Impact of the COVID-19 pandemic on the training of Spanish neurology residents

Introduction: The COVID-19 pandemic has transformed medical practice and severely disrupted the training of medical residents worldwide. The Spanish Society of Neurology conducted a study to assess its impact on the training of neurology residents in Spain. Method(s): We performed a descriptive, cross-sectional study through a survey distributed by e-mail to all neurology residents belonging to the Society. The survey included questions on demographic variables, care activity, and personal and educational impact of the pandemic, as well as respondents' expectations for the future of their work in the post-pandemic era. Result(s): Of 422 surveys sent, we received a total of 152 responses (36%);79 respondents (52%) were women and 73 (48%) were men. By year of residency, 51 respondents (33.6%) were in the fourth year, 45 (29.6%) in the third year, 28 (18.4%) in the second year, and 28 (18.4%) in the first year. A total of 139 respondents (90.8%) reported changes in hospital activity, and 126 (82.8%) considered the situation to have had a negative impact on their training, with 99 (64.7%) having lost non-recoverable rotations. Sixty-six percent of respondents (n=101) expressed a desire to extend their residency period. Conclusion(s): The pandemic has had an extremely severe impact on all areas of the health system, with trainee physicians being one of the most affected groups. Among neurology residents, the crisis has caused significant shortcomings in their training and clinical activities, through the suspension of specific rotations. A high percentage of respondents wished to extend the residency period.Copyright © 2021 Sociedad Espanola de Neurologia

Changes in alcohol consumption in the Russian Federation during the first months of the COVID-19 pandemic

Introduction: Excessive alcohol consumption is a known risk factor for various mental health disorders and can exacerbate the already high burden of COVID-19 pandemic on mental health. On the other hand, the COVID-19 pandemic itself can adversely affect alcohol consumption and thus contribute to alcohol-related problems, including mental health problems. Objective(s): This study was aimed to assess changes in alcohol consumption that may have occurred as a result of the COVID- 19pandemic and determine associated factors among population of Russian Federation. Method(s): By distributing a link to take part in an anonymous online survey, changes in volume and frequency of alcohol use, and frequency of heavy episodic drinking(6 or more servings of alcohol at a time)in the first months of COVID-19pandemic were assessed. 819respondents from Russia:321 men and 498women, submitted their responses during May-July,2020. Associations between changes in alcohol use were assessed in a univariate analysis with socio-demographic factors, alcohol use over the previous 12months, stress, individual perceptions of changes in daily and social life and other negative consequences of pandemic. The statistical significance of associations was assessed using the Pearson'schi2 test. Result(s): Individuals with initially higher alcohol consumption increased their alcohol use, while those who drank less, decreased alcohol use even more during pandemic (p<0.05). Severe restrictions of social/everyday life were associated with more frequent alcohol use and in larger volumes (p<0.001). Negative professional/ financial consequences of pandemic and stress were associated with increase of typical drinking volume (p<0.001), more frequent alcohol use (p<0.001)and heavy episodic drinking (p<0.05). Conclusion(s): The COVID-19 pandemic could have increased health inequalities in Russia through changes in alcohol consumption.

"I've discovered the COVID-19 vaccine". Approach of a bipolar disorder clinical case in the Mental Health Day Hospital of Salamanca during the pandemic

Introduction: A 21-year-old woman diagnosed with bipolar disorder was hospitalized in the Mental Health Day Hospital of Salamanca during the Covid pandemic. The patient engaged with 4 different jobs and a master's degree, beginning with verbose speech, dysphoria, global insomnia, grandiose delusions, extremely high energy and thinking she has the vaccine. She works the following objectives: illness insight, risk factors, psychopathological stabilization, social skills, slowing down of activities and taking responsibilities. Objective(s): The objective is do a follow-up of the patient during her hospitalization in the Mental Health Day Hospital and to carry out a structured search in PubMed and Up-to-Date about psychotherapy and bipolar disorder. Method(s): 3-month follow-up of a 21-year-old woman diagnosed with bipolar disorder during her hospitalization in the Mental Health Day Hospital in Salamanca and a structured search in PubMed and Up-to-Date in April 2021 in English, French and Spanish, including the last 10 years with the keywords "psychotherapy", "psychotherapies" and "bipolar disorder ".77 studies were analyzed: 12 included, 65 excluded. Result(s): Several randomized trials highlight the efficacy of group psychoeducation and cognitive-behavioural therapy in relapse prevention, improving illness insight, medical adherence and less hospitalizations. Therapeutic alliance plays a significant role in the process. Our patient improved her knowledge of her illness and treatment, her social skills and reconnected with her relatives and slowed down her activity. She then was referred to her community mental heath center psychiatrist. Conclusion(s): The insight in bipolar disorder plays an important role in medical adherence and prevention of relapses. Therapeutic alliance improves their insight, their functionality in their daily life and enables close monitoring. Medical treatment should be accompanied by psychotherapy for a complete approach of the treatment.

