Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study.

After the resolution of the acute SARS-COV-2 infection, an important percentage of patients do not fully recover and continue to present several symptoms. Nevertheless, there is a lack of data in the literature on the effects of rehabilitation programs on medium- and long-term long COVID symptoms. Therefore, the aim of this study was to evaluate the long-term outcomes after rehabilitation programs in long COVID syndrome patients. A prospective cohort study was conducted from August 2021 to March 2022, involving 113 patients with long COVID syndrome. The patients in the experimental group (EG, n=25) received a tailored and multidisciplinary rehabilitative program, involving aquatic exercises, respiratory and motor exercises, social integration training and neuropsychologic sessions, LASER therapy and magnetotherapy. Patients in the other three comparison groups received eastern medicine techniques (CG1), balneotherapy and physiotherapy (group CG2), self-training and home-based physical exercise (CG3). Once the several rehabilitation protocols had been performed, a structured telephone contact was made with the patients after 6 months ± 7 days from the end of the rehabilitation treatment, in order to record the frequency of hospital ad-missions due to exacerbation of post-exacerbation syndrome, death or disability, and the need for other types of care or drugs. The patients in the comparison groups were more likely to request therapeutic care for emerging long COVID symptoms (χ2=6.635, p=0.001; χ2=13.463, p=0.001; χ2=10.949, p=0.001, respectively), as well as more likely to be hospitalized (χ2=5.357, p=0.021; χ2=0.125, p=0.724; χ2=0.856, p=0.355, respectively) when compared to the patients of the EG. The relative risk (RR) of hospital admissions in the observed cohort was 0.143 ±1,031 (СI: 0.019; 1.078); 0.580±1,194 (CI: 0.056; 6.022); 0,340±1,087 (CI: 0.040; 2.860). The RR of hospital admissions for patients with long COVID syndrome was reduced by 85.7%; 42.0% and 66.0%, respectively, when the experimental rehabilitation technique was employed. In conclusion, a tailored and multidisciplinary rehabilitative program seems to have a better preventive effect not only in the short term, but also over the next 6 months, avoiding the new onset of disabilities and the use of medicines and specialist advice, than other rehabilitative programs. Future studies will need to further investigate these aspects to identify the best rehabilitation therapy, also in terms of cost-effectiveness, for these patients.

Can aquatic exercises contribute to the improvement of the gait stereotype function in patients with Long COVID outcomes?

A variety of rehabilitation programmes can be offered to Long COVID patients, specifically physical training. Indeed 90% of these patients reports impairments of verticalization, stability and spatial orientation, making difficult exercise in the gym. The aim of our study was to assess the effectiveness and safety of aquatic exercise techniques as part of a comprehensive rehabilitation program for patients with Long COVID. The first of a two-stage program involved development of aquatic exercises technique, which was evaluated in 12 patients with impaired upright posture control before and after exercising by "Habilect" video gait analysis system. During the second phase, effectiveness and safety of aqua exercises were tested in water pool as part of a comprehensive rehabilitation programme conducted in 23 patients with Long COVID outcomes. Physical examination, 6-minute step test, Euro-QL-5D questionnaire, Borg scale, laser Doppler flowmetry, cardiointervalography, and spirometry were performed before and after the aquatic exercises program. After the training with aquatic exercises, indices of deviations of the main body axes of the head and the body mass centre ameliorated, as well as direction of body movement vector decreased (p<0.05). This study demonstrated a statistically significant improvement in exercise tolerance in both groups, as measured by the 6-minute step test after rehabilitation. The comparison group averaged 236.7 metres [126; 380] (T=8, p=0.047) after the rehabilitation course and the intervention group averaged 233.71 metres [150; 320] (T=8.0, p=0.047). When tested with the Euro-QL-5D questionnaire, a post-treatment improvement was noted in the comparison group on the anxiety/depression subscale (3 [3;3] (T=0, p=0.043)). In the intervention group, laser Doppler flowmetry revealed a statistically significant increase in microcirculation (6.36 standard units after rehabilitation) [5.54; 8.17] (T=7.0, p=0.004), and a decrease of oxidative metabolism index of 6.89 standard units. [4.76; 6.96] (T=4.0, p=0.03). No serious adverse events were reported. In conclusion, the developed aquatic exercises technique seems to contribute to recovery of impaired upright posture and motor function, normalizing the walking pattern.

Strengthening Collaboration of the Indigenous Peoples in the Russian Arctic: Adaptation in the COVID-19 Pandemic Times

The article presents the challenges of the Indigenous peoples' interplay with the key actors (Indigenous communities, Indigenous associations, regional governments, corporate businesses, and scientific institutions) in the Russian Arctic. Invoking actor–network theory offered knowledge to analyse how the effectiveness of this collaboration may lead to Indigenous peoples' social adaptation in the COVID-19 times. It revealed the main problems increasing their vulnerability and making barriers to meeting sustainable development goals (SDGs). The primary sources included the data collected from expert interviews in the Yamal-Nenets Autonomous Okrug, the Nenets Autonomous Okrug, and the Murmansk region in 2020–2021. The main findings proved the gaps in the interplay of Indigenous peoples with key actors in the Russian Arctic due to insufficient interregional and international cooperation, indirect communication of governments with Indigenous peoples via Indigenous associations and communities focused mostly on supporting elites, and the lack of systematic feedback of all key actors. This collaboration must be focused on meeting SDGs and guaranteeing their economic, social, and cultural rights to maintain a traditional lifestyle and livelihoods, involving them in natural resource management, improving quality of life and well-being, increasing access to ethnocultural education, reducing inequality, and promoting Indigenous peoples' self-government.

Food Sovereignty of the Indigenous Peoples in the Arctic Zone of Western Siberia: Response to COVID-19 Pandemic.

This article presents the challenges facing reindeer herding as being both a profitable business and part of the traditional culture of the nomadic Indigenous peoples in the Arctic zone of Western Siberia which addresses substantial needs of the local population. Reindeer herding products are used as traditional nutrition, and as effective preventive means and remedies for adapting to the cold and geomagnetic activity in the High North. Export trends of traditional reindeer products have decreased local Indigenous peoples' access to venison and had a negative impact on their health. Due to the COVID-19 pandemic, it is especially urgent for the Indigenous peoples to have sufficient access to traditional food and be involved in policy decision-making to maintain this traditional business. We aim to analyze the dependencies of Indigenous peoples on the reindeer produce-exporting "food value chain" and explore how (1) the independence of reindeer herders could be increased in these export chains and (2) how provision of their products to local communities could be secured. The study takes a multidisciplinary approach based on policy and socioeconomic analyses with input from medical research. Primary sources include data collected from interviews and surveys of Indigenous peoples during expeditions to the Nyda settlement, the Nydinskaya tundra, the Tazovsky settlement, the Tazovskaya tundra, the Nakhodka tundra, the Gyda and Gydansky settlements, the Yavai-Salinskaya tundra, the Seyakha settlement, the Seyakhinskaya and Tambeyskaya tundras located along the southern coast of the Ob Bay, the northeast coast of the Yamal Peninsula, the Tazovsky and Gydansky Peninsulas, and the Shuryshkarsky district. Data were collected during the summers and winters of 2014-2020.