Long-Term Sequelae of severe COVID-19: outpatient assessment of radiological and pulmonary function tests Secuelas a largo plazo de la COVID-19 grave: valoración ambulatoria de pruebas radiológicas y de función pulmonar

Objective: Identify lung sequelae of COVID-19 through radiological and pulmonary function assessment. Design: Prospective, longitudinal, cohort study from March 2020 to March 2021. Setting: Intensive Care Units (ICU) in a tertiary hospital in Portugal. Patients: 254 patients with COVID-19 admitted to ICU due to respiratory illness. Interventions: A chest computed tomography (CT) scan and pulmonary function tests (PFT) were performed at 3 to 6 months. Main variables of interest: CT-scan;PFT;decreased diffusion capacity of carbon monoxide (DLCO). Results: All CT scans revealed improvement in the follow-up, with 72% of patients still showing abnormalities, 58% with ground glass opacities and 62% with evidence of fibrosis. PFT had abnormalities in 94 patients (46%): thirteen patients (7%) had an obstructive pattern, 35 (18%) had a restrictive pattern, and 58 (30%) had decreased DLCO. There was a statistically significant association between abnormalities in the follow-up CT scan and older age, more extended hospital and ICU stay, higher SAPS II and APACHE scores and invasive ventilation. Mechanical ventilation, especially with no lung protective parameters, was associated with abnormalities in PFT. Multivariate regression showed more abnormalities in lung function with more extended ICU hospitalization, chronic obstructive pulmonary disease (COPD), chronic kidney disease, invasive mechanical ventilation, and ventilation with higher plateau pressure, and more abnormalities in CT-scan with older age, more extended ICU stay, organ solid transplants and ventilation with higher positive end-expiratory pressure (PEEP). Conclusions: Most patients with severe COVID-19 still exhibit abnormalities in CT scans or lung function tests three to six months after discharge.

Teachers' Perceptions of Remote Learning during the Pandemic: A Case Study

The closure of higher education institutions (HEIs) due to the outbreak of the COVID-19 pandemic led to visible changes in pedagogical practices. With the lockdown, there was ambiguity and disagreement about the workload of teachers and students, and about what to teach and what strategies to select. For most instructors, the first challenge was to recreate the face-to-face experience. Worldwide, most universities have speedily adopted synchronous and asynchronous communication modes. Google Classroom, Microsoft Teams, Cisco, Webex, Zoom, and Moodle were among the most used tools. The present study is based upon a quantitative approach, and it intends to analyse teachers' perceptions of remote teaching during the first pandemic period. Data were collected through an online questionnaire during June and July 2020. The questionnaire had 27 questions divided into three main sections: sociodemographic characterization, e-Learning strategies, and remote assessment. The study population was teachers of a Portuguese HEI. A random sample was used with 547 participants. The main conclusions show that the less experienced teachers are, the more satisfied they feel with remote classes and remote assessment. On the other hand, the most experienced teachers used more tools during the remote teaching period and developed more strategies to perform remote assessment. Regarding the overall assessment of the emergency remote teaching, the participants consider that it was a positive period, and they were moderately satisfied with remote classes and the strategies and tools used during this period.

The impact of severe COVID-19 on health-related quality of life and disability: an early follow-up perspective. / Impacto da COVID-19 grave na qualidade de vida relacionada com a saúde e a incapacidade: uma perspectiva de follow-up a curto-prazo.

OBJECTIVE: To assess early postdischarge health-related quality of life and disability of all survivors of critical COVID-19 admitted for more than 24 hours to na intensive care unit.. METHODS: Study carried out at the Intensive Care Medicine Department of Centro Hospitalar Universitário São João from 8th October 2020 to 16th February 2021. Approximately 1 month after hospital discharge, an intensive care-trained nurse performed a telephone consultation with 99 survivors already at home applying the EuroQol Five-Dimensional Five-Level questionnaire and the 12-item World Health Organization Disability Assessment Schedule 2.0. RESULTS: The mean age of the population studied was 63 ± 12 years, and 32.5% were submitted to invasive mechanical ventilation. Their mean Simplified Acute Physiologic Score was 35 ± 14, and the Charlson Comorbidity Index was 3 ± 2. Intensive care medicine and hospital lengths of stay were 13 ± 22 and 22 ± 25 days, respectively. The mean EuroQol Visual Analog Scale was 65% (± 21), and only 35.3% had no or slight problems performing their usual activities, most having some degree of pain/discomfort and anxiety/depression. The 12-item World Health Organization Disability Assessment Schedule 2.0 showed marked impairments in terms of reassuring usual work or community activities and mobility. The use of both tools suggested that their health status was worse than their perception of it. CONCLUSION: This early identification of sequelae may help define flows and priorities for rehabilitation and reinsertion after critical COVID-19.