Factors associated with an increase in alcohol consumption among users of online social networks in Russia in the early months of the COVID-19 pandemic

Introduction: The various restrictions and physical distancing introduced inRussia in early months of COVID-19pandemic could have a particular impact on people who use alcohol and create new needs for prevention and treatment of associated disorders. Objective(s): The study was aimed at assessing changes in alcohol consumption among users of online social networks in Russia. Method(s): During June-September 2020,1518 adult users (18+) of the most popular social networks in Russia (Odnoklassniki, VKontakte,Facebook, Twitter), completed an anonymous online survey regarding alcohol use changes in the first months of COVID-19 pandemic. Binary logistic regression was used to estimate associations of increased alcohol consumption with sociodemographic and pandemic-related factors. Result(s): 35.4%of men and 25.6%of women increased their frequency of drinking;24.9%of men and 17.7%of women increased their typical one-time volume of alcohol consumption,and 28.5% of men and 27.9% of women increased frequency of heavy episodic drinking in the early months of pandemic. After mutual adjustment of independent variables,age18-29 years(OR=1.710;95%CI 1.002- 2.917), very strong restrictions of everyday life(3.127;1.011-9.675) and severe negative consequences in relation to professional or financial situation due to spread ofSARS-CoV-2 (2.247;1.131- 4.465) were positively associated with increase in frequency of drinking. The odds of increase in frequency of heavy episodic drinking were more than twice higher(2.329;1.001-5.428) among those who experienced severe negative consequences to their professional/financial situation.Higher typical frequency,larger onetime volume of alcohol use,and higher frequency of heavy episodic drinking before pandemic were positively associated with increase of alcohol consumption in early months of pandemic. Conclusion(s): Timely monitoring of changes in alcohol consumption during pandemic can allow prevention of alcohol-related disorders, including mental disorders, among users of online social networks.

Burnout Syndrome in Emergency Physicians in Venezuela Early in the COVID-19 Pandemic

Background: Burnout syndrome is a clinical entity that can negatively affect healthcare workers, especially frontline medical staff. Objective(s): Determine the prevalence of burnout in emergency physicians at the start of the COVID-19 pandemic. Method(s): The Maslach Burnout Inventory was administered to 150 emergency physicians in 2020 during the first months of the pandemic in a Venezuelan hospital. There are two limitations, the size of sample is small and the study physicians have poor social conditions that do not allow generalizing the results. Result(s): Over three quarters of the physicians surveyed (76.7%) experienced burnout and 55.3% had health problems due to stress. The higher the number of years working in the hospital and/or the lower the job satisfaction, the higher the burnout rate (p <0.05). Conclusion(s): A large number of physicians in Venezuela experienced burnout during the first months of the pandemic, but half of them believed they did not need psychological help. Prevalence of burnout was high among physicians with more years of service and among those with lower job satisfaction. Copyright © 2022 Bentham Science Publishers.

Lessons from outbreaks of COVID-19 at Israeli military bases.

