Prevalence of grief symptoms and disorders in the time of COVID-19 pandemic: A meta-analysis.

Millions of people worldwide are mourning the loss of loved ones due to the COVID-19 epidemic, which may adversely impact their mental health. This meta-analysis aimed to investigate pandemic grief symptoms and disorders for developing policy, practice, and research priorities. The databases of Cochrane, Embase, Ovid-MEDLINE, WHO COVID-19, NCBI SARS-CoV-2, Scopus, Web of Science, CINAHL, and Science Direct were comprehensively searched until July 31, 2022. The Joanna Briggs Institute's and Hoy's criteria were used to evaluate the studies. A pooled prevalence was presented in a forest plot figure with a corresponding 95% confidence interval (CI) and prediction interval. Between-study heterogeneity was measured using the I2 and Q statistics. Variations in the prevalence estimates in different subgroups were examined by moderator meta-analysis. The search identified 3677 citations, of which 15 studies involving 9289 participants were included in the meta-analysis. The pooled prevalence rate of grief symptoms was 45.1% (95%CI: 32.6%-57.5%), and grief disorder was 46.4% (95%CI: 37.4%-55.5%). Grief symptoms were significantly higher in <6 months (45.8%; 95%CI: 26.3%-65.3%) compared to the period of more than 6 months. Unfortunately, moderator analyses for grief disorders could not be performed due to limited studies. The prevalence of grief problems during the pandemic was substantially higher than in non-pandemic conditions; therefore, it is crucial to strengthen bereavement support to reduce psychological distress. The results provide a foundation for nurses and healthcare workers to anticipate a heightened need for support and provision of bereavement care in the post-pandemic era.

Effectiveness of respiratory rehabilitation in patients with COVID-19: A meta-analysis.

AIM: Examine effectiveness of respiratory rehabilitation and moderating factors on lung function and exercise capacity in post-COVID-19 patients. DESIGN: Meta-analysis. METHODS: R software 4.0.2 assessed the effectiveness of respiratory rehabilitation adopting the random-effects model and presenting standardised mean differences (SMDs). Heterogeneity was determined by Cochran's Q and I2 . The Cochrane Risk of Bias 2.0 and MINORS evaluated quality of the included studies. DATA SOURCES: A comprehensive search was undertaken in Cochrane, Embase, Ovid-MEDLINE, Scopus, NCBI SARS-CoV-2 Resources, ProQuest, Web of Science and CINAHL until March 2022. RESULTS: Of the 5703 identified studies, 12 articles with 596 post-COVID-19 patients were included. Eleven of our twelve studies had moderate to high quality and one study had high risk of bias assessed with MINORS and RoB 2 tool. Overall, respiratory rehabilitation was effective in improving forced expiratory volume in 1 s (1.14; 95%CI 0.39-1.18), forced vital capacity (0.98; 95%CI 0.39-1.56), total lung capacity (0.83; 95%CI 0.22-1.44), 6-minute walk distance (1.56; 95%CI 1.10-2.02) and quality of life (0.99; 95%CI 0.38-1.60). However, no significant differences were observed for ratio of the forced expiratory volume in 1 s to the forced vital capacity of the lungs, anxiety and depression. Respiratory rehabilitation for post-COVID-19 patients was effective in those without comorbidities, performed four types of exercise programs, frequency ≥3 times/week and rehabilitation time 6 weeks. CONCLUSIONS: Respiratory rehabilitation improved lung function, exercise capacity and quality of life in post-COVID-19 patients. The findings suggest rehabilitation programs for post-COVID-19 patients should use multiple respiratory exercise programs with frequency of ≥3 times per week for longer than 6 weeks. IMPACT: These findings will help improve the implementation of respiratory rehabilitation programs for post-COVID-19 patients. IMPLICATIONS FOR THE PROFESSION: Our findings can be used to develop patient-centred respiratory rehabilitation interventions by nurses and clinicians for post-COVID-19 patients. REPORTING METHOD: PRISMA guideline was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic: A meta-analysis.

OBJECTIVE: To estimate the global prevalence of low resilience among the general population and health professionals during the COVID-19 pandemic. METHODS: Embase, Ovid-MEDLINE, PubMed, Scopus, Web of Science, CINAHL, WHO COVID-19 databases, and grey literature were searched for studies from January 1, 2020, to August 22, 2022. Hoy's assessment tool was used to assess for risk of bias. Meta-analysis and moderator analysis was performed using the Generalized Linear Mixed Model with a corresponding 95 % confidence interval (95 % CI) adopting the random-effect model in R software. Between-study heterogeneity was measured using I2 and τ2 statistics. RESULTS: Overall, 44 studies involving 51,119 participants were identified. The pooled prevalence of low resilience was 27.0 % (95 % CI: 21.0 %-33.0 %) with prevalence among the general population being 35.0 % (95 % CI: 28.0 %-42.0 %) followed by 23.0 % (95 % CI: 16.0 %-30.9 %) for health professionals. The 3-month trend analysis of the prevalence of low resilience beginning January 2020 to June 2021 revealed upward then downward patterns among overall populations. The prevalence of low resilience was higher in females, studied during the delta variant dominant period, frontline health professionals, and undergraduate degree education. LIMITATIONS: Study outcomes showed high heterogeneity; however, sub-group and meta-regression analyses were conducted to identify potential moderating factors. CONCLUSIONS: Globally, 1 out of 4 people among the general population and health professionals experienced low resilience due to COVID-19 adversity. The prevalence of low resilience was twice as much among the general population compared to health professionals. These findings provide information for policymakers and clinicians in the development and implementation of resilience-enhancing programs.

Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis.

Background: Post-extubation and neurologic complications in COVID-19 patients have been shown to cause oropharyngeal dysphagia (OD). We performed the first meta-analysis to explore and estimate the pooled prevalence of OD, risk of mortality, and associated factors among hospitalized COVID-19 patients. Methods: We searched Scopus, PubMed, Embase, CINAHL, WHO COVID-19 database, and Web of Science for literature on dysphagia in COVID-19 patients. We used the generalized linear mixed model (GLMM) to determine the prevalence estimates of OD in the R software and the DerSimonian-Lard random-effects model in the Comprehensive Meta-Analysis software to explore the risk of mortality and associated factors of OD, presented as odds ratios (ORs) and corresponding 95% confidence intervals (CIs). We used Cochran's Q, τ2, and the I2 statistic to assess heterogeneity and conducted a moderator analysis to identify moderator variables. Results: We included eighteen studies with a total of 2055 participants from the 910 studies retrieved from electronic databases. The prevalence of OD among hospitalized COVID-19 patients was estimated at 35% (95% CI = 21-52; low certainty of evidence) associated with a high risk of mortality (OR = 6.41; 95% CI = 1.48-27.7; moderate certainty of evidence). Intubation (OR = 16.3; 95% CI = 7.10-37.3; high certainty of evidence), use of tracheostomies (OR = 8.09; 95% CI = 3.05-21.5; high certainty of evidence), and proning (OR = 4.97; 95% CI = 1.34-18.5; high certainty of evidence) among hospitalized COVID-19 patients were highly associated with developing OD. The prevalence of OD was higher among hospitalized COVID-19 patients who were admitted in intensive care units (ICU), intubated, and mechanically ventilated. Conclusions: The prevalence of OD among hospitalized COVID-19 patients is estimated at 35% associated with a high risk of mortality. OD assessment among hospitalized COVID-19 patients who are managed in an ICU, prone position, intubated, and mechanical ventilated deserves more attention. Registration: PROSPERO CRD42022337597.

Prevalence of depression, anxiety, and stress among first responders for medical emergencies during COVID-19 pandemic: A meta-analysis.

Background: The COVID-19 pandemic has been shown to cause enormous psychological burden among health care workers, including first responders. However, psychological well-being of first responders, essential in the fight against COVID-19 pandemic, has often been ignored. We performed the first meta-analysis to explore the prevalence of 1) depression, 2) anxiety, and 3) stress among first responders for medical emergencies during the COVID-19 pandemic. Methods: A comprehensive search was conducted in Embase, CINAHL, Web of Science, PsychInfo, PubMed, and the WHO COVID-19 database from 2020. The Freeman-Tukey double-arcsine transformation model in R-software determined the pooled prevalence and Comprehensive Meta-Analysis for associated factors of depression, anxiety, and stress with corresponding 95% confidence intervals (CI). The Cochrane Q, τ2, and I2 statistics were used to examine heterogeneity. Sub-group analysis was conducted to identify moderator variables. Results: We identified 765 records, from which 17 studies were included with 8096 first responders. The pooled prevalence was 31% (95% CI = 21%-41%) for depression; 67% (95% CI = 64%-70%) for mild depression, 24% (95% CI = 17%-31%) for moderate depression, and 16% (95% CI = 4%-34%) for severe depression. The pooled prevalence for anxiety was 32% (95% CI = 20%-44%); 60% (95% CI = 46%-73%) for mild anxiety, 27% (95% CI = 14%-42%) for moderate anxiety, and 14% (95% CI = 7%-22%) for severe anxiety. The pooled prevalence for stress was 17% (95% CI = 4%-34%); 58% (95% CI = 38%-77%) for mild stress, 22% (95% CI = 5%-44%) for moderate stress, and 19% (95% CI = 5%-37%) for severe stress. The prevalence of depression was 37% (95% CI = 25%-52%) for paramedics, 28% (95% CI = 12%-54%) for EMS personnel and 22% (95% CI = 13%-33%) for police. Similarly, the prevalence of anxiety was 38% (95% CI = 20%-60%) for paramedics, 28% (95% CI = 11%-53%) for EMS personnel, and 19% (95% CI = 10%-32%) for police. Married responders were likely at risk for depression (1.50, 95% CI = 1.26-1.78) and anxiety (1.94, 95% CI = 1.62-2.33), while unmarried responders were less likely at risk for depression (0.67, 95% CI = 0.56-0.79) and anxiety (0.50, 95% CI = 0.43-0.63). Conclusions: High prevalence of depression, anxiety, and stress during the COVID-19 pandemic among first responders for medical emergencies emphasizes the need for monitoring their psychological well-being. Early assessment and management of mild depression, anxiety, and stress among first responders are crucial in preventing progression into moderate and severe types.

