DISABILITY AND COVID-19 TESTING: A CROSS-SECTIONAL RADx-UP STUDY

Background: Nearly 26% of adults in the U.S. live with disability and are more likely to experience chronic health conditions, barriers to healthcare, and severe COVID-19 illness. Therefore, COVID-19 testing of adults living with disability is important to consider. The purpose of this study was to explore relationships between disability and COVID-19 testing, infection, and related challenges. Method(s): A Rapid Acceleration of Diagnostics-Underserved Population (RADx-UP) project in Miami, FL determined disability with a modified version of the Washington Group General Disability Measure. HIV serostatus and COVID-19 vaccination were confirmed with medical records. COVID-19 testing and infection history were self-reported. Statistical analyses included chi-squared tests and multiple binary logistic regression;variance inflation factors were calculated to ensure absence of collinearity. Result(s): A total of 1,689 RADx-UP participants with an average age of 55+/-12.3, 51% male, 49% Black non-Hispanic, 23% living with HIV (86% virally suppressed), and 76% received at least one dose of a COVID-19 vaccine. Nearly 40% were disabled, 37% reported employment disability, and 21% were functionally disabled (disability that interferes with performance of daily activities). Despite recruitment from the same sources, PLWH, compared to those without HIV, were more likely to be disabled (52% vs 36%;p< 0.0001), report employment disability (63% vs 30%;p< 0.0001), and report functional disability (29% vs 18%;p< 0.0001). Those with employment disability were less likely to have ever been tested for COVID-19 compared to those without (81% vs 85%;p=0.026). Employment disability was also associated with lower odds of having ever tested positive for COVID-19 after adjustment for demographics, health insurance, HIV, COVID-19 vaccination, smoking, and lung disease (aOR, 0.62;95% CI, 0.43-0.90;p=0.013). Disability was associated with greater odds of transportation challenges (aOR, 2.33;95% CI, 1.76-3.08;p< 0.0001), illicit drug use (aOR, 1.92;95% CI, 1.49-2.47;p< 0.0001), and smoking (aOR, 1.74;95% CI, 1.39-2.17;p< 0.0001). Compared to those without, those with transportation challenges (14% vs 40%;p< 0.0001) and illicit drug use (18% vs 30%;p=0.001) were more likely to postpone medical care. Conclusion(s): Lower COVID-19 testing rates may contribute to underestimated COVID-19 positivity rates in adults living with disability. Challenges with transportation and substance abuse contribute to less engagement in care.

Evolucion De La Epidemiologia De La Enfermedad Celiaca E Impacto De La Covid19. Resultados Preliminares Del Plan Nacional De Enfermedad Celiaca-Ciberehd

Introduccion: Se ha reportado que tanto la prevalencia como la incidencia de la enfermedad celiaca (EC) estan aumentando a nivel mundial. Este aumento podria ser atribuido a infecciones viricas como desencadenante de la EC, entre otros factores. La COVID-19 ha impactado de lleno en la realizacion del estudio de prevalencia del Plan Nacional de EC promovido por el CIBERHED. Se ha sugerido que SARS-CoV-2, que penetra por via digestiva, podria desencadenar brotes de EC. Objetivos: 1) Evaluar la prevalencia actual de EC en comparacion con la de la cohorte 2004-2009. 2) Evaluar el impacto de la COVID-19 en la prevalencia actual de EC. Metodos: Desde enero 2021 hasta la actualidad se han incluido 1886 individuos de entre 1 y 90 anos atendidos por cirugia menor en los 6 hospitales participantes (Hospitales Universitarios (HU) Mutua Terrassa- Sant Joan de Deu, HU Virgen del Rocio, HU Central de Asturias, HU Galdakao-Cruces y HU Fundacion Jimenez Diaz) (calculo muestral: 5.300). La inclusion se realiza ajustada por edad y sexo a la piramide poblacional. Se determinan Ac. antitransglutaminasa (tTGA) y en los casos positivos se confirma el diagnostico segun guias de consenso. Se reporta la prevalencia serologica (tTGA > 7 U/ml) mas los casos prevalentes previamente diagnosticados. La relacion entre COVID19, registrada mediante cuestionario, y los casos positivos (tTGA > 7 U/mL y tTGA zona gris 2-7 U/mL) se ha evaluado mediante prueba exacta de Fisher. Resultados: Se han detectado 11 sujetos con serologia positiva y 2 pacientes con diagnostico previo de EC;prevalencia 6,89 x 1.000, IC95% 3,68-11,76. En comparacion con la prevalencia de la cohorte (2004-2007), 5,67 x 1.000, no existen diferencias significativas. Se han detectado 3 casos con serologia tTGA positiva y COVID-19 sobre un total de 335 pacientes infectados y 8 casos con serologia tTGA positiva sin COVID-19 sobre un total de 1.547 individuos no infectados (p = 0,4247). Tampoco se ha encontrado relacion entre COVID-19 y valores de serologia en la zona gris. Conclusiones: No se detecta un incremento de la prevalencia de EC en las ultimas dos decadas en nuestro medio. La infeccion por COVID19 no ha tenido impacto en la aparicion de nuevos casos de la enfermedad.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.

