Immediate and Contributory Causes of Death in Patients Hospitalized with Covid-19

Background: Accurate determination of the immediate and contributory causes of death in patients with COVID-19 is important for optimal care and instituting mitigation strategies. Method(s): All deaths in Qatar between March 1, 2020 and August 31, 2022 flagged for likely relationship to COVID-19 by were evaluated by two independent reviewers trained to determine and assign the most likely immediate underlying cause of death. Each decedent's electronic medical records was comprehensively reviewed, and the cause of death was assigned based on the most plausible underlying event that triggered the event(s) that led to death based on clinical documentation and a review of laboratory, microbiology, pathology, and radiology data. After cause assignment, each case was categorized into major diagnostic groups by organ system, syndrome, or disease classification. Result(s): Among 749 deaths flagged for likely association with COVID-19, the most common admitting diagnoses were respiratory tract infection (91%) and major adverse cardiac event (MACE, 2.3%). The most common immediate cause of death was COVID pneumonia (66.2%), followed by MACE (7.1%), hospital associated pneumonia (HAP, 6.8%), bacteremia (6.3%), disseminated fungal infection (DFI, 5.2%), and thromboembolism (4.5%). The median length of hospital stay was 23 days (IQR 14,38). COVID pneumonia remained the predominant cause irrespective of the time from admission, though the proportion dropped with increasing length of stay in the hospital. Other than COVID pneumonia, MACE was the predominant cause of death in first two weeks but declined thereafter. No death occurred due to bacteremia, HAP, or DFI in the first week after hospitalization, but became increasing common with increased length of stay in the hospital accounting for 9%, 12%, and 10% of all deaths after 4 weeks in the hospital respectively. The majority of deaths (86%) occurred in the intensive care unit setting. COVID pneumonia accounted for approximately two-thirds of deaths in each setting. MACE and HAP were approximately equally represented in both settings while bacteremia and disseminated fungal infection were more common in the intensive care unit setting. Conclusion(s): Nearly one-third of patients with COVID infection die of non- COVID causes, some of which are preventable. Mitigation strategies should be instituted to reduce the risk of such deaths. (Figure Presented).

Winds of change due to global lockdowns: Refreshing digital social entrepreneurship research paradigm

Digital technologies have a significant potential for collaboration, designing, and implementing better business initiatives. COVID-19 global lockdowns have increased the emergence of the Digital Social Entrepreneurship (DSE) phenomenon, which has been key in responding to social needs using digital technologies. The DSE scholarly discussion has been limited to a few studies. Therefore, little is known about theoretical foundations that explain the intersection between digital, social, and entrepreneurship. Based on an integrative literature review and a thematic case study, this study theorizes the micro-foundations of digital-social value-creation and explores the flourishment of the DSE phenomenon during/after the global lockdowns. Our findings contribute to the literature by extending the DSE definition and identifying the fostering (micro, meso, and macro) conditions involved in the digital-social value-creation process. Several implications emerged from the DSE learning, adaptation, and co-creation strategies/practices. © 2023 Elsevier Inc.

New perspectives obtained during the COVID 19 pandemic: the importance of an adequate directed structured clinical interview prior to [18]FDG-PET/CT in cancer patients

Aim/Introduction: During the COVID 19 pandemic, mass vaccination campaign has played an important role, with a special importance in oncological and immunosuppressed patients, who form a large part of our [18F]FDG-PET/CT studies. Unexpected findings in the form of reactive lymphadenopathy were commonly detected in [18F]FDG-PET/CT studies. It is essential to recognize them and adapt their interpretation to the current epidemiological context. Material(s) and Method(s): Retrospective study of consecutive [18F] FDG-PET/CT studies performed at our center in 219 patients with oncological pathology from June 15 to September 20, 2021. A structured interview was conducted on all the patients who came to undergo [18F]FDG-PET/CT, in which they were asked about the type, date and arm of administration of the vaccine. The frequency of appearance of reactive lymphadenopathy, its relationship with the type of vaccine, sex, age and the importance of a detailed clinical interview prior to the isotope injection and/ or study interpretation were analyzed. Patients that presented ipsilateral axillary lymphadenopathies following vaccination and presented increased metabolic activity regardless of node size were considered positive, size and SUVmax were assessed. Result(s): From De 219 patients reviewed, 32% presented positive [18F]FDG-PET/CT axillary lymph nodes ipsilateral to the arm where the vaccine was inoculated. There was a relationship (p=0.01) between the mean size of the lymph nodes (11+/-9mm) and its mean metabolic activity (3.7+/-2.6 SUVmax). The appearance of lymphadenopathy was more frequent in women (40.5% vs 21% p<0.001), in younger patients (mean age 53+/-14 years vs 68.5+/-13 years p<0.001), in patients who had received the Moderna vaccine (58.5% p<0.001) and in which the time elapsed between vaccination and the performance of [18F]FDG-PET/CT was shorter. Conclusion(s): The appearance of post SARS-CoV2-vaccination reactive lymphadenopathies has been a frequent finding in [18F]FDG-PET/CT despite the main oncological indication of the study. Knowing the circumstances of these findings in oncological patients is important when interpreting them, so the use of a structured directed clinical interview has been very useful to help the physician understand and differentiate these findings.