BACKGROUND: To mitigate the spread of coronavirus disease 2019 (COVID-19), national guidelines, in accordance with international health authorities, mandated 14 days of quarantine for every close contact of a confirmed COVID-19 patient. Although health benefits are obvious, consequences are profound, especially for organizations required to maintain operational preparedness. OBJECTIVES: To present the Israel Defense Force (IDF) experience with outbreaks regarding quarantined individuals. To weigh the consequences of quarantined individuals needed for workforce and operation. METHODS: All positive COVID-19 cases in the IDF, as measured by a positive rRT-PCR test result, between 29 February and 18 May 2020 were evaluated. Numbers of positive individuals, quarantined individuals, and confirmatory exams conducted were collected. We compared the events in four units with the largest outbreaks and assessed the impact of confirmed cases, tests conducted, and workforce loss due to quarantine. RESULTS: Of the 187 soldiers who tested positive for COVID-19, source of infection was traced to 140 soldiers (75%). Almost no medical treatment was delivered, and hospitalization was rare. We found a median of 15.2% (interquartile range 5.3-34) for decline in unit workforce due to quarantine measures. Maximum reduction reached 47% of the workforce in one unit. CONCLUSIONS: Despite a relatively small number of confirmed cases, units underwent a substantial change in mode of operation due to the toll of quarantined individuals. In certain populations and organizations, perhaps a more liberal application of isolation and contact tracing is suitable due to the heavy economic burden and consequences in term of operational readiness.

for an integral pastoral care of the faithful in the event of a pandemic. canonical and pastoral profiles

The Church, by virtue of the mission received from Christ, has an original responsibility for the integral – material and spiritual – healing of the person which, as she has done in the past, must be able to exercise even in the event of a pandemic, in collaboration with the State, which must protect not only the material but also the spiritual health of all people, respecting their religious liberty. In the exercise of their mission in the event of a pandemic, the pastors of the Church must be inspired by the primacy of the salus animarum, the necessary protection of the salus corporum and a balanced appraisal of the goods at stake with aequitas canonica. Only the authorities of the Church – specifically the Apostolic See and the diocesan Bishop – are competent to regulate pastoral care and the liturgy, in compliance with the legitimate provisions established by the health authorities of the State for similar situations. In the event of a pandemic, the rules of common law apply to cases of (serious) inconvenience, (grave) necessity, and (imminent) danger of death, but it is desirable that special rules be issued by the competent authorities – at a universal and particular level – in the case of a pandemic, to better define the competences and faculties of each one and to foster a certain unity of criteria, compatible with the appropriate flexibility needed to adapt to the circumstances of the specific case. © 2022 Pensiero Economico Italiano. All rights reserved.

Pronóstico funcional a 3 meses de pacientes hospitalizados por ictus isquémico agudo en Aragón: análisis regional de la repercusión de la COVID-19 Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: Rregional analysis of the impact of COVID-19

Introducción La pandemia por COVID-19 ha tenido un impacto en el manejo del ictus isquémico;se ha descrito una disminución de los ingresos hospitalarios e incluso una interrupción en la cadena de atención y un aumento de la mortalidad intrahospitalaria. Sin embargo, falta evidencia sobre su impacto en el pronóstico funcional. El objetivo de este estudio es analizar el efecto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de los pacientes con ictus isquémico agudo hospitalizados en Aragón. Material y métodos Revisamos los datos de todos los pacientes ingresados por ictus isquémico en todos los hospitales de nuestro sistema sanitario entre el 30 de diciembre del 2019 y el 3 de mayo del 2020. Comparamos su mRS y la mortalidad a 3 meses de los hospitalizados antes y después de haberse establecido el estado de emergencia secundario a la pandemia por COVID-19. Resultados En total, 318 pacientes con ictus isquémico agudo cumplieron nuestros criterios de inclusión. No hubo diferencias en las características globales y específicas de cada periodo, excepto por una mayor proporción de pacientes mayores de 80 años de edad durante el periodo pre-CoV (42,2% vs. 29,0%, p = 0,028). En el análisis comparativo, no encontramos una diferencia significativa en la mortalidad (12,3 vs. 7,9, p = 0,465) o la proporción de pacientes con mRS ≤ 2 (57,7% vs. 57,1%, p = 0,425) a los 3 meses. Conclusión Hasta donde sabemos, este es el primer estudio que analiza el impacto de la pandemia por COVID-19 en el pronóstico funcional a 3 meses de pacientes con ictus isquémico. En nuestra comunidad autónoma, no ha habido un incremento en la mortalidad o discapacidad a 3 meses de pacientes hospitalizados por ictus isquémico durante el periodo de COVID-19.

