Intermediate respirtory care unit patient flow analysis during the covid-19 pandemic

The IRCU of our hospital has increased its activity in the COVID-19 pandemic. The respiratory isolation condition has been an organizational challenge and has had a huge impact in the patient flow. Our IRCU has 3 subunits: nonCOVID (8 beds), COVID (up to 24 beds in open stay) and non-tested (8 beds). We have analysed the hospital activity register from November 2020 to April 2021, analysing the patient flow. For COVID IRCU admission criteria, a positive PCR with FiO2 > 0.50 with SatO2 <95%, RR > 25 and PaO2/FiO2 <250. We had 685 admissions: 52% in the COVID IRCU (average stay 6.82 days), 27.6% in the non-tested IRCU (AS 3.94 d) and 26.4% in the non-COVID IRCU (AS 6.32 d). A total of 43% admissions of the COVID-IRCU came from the Infectious Diseases Unit (IDU), 43.5% from the ED/other hospitals, and 1.12% from the ICU. Of the overall of COVID-IRCU, 29% required admission to the ICU and the mortality rate (MR) was 15.16%. A total of 40.7% admissions of non-COVID IRCU, ED 45.7%, and 13.6% the ICU. Of 6.4% patients required admission to the ICU (MR 6.4%). A total of 61.4% admissions of the non-tested IRCU, ED and 22.2% required admission to the ICU, with a 13.2% MR. The pandemic has highlighted the importance of the IRCU, reducing admissions and ICU stay. Our IRCU, maintains optimal respiratory isolation conditions in the non-tested IRCU, maintaining the normal activity in the non-COVID IRCU.

T-cell responses to SARS-CoV-2 in patients during acute disease, convalescence and after vaccination

Background: T-cell response against SARS-CoV-2 is essential for disease control and to understand correlates of protection against various disease outcomes in COVID-19. This makes T-cell measurement an important tool for clinical management. Aim(s): To evaluate the IFN-gamma-releasing T-cell response against spike (S), nucleocapsid (N) and membrane (M) SARS-CoV-2 antigens using an ELISPOT-based assay in acute, convalescent, and vaccinated individuals. Method(s): Blood samples were collected from acute (n=71) and convalescent (n=59) individuals classified according to severity;and from vaccinated (n=48) and non-vaccinated (n=80) controls. After stimulating with S, N and M antigens overnight, T-cell response was measured (T-SPOT Discovery SARS-CoV-2. Oxford Immunotec, UK). IgG against S and N were also measured. Result(s): S antigen triggered the highest number of T-cell responses (46%), although responses against N and M were in a large percentage of individuals. The majority of convalescent individuals (93%) had a reactive T-cell response more than 200 days after diagnosis. Such response increased with severity. Acute patients had fewer positive responses (68%). S antigen triggered most responses in vaccinated controls, but only in half of them T-cell response was observed after the second dose. A higher percentage of individuals showed IgG response compared to IFN-gamma-releasing T-cell responses, and moderate correlations between both quantitative responses were seen. Conclusion(s): T-cell response against SARS-CoV-2 is low during acute phase but may increase over time, as seen in convalescent individuals. Regarding vaccinated individuals, half had a positive test result after the second dose.

Real-life experience of the efficacy, safety and pharmacokinetic data of switching from intravenous to subcutaneous infliximab in inactive inflammatory bowel disease patients. Results from the ENEIDA registry

