Prescription of anxiolytics, sedatives, hypnotics and antidepressants in outpatient, universal care during the COVID-19 pandemic in Portugal: a nationwide, interrupted time-series approach.

BACKGROUND: The COVID-19 pandemic has had a significant impact on the population's mental health. However, its impact on the consumption of anxiolytics, sedatives, hypnotics and antidepressants remains to be evaluated. Hence, this article aims to assess the prescription trends of these drugs in Portugal, from January 2018 to March 2021, while critically examining whether the COVID-19 pandemic had an impact on these prescription trends or not. METHODS: A nationwide interrupted time-series analysis of the prescription data of anxiolytics, sedatives, hypnotics and antidepressants in outpatient setting of the public health sector was conducted. The data encompassed the defined daily dose per month, age range and sex and were analysed following a segmented regression approach. RESULTS: The pandemic preceded an immediate reduction in the prescription of anxiolytics, sedatives and hypnotics for children and adolescents. However, an increasing trend throughout the pandemic has been noted in the prescription of these drugs, especially among adults aged 65 years or above. A drop in antidepressant prescription was observed as an immediate effect of the pandemic among male and female adolescents and elderly women. From March 2020 to March 2021, a decreasing prescription trend has been noted among men. CONCLUSIONS: When analysing specific genders and age ranges, differences can be noted, in terms of both immediate impact and prescribing trends throughout 1 year of the COVID-19 pandemic. The impact of the pandemic on mental health and its association with the consumption trends of psychoactive drugs, and with the access to mental health treatments, should be further assessed.

Repurposing selective serotonin reuptake inhibitors for severity of COVID-19: A population-based study.

The World Health Organization has proposed that a search be made for alternatives to vaccines for the prevention and treatment of COVID-19, with one such alternative being selective serotonin reuptake inhibitors (SSRIs). This study thus sought to assess: the impact of previous treatment with SSRI antidepressants on the severity of COVID-19 (risk of hospitalisation, admission to an intensive care unit [ICU], and mortality), its influence on susceptibility to SARS-CoV-2 and progression to severe COVID-19. We conducted a population-based multiple case-control study in a region in the north-west of Spain. Data were sourced from electronic health records. Adjusted odds ratios (aORs) and 95%CIs were calculated using multilevel logistic regression. We collected data from a total of 86,602 subjects: 3060 cases PCR+, 26,757 non-hospitalised cases PCR+ and 56,785 controls (without PCR+). Citalopram displayed a statistically significant decrease in the risk of hospitalisation (aOR=0.70; 95% CI 0.49-0.99, p = 0.049) and progression to severe COVID-19 (aOR=0.64; 95% CI 0.43-0.96, p = 0.032). Paroxetine was associated with a statistically significant decrease in risk of mortality (aOR=0.34; 95% CI 0.12 - 0.94, p = 0.039). No class effect was observed for SSRIs overall, nor was any other effect found for the remaining SSRIs. The results of this large-scale, real-world data study indicate that, citalopram, could be a candidate drug for being repurposed as preventive treatment aimed at reducing COVID-19 patients' risk of progressing to severe stages of the disease.

Impact of the COVID-19 Pandemic on the Prescribing of Antiasthmatic Treatments in Portugal: A Nationwide Study.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on everyday life, the environment, and health care services. A shift from in-person medical appointments to telemedicine was a main adjustment. Such changes can have repercussions on the control and management of chronic respiratory diseases, such as asthma. The available data suggest that there was an overall decrease in asthma-related morbidities during the first year of the pandemic. Therefore, the goal of this study was to quantify the effects of the pandemic on the prescribing of antiasthmatic treatments in outpatient care (public and private health care). METHODS: This before-after study used a time series approach based on data from monthly prescriptions of antiasthmatic drugs (anti-inflammatory drugs and bronchodilators) dated between April 2018 and March 2021. An interrupted time series (ITS) design was used for assessing changes in antiasthmatic prescribing patterns in the short and long terms after COVID-19 was recognized as a pandemic. The results are complemented with seasonal autoregressive integrated moving average (sARIMA) models. FINDINGS: The ITS analysis showed a non-significant increase in antiasthmatic prescribing in the short term. In the long term, after the pandemic was declared, a statistically significant decrease was observed in the prescribing of antiasthmatics (in anti-inflammatory drugs and, more pronounced, in bronchodilators). In the sARIMA model, the mean monthly volume of antiasthmatic prescriptions was 18.1% lower than predicted. The numbers of months outside of the 95% CIs were different between anti-inflammatory drugs (1 month) and bronchodilators (7 months). IMPLICATIONS: The prescribing of antiasthmatic drugs in the long term was significantly decreased with the COVID-19 pandemic, with a greater effect in the case of bronchodilators.

Understanding Primary Care Physician Vaccination Behaviour: A Systematic Review.