ACE2 expression in the brain during development and susceptibility to brain infection by SARS-COV-2.

The COVID-19 pandemic spread around the world due to the enormous transmission of the SARS-CoV-2 among humans. COVID-19 represents a threat to global public health. The entry of this virus into cells is greatly facilitated by the presence of angiotensin-converting enzyme 2 (ACE2) in the cell membrane. Today we do not have a precise understanding of how this receptor expresses in the brain during human development and, as a consequence, we do not know whether neural cells in the developing brain are susceptible to infection. We review the knowledge about ACE2 expression in the developing human brain, with special attention to the fetal stage. This stage corresponds to the period of the cerebral cortex formation. Therefore, SARS-CoV-2 infection during the fetal period may alter the normal development of the cerebral cortex. Although few cases have been published demonstrating vertical transmission of SARS-CoV-2 infection, the large number of infected young people may represent a problem which requires health surveillance, due to the possibility of cognitive alterations and abnormalities in the development of cortical circuits that may represent a predisposition to mental problems later in life.Copyright © 2023, Instituto de Investigaciones Medicas. All rights reserved.

Evolution de la perception des patients vis-a-vis de la teleconsultation dans le syndrome d'apnees du sommeil lors de la premiere vague de COVID-19.

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets.Copyright © 2023

Advocating for individuals and communities

The role of advocating for individuals and communities not only includes advocating for the basic needs and resources of communities and entails conducting policy advocacy. This chapter provides two accounts of how CHWs provide advocacy and advocate for their profession. CHWs in Arizona advocated for their communities and their workforce on the state, local, and federal level to address the social determinants of health and structural issues such as poverty, unemployment, the built environment, and discrimination. The first team explores stories of CHWs who have advocated on multiple levels, including organizational and policy levels, and discusses the factors that support and hinder CHW advocacy efforts. The team describes how local and grassroots advocacy efforts ultimately helped to create a CHW workforce sustainability movement and support the statewide CHW professional association, Arizona Community Health Workers Association (AzCHOW), in advocating for voluntary certification on the state level. The second team provides timely information on how CHWs with Enlace Chicago advocated for their communities during COVID-19 to address social determinants of health, including poverty, unemployment, discrimination, and exploitation of worker rights, and provide basic needs. The CHW stories describe how advocacy efforts were instrumental in directing community members to food banks, personal protection equipment, sources of employment and workers' rights, and emergency rental assistance programs. These stories underscore how CHWs were often the only links connecting their community members to what they needed while facilitating the community's understanding to public health guidelines during COVID-19 and addressing mental health needs. © Springer Nature Switzerland AG 2021.

HEALTHY HABITS IN CSIC WORKERS DURING COVID-19 LOCKDOWN IN SPAIN

Aim: COVID-19 crisis has caused a deep change in citizen's lifestyle. Previous outbreaks have shown that people under confinement can develop mental health problems and cause effects on physical activity (PA) and changes in the diet habits. Subject and Methods: An online questionnaire about healthy habits during the Spanish lockdown was sent to workers from the Spanish National Research Council (CSIC). Results: A general improvement in the dietary patterns, except for the intake of snacks and bakery goods was observed. PA was subs-tantially reduced, mostly in men, unlike the emotional changes, which were greater in women, mainly observed as anxiety and sleep disorders. Additionally, emotional eating (EE) behaviors were detected mainly in women, although the intake related to boredom was observed in both genders. Conclusions: Ove-rall, the dietary patterns of CSIC workers followed the general recommendations for COVID-19 lockdown. However, half of the participants decreased their PA practice. Regarding to the emotional changes, emotional eating behaviors were associated with anxiety, especially in women, and boredom for both genders. © 2022, CSIC Consejo Superior de Investigaciones Cientificas. All rights reserved.

