Types of Astroturfing campaigns of disinformative and polarised content in times of pandemic in Spain

The paper seeks to determine the application of Astroturfing strategies on Twitter in Spain during the COVID-19 pandemic in the spring of 2020. Statistical analysis, network analysis and machine learning techniques are used to evaluate approximately 32,527 messages published from the state of alarm decree in Spain (14 March, 2020) until the end of May of the same year, associated with eight tags that address issues related to misleading content identified by two of the main factchecking projects (Maldito Bulo and Newtral). Data allow us to observe the participation of users (not bots) who play the role of influencers despite having an average profile or a profile that is far from being considered a public personality. The application of Astroturfing can be seen as a communication strategy used to position issues on social networks through the distribution, amplification and flooding of disinformation. The scenario allows us to verify the presence of a digital communication scenario that would favour a framework difficult to detect, from strategies such as the one studied, aimed at breaking the echo chamber and filter bubble of social networks, with the aim of positioning issues at the level of public opinion. © 2023 Scientific Association Icono14. All rights reserved.

Clinical and paraclinical manifestations at hospital admission (triage) and their association with severity inpatients for SARS-CoV-2 pneumonia

OBJECTIVE: To explored whether initial laboratory data and symptoms predict further clinical outcome. MATERIALS AND METHODS: Retrospective cohort study. Clinical records from March to September 2020 were revised to extract clinical-demographic characteristics, laboratory data and outcomes from patients with SARS-CoV-2 pneumonia, admitted to Centro Medico Nacional 20 de Noviembre, ISSSTE, Mexico City. RESULT(S): One thousand three patients were evaluated at the Emergency-Triage, diagnosed with SARS-CoV-2 and received further in-hospital medical attention. Most of the patients were younger than 65 years-old, male and showed co-morbid conditions, such as obesity, hypertension or diabetes mellitus. After standard therapy, 389 cases (39%) required mechanical ventilation, vasopressor agents or showed fatal outcome. Higher values of C-reactive protein, D-dimer, procalcitonin and low O2 saturation at triage significantly predicted mechanical ventilation (p <0.05) and mortality (p <0.05);while presenting symptoms like fever, myalgia, cough and ageusia showed a particular association with longer hospital stage (p < 0.05). CONCLUSION(S): Laboratory values and presenting symptoms, both evaluated at hospital admission, showed different ability to predict clinical severity, mortality and longer hospitalization time in patients with COVID-19 pneumonia. These results could be useful in possible future pandemic waves of SARS-CoV-2.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.

Care for an elderly frail woman with double infection by Clostridium difficile and COVID-19 in the hospital setting

The objective was to present an individualized nursing plan of care for a 94-year-old woman, presenting frailty, without cognitive deterioration, coming from a nursing home and admitted to the Internal Medicine Unit by referral from the Emergency Unit, due to presenting infection by Clostridium difficile and respiratory infection by COVID-19. After assessment at admission, following Marjory Gordon's functional health patterns, the following NANDA diagnoses were prioritized: frailty syndrome of the elderly, skin integrity deterioration, and chronic pain. The desired NOC outcomes were determined for each: nutritional status, mobility, knowledge: prevention of falls, tissue integrity: skin and mucous membranes, pain: harmful effects, pain;adverse psychological response. The NIC interventions and their corresponding activities achieved an improvement in the basal score of all indicators, reaching the target score. It is essential to address care for elderly patients from the physical, mental, functional and social areas. © 2023 DAE Editorial, Grupo Paradigma. All rights reserved.

Onasm@: Helping severe asthma patients to prepare the telematic visit with their specialist

Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.

Asynchronous student engagement in analysis of climate data achieves learning objectives related to climate change understanding, statistical competence, and climate anxiety

Learning in asynchronous online environments has gained importance over the last several decades, and educational environment shifts from the COVID-19 pandemic appear to have increased this need. Science educators and students need information about which approaches work in the asynchronous environment where informal feedback tends to be reduced, compared to other teaching modalities. In this study, we asynchronously implemented a learning module across 5 institutions that guided students (N = 199) from prescriptive data analysis through guided inquiry and eventually to open inquiry. The module focuses on the science behind climate change. Students work with the same authentic data sets used by professional scientists to examine geologic history and causes of climate change. By analyzing contemporary atmospheric carbon dioxide and temperature data and then using the 800,000-year record available from the Vostok ice core proxy record of atmospheric properties, students identify the causes of climate change and discover the unprecedented nature of recent atmospheric changes. Using a pre/post-module assessment, we demonstrate improvement in students' understanding of climate change processes and statistical methods used to analyze data. However, there was no evidence that the module develops students' scientific reasoning about the relationship between causation and correlation. Students maintained that correlation is not causation, even when a robust causal mechanism (i.e., the greenhouse effect) explains the link between atmospheric carbon dioxide and temperature. Finally, our analysis indicated that generally, anxiety about climate change was reduced during the module, such that students become less anxious about the climate change the more they learn about it. However, science-denying students experienced much higher anxiety about climate change than students who accepted the scientific consensus about climate change. Climate science-dissenting students were so few in this study that a statistical comparison was not possible, but this intriguing finding warrants further investigation of the role of anxiety in science denial. Mainly, this study demonstrates how asynchronous online learning environments can indeed support the achievement of learning objectives related to conducting authentic science, such as increasing understanding of climate change and statistical concepts, all while not provoking anxiety about climate change. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

