Perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples of the Department of Presidente Hayes, Paraguay

Introduction: During the COVID-19 pandemic, factors such as border closures, late receipt of vaccines, limitation of population circulation, relocation of nurses from vaccination areas to areas of care for patients with COVID-19, added to the fear of contagion affected vaccination coverage in several countries. Objective: Describe the perception of the COVID-19 vaccine and its effect on the regular vaccination coverage of indigenous peoples in the department of Presidente Hayes, Paraguay 2022. Methods: Descriptive, retrospective, observational study with a qualitative-quantitative cross-sectional design. Results: The characteristics of the indigenous peoples reveals that 110 (26.44%) are between 28 and 37 years old, 276 (66.35%) are female, 133 (31.97%) are of the Angaité ethnic group, 290 (69.71%) have studies up to the primary level and 178 (42.79%) have single marital status. The perception towards the COVID-19 vaccination was favorable in 201 subjects (48%) and very unfavorable in 148 (36%). There are indigenous peoples with great influence of cultural and religious beliefs in relation to vaccines. Regular vaccination was affected. Discussion: It was observed that the COVID-19 pandemic and the appearance of the vaccine developed distrust not only in the COVID-19 vaccine but also in the rest of the vaccines in some of the towns studied. © 2023, Faculty of Medical Sciences, Santa Rosa del Aguaray Branch, National University of Asuncion. All rights reserved.

Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain Síndrome de dificultad respiratoria aguda asociado a la COVID-19. Características clínicas y de pronóstico en una unidad de cuidados intensivos de Valencia, España

Objective Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. Design Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. Setting 36-bed MCCU in referral tertiary hospital. Patients and participants SARS-CoV-2 infection confirmed by real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. Interventions None Main variables of interest Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. Results Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 – 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9);26.5% among ventilated patients. Conclusions The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.

Unequal literacy development and access to online education in public versus private Panamanian schools during COVID-19 pandemic

National and international tests have yielded low reading comprehension results for education in Panama, although there is limited information regarding literacy development and performance. There are wide gaps in social inequality, access to technology, and public versus private school achievement. Considering this, after a year off from regular face-to-face classes and a partial transition to online education due to the COVID-19 pandemic, the present study utilizes existing data to carry out a pre-post comparison of the reading performance of fourth (n = 167) and sixth (n = 164) grade students in the province of Panama employing a subsample stratified by educational system for comparability (Mann–Whitney U test, α = 0.05). The pre-post comparison was also carried out independently in both the public (n = 235) and private (n = 106) systems, as well as an additional comparison of the average weekly hours of online academic engagement in both systems during the pandemic in fourth (n = 117) and sixth grade (n = 109). The results support a significant decrease in reading performance. Based on the comparative analysis, findings indicate that public school students interacted online with their teachers significantly less than their private schools' counterparts;and that, in the same sample, only the public-school students exhibited a significant decrease in reading speed by phonological and lexical route with a medium effect size compared to pre-pandemic standards, greater than those reported in other contexts. This highlights the need to develop effective strategies to narrow the existing educational gaps in the country, which seem to have widened due to the pandemic, with particular emphasis on reading performance in primary school. Copyright © 2023 Cubilla-Bonnetier, Grajales-Barrios, Ortega-Espinosa, Puertas and De León Sautú.

SELECTIVE UNIVERSAL INTERVENTION RECOMMENDED FOR TEACHERS: A PROPOSAL FOR POSITIVE PSYCHOLOGICAL FUNCTIONING

Given the fact that being healthy implies the adequate functioning in all areas of an individual’s life and not only the absence of disease, attention has begun to focus on enhancing those positive or salutogenic factors in the individual in order to achieve greater wellbeing and thus a better quality of life. Among the main areas of application are educational institutions, in which the main subjects of intervention are students and family members, where the teaching staff seems to be the one that has received the least attention from researchers. This last point takes on greater relevance, since currently this group has been strongly affected by the health crisis of COVID-19, where not only the daily demands of the position count, but also the discomforts of private life and the sudden adaptation to new modalities has been able to generate a highly susceptible context for physical and mental discomfort. Therefore, the present work makes a brief proposal to increase positive factors using cognitive-behavioral and positive psychology techniques in a universal-selective-indicated intervention to favor positive psychological functioning in teachers. © 2022, University of Cienfuegos, Carlos Rafael Rodriguez. All rights reserved.