Background: Recently, a subcutaneous formulation of biosimilar infliximab (CT-P13) (SC-IFX) has been approved for inflammatory bowel disease (IBD). The aims of this study were to evaluate efficacy, safety, pharmacokinetics and patient experience following a switching to SC-IFX in patients who are in clinical remission on IV-IFX maintenance treatment. Method(s): Multicentre, descriptive, and observational study including Crohn's disease (CD) and ulcerative colitis (UC) patients who were going to be changed from IV-IFX to SC-IFX on the ENEIDA registry (a large, prospectively maintained database of the Spanish Working Group in IBD-GETECCU). All patients were on clinical and biological remission at least 24 weeks before changing. Demographic and disease data, clinical activity (Harvey-Bradshaw index for CD and mayo index for UC), analytical data (C reactive protein (CRP) and fecal calprotectin (FC), as well as trough levels were collected at baseline, at 12 and 24 weeks. Result(s): One hundred and fifty-five patients were included: 54 UC (35%) and 91 (65%) CD;44% women and 56% men;age 45.5 years (32-55). IV-IFX was mainly administered due to active disease (72%) and perianal disease (7%) and during 32 months [range 14-56]. Preswitch, 78 (50.3%) were on 8-weekly dosing of IV-IFX, 77 (49.7%) were with intensification dose and the half (50.3%) were on concomitant immunomodulatory therapy. SC-IFX was mainly switching by COVID-19 pandemic (60%), to increase through levels (15%) or patient request (25%). The majority of patients (140, 90%) remained with standard dose, 8 (5%) required dose intensification (120 mg weekly in 4 and 240 mg every 2 weeks in 4) and 7 (4.5%) had successful de-escalation (120 mg every 3 weeks in 4 and 120 mg every 4 weeks in 3). Clinical indices, CRP levels and FC remained unchanged (Figure). Median SC-IFX levels significantly increased from baseline of 4.5 mug/ dl [range 2.6-9.2] to 14 mug/dl [range 9.5-16.2] at week 12 and 13.2 mug/ dl [range 10.4-19.7] at week 24. No factors (immunossupresor, body mass index, disease location) were associated with the increase of IFX trough levels. During 24 weeks of follow-up, 16 of the 78 patients (20.5%) stopped immunosuppressant treatment. The adverse events were recorded in 9 patients (5.8%), 4 (2.6%) were hospitalized and 4 (2.6%) had surgery (one of them for perianal disease). Nine patients (5.8%) stopped SC-IFX (1 primary failure, 2 loss of response, 4 adverse events, 1 voluntarily, and 1 surgery). Conclusion(s): The switch from IV to SC IFX maintains clinical remission safely in IBD patients, offers higher drug levels and a good patient acceptance. However, the significance of higher drug levels with SC-IFX requires further exploration.

Cross-culturally approaching the cycling behaviour questionnaire (CBQ): Evidence from 19 countries

Given different advances in applied literature, risky and positive behaviours keep gaining ground as key contributors for riding safety outcomes. In this regard, the Cycling Behaviour Question-naire (CBQ) represents one of the tools available to assess the core dimensions of cycling behaviour and their relationship with road safety outcomes from a behavioural perspective. Nevertheless, it has never been psychometrically approached through a cross-cultural perspec-tive. Therefore, this study aimed to perform the cross-cultural validation of the CBQ, examining its psychometric properties, reliability indexes, validity insights and descriptive scores in 19 countries distributed across five regions: Europe, America, Asia, Africa, and Oceania. For this purpose, it was used the data retrieved from a full sample of 7,001 urban cyclists responding to a large-scale electronic survey. Participants had a mean age of M = 36.15 (SD = 14.71), ranging between 16 and 83 years. The results of this large-scale study empirically support the assumption that the 29-item version of the CBQ has a fair dimensional structure and item composition, good internal consistency, reliability indexes, and an interesting set of validity insights. Among these results, there can be highlighted that: (i) Structurally speaking, the questionnaire works better under a three-factor dimensionality, keeping all its 29 items, whose factor loadings are >0.400 in

Clinical-epidemiological and evolutionary aspects in the first 20 patients diagnosed with COVID-19, hospitalized in the Infectious and Tropical Diseases Clinical Hospital "Dr. Victor Babes"

In March 2020, the first patients diagnosed with COVID-19 were hospitalized in the Infectious and Tropical Diseases Clinical Hospital „Dr. Victor Babes“. Of the 20 patients, 11 were male and 9 were female. Patients were aged between 3 to 56 years. 8 patients traveled outside Romania during the incubation period of the disease. The most common symptom cluster encompassed the respiratory system: fever, cough and shortness of breath. 2 patients presented severe forms of disease that required transfer to the intensive care unit. Radiologically, 18 patients had interstitial lung damage. All patients had a favorable evolution. © 2020, Amaltea Medical Publishing House. All rights reserved.

Changes in the behavior of vegetable consumers in Bucharest and the neighboring areas caused by the COVID-19 crisis

Romania ranks third in the hierarchy of vegetable growing countries in Europe. This study focuses on the determinants of the decision to buy fresh and canned vegetables and on the satisfaction of buyers on these purchases. The quantitative survey was used as a method of collecting information, and the investigation technique was used as an investigation technique, structured in the form of an opinion poll. The opinion poll applied is a questionnaire-based survey that provided information on the situation of vegetable consumers and the change in consumption behavior caused by the COVID -19 health crisis. Most respondents prefer buying directly from the market, buying between 1-3 kg per purchase. If in previous years taste and provenance were the basic criteria in the purchase of vegetables, the economic crisis caused by the health crisis COVID-19, brought the price in the first place, due to the decrease of buyers' incomes or other financial problems. The need for consumption/family, however, did not suffer, the quantities purchased being comparable to those of previous years, buyers turning to vegetables with a low degree of perishability. The study provides results on consumers' criteria for selecting vegetables and their hierarchical changes during the COVID-19 health crisis.