Self-reported periodontal disease, dental loss and COVID-19 in older adults

Introduction: Upon completion of this research, there was no evidence of studies addressing self-reported periodontal disease in Cuba, nor any antecedent of research relating it to COVID-19 in adults over 60. Objective: To determine the relationship between self-reported periodontal disease, dental loss, and COVID-19 activity. Methods: A descriptive cross-sectional investigation was carried out. The sample included 238 individuals aged over 60 who were infected with COVID-19, and survived. They gave their consent. The study was performed for over 1 year in Playa municipality of Havana, Cuba. Variables such as gender, age, COVID-19 evolutionary severity, comorbidities, and self-reported periodontal disease were used. A validated 4-question survey was applied to identify the periodontal disease and all data were processed in a database. Some variables were dichotomized to perform the odds ratio and Pearson's Chi-squared test, and determine the relationship between possible risk factors and the evolutionary severity of COVID-19. Results: As a result, the odds ratio values and confidence intervals for periodontal disease and advanced periodontal disease were 1.598 (0.261;9.78) and 1.814 (0.296;11.105) respectively, and the p-values were 0.609 and 0.514 respectively. Conclusion: A relationship between periodontal disease and the evolutionary severity of COVID-19 cannot be established. However, a relationship was observed targeting dental loss and respiratory diseases as determinant risk factors in the severity of COVID-19. © 2022, Editorial Ciencias Medicas. All rights reserved.

SUCCESS CASE OF THE SGAC OPEN-COURSE INTRODUCTION TO SPACE ENGINEERING, AS A MEDIUM FOR CAPACITY BUILDING IN EDUCATION AND SPACE WORKFORCE DEVELOPMENT IN EMERGING COUNTRIES OF CENTRAL AMERICA

The world as we knew it has drastically changed due to the global pandemic of COVID-19, impacting many areas of the economy and society. The Educational sector has also been affected worldwide, with suspension of classes, school dropouts, and creating uncertainty to parents, teachers and students who now must quickly adapt to new methodologies such as online learning. This scenario is worse in developing countries where a significant percentage of the population lacks access to reliable internet and communications infrastructure. On the other hand, the new trend of remote education has caused the professors to get more familiar with IT resources and has given the students an opportunity to attend a myriad of webinars and online workshops globally, about complex topics in Science and Engineering, which otherwise would be inaccessible or at a high associated cost. The Space Generation Advisory Council (SGAC) has promoted several initiatives, both globally and regionally, such as Space webinars and workshops. In the Latin America region, a series of online activities has also been introduced, featuring subject matter experts in different areas, to discuss the steps required to develop the Space industry in Latin American countries. One common conclusion in these events, is that Latin America, especially Central America and the Caribbean region, is still lacking a clear capacity-building strategy, since limited educational programs for space workforce development exist. The initiative of an Introduction to Space Engineering course was initiated by Prof. Angel Arcia Gil in 2019 at the University Santa Maria la Antigua (USMA) in Panama to address this problem. The course was the 1st in Central America, almost in parallel with a program of The Costa Rica Institute of Technology (TEC). The initiative, which later evolved into an Open-Course, has expanded to other countries in Central America such as Nicaragua, Costa Rica and El Salvador, within the collaborative framework of the Space Generation Advisory Council and its National Point of Contacts (NPoCs). After its 3rd Edition, the open course has provided more than 130 students with an overview of Space technical concepts, a historical background of Space exploration and new trends of Space commercialization. This paper will explain the pedagogic approach, curriculum development, and the methodology used to successfully implement the open course in Central America, showing statistics such as approval rate, dropout rate, and female participation, along with lessons learned and recommendations. The paper will highlight the best practices for implementing an open course in space developing countries, and it is intended to be a reference for future initiatives. Copyright © 2021 by the International Astronautical Federation (IAF). All rights reserved.