Entrepreneurial university ecosystem's engagement with SDGs: looking into a Latin-American University

Sustainability themes have increasingly gained traction within academia and industry. The knowledge accumulation is at the development stage and remains more understanding about the phenomenon in the black box. Innovative sustainable initiatives are little known, especially in transforming individuals' values, culture, and well-being. Universities are well-placed to contribute to this academic conversation as they seek solutions and responses to current grand societal challenges through their core activities (teaching, research, and engagement). A good example has been the recent development of disruptions by universities to address the COVID-19 pandemic. Inspired by these debates, this study theorizes/tests how an entrepreneurial university ecosystem contributes to the UN SDGs' achievement through its core activities and social-entrepreneurial orientation. By adopting a retrospective case study of a Latin-American University, our study provides insights/implications into the configuration of university social entrepreneurial ecosystems and their sustainable contributions to the SDGs.

Cerebrovascular disease and mortality in hospitalized patients with COVID-19 in a Latin American country, Peru

Objective: This study aimed at: 1) Assessment of the frequency of stroke and related mortality rate in patients hospitalized for COVID-19 in two major hospital referral centers in Peru;2) Exploration of factors associated to mortality and dependency in these patients;3) Comparisons of frequency of admissions of stroke patients and reperfusion treatments in similar periods of time prior to (2019) and during the pandemia occurrence. Material(s) and Method(s): A retrospective cohort study was conducted in two of the largest referral hospital centers for COVID-19 in Peru. The study included patient victims of stroke and COVID-19, hospitalized between April and August 2020. Demographic, clinical and laboratory data, radiological findings, and severity levels measured by the NIHSS scale were collected. Poisson regression models to evaluate associated factors to mortality and dependency were applied. Result(s): A 31% reduction of admissions for stroke, and of 81% of intravenous reperfusion treatment, respectively, were found in 2020 when compared with 2019. 1.37% of the patients with COVID-19 experienced a stroke, with an overall mortality rate of 40.6%, and a dependency rate of 68.3% at discharge time (Rankin > 2). An age increase of 10 years was found in mortality, associated with a 29% increase in mortality risk. As well, having hypertension, chronic kidney disease, inflammatory markers (D dimer and ferritin) and the severity of the stroke were associated with mortality. Finally, the severity of stroke, lymphopenia, and inflammatory markers (D dimer and fibrinogen) were associated with greater risk of dependency. Conclusion(s): The care system of stroke patients was affected by the COVID-19 pandemic in two of Peru's major public hospitals. There was a decrease in admissions and reperfusion treatments of stroke cases, and 1.37% of patients with COVID-19 presented a stroke. Age, hypertension, chronic kidney disease, inflammatory markers and severity of stroke were associated with mortality in these patients. Copyright 2022 With Intelligence Ltd.

