COVID-19 pandemic has significantly affected the clinical practice of healthcare professionals. This study aimed to explore the perspectives of COVID-19 survivors regarding the healthcare they received during their stay in the Intensive Care Unit (ICU) and the inpatient COVID-19 ward. A qualitative case-study approach was implemented. Participants were recruited using non-probabilistic purposeful sampling strategy. Inclusion criteria included patients aged ≥18 years who received follow-up from the Pulmonology service at a Hospital in de North of Spain, were diagnosed with COVID-19 and bilateral pneumonia, and were admitted to the ICU before being transferred to a COVID-19 inpatient ward. Data was collected through in-depth interviews and researchers' field notes, and thematic analysis was performed. Techniques such as credibility, transferability, dependability, and confirmability were employed to ensure the trustworthiness of the data. A total of 25 individuals (six women) were included in the study. Three main themes emerged from the analysis: common challenges faced in both units, coping with the hospital stay, and developing strategies. Findings highlighted the need to improve information dissemination, individualize care, and enhance direct patient interaction. Moreover, the study shed light on the psychological impact of hospitalization and ICU experience, including feelings of loneliness, confinement, and the lack of memories from the ICU stay, as well as the influence of care and healthcare language. Finally, strategies such as keeping the mind occupied and maintaining self-discipline were identified as crucial during hospitalization. These findings provide valuable insights for healthcare professionals in delivering care to individuals with COVID-19 in the ICU and hospital ward settings.