BACKGROUND: Vaccine hesitancy decreases adult vaccination coverage and has been recognized by WHO as a major health threat. Primary care physicians (PCP) play a key role in vaccination by giving vaccine counselling to their patients. The aim of this systematic review is to identify the knowledge, beliefs, attitudes and barriers (KBAB) associated with own vaccination and patient recommendation in primary care physicians. METHODS: MEDLINE/PubMed, EMBASE and Cochrane Library databases were used to search and identify relevant studies based on their title and abstract. In the next step, the full text of each previously selected article was read for eligibility. Articles were selected by two independent reviewers and data extraction was performed using tables. The following information was extracted: methodological characteristics, demographic factors, professional characteristics, and intrinsic or extrinsic factors influencing vaccination or recommendation. RESULTS: Our search yielded 41 eligible papers, data-sources, previous practices, belief in the effectiveness or safety of the vaccine, perceived risk, and trust in health authorities were all shown to be related to own vaccination and patient recommendation. CONCLUSION: Internet is the main source of information for PCP related to vaccine hesitancy. It is therefore essential to increase the presence and access to pro-vaccination content in this area. In addition, involving PCP in the establishment of vaccination recommendations could improve their credibility in the institutions. On the other hand, training in communication skills and establishing reminder systems could reflect higher vaccination coverage among their patients.

Insights on COVID-19 Vaccination in Portugal: A Qualitative Study among Health Professionals and Teachers.

BACKGROUND: Vaccination against COVID-19 has had a major impact over the course of the pandemic, leading to a reduced number of hospitalizations and deaths. However, the mass vaccination process has been accompanied by skepticism and hesitancy since its beginning. As health professionals and teachers are important public health actors who can strongly intervene to reduce vaccination hesitancy among their patients and students, respectively, this study aimed to assess their main perceptions towards COVID-19 vaccination. METHODS: Two focus group sessions, one with health professionals and the other with teachers, were conducted according to the COREQ checklist. Qualitative data were analyzed through theoretical thematic analysis. RESULTS: In general, none of the groups showed vaccine hesitancy, although both groups had concerns regarding the safety and efficacy of the vaccines. The main concerns of health professionals were mostly related to the long-term impact of the COVID-19 pandemic, while teachers were more worried about the lack of access to reliable information about the COVID-19 vaccination. CONCLUSIONS: It is plausible to conclude that it is imperative to provide clear and accurate information for the population in order to avoid vaccination hesitancy.

Early Real-World Data to Assess Benefits and Risks of COVID-19 Vaccines: A Systematic Review of Methods.

Since the authorization of the first COVID-19 vaccines in December 2020, multiple studies using real-world data (RWD) have been published to assess their effectiveness/safety profile. This systematic review aimed to characterize the methods and outcomes of studies using RWD for assessment of COVID-19 vaccines, four months after vaccine approval. MEDLINE and EMBASE were searched to identify published studies until 6 May 2021. Two independent researchers selected relevant publications and extracted data from included studies. The risk of bias was assessed using New-Castle Ottawa tools. After screening 1086 studies, 15 were included. Out of the 15 studies, 12 (80%) followed a cohort design, 8 (53%) were based on USA data, 7 (47%) assessed health care professionals, and 14 articles (93%) assessed the BNT162b2 vaccine. Data sources included institutional databases, electronic health records, and patient-generated data. The primary endpoint mainly described was SARS-CoV-2-infection. Hospitalization and mortality were assessed in 2 studies. For the comparability domain, six studies (40%) had a high risk of bias. A few months after the beginning of COVID-19 vaccination, Real-world Evidence (RWE) provided timely safety surveillance and comparative effectiveness with findings that showed similar findings to Randomized control trial (RCT). Most of the initiatives assessed BNT162b2 and were conducted in the USA and used healthcare workers' data.

How Portuguese Health Entities Used Social Media to Face the Public Health Emergency during COVID-19 Disease.

BACKGROUND: During the COVID-19 pandemic, social media became an important and easily accessible source of information to keep the population informed. In this study, we explored how Portuguese health entities used social media during the public health emergency caused by COVID-19 disease. METHODS: A retrospective study on Portuguese public health entities' communication with the public using social media platforms was performed. Data were retrieved from Facebook, Instagram, and Twitter. All retrieved posts were analyzed, and the engagement of the public was calculated. A thematic analysis of all COVID-19-related posts was conducted. RESULTS: The analysis of each social media platform revealed that during the COVID-19 pandemic, health entities reinforced their presence on social media platforms. The most published posts were related to "epidemiological context" and "encouragement to take actions" to avoid the spread of COVID-19. High engagement frames were not associated with the most frequently published posts. CONCLUSIONS: Although health entities have reinforced their presence on social media platforms, they do not take full advantage of these platforms to improve health literacy.