OBJETIVO: Avaliar a qualidade de vida relacionada com a saúde e a incapacidade no primeiro mês após a alta para domicílio de todos os sobreviventes de COVID-19 grave internados por mais de 24 horas no Serviço de Medicina Intensiva. METÓDOS: Estudo realizado no Serviço de Medicina Intensiva do Centro Hospitalar Universitário São João, entre 8 de outubro de 2020 e 16 de fevereiro de 2021. Aproximadamente 1 mês após a alta para domicílio, uma enfermeira com experiência em medicina intensiva realizou uma consulta telefônica a 99 sobreviventes, aplicando os questionários EuroQol Five-Dimensional Five-Level e World Health Disability Assessment Schedule 2.0 - 12 itens. RESULTADOS: A média de idade da população estudada foi de 63 ± 12 anos, e 32,5% foram submetidos à ventilação mecânica invasiva. O Simplified Acute Physiology Score médio foi de 35 ± 14, e o Índice de Comorbilidades de Charlson foi de 3 ± 2. O tempo de internamento em medicina intensiva e no hospital foi de 13 ± 22 e 22 ± 25 dias, respectivamente. A média da Escala Visual Analógica da EuroQol foi de 65% (± 21), sendo que apenas 35,3% dos sobreviventes não apresentaram ou tiveram problemas ligeiros para realizar suas atividades habituais, a maioria com algum grau de dor/desconforto e ansiedade/depressão. O World Health Disability Assessment Schedule 2.0 - 12 itens, mostrou incapacidade marcada em retomar o trabalho habitual ou atividades comunitárias e na mobilidade. O uso de ambas as ferramentas sugeriu que o estado de saúde dos sobreviventes seria pior do que a sua percepção. CONCLUSÃO: A identificação precoce de sequelas pode ajudar a definir fluxos e prioridades para a reabilitação e reinserção após a COVID-19 grave.

Depressive and Anxiety Symptoms in Severe COVID-19 Survivors: A Prospective Cohort Study.

The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients' neuropsychiatric consequences. This study aims to describe the presence of depressive and anxiety symptoms in severe COVID-19 survivors and to identify associated baseline, in-hospital and post-discharge factors. This study is part of the MAPA longitudinal project conducted with severe COVID-19 patients admitted in Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ) in Porto, Portugal. Patients with ICMD length of stay ≤ 24 h, terminal illness, major auditory loss or inability to communicate at follow-up assessment were excluded. All participants were assessed by telephone post-discharge (median = 101 days), with a comprehensive protocol assessing depressive and anxiety symptoms, cognition, Intensive Care Unit (ICU) memories recall and health-related quality of life. Out of a sample of 56 survivors (median age = 65; 68% males), 29% and 23% had depressive and anxiety symptoms, respectively. Depressive and anxiety symptoms were significantly more prevalent among younger survivors and were associated with cognitive complaints, emotional and delusions ICU memories and fear of having COVID-19 sequelae, sleep problems and pain after discharge (all p < 0.05). An important proportion of these survivors suffers from depression and anxiety symptoms post-discharge, namely younger ones and those who reported more cognitive complaints, ICU memories, fear of having COVID-19 sequelae, sleep problems and pain. These findings highlight the importance of psychological consequences assessment and planning of appropriate and multidisciplinary follow-up care after hospitalization due to COVID-19.

[The Impact of the COVID-19 Pandemic on the Intensive Care Residency Program in Portugal]. / Impacto da Pandemia COVID-19 na Formação Especializada do Internato Médico de Medicina Intensiva em Portugal.

INTRODUCTION: In 2020, critical care departments underwent profound changes imposed by the COVID-19 pandemic. The aim of this study was to evaluate the impact of the pandemic on the intensive care residency program in Portugal. MATERIAL AND METHODS: The Association of Critical Care Residents (AIMINT) prepared a questionnaire using the Google Forms® tool, which was applied during August 2020 to the Critical Care residents in Portugal. A descriptive analysis was performed with the data collected. RESULTS: Eighty-five residents participated in the questionnaire, yieldinga response rate of 62%. Three-quarters of all participants provided care to COVID-19 patients. More than 80% of the surveyed participants were on rotations, and these were canceled in 59% of cases. Seventy-eight percent reported a workload greater than 40 hours per week. CONCLUSION: The COVID-19 pandemic had an impact on the Critical Care Residency program in Portugal. Most residents surveyed provided care to COVID-19 patients and not only saw their rotations suspended but also experienced difficulties in rescheduling them.