Impact of plasmapheresis on severe COVID-19.

The clinical course of COVID-19 may show severe presentation, potentially involving dynamic cytokine storms and T cell lymphopenia, which are leading causes of death in patients with SARS-CoV-2 infection. Plasma exchange therapy (PLEX) effectively removes pro-inflammatory factors, modulating and restoring innate and adaptive immune responses. This clinical trial aimed to evaluate the impact of PLEX on the survival of patients with severe SARS-CoV-2 and the effect on the cytokine release syndrome. Hospitalized patients diagnosed with SARS-CoV-2 infection and cytokine storm syndrome were selected to receive 2 sessions of PLEX or standard therapy. Primary outcome was all-cause 60-days mortality; secondary outcome was requirement of mechanical ventilation, SOFA, NEWs-2 scores modification, reduction of pro-inflammatory biomarkers and hospitalization time. Twenty patients received PLEX were compared against 40 patients receiving standard therapy. PLEX reduced 60-days mortality (50% vs 20%; OR 0.25, 95%CI 0.071-0.880; p = 0.029), and this effect was independent from demographic variables and drug therapies used. PLEX significantly decreased SOFA, NEWs-2, pro-inflammatory mediators and increased lymphocyte count, accompanied with a trend to reduce affected lung volume, without effect on SatO2/FiO2 indicator or mechanical ventilation requirement. PLEX therapy provided significant benefits of pro-inflammatory clearance and reduction of 60-days mortality in selected patients with COVID-19, without significant adverse events.

Effectiveness of SinergiAPS, an intervention based on Patient Feedback to Improve Patient Safety in Primary Care: a randomized clinical trial in Spain

Aims: To evaluate the effectiveness of SinergiAPS (a patient-centred audit and feedback intervention) in improving patient safety in primary healthcare (PHC) centres. Method(s): We conducted a cluster randomized controlled clinical trial in 59 PHC centres in Spain. We audited all the participant centres, assessing their level of patient safety based on the administration of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire to 75 patients/centre. Then, PHC centres were randomly allocated to receive the SinergiAPS intervention or usual care. Only the intervention centres were fed back with the audit results. They received: (1) a bespoke feedback report with quantitative (scale and item level scores) and qualitative (free text) results;(2) a set of educational materials (based on available evidence-based strategies for addressing patient safety problems);and (3) a structured template to record and monitor their safety improvement plans. The intervention was remotely delivered using a bespoke web tool. The primary outcome was patient safety culture among professionals (MOSPSC questionnaire). Secondary outcomes were patient-reported patient safety (mean scores of five PREOS-PC questionnaire scales), and rate of avoidable hospital admissions. After 12 months follow-up, we conducted 14 semi-structured qualitative interviews with PHC professionals to explore their perceptions of the intervention and to identify implementation barriers. Result(s): We successfully recruited 1053 professionals out of 1971 (53%) invited professionals (81% women;mean (SD) age 49 (10) years). The post-intervention followup rate was 75% (793/1053). No significant differences were observed at 12 months between groups in patient safety culture score (intervention: 3.60 [95%CI 3.55-3.64] vs. control: 3.64 [95%CI 3.60-3.68]), or in any of the secondary outcomes. The qualitative interviews revealed that the response to the COVID-19 pandemic (which in Spain started 6 weeks after starting to deliver feedback reports) severely limited the ability of PHC centres to use the intervention resources as planned. Despite its low ''reach'', the intervention presented high acceptability and perceived utility. Conclusion(s): In the context of a health emergency, SinergiAPS did not improve patient safety in Spanish PHC centres. Future studies are needed to evaluate its effectiveness in contexts more consistent with usual practice.