PERSONALITY FACTORS IN YOUNG MEXICANS AND THEIR RELATIONSHIP WITH ETHICAL DILEMMAS ABOUT COVID-19

Health challenges that society faces since the arrival of COVID-19 highlight the importance of making decisions that can result in a moral dilemma when it comes to taking actions that benefit both the person and the environment. The objective of this study was to describe personality traits and the level of moral development from dilemmas in situations of the COVID-19 pandemic. It is a non-experimental descriptive study with a correlational scope. A total of 1,043 adults (791 women, 114 men, and 138 unspecified), aged 18 to 30 years, participated. The Moral Dilemmas and Covid-19 Assessment Scale (EVaDiM-Covid-19) was developed and applied digitally together with the Big Five Inventory, which were shared through social networks. The results show that the population is mainly in the conventional and postconventional stages, having personality factors with average scores, which allow them to regulate and adapt in a positive way. However, it is noteworthy that the group of people in the preconventional stage shows personality traits with greater difficulty in emotional regulation.

DISTANCE TEACHING EXPERIENCE, POSITIVE PSYCHOLOGICAL FUNCTIONING AND PERSONALITY FACTORS IN MEXICAN TEACHERS

Due to the challenge that the process of adaptation to the virtual environment has implied for teachers, it is relevant to identify if their personality traits may be a factor that is related to their perception of psychological well-being. A non-experimental descriptive study of correlational scope was used. 198 adults from the general population participated, 139 women and 59 men, aged between 18 and 70 years, through snowball sampling through social networks. The participants answered an electronic form, made up of the informed consent of the study, the New Contexts, New Demands and Teaching Experience Questionnaire, together with the Gaudibility Scale, the Positive Psychological Functioning Scale and the Inventory of the Five Big. The results show that despite the fact that most teachers have an average level of psychological functioning and gaudinability, most of them reported difficulties in adapting to online classes. Those teachers with traits of extraversion report greater gaudibility and better psychological functioning. These types of studies make it possible to consider prevention strategies that promote positive resources to face challenges such as the COVID-19 pandemic.

Implementation of Lean Six Sigma to Lessen Waiting Times in Public Emergency Care Networks: A Case Study

Emergency Care Networks (ECNs) are integrated healthcare systems comprised of emergency departments (EDs). ECNs are called to be the primary response of healthcare authorities to deal with the expected uptick in the future demands for emergency care during the current Covid-19 pandemic. Lean Six Sigma (LSS) has been proposed to address this challenge since it allows managers to detect factors contributing to the extended waiting times (WT) throughout the patient journey. The suggested framework follows the DMAIC cycle that was initiated with the project charter definition;in the meantime, a SIPOC diagram was drawn to analyze the emergency care process and pinpoint critical process variables. Following this, a nested Gage R&R study was undertaken to study the measurement system performance;subsequently, a normal-based capability analysis was carried out to determine how well the ECN process satisfies the specifications. The next step was to identify the potential causes separating the ECN nodes from the desired target. Afterwards, improvement strategies were devised to lessen the average WT. After suitable data collection, a before-and-after analysis was performed to verify the effectiveness of the implemented strategies. Ultimately, a control plan containing an I-MR control chart was designed to maintain the improvements achieved with the LSS implementation. The results revealed that the average WT of the showcased node passed from 190.02 min to 103.1 min whereas the long-term sigma level increased from −0.06 to 0.11. The proposed framework was validated through a case study including the involvement of a medium-sized hospital from the public sector. © 2021, Springer Nature Switzerland AG.

Hospitalization budget impact during the COVID-19 pandemic in Spain.

OBJECTIVES: The aim was to determine the direct impact of the COVID-19 pandemic on Spain's health budget. METHODS: Budget impact analyses based on retrospective data from patients with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) admitted to a Spanish hospital between February 26 and May 21, 2020. Direct medical costs from the perspective of the hospital were calculated. We analyzed diagnostic tests, drugs, medical and nursing care, and isolation ward and ICU stays for three cohorts: patients seen in the emergency room only, hospitalized patients who tested positive for SARS-CoV-2, and patients who tested negative. RESULTS: The impact on the hospital's budget for the 3 months was calculated at €15,633,180, 97.4% of which was related to health care and hospitalization. ICU stays accounted for 5.3% of the total costs. The mean cost per patient was €10,744. The main costs were staffing costs (10,131 to 11,357 €/patient for physicians and 10,274 to 11,215 €/patient for nurses). Scenario analysis showed that the range of hospital expenditure was between €14,693,256 and €16,524,924. The median impact of the pandemic on the Spanish health budget in the sensitivity analysis using bootstrapped individual data was €9357 million (interquartile range [IQR], 9071 to 9689) for the conservative scenario (113,588 hospital admissions and 11,664 ICU admissions) and €10,385 million (IQR, 110,030 to 10,758) for the worst-case scenario (including suspected cases). CONCLUSION: The impact of COVID-19 on the Spanish public health budget (12.3% of total public health expenditure) is greater than multiple sclerosis, cancer and diabetes cost.