Introdução: No ano de 2020, os serviços de medicina intensiva sofreram profundas adaptações e reestruturações impostas pela pandemia de COVID-19. Este estudo teve como objetivo avaliar o impacto desta pandemia na formação especializada do internato médico de medicina intensiva em Portugal.Material e Métodos: A Associação de Internos de Medicina Intensiva elaborou um questionário usando a ferramenta Google Forms®, e que foi aplicado durante o mês de agosto de 2020 aos internos de formação especializada de medicina intensiva, em Portugal. Com base na informação recolhida realizou-se uma análise descritiva.Resultados: Oitenta e cinco médicos internos responderam ao questionário, perfazendo uma taxa de resposta de 62%. Três quartos dos participantes no estudo contactaram com doentes com COVID-19. Oitenta e seis por cento dos médicos internos inquiridos encontravam-se em estágios, tendo os mesmos sido cancelados em 59% dos casos. Setenta e oito por cento referiram uma carga assistencial superior a 40 horas semanais.Conclusão: A pandemia de COVID-19 teve impacto na formação especializada do internato médico de medicina intensiva em Portugal. A maioria dos internos inquiridos contactaram com doentes com COVID-19, com suspensão dos seus estágios e com prejuízo na remarcação dos mesmos.

A Longitudinal Study on Maternal Depressive Symptoms During the COVID-19 Pandemic: The Role of Strict Lockdown Measures and Social Support.

Objectives: This study examined the trajectory of perinatal depressive symptoms in Portuguese women during the COVID-19 pandemic and the role of individual, relational, and contextual risk and protective factors. Methods: This 3-wave longitudinal study followed 290 pregnant women from the third trimester of pregnancy until 6-months postpartum. Women self-reported on depressive symptoms, psychological (anxiety, perceived stress, mindfulness), relational (perceived social support, dyadic adjustment, sexual wellbeing), and contextual (lockdown status) factors. Results: Women who were under strict lockdown presented significantly higher scores of depressive symptoms at baseline (by 1.38 EPDS points) than women who were not under strict lockdown measures. Mixed Growth Models showed that trajectories of depressive symptoms were explained by differences in women's baseline depression. Differences in women's depressive symptoms at baseline were mainly explained by higher anxiety and lower social support (22% and 24% for women under lockdown; 39% and 6% for women not on lockdown, respectively). Conclusion: Preventative interventions targeted at pregnant women should aim to reduce anxiety and enhance women's social support to prevent depression in pregnancy and postpartum during the COVID-19 pandemic.

Hopes and Fears of First-Year Freshman College Students during the COVID-19 Pandemic

The COVID-19 pandemic made the experience of being a first-year freshman college student unique. This study aims to analyze the hopes and fears of these students concerning their current life and future goals. Participating students completed the Hopes & Fears questionnaire. Results showed that students' hopes and fears were mainly connected with domains of education and the global/collective dimension, followed by personal and family members' health. Two new categories emerged, self-fulfillment and solidarity, reflecting the importance of the contextual dimension that these students were navigating. The findings of the current study contribute to the research of college students' hopes and fears towards their future and accounts for the analyses of this topic as we progress to a post-pandemic phase.

Old critically ill COVID-19 survivors: Patient and in-hospital factors associated with cognitive dysfunction