Attitudes and perceptions of the population of Havana about COVID-19

Introduction: Any strategy designed to increase the perception of risk involves processes of change or modification of the underlying attitudes. Objective: To explore the attitudes and perceptions of the population of Havana about COVID-19. Methods: Cross-sectional descriptive study was carried out in a population of 2012 citizens of Havana who, anonymously and voluntarily, answered an online questionnaire distributed on social networks between May and June 2021. Variables on demographic characterization and those related to the object of study were used grouped into causes to which they attribute the current epidemiological situation: social, state and external. The chi-square statistical test and the corrected residuals model were used. Results: Participants from the municipalities of “Playa” (14.1%), “Plaza de la Revolución” (13.2%) and “Diez de Octubre” (12.7%) were the most frequent. The 3 predominant causes according to more than 80 % were “Violation of social distancing”, “Breakdown of social discipline” and “Celebration and festivities”. Of the state dimension, violations of social distancing, opening of airports and elimination of active investigations stood out. 43.5 % of the responses to 14 of the 32 indicated by those surveyed are related to the population's low perception of risk. Conclusions: It is not possible to attribute the epidemiological situation due to COVID-19 in Havana, only to the low perception of risk in society;This is a multicausal phenomenon with causes attributed to state action / inaction and social behavior. © 2021, Editorial Ciencias Medicas. All rights reserved.

FACTORS ASSOCIATED WITH INCREASE IN ALCOHOL CONSUMPTION DURING FIRST MONTHS OF COVID-19 PANDEMIC AMONG ONLINE SOCIAL MEDIA USERS IN RUSSIA

The significant proportion of the Russian population are active online social media users. Changes in alcohol consumption in this target group during the COVID-19 pandemic remain understudied. The aim of this survey was to investigate changes in alcohol consumption and factors associated with the increase in alcohol use among online social media users in Russia during the first months of the COVID-19 pandemic. An online survey was conducted among 1,518 users of online social networking services popular in Russia from June to September 2020. The survey revealed that 35.4% of men and 25.6% of women started drinking more frequently during the first months of the pandemic;24.9% of men and 17.7% of women increased their usual consumption (volume) of alcohol on a typical drinking occasion, whereas 28.5% of men and 27.9% of women increased the frequency of heavy episodic drinking. Adjusted binary logistic regression analysis revealed a positive association between the increase in the frequency of alcohol consumption and the following factors: age from 18 to 29 years (OR: 1.710;95% CI: 1.002-2.917), severe restrictions in everyday private life (OR: 3.127;95% CI: 1.011-9.675) and severe negative professional or financial consequences due to the spread of SARS-CoV-2 (OR: 2.247;95% CI: 1.131-4.465). The odds of an increase in the frequency of heavy episodic drinking were more than twice higher (OR: 2.329;95% CI: 1.001-5.428) among those who had experienced severe negative consequences of the pandemic to their professional and financial situation. Higher typical frequency and usual consumption (volume) of alcohol on a typical drinking occasion and higher typical frequency of heavy episodic drinking before the pandemic were positively significantly associated with the increase in these parameters of alcohol consumption during the first months of the pandemic. In times of large-scale epidemics and public health crises, it is advisable to consider the possibility of implementing screening and brief interventions, including via online social media, to prevent problems associated with alcohol use.

The impact of steroids on the incidence and course of clostridioides difficile colitis in COVID-19 patients receiving antibiotics

Introduction: Clostridioides difficile infection (CDI) causes an estimated 2.5-fold increase in 30-day mortality among hospitalized pts. On a molecular level, colonization of the colon is followed by an inflammatory cascade similar to that of IBD. Given the utility of steroids in IBD, the relationship between CDI and steroids warrants further study. Existing literature is contradictory and limited by small sample sizes or varying indications for steroid treatment. By analyzing a large cohort of pts with a singular indication for steroid treatment (COVID-19), this study aims to determine the impact of steroids on the incidence and course of CDI. Methods: A retrospective chart review of pts > 18 yrs old admitted with COVID-19 pneumonia to Montefiore Medical Center between March 1st and September 30th 2020 was completed. Pts with less than 3 doses of antibiotics in the 1st week of admission were excluded. Remaining pts were divided into 2 groups: those treated with antibiotics and steroids and those who only received antibiotics. Demographics, 30-day CDI incidence, 60-day CDI recurrence, and 30-day CDI mortality were determined for each group. Relevant secondary analysis was conducted based on the results. Analyses were done using t-test, Chi-squared test, or Fisher's exact test. Results: 2,679 pts were part of our analysis (Figure 1). Only 29 pts were identified as CDI positive within 30 days of admission with no meaningful demographic differences between the groups. 60-day CDI recurrence did not differ between the groups either. Higher 30-day CDI mortality (33.3%, p = 0.1686) in the antibiotic and steroid group was noted with a trend towards significance. Rates of steroid treatment and those of known contributors to mortality were then compared between pts with and without CDI mortality (Table 1). Rate of steroid treatment in the CDI mortality group was higher (83.3%, p = 0.1686) than in the CDI without mortality group (43.5%, p = 0.1686). However, lower albumin levels (2.15, p = 0.007) and higher intubation rates (83.3%, p = 0.0025) were significantly associated with CDI mortality. Conclusion: Our results show statistically insignificant yet notably higher rates of 30-day CDI mortality in COVID-19 pts treated with antibiotics and steroids compared to those who received antibiotics only. A multi-center retrospective study of an even larger COVID-19 cohort is needed to increase the sample size of CDI positive pts and reveal any associations between steroid use, disease severity and mortality. (Table Presented).