Radial To Peripheral: The Efficacy of Transradial Access for Peripheral Interventions in Patients With Complex Transfemoral Access

Introduction: The safety and feasibility of distal transradial access (TRA) is well-established for coronary interventions and has been increasingly used for peripheral angiography and intervention, especially with the increasing innovation and development of longer sheaths, balloons, and stent delivery systems. In the COVID-19 era, the emphasis on same-day discharge has led our institution to approach complex and challenging transfemoral cases through a transradial approach with favorable results. Methods: This is a retrospective review of cases deemed as complex femoral access due to the presence of complete total occlusion (CTOs), limited by patient body habitus or patients with prior endovascular aortic repairs (EVARs), and, thus, necessitated a TRA approach. Details of the patient characteristics and procedure were collected and evaluated. Results: Fifty-four patients underwent ultrasound-guided radial access. The average age was 67 ± 10 years, with 43 patients presenting with critical limb ischemia (Rutherford class 4). The mean height was 173 ± 9 cm and the mean body mass index was 30 ± 4.9 kg/m2. All patients underwent angiography through a transradial approach: 37% of patients had undergone intervention, with the majority of target vessels being iliac and/or femoral arteries;19% of patients were known EVARs with occluded graft limbs, and 22% had occluded surgical grafts. All patients received balloon angioplasty, 55% received mechanical aspiration thrombectomy or atherectomy, and 15% received stenting. The average procedure time was 88 ± 43 minutes with average contrast used of 179 ± 80 ml. The majority of patients were discharged the same day with an outpatient follow-up at one week. Conclusion: Our experience has emphasized the utility, efficacy, and safety in approaching peripheral interventions through distal radial access in obese patients with difficult, unfavorable transfemoral access, allowing same-day discharge and an economically feasible result.

A multiple criteria decision-making approach for increasing the preparedness level of sales departments against COVID-19 and future pandemics: A real-world case

The impact of the pandemic and the lockdown has been more devastating than expected on the world economy. It is essential to formulate strategies in real-time. In this research, a multicriteria decision-making model for increasing the preparedness level of sales departments when facing COVID-19 waves and future pandemics is proposed. The model is comprised of 8 criteria, 29 sub-criteria, and 7 alternatives. The study is based on the integration of the AHP and TOPSIS techniques. AHP is used for calculating the criteria and sub-criteria weights. While, TOPSIS is used for calculating the preparedness level, ranking the companies, and identifying the weaknesses that should be addressed for increasing their effectiveness in the current market scenario. The model is developed with the aid of an experts’ group from the electrical appliance sector and studies from the reported literature. This application is completely novel in the literature and has been applied in the wild with remarkable companies in Colombia. A case study in the electrical appliance sector is presented as a pilot study but it should be noted that the methodology is flexible and scalable in any scenario. © 2021 Elsevier Ltd

Convalescent plasma therapy prevents acute respiratory distress syndrome in patients with sars-cov-2 virus disease

Background: SARS-CoV-2 disease 2019 is a pandemic with no specific therapeutic agents and substantial mortality. The success of convalescent plasma therapy is based on the transfused plasma had high concentrations of anti-SARS-CoV-2 antibodies, and on the safe preparation of serum to eliminate potential risk factors, such as the transmission of viruses via transfusion. Methods: Five patients laboratory confirmed COVID-19, diagnosed using reverse transcriptase–polymerase chain reaction (RT-PCR) classified like of care and seriously non-ventilated patients with moderate hypoxemia were received 300 mL convalescent plasma treatment. Each donation was tested for antibody titers IgG class anti-SARS-CoV-2 by UMELISA. The transfused plasma units had an average antibody titer of 836.00 ± 617.155. The time interval between the onset of symptoms and transfusion was 9 days (7.20± 3). Before and after each transfusion, clinical and laboratory parameters were evaluated. Results: At 24-hour after the plasma transfusion, oxygen partial pressure increased from medium value of 70.4 to 101.6 mm Hg, C-reactive protein and lactate dehydrogenase enzyme values decreased in 3 of 5 patients;however, the ferritin values increased in all the patients. Post-transfusion hospital discharge time was from 48 hours to 12 days and the SARS-CoV-2 PCR was negative between 3 and 5 days. No adverse transfusion reactions were reported. Conclusion: This report emphasis about the efficacy and security of convalescent plasma transfusion to care and seriously non-ventilated patients infected like a preventive therapy for severe respiratory distress for SARS-CoV-2 virus disease. © 2020, Editorial Ciencias Medicas. All rights reserved.