Evaluation of Kidney Stone Patients' Reported Outcomes and Satisfaction with Urologic Telehealth Services

Introduction &Objective: Infection control practices and public policy in response to the COVID-19 pandemic shifted healthcare practices towards a telemedicine format. Even two years after peak onset of the pandemic, many clinics, including our own institution, maintain a working telehealth option for patient visits. Our objective was to evaluate patient satisfaction with a urologic telehealth program at our institution. Method(s): This was a prospective survey study sent to patients being seen by our institution's urology providers beginning in October 2021. All patients seen via any telemedicine platform were eligible to participate and were contacted via MyChart or email after their visit to complete this survey. We present a sub-analysis comparing patients being seen for kidney stones or pain (n = 52, 17.6%) vs. patients being seen for other benign conditions (Benign-Other: n = 107, 36.1%) or oncology diagnoses and care (Oncology: n = 137, 46.3%). Result(s): Patients were 89.6% Caucasian, 88.9% non-Hispanic, 70.7% male, with a mean Age of 59.7 years (SD = 15.1). 34.4% of patients used phone/audio, 45.0% used video by EPIC/MyChart, and the remaining used Doximity, UpDox, or Other. Kidney stone patients were most likely to use video by EPIC/MyChart (55.8%) compared to other method, and this was also higher compared to Benign-Other and Oncology patients (p = 0.013). Patients were overall very satisfied (M = 6.3/7, p < 0.001 vs. 'neutral') with their telehealth appointment, with kidney stone patients marginally more satisfied p = 0.084). Patients, regardless of diagnosis, indicated they would like to continue using telehealth even after COVID-19 restrictions and thought that their doctor managed their appointment and diagnosis appropriately via telemedicine. Finally, kidney stone patients reported higher satisfaction (p = 0.031) with troubleshooting prompts when an error occurred during their appointment. Conclusion(s): Patients seen via telemedicine for kidney stones and pain at our institution highly satisfied with their telemedicine visits, even as in-person visits could be scheduled, and this held across platform type. This suggest a usable program moving forward, even as social distancing requirements and patient safety concerns during the COVID-19 pandemic are reduced.

Emergency remote education, learning styles and emotions in medicine students at the onset COVID-19 pandemic

The confinement due to the COVID-19 pandemic had a devastating impact on different areas of social, emotional, economic and school life, among others, and university education was no exception, at that time the so-called emergency remote education emerged. Learning styles were adapted and changes in emotions were present according to the students' experiences. Three questionnaires were applied to 303 medicine students: #EstamosConectados, CESEA and AMAI, to identify availability of digital tools and devices, connectivity, learning styles, emotions, and socioeconomic level. According to data obtained, 45% had a computer, 55% had inadequate connectivity and the theoretical-operative learning style predominated with 25.4%. In relation to emotions, 62.7% felt accompanied, 60% experienced anxiety and stress. Finally, the majority socioeconomic level with 63.7% corresponded to level B of the AMAI scale. The results obtained suggested that a flexible educational model is required, which transforms, encompasses and guarantees inclusive quality teaching, adaptable to an equitable hybrid model, in addition to constant communication between peers and teachers through educational platforms, with free access to the Internet;as well as offering the necessary emotional accompaniment for students.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19

Introduction Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System» published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing», with 27.57% of positive responses) and 10 (“Support of the hospital management in safety”, with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service») with 85.29% of positive responses, and 5 («Teamwork») with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave.

INTRODUCTION: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. METHODS: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ2 and ANOVA tests were used. RESULTS: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 ("Staffing", with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 ("Expectation of actions by management/supervision of the service") with 85.29% of positive responses, and 5 ("Teamwork") with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. CONCLUSIONS: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.

Use of the Hefesto v2.0 methodology to implement a Data warehouse: Case applied COVID-19

The objective of this article is to present the proposal for the design and construction of a data repository with the intention of storing facts related to the current situation of COVID-19 and obtaining relevant and precise information for decision-making in the face of the latent risk of contagion. The motivation for this study arises from the need to centralize reliable and easily accessible information for monitoring cases in the face of the pandemic. Likewise, the use of the Hephaestus v2.0 methodology is proposed to guide the development of the Data warehouse step by step, which guarantees the success of the implementation. As an added value, the use of emerging technologies Microsoft SQL server 2019 and Visual Studio 2022 are integrated. The results presented will serve as an applied case study for information system administrators in the construction of data repositories and business intelligence solutions. Likewise, it contributes to the research line of scientific studies that integrate accepted and recognized methodologies or standards with emerging technologies.