Effectiveness of prone position in acute respiratory distress syndrome and moderating factors of obesity class and treatment durations for COVID-19 patients: A meta-analysis.

OBJECTIVES: To examine the effectiveness of prone positioning on COVID-19 patients with acute respiratory distress syndrome with moderating factors in both traditional prone positioning (invasive mechanical ventilation) and awake self-prone positioning patients (non-invasive ventilation). RESEARCH METHODOLOGY: A comprehensive search was conducted in CINAHL, Cochrane library, Embase, Medline-OVID, NCBI SARS-CoV-2 Resources, ProQuest, Scopus, and Web of Science without language restrictions. All studies with prospective and experimental designs evaluating the effect of prone position patients with COVID-19 related to acute respiratory distress syndrome were included. Pooled standardised mean differences were calculated after prone position for primary (PaO2/FiO2) and secondary outcomes (SpO2 and PaO2) RESULTS: A total of 15 articles were eligible and included in the final analysis. Prone position had a statistically significant effect in improving PaO2/FiO2 with standardised mean difference of 1.10 (95%CI 0.60-1.59), SpO2 with standardised mean difference of 3.39 (95% CI 1.30-5.48), and PaO2 with standardised mean difference of 0.77 (95% CI 0.19-1.35). Patients with higher body mass index and longer duration/day are associated with larger standardised mean difference effect sizes for prone positioning. CONCLUSIONS: Our findings demonstrate that prone position significantly improved oxygen saturation in COVID-19 patients with acute respiratory distress syndrome in both traditional prone positioning and awake self-prone positioning patients. Prone position should be recommended for patients with higher body mass index and longer durations to obtain the maximum effect.

Humoral Immunogenicity and Reactogenicity of the Standard ChAdOx1 nCoV-19 Vaccination in Taiwan.

BACKGROUND: The ChAdOx1 nCoV-19 vaccine has been widely administered against SARS-CoV-2 infection; however, data regarding its immunogenicity, reactogenicity, and potential differences in responses among Asian populations remain scarce. METHODS: 270 participants without prior COVID-19 were enrolled to receive ChAdOx1 nCoV-19 vaccination with a prime-boost interval of 8-9 weeks. Their specific SARS-CoV-2 antibodies, neutralizing antibody titers (NT50), platelet counts, and D-dimer levels were analyzed before and after vaccination. RESULTS: The seroconversion rates of anti-RBD and anti-spike IgG at day 28 after a boost vaccination (BD28) were 100% and 95.19%, respectively. Anti-RBD and anti-spike IgG levels were highly correlated (r = 0.7891), which were 172.9 ± 170.4 and 179.3 ± 76.88 BAU/mL at BD28, respectively. The geometric mean concentrations (GMCs) of NT50 for all participants increased to 132.9 IU/mL (95% CI 120.0-147.1) at BD28 and were highly correlated with anti-RBD and anti-spike IgG levels (r = 0.8248 and 0.7474, respectively). Body weight index was statistically significantly associated with anti-RBD IgG levels (p = 0.035), while female recipients had higher anti-spike IgG levels (p = 0.038). The GMCs of NT50 declined with age (p = 0.0163) and were significantly different across age groups (159.7 IU/mL for 20-29 years, 99.4 IU/mL for ≥50 years, p = 0.0026). Injection-site pain, fever, and fatigue were the major reactogenicity, which were more pronounced after prime vaccination and in younger participants (<50 years). Platelet counts decreased and D-dimer levels increased after vaccination but were not clinically relevant. No serious adverse events or deaths were observed. CONCLUSION: The vaccine is well-tolerated and elicited robust humoral immunity against SARS-CoV-2 after standard prime-boost vaccination in Taiwanese recipients.

Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan.

BACKGROUND: Since coronavirus disease 2019 was first discovered, at the time of writing this article, the number of people infected globally has exceeded 1 million. Its high transmission rate has resulted in nosocomial infections in healthcare facilities all over the world. Nursing personnel account for nearly 50% of the global health workforce and are the primary provider of direct care in hospitals and long-term care facilities. Nurses stand on the front line against the spread of this pandemic, and proper protection procedures are vital. OBJECTIVES: The present study aims to share the procedures and measures used by Taiwan nursing personnel to help reduce global transmission. REVIEW METHODS: Compared with other regions, where large-scale epidemics have overwhelmed the health systems, Taiwan has maintained the number of confirmed cases within a manageable scope. A review of various national and international policies and guidelines was carried out to present proper procedures and preventions for nursing personnel in healthcare settings. RESULTS: This study shows how Taiwan's health system rapidly identified suspected cases as well as the prevention policies and strategies, key protection points for nursing personnel in implementing high-risk nursing tasks, and lessons from a nursing perspective. CONCLUSIONS: Various world media have affirmed the rapid response and effective epidemic prevention strategies of Taiwan's health system. Educating nurses on procedures for infection control, reporting cases, and implementing protective measures to prevent nosocomial infections are critical to prevent further outbreaks.