Business innovation and critical success factors in the era of digital transformation and turbulent times

PURPOSE: Explore what entrepreneurship and success factors can help drive business to resilience and stability and achieve competitive advantage through innovation in different countries and business realities in the era of digital transformation and turbulent times. METHODOLOGY: Based on the narrative literature review, we present research findings concerning new strategies and outlooks for business innovation in times of many unknowns. Each organization wants to find its way to gain success and create its unique business model, which can capture value creation and innovativeness and be more adaptive, resilient, and stable in critical moments and sustainable over time. FINDINGS: The articles presented in this issue explore the essential factors of business innovation and success in different organizations and the environments in which these businesses function. IMPLICATIONS FOR THEORY AND PRACTICE: This article synthesizes the presented research field's importance and relevance, connecting its theoretical background with practical research. Recommendations and implications for future trends of this research stream might also be helpful for professionals and academicians. ORIGINALITY AND VALUE: The novel studies presented in this issue were done in five different (developing and developed) countries and business sectors that present human-based and non-human-based factors as crucial factors needed to empower business transformation in a complex world. Each group of elements is essential in business success, and their components are interdependent. We need to look at the interactions and interdependencies of their components in a dynamic and network form and cannot simplify the reality, focusing only on one group of business components and ignoring the other. These unique studies provide a valuable outlook to establish dynamic, adaptive business pathways towards a sustainable and resilient organizational future and propose future research paths needed to execute structural changes in businesses.

Impact of COVID-19 on new-onset type 1 diabetes mellitus - A one-year prospective study.

OBJECTIVE: A positive relationship between the recently emerged Corona Virus Disease-19 (COVID-19) and diabetes has been inferred, but not confirmed, in children. The aim of the present study was to investigate the possible impact of COVID-19 on new-onset Type-1 Diabetes Mellitus (T1DM) in a pediatric population. PATIENTS AND METHODS: This is a prospective study of all children and adolescents diagnosed with T1DM during the first year of the COVID-19 pandemic (March 2020-February 2021) in Western Greece (population coverage ≈1,000,000). The incidence and severity of T1DM, the age and sex of the participants and HbA1c and c-peptide concentrations at diagnosis were recorded and compared to those of the previous year (pre-COVID-19 year). RESULTS: 21 children aged 8.03±0.90 years old were diagnosed with T1DM in the COVID-19 year and 17, aged 9.44±3.72 years old, in the pre-COVID-19 year. A different seasonality pattern of new onsets was observed during the COVID-19 year compared to the previous year, with increasing trend from spring to winter (spring: 9.5% vs. 23.5%, autumn: 23.8% vs. 29.4%, summer: 19% vs. 11.8%, winter: 47.6% vs. 35.3%). Also, compared to the preceding year, HbA1c was significantly higher (p=0.012) and the incidence and severity of diabetic ketoacidosis greater (p=0.045, p=0.013, respectively). CONCLUSIONS: This is the first study to report a different seasonality pattern and increased severity of new-onset T1DM during the first year of the COVID-19 pandemic. Future research should further investigate the possible role of SARS-CoV-2 and the different pattern of overall infection incidence during the COVID-19 year.