Characterization of cape gooseberry (Physalis peruviana L.) fruits from plants irrigated with different regimens and calcium doses

Cape gooseberry fruits have positioned in the world market due to their excellent nutritional characteristics, because they are an ideal food that contributes to raising the defenses of the human body and helps it to face diseases such as COVID-19, they are also a natural source of antioxidants and anticancer agents. In order to avoid the physiopathy of cracking in cape gooseberry fruits, these were characterized at harvest time, coming from greenhouse plants irrigated with different applications of water levels and irrigation frequencies, as well as different calcium doses, in a design of randomized complete blocks with 12 treatments. The blocks were the irrigation frequencies (4, 9 and 14 days), while the treatments were the combination of four irrigation coefficients (0.7, 0.9, 1.1 and 1.3 of the evaporation of the tank class A) and three doses of calcium (0, 50 and 100 kg ha-1). The plants were sown in 20 L pots with peat moss substrate. Fruits were harvested at the color stage 5 and 6 of the calyx, from 19 weeks after transplanting. The different water levels and irrigation frequencies did not significantly affect the firmness of the cape gooseberry fruits, but there was a strong tendency that cracked gooseberry fruits are less firm than healthy fruits. As the irrigation coefficient increased, the total soluble solids (TSS) increased while the total titratable acids (TTA) decreased. Irrigation frequency of 14 days generated fruits with higher TSS and pH values. The calcium doses did not affect the calcium concentration in the fruits or the TSS, TTA and pH values. Therefore, it can be concluded that incremented irrigation coefficients (up to 1.3) increase the quality of cape gooseberry fruits.

Incremento del riesgo cardiovascular en pacientes con COVID-19 a corto y largo plazo

Si bien la COVID-19 es una enfermedad dominantemente y los síntomas respiratorios tienden a ser la presentación clínica inicial, la evidencia acumulada ha sugerido que esta entidad clínica está estrechamente asociada con complicaciones cardiovasculares. Aunado a esto, aunque inicialmente se evidenció que las complicaciones cardiovasculares forman parte de la presentación aguda de la COVID-19, se dispone de datos limitados a largo plazo de las complicaciones posteriores a la misma. Hoy en día algunos estudios soportan que este tipo de complicaciones pueden persistir después de la resolución de la infección, evidenciándose la necesidad de un mayor entendimiento de las implicaciones a corto y largo plazo de la infección por SARS-CoV-2. El objetivo de esta revisión sintetizar la evidencia actual de las complicaciones cardiovasculares a corto y largo plazo de la COVID-19.Alternate :Although COVID-19 is a predominantly respiratory disease, and respiratory symptoms tend to be the initial clinical presentation, accumulated evidence suggests this clinical entity is closely related to cardiovascular complications. In addition, although cardiovascular complications have been an early observation of the acute presentation of COVID-19, limited data is available regarding the long-term complications in this respect. At present, some studies suggest that the risk for this type of complications may persist after the resolution of the infection, highlighting the need for a greater understanding of the implication of the SARS-CoV-2 infection in the short and long term. The objective of this review is to synthesize current evidence on the short-term and long-term cardiovascular complications of COVID-19.

Use of the Hefesto v2.0 methodology to implement a Data warehouse: Case applied COVID-19

The objective of this article is to present the proposal for the design and construction of a data repository with the intention of storing facts related to the current situation of COVID-19 and obtaining relevant and precise information for decision-making in the face of the latent risk of contagion. The motivation for this study arises from the need to centralize reliable and easily accessible information for monitoring cases in the face of the pandemic. Likewise, the use of the Hephaestus v2.0 methodology is proposed to guide the development of the Data warehouse step by step, which guarantees the success of the implementation. As an added value, the use of emerging technologies Microsoft SQL server 2019 and Visual Studio 2022 are integrated. The results presented will serve as an applied case study for information system administrators in the construction of data repositories and business intelligence solutions. Likewise, it contributes to the research line of scientific studies that integrate accepted and recognized methodologies or standards with emerging technologies. © 2022 IEEE Computer Society. All rights reserved.

Modulation of behavior before COVID-19, in contact patients treated at the Villa Azucarera isolation center

Background: The prevention of the contagion of the SARS-CoV-2 coronavirus is the main weapon against the disease, and in Cuba it is carried out, fundamentally,with social isolation in specific centers where a modeling of the behavior of classified people is intended as contacts. Objective: To describe the modulation of behavior in contact patients treated in the Villa Azucarera isolation center before, during and at the end of their epidemiological surveillance. Methods: Observational, descriptive and cross-sectional study in the Villa Azucarera de Camaguey isolation center for patient contacts of SARS-CoV-2 coronavirus patients during February and March 2021. Theoretical methods were used:analysis-synthesis and inductive-deductive and empirical: observation, epidemiological survey and interviews. Results: Behavior modulation was demonstrated at the conclusion of the epidemiological surveillance and the increase in the need to use the nasobuco, frequent hand washing and social distancing. Male patients aged between 31 and 40 years predominated. Conclusions: The attitude of the patient during the surveillance in the institution changes from an explicit rejection at the beginning, to an acceptance at the time of discharge, and an increase in the perception of the risk of becoming ill due to the increase in the level of information and of the therapeutic relationship established with health personnel.