Changes in the management of IBD patients since the onset of COVID-19 pandemic. A path toward the implementation of telemedicine in Spain?

Background: COVID-19 pandemic increased medical services demand aside from interrupting daily clinical practice for other diseases such as inflammatory bowel disease (IBD). Here we present the results of a survey to gain the perception of IBD specialists in their patient-management using telemedicine in their daily practice. Methods: This was an observational survey study among physicians focused on IBD (gastroenterologist, surgeons, and pediatricians) members of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU), the Spanish Association of Gastroenterology (AEG), and the Spanish Association of Coloproctology (AECP), regarding changes of management of IBD patients. Results: We received a total of 269 responses to the survey (from May to June 2020). Before the pandemic, nearly all the respondents reported performing very frequently their visits face-to-face (n = 251, 93.3%) while, during the pandemic, the telephone visits were the most frequent visits performed (n = 138, 51.3%). Regarding communication difficulties, 157 (58.4%) respondents reported the impossibility of performing a proper examination as the most relevant issue. Also, 114 (42.4%) respondents considered remote visits more time-consuming than face-to-face visits. Most gastroenterologists (n = 188, 83.2%) considered patients with active perianal disease in special need of face-to-face consultation and more than half of the surgeons (n = 35, 50.7%) reported having performed an immediate postoperative follow-up remotely. Conclusions: Most IBD units have implemented remote visits during the pandemic, but most professionals found them more time-consuming and unsuitable for some disease profiles. Therefore, there is a need for the development of better telemedicine systems that can meet professionals’ and patients’ requirements.

Thrombosis and COVID-19: a scoping review

Coronavirus disease-19 (COVID-19) has triggered the worst public health crisis of modern times. The prothrombotic state induced by the infection is considered directly and substantially related to acute lung damage and other medical complications, including death. This scoping review summarises and critically assesses the existing evidence on the association between thrombosis and COVID-19, and is based on a systematic literature search of all articles published up to May 5th, 2020, included in the following databases: PubMed, Scopus, Cochrane, and Clinicaltrials.gov. A total of 26 articles were included, and their quality evaluated using STROBE guidelines. The main symptoms presented by patients that had been diagnosed with COVID-19 are dyspnoea, fever, cough, diarrhoea, and vomiting. In the laboratory findings, it is characteristic to observe an increase in D-dimer, fibrinogen, prothrombin time, and lymphopenia. Ultrasound and computed axial tomography were the radiological techniques most used for diagnosing pulmonary thromboembolism, deep vein thrombosis, and other thrombotic phenomena. In conclusion, there is still limited scientific evidence on COVID-19 and its thrombotic complications. This review summarises the body of evidence, assesses its quality, and offers conclusions that should help in the next steps in this highly relevant and expanding research area. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

COVID-19 in Costa Rica: longitudinal analysis of the transmission and death rates from the social inequality approach

Introduction: This article addresses the relationship between the gross rates of transmission and the net death rates from COVID-19 study variables, with socioeconomic and health indicators contrast variables at four moments of observation during the first year of the syndemic in Costa Rica. The objectives of the research work are: a) identify the moments of observation based on the number of accumulated cases per epidemiological week;b) establish the statistical correlation between the crude rates of transmission and the contrast variables;c) establish the statistical correlation between the net death rates and the contrast variables;d) describe the development of transmission and death rates at the cantonal level, and e) socioeconomically characterize the cantons with very high values in those rates. Methods: A study with a quantitative approach is developed through the statistical method and the application of hypothesis tests at a bivariate level, namely, Pearson and Spearman correlations. Results: The main results indicate that transmission is closely related, mostly, to socioeconomic factors -population density;Social Development Index (IDS);Human Development Index (HDI) and crime rates against property-, while deaths they are related to biological factors such as the rates of diseases -hypertension and respiratory-. Conclusion: The study demonstrates the relationship between disease and social inequalities, that is, how social inequality is reproduced in the field of health.