[Vaccination against community acquired pneumonia in adults. Update 2021 of the position paper by Neumoexpertos en Prevención Group]. / Vacunación frente a la neumonía adquirida en la comunidad del adulto. Actualización 2021 del posicionamiento del Grupo de Neumoexpertos en Prevención.

Community-acquired pneumonia (CAP) continues to be an important cause of morbidity and mortality in adults. The aim of this study is to update the practical prevention guide for CAP through vaccination in Spain developed in 2016 and updated in 2018, based on available vaccines and evidence through bibliographic review and expert opinion. The arrival of COVID-19 as a new cause of CAP and the recent availability of safe and effective vaccines constitutes the most significant change. Vaccines against pneumococcus, influenza, pertussis and COVID-19 can help to reduce the burden of disease from CAP and its associated complications. The available evidence supports the priority indications established in this guide, and it would be advisable to try to achieve a widespread dissemination and implementation of these recommendations in routine clinical practice.

Data Empowerment of Decision-Makers in an Era of a Pandemic: Intersection of "Classic" and Artificial Intelligence in the Service of Medicine.

BACKGROUND: The COVID-19 outbreak required prompt action by health authorities around the world in response to a novel threat. With enormous amounts of information originating in sources with uncertain degree of validation and accuracy, it is essential to provide executive-level decision-makers with the most actionable, pertinent, and updated data analysis to enable them to adapt their strategy swiftly and competently. OBJECTIVE: We report here the origination of a COVID-19 dedicated response in the Israel Defense Forces with the assembly of an operational Data Center for the Campaign against Coronavirus. METHODS: Spearheaded by directors with clinical, operational, and data analytics orientation, a multidisciplinary team utilized existing and newly developed platforms to collect and analyze large amounts of information on an individual level in the context of SARS-CoV-2 contraction and infection. RESULTS: Nearly 300,000 responses to daily questionnaires were recorded and were merged with other data sets to form a unified data lake. By using basic as well as advanced analytic tools ranging from simple aggregation and display of trends to data science application, we provided commanders and clinicians with access to trusted, accurate, and personalized information and tools that were designed to foster operational changes and mitigate the propagation of the pandemic. The developed tools aided in the in the identification of high-risk individuals for severe disease and resulted in a 30% decline in their attendance to their units. Moreover, the queue for laboratory examination for COVID-19 was optimized using a predictive model and resulted in a high true-positive rate of 20%, which is more than twice as high as the baseline rate (2.28%, 95% CI 1.63%-3.19%). CONCLUSIONS: In times of ambiguity and uncertainty, along with an unprecedented flux of information, health organizations may find multidisciplinary teams working to provide intelligence from diverse and rich data a key factor in providing executives relevant and actionable support for decision-making.

Three-month functional prognosis of patients hospitalised due to acute ischaemic stroke in Aragon: regional analysis of the impact of COVID-19.

INTRODUCTION: The COVID-19 pandemic has had an impact on ischaemic stroke management, with a reported decrease in hospital admissions, and even disruptions in healthcare and increased in-hospital mortality. However, there is a lack of evidence on the impact of the pandemic on functional prognosis. The aim of this study is to analyse the effect of the COVID-19 pandemic on the 3-month functional outcomes of patients hospitalised due to acute ischaemic stroke in Aragon (Spain). METHODS: We reviewed the data of all patients admitted due to ischaemic stroke to any hospital in our regional healthcare system between 30 December 2019 and 3 May 2020. We compared modified Rankin Scale scores and mortality at 3 months in patients hospitalised before and after the declaration of a state of emergency due to the COVID-19 pandemic. RESULTS: In total, 318 patients with acute ischaemic stroke met our inclusion criteria. No differences were observed between periods in global or specific characteristics, with the exception of a higher proportion of patients older than 80 years during the first period (42.2% vs 29.0%, P = .028). In the comparative analysis, we found no significant differences in mortality (12.3 vs 7.9, P = .465) or in the proportion of patients with modified Rankin Scale scores ≤ 2 (57.7% vs 57.1%, P = .425) at 3 months. CONCLUSION: To our knowledge, this is the first study to analyse the impact of COVID-19 pandemic on the 3-month functional outcomes of patients with ischaemic stroke. In our region, there has been no increase in rates of mortality or disability at 3 months in patients admitted due to ischaemic stroke during the pandemic.