Quantification and Progress Over Time of Specific Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 in Breast Milk of Lactating Women Vaccinated With BNT162b2 Pfizer-BioNTech Coronavirus Disease 2019 Vaccine (LacCOVID).

Background: Several observational studies demonstrated the passage of postvaccine antibodies through breast milk in women vaccinated against coronavirus disease 2019 (COVID-19), mostly with messenger RNA (mRNA)-based vaccines, but lacked long-term data. Methods: A 6-month prospective cohort study was performed to determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-induced antibody levels in the breast milk of 33 lactating healthcare workers at different timepoints after mRNA BNT162b2 Pfizer-BioNTech COVID-19 vaccination. Moreover, we examined the correlation of SARS-CoV-2 antibody levels between serum and breast milk, adverse events related to vaccination, and rate of SARS-CoV-2 infections. Results: Mothers' median age was 38 (interquartile range [IQR], 36-39) years and 15 (IQR, 10-22) months for infants. Median (IQR) SARS-CoV-2 immunoglobulin G (IgG) spike protein subunit S1 (S1) vaccine-induced levels at different timepoints for serum-milk pairs were 519 (234-937) to 1 (0-2.9) arbitrary units (AU)/mL at 2 weeks after first dose and 18 644 (9923-29 264) to 78 (33.7-128), 12 478 (6870-20 801) to 50.4 (24.3-104), 4094 (2413-8480) to 19.9 (10.8-51.9), 1350 (831-2298) to 8.9 (7.8-31.5) AU/mL at 2, 4, 12 and 24 weeks after second dose, respectively. We observed a positive correlation of antibody levels between serum and breast milk, no serious adverse events related to vaccination, and 2 (6%) COVID-19 vaccine breakthrough infections. Conclusions: Women vaccinated with Pfizer-BioNTech transmit antibodies into breast milk with a positive correlation with serum levels. Both decreased over time in a 6-month follow-up.

Translation, journalism and disinformation: conspiracy theories in Global Research

The appearance of covid-19 in 2020 triggered disinformation in all its forms and gave birth to new conspiracy theories spread by different journalistic organizations, among which Global Research. This study analyzes the role of translation in the production and dissemination of journalistic disinformation. To do this, we have analyzed a corpus of articles related to covid-19 translated from March to December 2020 in Globalización, the Spanish edition of Global Research. During the analyzed period, the translation contributed to the dissemination of conspiracy theories elaborated to influence the opinion of Spanish-speaking audiences. Combining the comparative content analysis with framing theory, the study shows that the articles translated in Globalización favoured specific frames for their dissemination, coinciding with the conspiracy theories about the pandemic disseminated on the web in English. The analysis and description of these frames make it possible to detect the discourses that constitute the ideological agenda of this journalistic organization and analyze how the translation acted on that agenda. © 2021 Academia Mexicana de Cirugía.

DISCRIMINATION FOR HEALTH REASONS: THE, IMPACT OF COVID-19 ON LABOR RELATIONS

This paper analyzes the new forms of discrimination for health reasons, cause the irruption of the SARS-Cov-2 virus in our lives, in the field of labor relations. We will analyze the protection mechanisms that our legal system arbitrates against these new forms of discrimination both in access to employment, as in the development of the employment relationship or at the time of its termination. Faced with the application of apparently neutral norms, discriminatory behaviors may underlie that towards certain groups of people. First of all, we will analyze how these discriminatory acts can violate other fundamental rights such as privacy, dignity or the protection of personal data related to health. Second, we will focus on determining when business decisions caused by the health situation of workers violate the principle of equality and non-discrimination. And, finally, we will analyze the classification of the dismissal based on causes related to COVID 19.