Background Cognitive dysfunction (CD) commonly occurs in survivors of critical illness, namely in those with severe respiratory failure, invasive mechanical ventilation (IMV), deep sedation and delirium. Many critically ill patients with COVID-19 are also expected to have an increased risk of CD, which may be exacerbated by specific conditions of hospitalization during COVID-19 pandemic. This study aimed to estimate the frequency of post-discharge CD in first wave COVID-19 survivors and to identify baseline and in-hospital associated factors. Methods This study is part of a multidisciplinary longitudinal project (MAPA-Mental health in critically ill COVID-19 patients), that is being conducted in Intensive Care Medicine Department of a Portuguese University Hospital. Patients >60 years, admitted due to COVID-19-associated Pneumonia, were included. Exclusion criteria were: Intensive Care Unit (ICU) length of stay (LoS)≤24h, terminal illness, major sensory loss or inability to communicate at the time of follow-up. Participants were evaluated with Six-item Cognitive Impairment Test (6CIT) by telephone. Baseline demographic, clinical and in-hospital data were collected, including sedation, respiratory support, major complications and LoS. Patients with and without CD after-discharge were compared. Results Thirty-two patients were included, with a median age of 72(IQR:64-76) years, mostly were male (66%) and none had previous clinical registry of cognitive impairment or dementia. Nosocomial infection (75%) and difficult weaning from MV (63%) were the most frequent complications. Deep sedation was used in 81% of the patients (median=20 days;IQR:15-42). About 81% needed IMV and 13% were supported with Extracorporeal Membrane Oxygenation (ECMO). Median ICU and hospital LoS were 29(IQR:144-56) and 66(IQR:33-102) days, respectively. Follow-up assessment occurred 93.4 days (IQR:68-120) after-discharge. Based on 6CIT, 16% of survivors had CD. Comparing both groups, those with CD were older (73vs.64;p=0.020), had a higher duration of IMV (73vs.22;p=0.017) and mostly were supported with ECMO (75%vs.25%;p=0.008). Conclusion Data suggest that CD is more frequent among older COVID-19 survivors, and those who needed prolonged IMV and ECMO support. Despite full clarification of all mechanisms involved, these findings highlight the importance of a timely and organized post-intensive care response composed by multidisciplinary teams to optimize assistance to survivors of critical illness.

Adapting to Uncertainty: A Mixed-Method Study on the Effects of the COVID-19 Pandemic on Expectant and Postpartum Women and Men

Detrimental biopsychosocial effects of the COVID-19 pandemic on populations have been established worldwide. Despite research indicating that the transition to parenthood is a vulnerable period for maternal and paternal health, an in-depth examination of the specific challenges the pandemic poses for new mothers and fathers is still lacking. Using a mixed-method design, we investigated individual and relational well-being of women and men who were expecting their first child during the first months of the COVID-19 pandemic in Portugal and its associations with contextual, individual, and relational factors. Adults older than 18 (n = 316, 198 women) from early pregnancy to 6-months postpartum completed a cross-sectional online survey assessing sociodemographic, individual (depression, anxiety, perceived stress), and relational (dyadic adjustment, perceived social support) self-report measures. From those, 99 participants (64 women) responded to an open-ended question and reported perceived changes in their couple’s relationship due to the pandemic. Men responding during strict lockdown measures reported significantly higher levels of perceived stress relative to those men who were not under lockdown. Overall, women reported higher levels of depression and greater social support than men. Qualitative analyses resulted in two main themes: Individual Changes and Relational Changes. These themes aggregate personal concerns and experiences (e.g., worsening of mental health, uncertainty about the future, lack of freedom) interrelated with relational issues (e.g., increased togetherness, avoidance of physical contact, and increased availability for parenthood during lockdown). The prevalence of negative effects (58.6%) exceeded the described positive effects (28.3%), and 13.1% described both positive and negative effects of the pandemic. Current findings offer grounds for important evidence-based strategies to mitigate the potential adverse effects of the current pandemic on new mothers’ and fathers’ individual and relational well-being.

Neuropsychiatric symptomatology after severe COVID-19 in older survivors

Background:The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients’ neuropsychiatric morbidity. Currently, there is still few data regarding mental health after hospital discharge of severe COVID-19 elderly patients. Considering this, the present study aims to characterize the neuropsychiatric morbidity in old severe COVID-19 patients.Methods:In the context of an ongoing multidisciplinary research project, this study analyzed a subsample of patients aged ≥60 years, admitted due to COVID-19, during the first wave, in the Intensive Care Medicine Department (ICMD) of a University Hospital in Porto, Portugal. ICMD length of stay (LoS) ≤24h, terminal illness, major auditory loss or inability to communicate at the time of follow- up were used as exclusion criteria. Participants were evaluated by telephone in average 99 (±32) days after being discharged from the hospital, with Six-item Cognitive Impairment Test, PatientHealth Questionnaire and Generalized Anxiety Disorder Scale. Sociodemographic and relevant clinicaldata were obtained from hospital electronic records and clinical interview.Results:A sample of 39 survivors with a mean age of 70 (±6.3) years old were assessed. The majority were male (62%), married (64%), retired (77%), with low educational level (59%), and 15% lived alone. The average number of comorbidities and the daily medications per patient were 4.7 (±1.7) and 5.5 (±3.5), respectively.During ICMD stay, 69% had nosocomial infections and 56% delirium. Deep sedation was used in 74% of the patients (mean=30 days) and 74% needed Invasive Mechanical Ventilation. ICMD mean LoS was33 (±28.3) days. Based on follow-up assessment, 18% of survivors had cognitive impairment, whereas23% and 15% had depressive and anxiety symptoms, respectively. A positive and high correlation between depression and anxiety was found (rs=0.792;p<0.001). No significant associations were observed with cognitive impairment.Conclusions:The presence of this symptomatology may hinder a successful recovery once the patient is discharged back home. This is particularly relevant accruing the strong relationship between depressive and anxious symptoms found in this sample. Therefore, early screening and timely multidisciplinary support interventions to minimize these neuropsychiatric symptoms after discharge should be considered in order to achieve positive health outcomes.

