The unintended consequences of confinement: Evidence from the rural area in Guatemala

Individual and social preferences have shown to be important factors in individual decision making and general economic performance. Yet, they are usually assumed as given and stable, underestimating their impact in the rhythm of economic recovery after a natural disaster or pandemic. This paper examines the effects of COVID-19 initial confinement on households' individual and social preferences across small communities in the rural area of Guatemala. We use a comprehensive panel household survey of agricultural smallholders collected during two survey rounds in 2019, prior to the pandemic, and 2020 and find that preferences generally shifted following the onset of the pandemic. We observe a significant increase in risk tolerance, deteriorated perceptions towards trust and generosity, and a higher frequency of emotional issues, while intra-household relationships remain stable. We find that experiencing a household adverse situation, a higher degree of exposure to the virus, and more stringent local confinement measures shaped several of the variations in preferences. The focus of the study on a region with high poverty and malnutrition rates offers important insights of the consequences of confinement on perceptions and attitudes in complex and vulnerable rural contexts during the wake of a public health emergency. © 2022 The Author(s)

Adverse events reported after administration of BNT162B2 and mRNA-1273 COVID-19 vaccines among healthcare workers

Background and importanceSince December 2019, the world has faced a new disease known as COVID-19. On 11 March 2020, the World Health Organization officially declared the COVID-19 pandemic. Given the health emergency, vaccine development progressed rapidly, but with limited safety data under real-world conditions.Aim and objectivesTo describe and compare the incidence of adverse events with the BNT162b2 and mRNA-1273 COVID-19 vaccines, taking into account the number of doses and subjects previously positive for SARS-CoV-2 infection.Material and methodsA retrospective observational study was conducted in a tertiary hospital between March and April 2021. Data were collected through a questionnaire sent by email to hospital staff. Demographics and data regarding the occurrence of adverse events were collected, indicating which vaccine was administered. Statistical analysis was performed using SPSS software. Groups were compared using the Chi-square test and Fisher’s exact test when necessary.Results1249 respondents completed the survey (25% of all hospital staff);52% (650) received BNT162b2 vaccine and 48% (599) mRNA-1273. 14 402 adverse reactions were recorded. 6896 were local: 3939 were with mRNA-1273 and 2957 with BNT162b2 (6.6 vs 4.4 reactions per patient);and 7506 were systemic: 4460 with mRNA-1273 and 3046 with BNT162b2 (7.4 vs 4.7 per patient). The occurrence of local reactions was 95.8% after the first dose/89.1% after the second dose with mRNA-1273 versus 89.7%/82.5% with BNT162b2. For systemic reactions, this proportion was 64.3%/93.3% versu 46.8%/73.2% (p value<0.05).In terms of severity, 379 patients (63.3%) with mRNA-1273 confirmed a severe reaction versus 222 (34.2%) with BNT162b2 and 60 patients (10%) with mRNA-1273 confirmed an urgent reaction versus 33 (5.1%) with BNT162b2 (p value<0.001). For both vaccines, there was no difference in the occurrence of local or systemic reactions between patients seropositive and seronegative for SARS-CoV-2.Conclusion and relevanceThe results are consistent with the limited data available to date, confirming that although these are not particularly serious adverse effects, they do occur in a large majority of vaccinated persons and in greater numbers after administration of the mRNA-1273 vaccine. The Hospital Pharmacy Service is a key agent in pharmacovigilance within the healthcare system and must be aware of the safety profile of new drugs. This study is an essential tool to detect and prevent adverse events.References and/or acknowledgementsConflict of interestNo conflict of interest

Baricitinib in Patients with Severe Pneumonia due to COVID-19 in Veracruz, Mexico

Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

Experience of a Private Hospital in the Treatment of COVID-19 Pneumonia in Veracruz, Mexico

Background. Large mortality rates have been reported in the Mexican public health system, however in the experiences of private hospitals that have resources and infrastructure this is lower compared to the national average. Methods. Descriptive and retrospective study. Adult patients treated for pneumonia due COVID-19 from April to December 2020 are entered into the study. Its general characteristics such as gender and age, comorbidities, influenza vaccination history, clinical characterization, laboratory and tomographic diagnosis of sars cov2 pneumonia are studied, as well as the drug and oxygen therapy treatments received and finally, its evolution and clinical outcome. Results. 132 patients were studied, of which 51% were female. The main age groups affected were 65 and over (43.9%), 50-59 years (20.4%) and 25-44 years (16.6%). The main comorbidities found were: arterial hypertension (43.9%), Diabetes mellitus 2 (33.3%), heart disease (11.3%) and obesity (10.6%). 95.4% of the patients were not vaccinated against influenza. The main symptoms reported were: fever (92%), cough (87%), dyspnea (76%) and headache (52%). The diagnosis was confirmed with RT-PCR in 63%, reporting negative RT-PCR in 36%;the antigen test was positive in 1%. Regarding the findings of the chest computed tomography, CORADS 5 was reported in 30%, CORADS 6 in 3% and CORADS 4 in 20%. The main treatments used in patients with severe inflammatory pneumonia were: steroids (98%), enoxaparin (100%), tocilizumab (20%), baricitinib (60%), direct oral anticoagulants (10%), fibroquel (5%). 60% were treated with a combination of two or more drugs. The main oxygenation contributions were: 20% nasal tips - mask/reservoir, 60% high flow nasal cannula, 20% mechanical ventilation. In 95% the prone position was indicated. Regarding the clinical evolution, 65.1% were towards improvement, 17.4% died, 12.1% requested transfer to another unit and 5.3% requested voluntary discharge. Overall mortality was 17%. Conclusion. A hospital strategy that has the necessary resources and infrastructure as well as openness to the use of medication with emergency approvals for its use or off-label indications, can help limit morbidity and mortality in vulnerable populations and manifest risk factors such as Mexican population.