Quantification and progress over time of specific antibodies against SARS-CoV-2 in breast milk of lactating women vaccinated with BNT162b2 Pfizer-BioNTech COVID-19 vaccine (LacCOVID)

Background Transfer of passive and active immunity through human milk is a key aspect in infant protection against infections. Several observational studies demonstrated the passage of postvaccine antibodies through breast milk in women vaccinated against COVID-19, mostly with mRNA-based vaccines, but lacked long-term data. Methods A six-month prospective cohort study was performed to determine SARS-CoV-2 vaccine-induced antibody levels in the breast milk of 33 lactating healthcare workers at different time-points after mRNA BNT162b2 Pfizer-BioNTech COVID-19 vaccination. Moreover, we examined the correlation of SARS-CoV-2 antibody levels between serum and breast milk, adverse events related to vaccination (AErV) and rate of SARS-CoV-2 infections. Results Mothers’ median (IQR) age was 38(36-39) years and 15(10-22) months for infants. SARS-CoV-2 IgG-S1 vaccine-induced levels at different time-points for serum–milk pairs, median (IQR), were: 519(234-937) to 1(0-2.9) arbitrary units (AU)/mL at 2w after first dose, 18,644(9,923-29,264) to 78(33.7-128) AU/mL at 2w, 12,478(6,870-20,801) to 50.4(24.3-104) AU/mL at 4w, 4,094(2,413-8,480) to 19.9(10.8-51.9) AU/mL at 12w, and 1,350(831-2,298) to 8.9(7.8-31.5) at 24w after second dose. We observed a positive correlation of antibody levels between serum and breast milk (Pearson correlation coefficient 0.68), no serious AErV and 2(6%) COVID-19 vaccine breakthrough infections. Conclusions Women vaccinated with Pfizer-BioNTech transmit antibodies into breast milk with a positive correlation with serum levels. Both decreased over time in a 6-month follow-up. Finally, Infants of breastfeeding vaccinated women could be acquiring vaccine antibodies for at least six months after vaccination and serum determination of SARS-CoV-2 IgG-S1 could indicate breastmilk antibody levels.

[Assessment of the patient safety culture in the ICU of a second level hospital at the end of the third COVID-19 wave]. / Valoración de la cultura de seguridad del paciente en la UCI de un hospital de segundo nivel al finalizar la tercera oleada de COVID-19.

Introduction: Current healthcare settings and ICUs especially are complex, highly technical, and multidisciplinary, with interactions between healthcare professionals and users, in which there may be errors at different levels. Our objective was to assess the perception of patient safety in our unit at the end of the third wave of the COVID pandemic, with the intention of conducting subsequent improvement actions. Methods: Observational, cross-sectional, and descriptive study. The perception of Safety Culture was estimated using the HSOPS questionnaire translated into Spanish. Some questions were posed in a positive sense, and others in a negative sense. The response was also rated as positive, negative, or neutral. Our findings were compared visually, not mathematically, with those found in the previous national study «Analysis of the culture on patient safety in the hospital setting of the Spanish National Health System¼ published in 2009. A subgroup analysis was performed according to professional group and seniority as a health worker. The Student's t, χ? and ANOVA tests were used. Results: Sixty-two professionals responded to the questionnaire, 73.90% of the total. The median time working in ICU 2 years (interquartile range 2-4.5 years). The rating for the degree of safety was 8.06 (SD 1.16). The majority (91.20%) had not reported any adverse event in the last year. A total of 30.90% had recently received patient safety training. The dimensions considered as weaknesses were 9 («Staffing¼, with 27.57% of positive responses) and 10 ("Support of the hospital management in safety", with 17.64% of positive responses). The dimensions considered as strengths were 3 («Expectation of actions by management / supervision of the service¼) with 85.29% of positive responses, and 5 («Teamwork¼) with 95.58% of positive responses. The Cronbach's alpha index values suggest that the questionnaire has adequate internal consistency. In general, our data are more positive than those collected in the 2011 national survey, although the 2 dimensions considered weaknesses were already considered such in the previous work. Conclusions: The perception of patient safety in the ICU of our hospital after the end of the third wave of the COVID pandemic is adequate, with a more positive rating than that of the national study on safety culture at the hospital level carried out in 2009. The constant quest for patient safety should prioritize activity in the 2 dimensions considered weaknesses: staffing, and support from hospital management in everything related to patient safety.