ABSTRACT
During the COVID-19 pandemic, the increased work overload of healthcare professionals, in the near breakdown of healthcare services, may have affected their emotional state and burnout levels. To know the impact of the COVID-19 pandemic on the burnout levels of healthcare professionals in a hospital institution, identifying the relationship with sociodemographic, organisational and other characteristics. Quantitative, observational, descriptive, analytical and transversal methodology, in a convenience sampling process, consisting of 324 healthcare professionals. A questionnaire-based on validated methods was used as a data collection instrument. The data obtained were statistically analysed. Healthcare professionals presented moderate levels of burnout in emotional exhaustion and depersonalisation, and high in the professional achievement dimension;30.2% met high burnout criteria. Higher burnout levels have been associated with organisational aspects such as working directly with infected patients, not having access to the necessary personal protective equipment, and high-risk perception of COVID-19 infection. It is essential to implement organisational measures, health and psychosocial risks surveillance and psychosocial risks to stop burnout increase in healthcare professionals,, an alarming trend and transversal to various health services.
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The years leading up to the outbreak of the COVID 19 pandemic saw a significant growth in tourist arrivals, which led to several problems that came to be known as "overtourism". The reduction of tourist pressure became an important aspect of the management of historic centers and involved the adoption of various strategies, including demarketing. The aim of this paper is to determine the contribution of this strategy to the control of overtourism in the historic centers of Spanish cities. To this end, demarketing actions in Barcelona, Bilbao, Donostia-San Sebastian, Madrid, Santiago de Compostela, Seville and Valencia have been identified and analyzed through the study of plans, brochures, tourism websites and social networks. Although specific demarketing actions have been applied in all these destinations, especially those related to decentralization and diversification objectives, in general there is a notable lack of use of their potential to reduce the tourist pressure on historic centers. In fact, even in the most intense moments of overtourism, traditional models of tourism management oriented towards the undifferentiated attraction of a greater number of visitors and the promotion of heritage tourist attractions suffering from saturation continued to prevail.
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Background/Aim: Long COVID-19 is one of the post-infection challenging issues. We aimed to assess the prevalence and characteristics of this syndrome in patients with autoimmune and rheumatic diseases (AIRDs) through a multicentre international e-surveys (The COVID-19 Vaccination in Autoimmune Diseases) COVAD study. Method(s): The COVAD group comprised of collaborators from 109 countries. An online survey platform was conducted in Jan-July 2022 to capture self-reported COVID-19 infection and vaccination data in patients with AIRDs and healthy controls (HCs). Long COVID-19 was defined as per WHO definitions as persistence of symptoms beyond 3 months of COVID-19 infection. Descriptive statistics and multivariable regression adjusted for age, gender, ethnicity, and disease modifying anti-rheumatic drugs (DMARDs) were employed. Result(s): Among the 7666 complete survey respondents, 1677 who had taken the survey >90 days of last COVID-19 infection were analyzed. Among them, a total of 8.1% (n = 136) had long COVID-19 syndrome and the median age was 46 (34-55) years, with Male: Female ratio of 1:6.3. The prevalence of long COVID-19 was significantly higher in patients with AIRDs compared to HCs (OR 2 [1.3-2.9], P < 0.001). Respondents with long COVID-19 had worse PROMIS 10a quality of life global physical and mental health score, as well as fatigue and pain VAS compared to those without post-COVID- 19 (all P < 0.001). Among patients with AIRDs, those with long COVID-19 reported to have higher flares of AIRDs following COVID-19 infection (OR 4.3, P < 0.01). On multivariable regression analysis, the characteristics of patients with long COVID-19 were female gender, Caucasian ethnicity and presence of comorbid insomnia. Presence of fatigue, muscle aches, dyspnoea and loss of taste during previous COVID-19 infection were the significant predictors of long COVID-19. Among patients with AIRDs, comorbidities (OR 2.0;95% CI: 1.08-3.6, P = 0.026), and advanced treatment (OR: 1.9;95% CI: 1.08-3.3, P = 0.024), or intensive care (OR: 3.8;95% CI: 1.01-14.4, P = 0.047) for severe COVID-19 were risk factors for long COVID-19. The use of rituximab, iv immunoglobulins (IVIG), mycophenolate mofetil and anti-TNF agents use also predicted long COVID-19. Conclusion(s): Patients with AIRDs are at higher risk of long-COVID- 19 syndrome. Associated comorbid conditions and advanced treatment or intensive care for severe COVID-19 confer a higher risk.
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Online shopping has accelerated during to the pandemic and an increase in online shopping cart abandonment (SCA) was also evident. The growth of online shopping is contributed by the rising middle class, high consumer spending, millennials, and a tech-savvy population which is valuable to the growth of e-commerce. This study aimed to predict the factors that affect SCA during the COVID-19 Pandemic utilizing the SEM-RFC hybrid. Several factors such as self-efficacy, attribute conflicts, hesitation at checkout, emotional ambivalence, choice process satisfaction, attitude, subjective norms, and perceived behavioral control were analyzed simultaneously. This study integrated the cognition-affect-behavior paradigm with the Theory of Planned Behavior to provide a conceptual framework measured through an online survey questionnaire answered by 1015 valid responses collected by convenience sampling. Results showed that Attitude, Attribute Conflict, Self-Efficacy, and Emotional Ambivalence are the primary significant factors affecting SCA. Amidst the pandemic, consumers still value the ease of use, convenience and safety of the mobile online shopping applications that they have, which they do not positively experience at this time. The findings of this study may be applied and extended by researchers, online retailers, and businesses to understand consumer's abandonment intentions. Moreover, the results and framework of this study may be capitalized on by the business sector to create marketing strategies and develop business models for a sustainable online shopping business worldwide.
