Predictors of mortality in patients less than 50 years old with coronavirus disease 2019: a multicenter experience in Istanbul.

OBJECTIVE: The objectives of this study were to identify predictors of mortality in young adult patients with coronavirus disease 2019 and to assess the link between blood type and mortality in those patients. METHODS: This multicenter retrospective study, which was conducted in seven training and research hospitals in Istanbul, involved young adults who aged ≥18 and <50 years and hospitalized with coronavirus disease 2019. RESULTS: Among 1,120 patients, confusion at admission (p<0.001) and oxygen saturation (p<0.001) were significantly predictive factors of mortality. Blood type O was significantly associated with mortality compared to those discharged from the hospital (p<0.001). Among co-morbidities, the most reliable predictive factors were cerebral vascular disease (p<0.001) and chronic renal failure (p=0.010). Among laboratory parameters, high C-reactive protein (p<0.001) and low albumin (p<0.001) levels were predictors of mortality in young adult patients with coronavirus disease 2019. CONCLUSIONS: SpO2 at admission was the best predictor of mortality in young adult patients with coronavirus disease 2019. The mortality rate was increased by cerebral vascular disease and chronic renal failure. Also, high C-reactive protein and low albumin levels were predictive factors of mortality. Moreover, blood type O was associated with a higher mortality rate than the other types.

Hesitancy Regarding Medical Advice on COVID-19: An Emergency Department Perspective.

OBJECTIVE: The rejection of or non-compliance with treatment arises for different reasons by patients who receive treatment recommendations for various diseases. These states are described by various concepts, such as discharge against medical advice (DAMA) and medication nonadherence (MNA). The basis of the study is to determine how these states have arisen during the coronavirus disease (COVID-19) pandemic. METHOD: The data of this study were collected through standardized interviews with 103 volunteer participants who were diagnosed with COVID-19 at different times and who did not use their prescribed medicine during the pandemic in Turkey. The data obtained in the research were analyzed through the MAXQDA qualitative analysis program. RESULTS: As a result of the analysis of the data, 4 main themes and sub-codes have been reached: (1) prescribed medicine, (2) an information source for the COVID-19 period/treatment, (3) the reason for medication nonadherence, and (4) treatment of choice. When the approach toward treatment of patients who were diagnosed with COVID-19 and had started treatment by a physician was evaluated, it was revealed that the nonadherence state emerged as a cycle. In the initial period, nonadherence due to the medication itself was observed. The second period is when the patients recognize their disease and collect information from their environment. Although this period begins before the disease, the search for informative sources intensifies, especially once the diagnosis has been received. In the third period, with their diagnosis and the information they had obtained, patients consider the reasons to use the medication and then decide whether or not to use it. In the fourth period, the patients who will not use antivirals consider other medications, such as anti-flu, anticoagulant, supplements, and nutrition. CONCLUSION: Since a specific treatment protocol has not yet been revealed for COVID-19, a new conceptual framework is required. In the current condition, the state of "hesitation for medical advice" arises for non-hospitalized patients.

Vaccine Hesitancy of Health-Care Workers: Another Challenge in the Fight Against COVID-19 in Istanbul.

OBJECTIVE: Health-care workers (HCWs) are often seen as the most reliable source of vaccine-related information for their patients; nevertheless, various studies show that HCWs experience vaccine hesitation. In this study, the aim was to determine the reasons for vaccine hesitation among HCWs working in a large public hospital and its affiliated units in Istanbul. METHODS: A descriptive method for collecting qualitative data was designed for this study. The data of the HCWs were analyzed in line with the vaccine hesitancy factors put forward by the World Health Organization (WHO). RESULTS: The most important vaccine hesitancy theme that emerged was the fear and lack of confidence in the vaccines, which was expressed at a higher rate than any other theme in all HCWs. The most cited reason for fear/lack of confidence in the vaccine was the fear of its side effects. It was observed that the HCWs who reported hesitation about vaccination due to pregnancy and breastfeeding consisted of women. The second most common theme for vaccine hesitation was reported as an inconvenience in accessing the vaccines. Although HCWs have priority, they stated that their reason for vaccine hesitancy was due to heavy personal issues or workloads. The final theme was about complacency, or thinking they do not need the vaccine. CONCLUSIONS: Vaccine hesitation is a challenge that can be overcome with detailed monitoring and policy-making. Although the vaccine seems to be more significant, we do not want to see vaccine hesitancy grow more than the vaccine itself.