[Pulmonary cavitations, late complication of COVID-19].

Patients who have recently suffered from SARS-CoV-2 infections may suffer serious complications, such as pneumothorax or pulmonary cavitations that increase morbi-mortality and imply a challenge for the design of the most appropriate therapeutic strategy to improve their prognosis. Pulmonary cavities are usually associated with secondary complications such as hemoptysis and pneumothorax, and so offer a poor prognosis. We present the case of two patients with COVID-19 disease confirmed by nasopharyngeal PCR who showed satisfactory evolution before readmission with pulmonary involvement compatible with pulmonary cavitation and respiratory failure. Cavitated lesions in the lungs of patients who recently suffered COVID-19 must be identified early in order to discard additional superinfections that may worsen the prognosis.

[Interinstitutional Command Mexico: organizational decision-making in the face of COVID-19]

Background: The third wave of COVID-19 in Mexico produced a high demand for hospital care, which is why it was created a multidisciplinary group to optimize decision-making: the Interinstitutional Command for the Health Sector (COISS, according to its initials in Spanish). So far, there is no scientific evidence of the COISS processes or their effect on the behavior of epidemiological indicators and the hospital care needs of the population in the context of COVID-19 in the entities involved. Objectives: To analyze the trend on epidemic risk indicators throughout the COISS group's management in the third wave of COVID-19 in Mexico. Material and methods: Mixed study: 1) non-systematic review of information from technical documents issued by COISS, 2) secondary analysis of open-access institutional databases through the description of healthcare needs of cases notified with COVID-19 symptoms, and an ecological analysis by each Mexican state on the behavior of hospital occupancy, RT-PCR positivity, and COVID-19 mortality in two-time points. Results: The COISS activity in identifying states with epidemic risk generated actions aimed at a reduction in hospital occupancy of beds, positivity by RT-PCR, and mortality from COVID-19. Conclusions : The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Conclusions: The decisions of the COISS group reduced the indicators of epidemic risk. Continuing the work of the COISS group is an urgent need. Copyright © 2023 Revista Medica del Instituto Mexicano del Seguro Social.

IMPROVING HOME-CARE SERVICES FOR HIGH-RISK OLDER ADULTS USING PEER-LED VIDEO VISITS TO HOME

Older Veterans at high-risk for institutionalization often require home- and community-based services (HCBS). Yet, current HCBS delivery often fails to meet the needs of high-risk Veterans due to decreased veteran engagement in outpatient programs and limited HCBS capacity. A promising approach to address these gaps is the use of Veteran-Peers to make home-visits. Peer-2-PACT is a peer-led needs-assessment intervention for high-risk older veterans. Two trained peers conducted a checklist-guided virtual and/or in-person home-assessment to identify unmet needs and home-safety concerns. Veterans with access, acceptance and ability for video-capable technology were offered video-visits. We report on the feasibility of video home-visits in this high-risk group, and the experience of the video-visits using the visit-data and interviews with peers.Eight of 27 Peer-2-PACT Veterans successfully completed initial video-visit to home. The video-visit participants (n=8) were age 74±9;Non-Hispanic Black (50%);males (100%), compared to initial in-person home-visit participants (n=19), age 75.3±10.8;Non-Hispanic Black (47%);males (89%). The commonest needs identified during video-home-visits were home-safety devices 5(62.5%), housing assistance 4(50%), and medication refills 2(25%). Peers report that identifying veterans suitable for video-visits was challenging. During video-visits, depth-perception by peers is limited and sometimes needed in-person follow-up. Main advantages of video-visits was ability to identify unmet needs, engage veterans, provide care during COVID, and tele-present to remote clinicians. Preliminary data suggest that peer-conducted video home-visits is a feasible way to identify unmet needs in some high-risk older adults. This is particularly important improve care of Veterans who live at a distance from the facility.