What determines health professionals' COVID-19 vaccine hesitancy? A nationwide study.

INTRODUCTION: To contain the COVID-19 pandemic, higher vaccination rates are essential. However, as vaccine hesitancy is a reality, it is important to understand what drives health professionals to refuse getting vaccinated against COVID-19, who have been in the frontline of this pandemic since its beginning and may be key actors to improve vaccine coverage among their patients. PURPOSE: This study aims to assess the factors associated with vaccine hesitancy (VH) among health professionals (physicians, nurses, pharmacists and dentists). METHODS: A nationwide cross-sectional study was conducted through an online survey, with 890 Portuguese health professionals. A logistic regression analysis was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge and attitudes) per 1-point increase in the Likert scale and VH. RESULTS: Complacency, communications, confidence and convenience were strongly associated with VH probability. Concerns about vaccines' efficacy (ORPhysicians  = 8.33, 95% CI: 4.51-15.36) and safety (ORNurses  = 11.07, 95% CI: 4.12-29.77) increase the risk of VH on all health professional groups. A reduction of VH probability is associated with higher risk perceptions of getting infected (1/ORNurses  = 2.76, 95% CI: 1.52-5.02) and suffering complications (1/ORNurses  = 33.72, 95% CI: 8.48-134.13), higher confidence in the effectiveness of COVID-19 vaccines (1/ORDentists  = 12.29, 95% CI: 2.91-51.89), risk perception of getting infected if vaccinated (1/ORPhysicians  = 14.92, 95% CI: 6.85-32.50), risk of suffering from complications after getting vaccinated, and higher trust levels on the information transmitted by competent authorities (1/ORDentists  = 17.76, 95% CI: 3.83-82.22). CONCLUSIONS: To reduce COVID-19 VH, which appears to be highly influenced by perceptions, knowledge and attitudes, it is essential to promote interventions directed to transforming these potentially modifiable determinants.

Perceptions, knowledge and attitudes about COVID-19 vaccine hesitancy in older Portuguese adults.

BACKGROUND: Coronavirus 2019 (COVID-19) has become a public-health emergency of international concern. Most efforts to contain the spread and transmission of the virus rely on campaigns and interventions targeted to reduce Vaccine Hesitancy and Refusal (VHR). OBJECTIVE: this study aims to assess the major factors associated with VHR in the older population in Portugal. METHODS: a nation-wide cross-sectional study was conducted in the older Portuguese population (≥65 years old) through computer-assisted telephone interviewing. Logistic regression was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge and attitudes) and of the outcome (VHR). RESULTS: the response rate was 60.1% (602/1,001). Perceptions, knowledge and attitudes were strongly associated with VHR probability. A 1-point Likert scale increase in concerns about the vaccines' efficacy and safety increased the risk of VHR by 1.96 (95% confidence interval [CI]: 1.40-6.28) and 3.13 (95%CI: 2.08-8.22), respectively. A reduction of VHR probability for 'reliability of the information released by social media' (OR = 0.34, 95%CI: 0.16-0.70) and for 'trust in national and international competent authorities' (OR = 0.34, 95%CI: 0.17-0.69) is also observed per 1-point increase. CONCLUSIONS: as VHR seems to be strongly associated with perceptions, knowledge and attitudes, the design and promotion of vaccination campaigns/educational interventions specifically targeted at changing these potentially modifiable determinants may help to tackle COVID-19 VHR and achieve a wider vaccine coverage.

The Impact of the COVID-19 Pandemic on Antibiotic Prescribing Trends in Outpatient Care: A Nationwide, Quasi-Experimental Approach.

Coronavirus disease 2019 (COVID-19) has spread globally and is currently having a damaging impact on nearly all countries in the world. The implementation of stringent measures to stop COVID-19 dissemination had an influence on healthcare services and associated procedures, possibly causing antibiotic consumption fluctuations. This paper aims to evaluate the immediate and long-term impact of the COVID-19 pandemic on antibiotic prescribing trends in outpatient care of the Portuguese public health sector, including in primary healthcare centers and hospitals, as well as on specific antibiotic groups known to be closely associated with increased resistance. Segmented regression analysis with interrupted time series data was used to analyze whether the COVID-19 pandemic had an impact in antibiotic prescribing tendencies at a national level. The outcomes from this quasi-experimental approach demonstrate that, at the beginning of the pandemic, a significant, immediate decrease in the overall antibiotic prescribing trends was noticed in the context of outpatient care in Portugal, followed by a statistically non-significant fall over the long term. The data also showed a significant reduction in the prescription of particular antibiotic classes (antibiotics from the Watch group, 3rd-generation cephalosporins, fluoroquinolones, and clarithromycin) upon COVID-19 emergence. These findings revealed an important disruption in antibiotics prescribing caused by the current public health emergency.