THE IMPACT OF COVID-19 ONTHE LIVING CONDITIONS OF SINGLE-PARENT HOUSEHOLDS IN SPAIN. A PRELIMINARY READING FROM THE LIVING CONDITIONS SURVEY 2020

The pandemic caused by Covid-19 has had a major impact on society, although it has been particularly hard on groups that were already vulnerable. This is the case of single-parent households, generally the mother, and her dependent children. The aim of this research is to identify the impact that the pandemic has had on the living conditions of these households. To do so, a secondary analysis has been carried out using data from the Living Conditions Survey (LCS) conducted by the Spanish National Statistics Institute (INE). The results of the study refer, in particular, to the changes that the pandemic has brought about in the material situation of the household. These constitute a preliminary reading of the situation, which will have to be completed with future revisions.

Biologic treatments for psoriasis: the cost of alternative methods of dispensation of medication in Spain

OBJECTIVE: Hospital pharmacy services have adapted to the COVID-19 pandemic. The aim of the study is to determine the economic consequences of replacing hospital pharmacy dispensation with other dispensing methods in the context of biological treatments for psoriasis in Spain. METHOD: Multiple dispensation scenarios were evaluated, combining different dispensation frequencies and sites, and telepharmacy followup intervals. Self- injectable biological medicines for psoriasis (interleukin and tumour necrosis factor alpha inhibitors) were included. All costs (in 2020 euros) were considered from the perspective of the National Health System. RESULTS: The annual cost of hospital pharmacy-based dispensations every 4 weeks combined with telepharmacy monitoring at each administration ranged from 194.9 to 2,088.0 per patient. Across the different simulated scenarios, biological medicines associated with the lowest cost were those administered less frequently (every 12 weeks). CONCLUSIONS: In the post-COVID-19 era, new models of hospital pharmaceutical care that include changes in drug dispensation and telepharmacy strategies will have economic consequences for the National Health System that merit consideration.

Short-term impacts of COVID-19 on food security and nutrition in rural Guatemala: phone-based farm household survey evidence

This article examines the short-term effects of the COVID-19 lockdown on food security and nutrition in rural Guatemala. We rely on a comprehensive panel dataset of 1,824 small agricultural households collected over two survey rounds, on November-December 2019 and May-June 2020. We place special emphasis on changes in agricultural and nonagricultural income sources, including remittances, and changes in dietary diversity, including consumption of animal source foods (ASF) and fruits and vegetables (F&V). We find that COVID-19 affected the incomes, food security, and dietary patterns of households, with a decrease in ASF diversity and an increase in F&V diversity, and an overall net decrease in dietary diversity across all food groups. Dietary diversity among women in reproductive age, however, remained unchanged, and increased among children under 2 years old. Interestingly, households with relatively higher incomes appear to have reduced their dietary diversity to a larger extent than lower income ones, as well as households located in communities with more severe access restrictions. The focus of the study in a region with a high prevalence of poverty and chronic malnutrition provides an important perspective into the consequences of the lockdown in complex rural contexts with vulnerable populations and contributes to inform eventual recovery measures.

ECOLOGICAL STUDY ON INFECTIONS, MORTALITY AND LETHALITY DUE TO COVID-19 IN THE WORLD: CORRELATION WITH VARIOUS ECONOMIC AND HEALTH INDICATORS

To analyze the correlation of the rates of infections, mortality and lethality of COVID-19 with different economic and health indicators at an ecological level. An ecological study was carried out with data from various sources. In total, 150 countries were included that as of July 12, 2020 had at least 500 COVID-19 infections. The variables considered as dependent were the infection, mortality and lethality rates of COVID-19, while the independent variables were: the gross domestic product (GDP), the human development index (HDI), life expectancy at birth, the average of schooling, GDP per capita in international dollars (PPP), prevalence of obesity and diabetes. Also, for Organization for Economic Co-operation and Development (OECD) countries members, health spending per capita in international dollars and hospital beds per 1,000 inhabitants. Statistical analysis was performed in Stata 14.0. The population of the 150 countries represented 94.24% of the world population. A correlation (p<0.05) was observed between the number of infections and the number of deaths with the total population. Between the number of deaths and the number of infections. Various economic indicators (HDI, GDP, average schooling, GDP per capita) and health (health expenditure per capita, obesity and diabetes) correlated positively with the rates of infections, mortality and fatality, but negatively with hospital beds. Economic and health indicators are related at an ecological level with the rates of infections, mortality and fatality in the world.