The Value of Vaccination: Capturing the Impact of Vaccination on Health Equity in Health Economic Analysis

Objectives: The COVID-19 pandemic dramatically highlighted health inequities and the differential impact that vaccination can have on health, depending on social advantage. In a non-pandemic setting, vaccination can improve equity, but this broader value of vaccination is not currently considered in health economic analysis despite equity being a policy priority in many countries. Method(s): A panel of health economists and policy experts convened to discuss how to capture the equity dimension of the value of vaccination. This was conceptualized using a distributional cost-effectiveness analysis framework with four steps leading to differential health impact: (i) differences in vaccine preventable disease incidence;(ii) differences in the vaccination uptake;(iii) differences in health effects;and (iv) differences in health opportunity costs. The concept was illustrated by a retrospective modelling exercise of 4-component meningococcal serogroup B (4CMenB) infant vaccination against serogroup B invasive meningococcal disease (MenB) in England, for which an existing model was adapted. Five social groups were analysed based on Index of Multiple Deprivation Quintiles (IMDQ). Result(s): 4CMenB infant vaccination disproportionately prevented MenB cases among more deprived groups: of all prevented cases, 40.3% were among the most deprived IMDQ (accounting for 25.9% of the target population <5 years of age) and 78.1% among the three most deprived IMDQs. Vaccination had a positive, though small, net equity benefit, and the direction of equity impact was robust to sensitivity analyses varying the distribution of uptake, MenB carriage prevalence, and assumptions related to life expectancy and utility stratified by IMDQ. Conclusion(s): Within a national immunisation programme, 4CMenB vaccination improves health equity by preventing disproportionately more cases in more socially disadvantaged groups. The health equity impacts of vaccination can be captured in health economic evaluation although there is a need to improve the evidence base and develop more user-friendly equity impact measures. Copyright © 2022

A Comparative Analysis of St-Segment Elevation Myocardial Infarction between Canada and the United States from the North American Covid-19 Stemi Registry

Background: Important healthcare differences exist between the US and Canada. The goal of this investigation is to compare clinical characteristics, treatment strategies and clinical outcomes of STEMI patients with COVID-19 infection treated in the US versus Canada. Methods and Results: The North American COVID-19 Myocardial Infarction (NACMI) registry is a prospective, investigator-initiated study enrolling STEMI patients with documented COVID infection in the US and Canada. The primary end-point is in-hospital mortality. The secondary end-points include stroke, reinfarction and a composite of death, stroke or reinfarction. Of the 767 STEMI-COVID patients, 67 (9%) were from Canada and 669 (91%) from the US. Patients enrolled in Canada were more likely to present with chest pain (79% vs. 54%, p< 0.001), otherwise patients across both countries had comparable presenting demographics (Table 1). The proportion of patients not undergoing coronary angiography was significantly lower in Canada compared with the US (9% vs. 19%, p=0.039);of those who underwent angiography, no significant differences in reperfusion modalities were noted. Compared with the US, patients in Canada had a significantly lower unadjusted risk for in-hospital mortality (15% vs. 29%, p=0.016) and the risk for the composite of death, stroke or re-infarction (15% vs. 31%, p=0.006). Vaccination status was available in Canada 26 / 67 patients (unvaccinated 13, vaccinated 13) and US 328/ 669 patients (unvaccinated 282, vaccinated 46);a strong association between vaccination and adverse clinical composite is noted in both countries (Canada: 3/13, 23% (unvaccinated) vs. 0/13, 0% (vaccinated), p=0.22;and, US: 75/282, 27% (unvaccinated) vs. 6/46, 13% (vaccinated), p=0.048). Conclusion(s): Among patients with STEMI and COVID-19 infection those treated in Canada had higher proportions undergoing angiography and a lower risk of death, stroke or reinfarction. Regardless of geography, vaccination was associated with significantly lower risk of mortality in both countries. [Formula presented] Copyright © 2022

