ABSTRACT
Objective: The link with angiotensin-converting-enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is because of the known association between angiotensin-converting enzyme 2 (ACE) and SARS-COV 2. ACE 2 has been shown to be a co-receptor for viral entry for SARS-COV-2 in the respiratory epithelium. It has been a global concern that the use of this drugs may be a risk for patients with COVID-19 infection. It has been published many studies about this subject. Even today there are still controversies regarding to the impact of these drugs. The aim of this study was to determine the association between the previous use of ACEI/ARB and the prognosis of patients with COVID-19 infection Design and method: Single-center, restrospective, cohort study included 608 patients with hypertension diagnosed with COVID-19, who where hospitalized in Macarena's hospital from Mars to December 2020. Analyses of main outcomes (mortality, need of intensive cares (ICU), and days of mean study) were adjusted by multivariate logistic regression. Results: Of a total population of 500,000, 608 patients (0.12%) required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI and 24.8% with ARBs. Treatment with ACEI / ARB-II (combined or individually) had no impact on mortality (OR = 1.29;95% CI, 0.829-2.014;p = 0.257), nor ICU admission (OR = 1, 7;95% CI, 0.68 - 4.95;p = 0.232), nor on the days of mean stay (OR = 0.98;95% CI, 0.95-1.04;p = 0.325). Conclusions: It is unlikely that previous treatment with ACEI/ARB was associated with an increased mortality risk, neither ICU admission or an increase in days of mean stay. This study supports current guidelines that discourage discontinuation of ACEIS or ARBs in COVID-19 patients.
ABSTRACT
Objective: Hypertension is one of the most important factors for cardiovascular disease. It has been repeatedly proposed as a prognostic factor of severe COVID- 19 and has been included in clinical risk scores to predict the occurrence of critical illness in ospitalised with COVID-19. Also, it has been postulated the relation between antihypertensive drugs and the severity of COVID-19. The aims of our study were to analyze whether hypertension and antihypertensive treatment represent an independent risk factor for death or intensive care unit admission in patients with SARS-COV2. Design and method: Observational, retrospective, single-center cohort study of all patients admitted to Hospital Virgen Macarena diagnosed with COVID-19 between the months of March and December 2020. A bivariate analysis was performed using Pearson's chi-square Results: 608 patients required admission for COVID-19. A total of 83.7% were hypertensive, specifically 75.9% were under antihypertensive treatment (35.7% with only 1 drug, 29.9% were taking two drugs, 9% with three drugs, and 1.3% with 4 drugs). 26.2% were treated with an ACEI, 24.8% with ARA-II, 16.8% with calcium-antagonists, 30.9% with diuretics, 21.2% with beta-blockers, 0, 5% with alpha-blockers). Hypertension did not show a statistically significant relationship with mortality (p = 0.34), increase in mortality and ICU admissions. Neither treatment with ACEI (p = 0.4), ARB-II (p = 0.45), calcium antagonists (p = 0.53), diuretics (p = 0.68), alpha blockers (p = 0.07) demonstrated relation with those items. Surprisingly, beta-blockers increased the mortality in patients with SARS-COV2 (p = 0.048). Probably this results can be explained as these drugs were indicated for rate control in patients with atrial fibrillation (p = 0.006). The number of antihypertensive drugs used also did not show a statistically significant relationship with an increase in mortality (p = 0.978). Conclusions: Hypertension is a highly prevalent pathology in patients ospitalised with COVID-19 infection. However, high blood pressure was not associated with a higher risk for mortality in patients with SARS-COV-2, neither the type or the number of antihypertensive drug used. Only beta-blockers alter outcomes in hypertensive patients with COVID-19, as they were associated with more deaths.
ABSTRACT
Purpose: There is little knowledge to date regarding the influence of the COVID-19 health crisis on tourists' intention to travel differently in the future. This paper addresses this and explores its determinants. The objective of the present study is to determine to what extent the Spanish tourists affected by COVID-19 may change the way they travel in the future, according to the perceived risk of travel in a pandemic context. Design/methodology/approach: Between May and June 2020, the authors conducted a survey with a sample population of Spanish tourists who were resident in Spain during the COVID-19 pandemic, for the purposes of studying the role of attitudes and risk in the intention to change the way they want to travel in the future. Cluster analysis and one-way ANOVA were conducted to assess differences among the respondents. Finally, some models were built using the linear regression technique in order to evaluate the role of attitudes in the tourists' adaptive response to the perceived risk of travel. Findings: Results confirm the formation of a new way of life influencing tourists' intentions to travel more sustainably. Accordingly, tourists with a previous environmental attitude are less interested in visiting mass tourism beach destinations in the future. However, changes in the way some tourists travel can also be read as an adaptive and temporary response to the perceived risk of contracting the disease, and do not point to a reduction of the vital importance of tourism in their lives. Research limitations/implications: The exploratory nature of the study and the lack of similar international analyses does not allow the authors to contrast its results at a global level, though it offers a starting point for future research in other countries. There are also methodological limitations, since the field work was carried out between the first and second waves of the disease, at a time when the pandemic was in remission, possibly affecting the orientation of some responses, given the desire to recover normalcy and “normal” travel, and this may have influenced the priority given to tourism. Social implications: This study gives new insights into the debate on the social transformation of the collective consciousness. Despite some signs of change, part of the Spanish tourists are still anchored in traditional tourism practices embedded in cultural factors, which can hinder sustainability in the Spanish tourism industry. The experience of the COVID-19 crisis has not been sufficient to change the declared travel habits of Spanish tourists. Therefore, progress towards the definition of a new tourism system that implies the effective transformation of demand will require applying policies and promoting institutional innovation and education to create paths that facilitate transformative experiences. Originality/value: The study is focused on the analysis of the relationship between attitudes and risk perception, including novel elements that enrich the academic debate on social progress in the transformation of tourism and the possibilities of promoting a reset from the demand side. Moreover, it incorporates, for the first time, the COVID-19 as it was experienced as an explanatory variable to analyse the changing travel attitudes in a post-COVID-19 era. The analysis of the psychosocial mechanisms of risk offers a good opportunity for a better assessment of post-pandemic demand risk perception. Finally, the study offers empirical evidence on how Spanish tourists are reimagining their next and future holidays, which can be highly valuable for destination managers. © 2022, Francesc González-Reverté, Joan Miquel Gomis-López, Pablo Díaz-Luque.
ABSTRACT
The study was carried out with the objective of comparing and analyzing psychosocial factors such as stress, depression and anxiety in undergraduate university students from Loreto, Ancash, Moquegua and Puno during confinement by Covid-19, Peru. The study was based on a non-experimental, quantitative-descriptive, cross-sectional and correlational design with non-probability and intentional sampling, an online survey was applied to a sample of 665 undergraduate students using validated instruments such as the List of Indicators of Vulnerability to stress, the Zung Depression Scale, and the Hamilton Anxiety Scale. The study reports vulnerability to stress in 50.8%, 46.3%, 36.4% and 37.5% in Loreto, Ancash, Moquegua and Puno. The prevalence of depression was 100.0%, 97.6%, 96.9% and 95.2% between mild, moderate and severe;likewise, 100.0% presented anxiety symptoms. It was concluded that a situation of obligatory social confinement is directly related to the presence of stress, depression and anxiety, particularly in undergraduate university students, affecting a greater proportion of women;of these between 19 and 22 years, and with a higher incidence in regions with a greater number of confirmed cases;where insomnia, worry and irritability are the most significant symptoms.