Difficult airway in adult ICU in Quindío: a cross-sectional study

Introduction: The risk of complications and death related to difficult airway (DA) in critically ill patients is higher than in controlled settings such as the operating room. Statistics on DA in intensive care in Colombia are scarce, as are the intervention data and resources available in the units. The main objective was to determine the prevalence and characteristics of anatomical and physiological difficult airway. Methods: An observational, cross-sectional, multicentre study was conducted in adult Intensive Care Units (ICU) in Quindío. Links to two Google® forms were sent to the Coordinating Intensivists, one general and one specific related to DA anatomical factors (Mallampati, obstructive apnoea, stiff cervical spine, obesity, external appearance, Cormack-Lehane > 2, etc.) and physiological (oxygenation disorder, state of collapse, anaemia, etc.). Results: Four units participated, with 62 beds (83.9% of the beds in the department);56 hospitalized patients were found, 38 patients (67.8%) were intubated. Of the patients, 29% had some type of difficult airway. Of the patients with difficult airway, 100% had physiological DA parameters and 27.3% anatomical difficult airway: 18.2% Cormack-Lehane (CL) > 2, and 9.1% subglottic stenosis. Obesity was the best predictor of CL > 2. LR+: 4.5, LR−:. 001. Conclusions: Physiological DA is highly prevalent in the adult ICU, which represents a challenge for the intensivist, and a high risk of complications for patients. In this study, obesity was the main predictor of anatomical DA in critically ill patients. Intensive care units must have sufficient resources and personnel trained in the management of difficult airway. © 2022 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo

Elizabethkingia miricola: an opportunistic pathogen in ICU : Eva Soler

Background The Elizabethkingia genus is formed by a group of bacteria which are widely distributed in nature. Elizabethkingia is not part of human microbiota, therefore is considered to be an opportunistic pathogen. In the last years, it has become a cause of potentially fatal disease, becoming an emerging bacteria of increasing relevance. The objective of this study is to describe the impact of Elizabethkingia bacteria in infected patients in the ICU of a hospital in Granada. Methods Descriptive study. Patients who have been isolated in a biological sample of Elizabethkingia miricola throughout the year 2.021 in the ICU of San Cecilio University Hospital in Granada. Date and place of isolation were registered. Other variables registered were sex, age, length of ICU stay, days between ICU admission and bacterium isolation, days between bacterium isolation and death, infection, cause of admission or cause of death. Results Bacterium was isolated in 15 patients. Cause of admission was COVID-19 in 73.3% of patients. 73.3% were men and 26.6% women.The average age was 56.9 years. The average length of ICU stay was 43.8 days. 4 patients were diagnosed with ventilator-associated pneumonia and 5 patients were diagnosed with tracheobronchitis.The average days between ICU admission and bacterium isolation was 26,4 days. The average days between mechanical ventilation and bacterium isolation was 25.9 days. 53.3% of patients died. The average days between bacteria isolation and death was 18.2 days. Conclusions Elizabethkingia miricola is an emerging bacterium under special vigilance due to its capacity to cause major morbidity and mortality in admitted patients in ICU. The rapid identification and the study of the antibiotic susceptibility is considered of special relevance so they can be correctly managed to avoid infections and complications resulting from this microorganism. Key messages • Elizabethkingia is a special surveillance bacterie due to its morbidity and mortality effects. • Elizabethkingia could be a severity indicator in admitted patients to the ICU.

COVID-19 infection in cancer patients and association with the antineoplastic treatment

Evidence linking anticancer therapy with the incidence of COVID-19 varies according to the type of therapy administered. The reported COVID-19 incidence in patients receiving antineoplastic treatment varies between 1 and 4%. The aim of this study was to determine the incidence of COVID-19 in cancer patients under active treatment and to assess whether there is an association with the received anticancer therapy. It was a retrospective cohort that consecutively included adult outpatients who underwent treatment in a referral center from March 2020 to April 2021. The primary endpoint was the confirmed diagnosis of COVID-19. The association with anticancer treatments was evaluated using multivariate logistic regression adjusting for age, sex, tumor site, health coverage status, and place of residence. The sample included 463 patients, the median age was 58 years (IQR = 47-66), 73.3% (n = 337) were women. The incidence of COVID-19 was 5.6% (n = 26) with a mortality rate of 12% (n = 3). The risk of infection was higher in patients undergoing treatment only with monoclonal antibod-ies, 14.3% vs. 4.9% (adjusted OR = 3.3, p = 0.03) and those in treatment with immunotherapy, 23.1% vs. 5.1% (adjusted OR = 5.8, p = 0.03). Cytotoxic chemotherapy, alone or in combination with monoclonal antibodies, did not present an increased risk of infection. Age, sex, tumor site, health coverage, and place of residence did not show association with the incidence of COVID-19. Based on our results, treatment with monoclonal antibodies or immunotherapy was associated with a higher rate of COVID-19 infection while chemotherapy did not modify the incidence of COVID-19. Copyright © 2022, Instituto de Investigaciones Medicas. All rights reserved.