Clozapine Toxicity in the Setting of COVID-19: A case of differential diagnosis

Introduction: Together with agranulocytosis, fever and immflamatory manifestations are clozapine side effects to be monitorized during initial treatment. In the context of COVID-19 pandemic, implied mechanisms, and symptomatology should be carefully controlled. Objective(s): To analyze the clinical analytic and inflammatory chracterisctics the resembles and differenciates clozapine immune response and SARS-CoV-2 infection. To describe a case of clozapine induced fever and pneumonitis during COVID-19 pandemic. Method(s): A case of clozapine-induced pneumonitis during COVID-19 pandemic is described.- A mini-review of clozapine inflamamtory effects, induced-pneumonitis and SARS-CoV-2 was performed. Result(s): A 33 year old afrolatin male started treatment with clozapine up to 250 mg daily. He developed fever and respiratory symptoms in the 11th day of treatment. The exploration revealed pulmonary sounds decreased and 91% basal saturation, making the probable causes viral infection (local incidence of SARS-CoV-2 >800/100000hab), nosocomial bacterial infection or pulmonary thromboembolism. The patient was isolated due to probable COVID-19. Blood tests showed leucocytosis (13400/mcL), Lymphocytopenia (11.8%), high PCR (14.4mg/dL), Ferritine (506.9ng/ mL), Fibrinigen (663.83 mg/dL), D-Dimer (1.61mg/dL), and Interleukin-9 /25.8pg/mL). The angioTC revealed a pleural efusion and ground glass infiltrates (figure1). Only after 2 weeks eosinophilia was discovered (88/mcL) After 2 negative consecutieve PCRs for SARS-CoV-2, no imrovement with ampirical antibiotics and all infectious pannels negative, we started decreasing clozapine with improvement of the symptoms and resolution after suspending clozapine completely. Conclusion(s): Clozapine may induce a generalize inflammatory response mediated by interleukin-6. Patients treated with clozapine may exhibit fever and rarely, insterstitial lung inflammation. The expression of induced pneumonitis resembles viral infections, particularly SARS-CoV-2.

Changes in psychiatric emergencies during COVID-19 pandemic lockdown in El Bierzo (Spain)

Introduction: The interest have focused in the effects of COVID-19 in mental symptoms. However, the pandemic and restrictions such as the lockdown decreed in Spain limited access to resources and lead to a change in assistance organization. Objective(s): to compare the incidence and characteristics of psychiatric emergencies during the Spanish 2020 Lockdown with the same period in 2019 Methods: All the emergencies attended the the emergency room (Hospital El Bierzo) From 01/02/2019 to 30/06/2019 and those from 01/02/2020 to 30/06/2020 were analysed by two senior psychiatrists. Cases were selected if attended by any psychiatric reason. The cases were evalueated identifying ICD-10 diagnosis (according to clinical records and best criteria matching), sociodemographics, factors associated to the emergency and resolution. Result(s): 23360 cases were attended in 2019 (799 psychiatric), 14907 (578) in 2020. That means a 36.19% of reduction in general emergencies and 27.66% in psychiatric emergencies (psychiatric emergencies proportion increased form 3.42% to 4.03%). The reduction started the week just before the lockdown declaration, minimal records coincided with the highest COVID-19 incidence and the recovery starts in early june for psychiatric and late June for general emergencies (figure 1). A decrease of 62.79% of anxiety cases and 45.9% of depresion was observed with no incresaes in any diagnosis. A slight increase in suicide attempts (two cases) was observed. Conclusion(s): The lockdown seem to decrease psychiatric emergency care. Only suicidability was maintained/increased during the period. Psychiatry services must be aware of the risk of unattended inicidence that may cause an increase of cases after the lockdown. (Figure Presented).

Disinfection Method Based on UV-C Light Using the Internet of Things for Cleaning Hospital Areas (COVID-19)

Since the SARS-CoV-2 transmission can occur by contact with surfaces contaminated with respiratory secretions and other fluids like faeces or saliva, the superficial disinfection has been one of the main problems during the COVID-19 pandemic. Cross-contagion has been observed between health personnel and cleaning staff from hospitals attending COVID-19 patients. The problem was solved through the implementation of a contact-less disinfection system that reduces the COVID-19 exposition of sanitation workers from healthcare facilities. This work presents the results observed from the implementation of an Ultraviolet-C (UV-C) disinfection method controlled and monitored using an Internet of Things (IoT) scheme. Also, implementation experiences obtained from the application of the proposed solution at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) are discussed in this article. The main contribution of this work relies in the fulfillment of a disinfection proceeding that helps reducing the cross-contagion between the cleaning staff of hospitals attending the COVID-19 pandemic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

A NEW ERA FOR THE RIGHTS OF THE CHILD: THE NEW “ROME STRATEGY” (2022-2027) The Council of Europe Convention on the Protection of Children against Sexual Exploitation and Sexual Abuse: “The Lanzarote Convention” as an instrument of protection

The significant increase in the existence and exploitation of self-generated sexual images and videos by boys and girls, is the focus of the new monitoring Report presented by the Council of Europe´s Lanzarote Committee in Rome. In 2017, exploitation of boy and girls self-generated sexual material was already perceived as a potentially serious risk. Later, in 2019-2020, a large increase in the existence of sexual material generated by minors was observed. The pandemic situation derived from Covid-19 exacerbated this reality. The Report examines 43 European States Parties to The Lanzarote Convention, with special mention to the fact of preventing this particular form of sexual exploitation of boys and girls, investigat-ing and prosecuting it, improving the identification and protection of victims and and likewise, an improvement of the framework law in this matter with the consequent guidelines to the respective governments. © GKA Ediciones, authors.