Health-Related Quality of Life in Survivors of Severe COVID-19 of a University Hospital in Northern Portugal.

INTRODUCTION: Long-term health impairments are often experienced among survivors of critical illness, which may have a negative impact on their quality of life. The aim of this study was to characterize COVID-19 survivors of critical illness and to evaluate health-related quality of life and disability following hospital discharge. MATERIAL AND METHODS: This is a retrospective case-series study that included COVID-19 survivors admitted to the Intensive Care Medicine Department of a University Hospital. Follow-up evaluation was performed between the 30th and the 90th day after discharge. Quality of life was explored using the five-level version of the EQ-5D instrument (EQ-5D-5L) and functionality using the 12-question World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS: Forty-five survivors were enrolled, 28 (62.2%) men, median age 63.0 years. The EQ-5D-5L questionnaire showed moderate to extreme problems in some dimension in 29 patients (64.4%): mobility in six (13.3%), self-care in seven (13.3%), usual activities in 23 (51.1%), pain/discomfort in 14 (31.1%) and anxiety/depression in 17 (37.8%). When using the 12-question WHODAS 2.0 questionnaire, moderate to extreme disability was reported in some question in 37 patients (82.2%): 19 (42.2%) in standing for long periods, 18 (40.0%) in long-distance walking; 14 (31.1%) on taking care of household responsibilities and 17 (37.8%) in their day-to-day work; 23 (51.1%) felt emotionally affected by their health problems. DISCUSSION: Based on COVID-19 survivors-reported outcomes after critical illness, mobility, pain/discomfort, and anxiety/depression were the main problems that persisted one to three months after hospital discharge. CONCLUSION: An organized follow-up structure is crucial to improve health-related quality of life in critical COVID-19 survivors.

Introdução: Os sobreviventes de doença crítica apresentam frequentemente sequelas a longo prazo. O objetivo deste estudo foi caracterizar os sobreviventes da COVID-19 grave e avaliar a qualidade de vida após a alta hospitalar. Material e Métodos: Série de casos que inclui sobreviventes COVID-19 admitidos no Serviço de Medicina Intensiva de um Hospital Universitário. A consulta de seguimento foi realizada entre o 30º e o 90º dia após alta hospitalar. A qualidade de vida foi avaliada através do questionário EQ-5D com cinco níveis (EQ-5D-5L) e a funcionalidade através do instrumento World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) de 12 questões. Resultados: Foram incluídos 45 sobreviventes, 28 homens (62,2%), idade mediana de 63,0 anos. No questionário EQ-5D-5L 29 sobreviventes (64,4%) mostraram problemas moderados a extremos em alguma dimensão: seis (13,3%) na mobilidade, sete (13,3%) nos cuidados pessoais, 23 (51,1%) nas atividades habituais, 14 (31,1%) na dor/desconforto e 17 (37,8%) na ansiedade/depressão. No WHODAS 2.0 37 sobreviventes (82,2%) revelaram alterações funcionais moderadas a extremas em alguma questão: 19 (42,2%) em permanecer de pé por longos períodos, 18 (40,0%) em percorrer longas distâncias, 14 (31,1%) em cuidar das responsabilidades domésticas e 17 (37,8%) no dia-a-dia no trabalho; 23 (51,1%) mostraram-se emocionalmente afetados pelos seus problemas de saúde. Discussão: A avaliação dos sobreviventes COVID-19 após a doença crítica demonstra que a mobilidade, a dor/desconforto e a ansiedade/depressão são os principais problemas que persistem um a três meses após a alta hospitalar. Conclusão: O acompanhamento estruturado após alta poderá ter impacto significativo na qualidade de vida destes doentes.