Parental perceptions of increased child-to- parent violence of Spanish adolescents during COVID-19 lockdown

Background: Internationally, there was a warning of the risk of increased domestic violence during lockdown due to the COVID-19 pandemic, including child-to-parent violence. The objective of our study was to assess the prevalence of different violent behaviors from children to parents during pre-lockdown, lockdown and immediately after, between March 14 and June 20, 2020, and to assess differences in behaviors between pre-lockdown and lockdown and between pre-lockdown and post-lockdown.

The irruption of COVID-19 in the Spanish asylum system: Almería as a case study

The COVID-19 pandemic has affected the process of acquiring autonomy for asylum seekers in Spain who are in the Reception System for Applicants and Beneficiaries of International Protection (SAISAR). This article analyses the impact of the COVID-19 measures and the changes in political strategy from the perspective of professionals who work with refugees. The negative effects on services of the specific reception programme are determined based on fieldwork from Almería. Mainly, they are the result of communication issues, the digital divide, slow administrative processes and prolonged stays in prior stages, added to which is an acceleration of decisions - mostly negative - which has left many asylum seekers outside the system. © 2021. All Rights Reserved.

Blending and Compounding in English Coroneologisms

This article focuses on English coroneologisms coined during the COVID-19 pandemic. In order to contextualise two of the main morphological mechanisms underlying the coinage of coroneologisms in non-specialised terminology, namely blending and compounding, I will discuss the whole spectrum of lexical items traditionally ascribed to these word-formation processes and their relation to other lexicogenetic mechanisms. The rapid shift in the status of the word corona from having its primary sense, "crown", in Romance languages prior to the pandemic, to being automatically perceived as a clipping of coronavirus in Romance and Germanic languages alike is illustrated, as well as the high frequency of COVID, among other base forms, in the coinage of numerous words in a matter of months. References will be made to the use of these neologisms in English and their adoption and adaptation into other languages. © 2021 Masarykova Univerzita. All rights reserved.

Right to food and COVID-19: A qualitative study of key actors' perceptions in Chile

The COVID-19 pandemic and the sanitary measures to control it have affected people's diets, which is likely to lead to high rates of malnutrition in all its forms. The objective of this study was to describe the perceptions of a group of key actors on the assurance of the right to food in the context of a pandemic. This was a qualitative study conducted in Chile. The interviewees were selected by convenience with a transdisciplinary approach. We conducted 26 semi-structured interviews online, during September and October 2020. Data analysis was carried out using an inductive approach and a thematic analysis. We organized information using Atlas.ti 9.0 software. From the participants' narratives, we obtained 4 themes: 1. Food security in times of pandemic, 2. Appreciation of government food strategies, 3. Community response to the pandemic and 4. Other perspectives for facing the pandemic. We concluded that access to food is the dimension of the right to food most affected during the pandemic. State strategies are recognized as maintaining the population's nutrition;however, these are perceived as insufficient. On the other hand, the relevance of community organization stands out. It is necessary to monitor the actions taken to guarantee the right to food in the country and learn about the experience of other Latin American and Caribbean countries to prepare for future crises.

Epidemiological factors associated with safety incidents due to patient behavior reported in the hospital setting

Background: Incident reporting systems are an essential element in hospital safety programs. Our objective was to describe the magnitude, evolution and characteristics of adverse events due to patient behavior reported in a high complexity reference university hospital. Methods: Cross-sectional study. Period 20162019. From the hospital registry of adverse events, the notifications of the taxonomy "Patient behavior" were obtained. They were classified according to: type of behavior, category of the reporting professional, care area, sex of the patient/companion, risk and year. The chi(2) test for the comparison of qualitative variables was used, and using a generalized linear model with Poisson distribution, prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. Results: Patient behavior reported incidents represented the 8.2%. There was an increasing trend with a slight decrease in the last year (2016 12.4%;2017 29.5%;2018 32.5% and 2019 25.6%). The areas of neurological and psychiatric diseases, and emergencies reported 36.9% and 19.7% of the cases, respectively. Nursing was the most reporting group (73.2%). More than 60% of notifications involved male patients. The PR doubled in escapes or attempts (2.2;95%CI=1.43.5), tripling in non-compliance with hospital rules (3.0;95%CI=1.9-4.7) and aggressive or intimidating behaviors (3.4:95% CI=2.2-5.3). Conclusions: An increase in notifications related to patient behaviors is observed, with a slight decrease in the last year. This study objectively shows and characterizes a problem that is now especially relevant due to the influence of the COVID-19 pandemic on mental health, which quality and clinical safety programs must consider to minimize the associated risks.