Acute respiratory distress syndrome due to COVID-19. Clinical and prognostic features from a medical Critical Care Unit in Valencia, Spain.

OBJECTIVE: Information from critically ill coronavirus disease 2019 (COVID-19) patients is limited and in many cases coming from health systems approaches different from the national public systems existing in most countries in Europe. Besides, patient follow-up remains incomplete in many publications. Our aim is to characterize acute respiratory distress syndrome (ARDS) patients admitted to a medical critical care unit (MCCU) in a referral hospital in Spain. DESIGN: Retrospective case series of consecutive ARDS COVID-19 patients admitted and treated in our MCCU. SETTING: 36-bed MCCU in referral tertiary hospital. PATIENTS AND PARTICIPANTS: SARS-CoV-2 infection confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay of nasal/pharyngeal swabs. INTERVENTIONS: None MAIN VARIABLES OF INTEREST: Demographic and clinical data were collected, including data on clinical management, respiratory failure, and patient mortality. RESULTS: Forty-four ARDS COVID-19 patients were included in the study. Median age was 61.50 (53.25 - 67) years and most of the patients were male (72.7%). Hypertension and dyslipidemia were the most frequent co-morbidities (52.3 and 36.4% respectively). Steroids (1mg/Kg/day) and tocilizumab were administered in almost all patients (95.5%). 77.3% of the patients needed invasive mechanical ventilation for a median of 16 days [11-28]. Prone position ventilation was performed in 33 patients (97%) for a median of 3 sessions [2-5] per patient. Nosocomial infection was diagnosed in 13 patients (29.5%). Tracheostomy was performed in ten patients (29.4%). At study closing all patients had been discharged from the CCU and only two (4.5%) remained in hospital ward. MCCU length of stay was 18 days [10-27]. Mortality at study closing was 20.5% (n 9); 26.5% among ventilated patients. CONCLUSIONS: The seven-week period in which our MCCU was exclusively dedicated to COVID-19 patients has been challenging. Despite the severity of the patients and the high need for invasive mechanical ventilation, mortality was 20.5%.

Attendee Survey and Practical Appraisal of a Telegram®-Based Dermatology Congress During the COVID-19 Confinement. / Congreso virtual de dermatología realizado a través de Telegram® durante el confinamiento de la COVID-19: organización y evaluación.

INTRODUCTION: The COVID-19 pandemic outbreak introduced dramatic changes in all our lives, daily practice, and medical conferences. In search of a tool to spread dermatologic knowledge during confinement, an online medical meeting was held on April 25th to 26th, 2020. In this study, we aimed to assess the characteristics, opinion and satisfaction of the attendees to a free-of-charge online congress. Secondarily, we intended to explain how this meeting was prepared. MATERIAL AND METHODS: Online survey administered to the attendees to an online congress organised via the Telegram® Messenger App. Its organisation and planning, which needed no financial support and was done by volunteer organisers, moderators and speakers, is described step by step. RESULTS: The satisfaction of both speakers and attendees was very high. All participants considered that this format had a great present and future, and most of them rated it as superior to regular face-to-face meetings. Female gender and predominantly private practice favoured this opinion. DISCUSSION: The COVID-19 pandemic has forced the cancellation of most scientific gatherings. This has been seen by some authors as an excellent opportunity, encouraging medical societies and organisations to lead the change to virtual meetings. Although confinement did not allow real contact, our online meeting showed it was possible to ensure interaction and participation between attendees, moderators and speakers. Dermatologists enjoyed some dermatologic science, even despite the extraordinary circumstances disrupting their daily clinical practice. Most of them felt they were participating in something new and compelling that many felt superior to traditional meetings.