Overburden and correlates among caregivers of people with dementia during the COVID-19 pandemic

Introduction: The existence of the SARS-CoV-2 coronavirus (COVID-19) represents an unprecedented health problem around the world, including people with dementia, their families and caregivers. Objectives: To study the characteristics of caregivers and care recipients as well as the burden among caregivers of people with dementia during the COVID-19 pandemic. Material and Methods: Prospective observational study. The universe comprised 3000 people aged 65 years who were selected by simple random sampling without replacement from the population based study of Aging and Alzheimer’s Disease. Of them, 160 participants from Havana were evaluated at two different moments: in 2016-2018 and from October 1 to November 30, 2020. Results: The caregivers who were evaluated during the pandemic presented higher levels of stress or higher Zarit burden Interview scores (p=0,017) as well as a greater morbidity as measured by the General Health Questionnaire (p<0,0001) in relation to the study conducted in 2016-2018. Stress among caregivers was associated with the presence and severity of behavioral and psychological symptoms, OR = 1,02 (95 % CI 1.00-1.03);stages of dementia, OR = 1,61 (95 % CI, 1.45-1.76);greater care needs, OR = 1,56 (95 % CI, 1.14-2.77);fear of getting sick from COVID-19, OR = 1,52 (95 % CI, 1.11-4.12);insecurity about the future, OR = 1,26 (95 % CI, 1.04 -2.53) and job abandonment due to care, OR = 1,19 (95 % CI, 1.01-2.12). Conclusions: Our findings confirm that there is greater stress and burden among caregivers of people living with dementia during the COVID-19 pandemic and that there is a need to achieve coordinated actions in the national health system strategies aimed at supporting people with dementia and caregivers.

Molecular and serological prevalence of Coronavirus in Chiropterans: A systematic review with meta-analysis

In recent years, and now especially with the arrival of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), there has been increased interest in understanding the role of bats in the dynamics of transmission and origin of this pandemic agent. To date, no systematic reviews have been published on this topic. This systematic review aimed to summarize and highlight the frequency of bat infections reported in currently available observational studies for coronavirus. The purpose of this study was also to examine the differences between the pool prevalence by technique and country. We performed a systematic literature review with meta-analysis, using three databases to assess coronavirus (CoV) infection in bats and its diagnosis by serological and molecular tests. We carried out random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95% CI). In all, 824 articles were retrieved (1960-2021). After screening by abstract/title, 43 articles were selected for full-text assessment. Of these, 33 were finally included for qualitative and quantitative analyses. From the total of studies, the pool prevalence by RT-PCR (n=14,295 bats) for CoV was 9.8% (95% CI 8.7-10.9%);Italy reported the highest pooled prevalence (44.9%, 95% CI 31.6-58.1%), followed by the Philippines (29.6%). Regarding the ELISA, the pool prevalence for coronavirus from 15 studies, including 359 bats, was 30.2% (95% CI 14.7-45.6%). The results for coronaviruses with the MIF were significantly lower, 2.6% (95% CI 1.5-3.7%). A considerable proportion of infected bats tested positive, particularly by molecular tests. This essential condition highlights the relevance of bats and the need for future studies to detail their role as potential reservoirs of SARS-CoV-2. In this meta-analysis, bats were positive in almost 10% by RT-PCR, suggesting their relevance and the need to understand their potential participation in maintaining wild zoonotic transmission.

Approaching grief and death in family members of patients with COVID-19: Narrative review

Objective: The objective of this review was to synthesize the possible evidence to establish recommendations on the approach of mourning and death in relatives of COVID-19 patients, as well as offering substitute resources for the necessary rituals and procedures in order to build up functional griefs and prevent complicated bereavements. Method: A bibliographic research was conducted in MEDLINE, EMBASE, SCIENCEDIRECT, WOS, CINAHL and CUIDEN databases, using MeSH terms, (family, patient, isolation hospitals, grief, death, ceremonial behavior, self -care, affects and social networks) with its corresponding boo lean equation. The selected articles have been published in a critical reading through the Critical Assessment Skills Program in Spanish (CASPe). Results: A total of 560 articles were initially found, after applying the selection criteria, 13 studies were included in the analysis, of which 8 were systematic reviews, 3 qualitative studies, 1 cross-sectional prospective pilot study and 1 clinical guide, which allowed identifying strategies for the approach grief and death attending to this moment of exceptionality covid19, influencing the competence management of health professionals in emotional support and accompaniment as well as the monitoring throughout the process, as well as in the communication with the family. Conclusion: In the final process of life in COVID-19's time, health professionals must work farewells, alternative funeral rites, spiritual care and early coping that wilt allow the prevention (C) 2020 Elsevier Espana, S.L.U. All rights reserved.