Epidemiological factors associated with safety incidents due to patient behavior reported in the hospital setting

OBJECTIVE: Incident reporting systems are an essential element in hospital safety programs. Our objective was to describe the magnitude, evolution and characteristics of adverse events due to patient behavior reported in a high complexity reference university hospital. METHODS: Cross-sectional study. Period 2016-2019. From the hospital registry of adverse events, the notifications of the taxonomy "Patient behavior" were obtained. They were classified according to: type of behavior, category of the reporting professional, care area, sex of the patient/companion, risk and year. The chi2 test for the comparison of qualitative variables was used, and using a generalized linear model with Poisson distribution, prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. RESULTS: Patient behavior reported incidents represented the 8.2%. There was an increasing trend with a slight decrease in the last year (2016 12.4%;2017 29.5%;2018 32.5% and 2019 25.6%). The areas of neurological and psychiatric diseases, and emergencies reported 36.9% and 19.7% of the cases, respectively. Nursing was the most reporting group (73.2%). More than 60% of notifications involved male patients. The PR doubled in escapes or attempts (2.2;95%CI=1.4-3.5), tripling in non-compliance with hospital rules (3.0;95%CI=1.9-4.7) and aggressive or intimidating behaviors (3.4:95% CI=2.2-5.3). CONCLUSIONS: An increase in notifications related to patient behaviors is observed, with a slight decrease in the last year. This study objectively shows and characterizes a problem that is now especially relevant due to the influence of the COVID-19 pandemic on mental health, which quality and clinical safety programs must consider to minimize the associated risks.

[Parental perceptions of increased child-to-parent violence of Spanish adolescents during covid-19 lockdown.]

OBJECTIVE: Internationally, there was a warning of the risk of increased domestic violence during lockdown due to the COVID-19 pandemic, including child-to-parent violence. The objective of our study was to assess the prevalence of different violent behaviors from children to parents during pre-lockdown, lockdown and immediately after, between March 14 and June 20, 2020, and to assess differences in behaviors between pre-lockdown and lockdown and between pre-lockdown and post-lockdown. METHODS: The researchers developed a survey with closed questions about different violent behaviors of the children (poor responses, insults and physical aggression). This was distributed with the CAWI methodology during the months of August and September 2020 to a sample of Spanish parents stratified by autonomous communities. 1,500 families with 1,927 adolescents aged 12 to 18 years participated. The frequency of responses obtained between the pre-lockdown and lockdown and between pre-lockdown and post-lockdown was compared through the Mac Nemar test for comparison of related samples. RESULTS: The prevalences of poor responses, insults and aggressions in a pre-lockdown setting were 30.1%, 3.8% and 0.6%, respectively. Poor responses and insults increased significantly between pre-lockdown and lockdown (p<0.001) and between pre-lockdown and post-lockdown (p<0.001) in all autonomous communities, age groups, genders, occupation type of the adolescent and type of household. No statistically significant differences were found in physical aggression for the periods evaluated. Single-parent families, adolescents residing in subsidized housing and those without an occupation or education ("NEET") exhibited more violent behavior in the three periods. CONCLUSIONS: Lockdown led to an increase in nonphysical violent behaviors, which were maintained to the end, warning of the potentially persistent risks of lockdown in this age group, especially in vulnerable families.

TECHNOLOGICAL TOOLS IN THE TEACHING MANAGEMENT OF THE TRAINING PROCESS PLAN FOR THE HOME UNIVERSITY AND DISTANCE EDUCATION

The main objective of this article is to explain the potential offered by technological tools, as a complement to comply with the management of university teachers, the context of the COVID-19 pandemic, along with the evolution of Technologies of Information and Communication (ICT). The University at Home and Distance Education Plan (PUCED) developed by the Ministry of Popular Power for University Education of Venezuela was taken as an object of study, and it highlights the opportunities in terms of its application not only for the influence that notoriously impacts the student but also all the advantages it brings to the teachers. The methodology used was documentary research through the method of content analysis through systemic review that generated the following conclusion, the PUCED training processes regarding teacher adaptation have been marked by the need to train from the distance education, which proposes a complementation between traditional pedagogical resources with the ICT that they have. However, the incipient need for teacher training in the management of technologies for pedagogical purposes forced the MPPEU to enter into a process of constant and progressive training, the result of which has been a radical transformation in its vision of the distance teaching-learning process.