Occupational Safety and Health and Workplace Health Promotion: an Essential Area for a Recovery from Covid-19 Based on Decent Work

Against the rapid increase in psychosocial risks around the world brought by the COVID-19 pandemic, the workplace has become an ideal venue to address emerging psychosocial risks to protect the health and well-being of all workers. The paper aims to study how the promotion of Occupational Safety and Health measures could contribute to the recovery from COVID-19, with a particular focus on Workplace Health Promotion and Well-being at Work. The analysis will also focus on the inclusion of safe and healthy working conditions in the ILO's Framework about Fundamental Principles and Rights at Work.

[Influence of risk factors on mortality from COVID-19]

Background: The main risk factors studied that have an influence on mortality from COVID-19 have so far been inconclusive in the world literature, mainly in relation to the male gender. Objective: To determine which are the main risk factors that influence a higher mortality from COVID-19. Material and methods: A case-control study was conducted, including 1190 patients with positive RT-PCR. The risk factors studied were: gender, age, systemic arterial hypertension (SAH), Diabetes mellitus (DM), obesity, Chronic Obstructive Pulmonary Disease (COPD), asthma, smoking, immunosuppressants, Human Immunodeficiency Virus (HIV), influenza vaccine. In the Group of Cases: they died from COVID-19 (n = 576), while in the Controls group: they survived (n = 614). The statistical plan included cross-tables and multivariate logistic regression model to determine the influence of these risk factors on mortality from COVID-19. Results: We found no statistically significant differences between cases and controls in relation to gender. However, the cases were aged >60 years, SAH, DM, obesity compared to controls. Conclusions: Male gender was not a risk factor for mortality from COVID-19, however, other risk factors such as age over 60 years, being hypertensive, diabetic and obese, were corroborated as such for a higher mortality from COVID-19.

[Confinement and social distancing: stress, anxiety, depression in children and adolescents]

Among the strategies to avoid COVID-19 disease that affects the world population it is keeping away from contagion through confinement and social distancing, which can cause in children and adolescents a change in the psychosocial environment with a high prevalence of psychological and psychiatric disorders, such as stress, anxiety disorders, depressive disorders, risk of suicide and eating disorders. During confinement, were made school closures, shutdowns of recreational and sports spaces, cancellation of outdoor activities, which can have consequences in social habits, sleep, modifications in the eating pattern that entails alterations in anthropometric variables, neurophysiological alterations with behaviors that affect mental health, in addition to the frustration of not executing plans, fear, boredom and the uncertainty of the duration of the pandemic could lead to further stress. Social distancing favors a reduction in interaction, is related to anxiety, stress and depression, in addition to the concern of infecting the family. These scenarios can generate stress for parents, domestic violence and uncontrolled use of the internet. Children and adolescents are vulnerable populations that adapt to the environment in crisis. The objective of this work was to review the influence of confinement and social distancing on stress, anxiety and depression in children and adolescents.

Association of sedation level and 28-day mortality: a COVID-19 cohort multicentre study sub analysis

Introduction: COVID-19 started in Wuhan (China) in December 2019 [1]. World pandemic was declared by the WHO in March 2020 [2]. Since then, millions of patients have been infected worldwide. Our group published in March 2021 a multicentre study analysing the prevalence and risk factors for delirium in critically ill patients with COVID-19 infection [3]. In this sub analysis of the main study, the primary outcome was the association of sedation level since ICU admission with 28-day mortality in patients admitted to ICU due to COVID-19. Methods: The exposure tested against mortality was excessive sedation (in the coma range) defined as 'Did patients have a documented sedation score in the coma range at any point this day? RASS = - 4 or - 5;SAS = 2 or 1;MAAS = 0 or 1;Ramsay 5 or 6'. Data from 2017 patients was available for analysis, collected after patients' admission to ICU. Other covariates analyzed were baseline patient characteristics, medical history and treatment applied in the ICU. Logistic regression was used in all analyses and results presented as odd ratios (OR) with 95% confidence intervals. Results: Deep sedation (RASS = - 4 or - 5, SAS = 2 or 1, MAAS = 0 or 1, Ramsay 5 or 6) was positively and significantly associated to mortality within 28 days since ICU admission. P value was 0.012 and the OR was 2.00 with a 95% confidence interval of 1.16-3.45. Conclusions: As shown by this sub analysis, deep sedation increases mortality rates in critically ill COVID 19 patients. We should try to decrease sedation levels to avoid RASS of - 4 and - 5 to favor patients' outcomes admitted to the ICU.