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Objetivos Las vacunas son la principal herramienta para prevenir la enfermedad neumocócica invasiva (ENI). El reemplazo por serotipos no vacunales es una amenaza para la efectividad de las vacunas antineumocócicas conjugadas (VCN). El objetivo principal de este estudio es valorar el impacto del SARS-CoV-2 en la epidemiología de neumococo, analizando concretamente los nuevos serotipos vacunales 22F y 33F. Métodos Se han evaluado 30.929 aislados clínicos de neumococo tanto de la población pediátrica como la adulta durante el período 2009-2021 para analizar la evolución de los serotipos 22F y 33F y el impacto de la pandemia por SARS-CoV-2 en la epidemiología de estos serotipos. Resultados Desde la introducción de la VCN13 han aumentado el número de casos de ENI por serotipos 22F y 33F en todas las poblaciones, destacando en adultos (de 64 casos en 2009 a 133 casos en 2019 para el serotipo 22F;de 26 casos en 2009 a 70 casos en 2019 para el serotipo 33F), con un aumento significativo en adultos ≥ 65 años. Entre los clones circulantes, ST43322F y ST71733F son los genotipos predominantes. Desde el inicio de la pandemia (2020) la incidencia por los serotipos 22F y 33F ha disminuido notablemente, concretamente en los adultos (de 133 casos en 2019 a 76 casos 2020/2021 para el serotipo 22F;de 70 casos en 2019 a 46 casos en 2020/2021 para el serotipo 33F). Sin embargo, la proporción de casos por estos 2 serotipos no ha disminuido, siendo el serotipo 22F la tercera causa de ENI en los adultos en España. Conclusiones Incluso en el contexto de la pandemia por SARS-CoV-2, donde han disminuido los casos de ENI por todos los serotipos, los serotipos 22F y 33F que se incluyen en las nuevas vacunas conjugadas VCN15 y VCN20 siguen siendo relevantes en la epidemiología del neumococo en España.
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Introducción y objetivos Se evaluó la distribución de serotipos de la enfermedad neumocócica invasiva (ENI) por grupos de edad en España, así como el impacto de las vacunas antineumocócicas y el SARS-CoV-2. Métodos Estudio descriptivo que incluye 4.297 aislados clínicos de neumococo procedentes de niños y adultos con diagnóstico de ENI y durante el periodo 2019-2022. Resultados Se observó una disminución del 58% de los casos de ENI para todas las edades durante el primer año de pandemia por SARS-CoV-2 (2.435 casos en 2019 frente a 1.031 casos en 2020) con una reducción del 22% en 2021 (801 casos) frente a 2020. En los niños, la reducción fue del 53% en 2020 (239 casos en 2019 vs. 112 casos en 2020) con un aumento del 18% en 2021. El serotipo más frecuente en los 3 años fue el 24F. En adultos de 18-64 años y ≥ 65 años se observó una marcada reducción de casos de ENI durante el 2020 en comparación con 2019 (55% para 18-64 años y 61% para ≥ 65 años). Sin embargo, durante el año 2021, la disminución de ENI fue mucho más atenuada en comparación al 2020 (< 28% en ambos grupos de edad) y en lo que llevamos de 2022 han aumentado los casos con respecto al mismo periodo de 2021. En los adultos, el serotipo más frecuente fue el 8 seguido por el 3, representando entre los 2 hasta el 37% de todos los casos de ENI durante 2019-2021. Conclusiones La aparición del SARS-CoV-2 en España se asocia a una disminución de los casos de ENI con una recuperación parcial en los niños en el 2021 y en el 2022 tanto en la población pediátrica como adulta. Las nuevas vacunas conjugadas de 15 y 20 serotipos, incrementarán la fracción de la enfermedad prevenible por la vacunación frente a los serotipos circulantes.
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Introduction: Due to the covid-19 outbreak, cardiac rehabilitation programs (CRP) underwent most needed adaptions to stay operative. To face all the requests and guarantee sanitary measures, we reduced the duration of the program from about 12 weeks to about 8 weeks, so we could have smaller groups but still respond to all patients who had been referred. However, it is still unclear whether less hours of contact and exercise sessions can achieve the same results as traditional CRP. Objective: To analyse the effectiveness of shorter duration CRP on risk factor control and exercise tolerance after concluding the program. Methods: Observational single center study including two groups of patients who underwent CRP: one group who had been in 12 weeks-CRP before the pandemic sprout and another group enrolled in an 8-week program after April 2021. Albeit differences in their duration, both CRP had the same structure: observation by cardiologist, physiatrist, specialist nurse, exercise (aerobic and strength exercises) and educational sessions, as well as nutrition and psychologist consultation. Results: A total of 114 pts were analysed (mean age 62,4±11,6 years, 85.1% men, 86% with ischemic heart disease). Main comorbidities were hypertension (68,4%), dyslipidaemia (70%) and diabetes (30,7%). 78 pts completed a longer programme with 12 weeks duration while 36 underwent a shorter CRP with 8 weeks. There were no statistically significant differences between both groups regarding population demographics, aetiology, LVEF and co-morbidities. After CRP, there was significant improvement in risk factor control (mainly lipidic profile and weight) and echocardiographic parameters in both groups. We noted an important reduction in LDL levels (85±42.6mg/dL before CRP and 67.68±28.45mg/dL after), approaching the guideline recommended levels (<55mg/dL): 29.8% before vs 42.6% after (p=0.079), with no difference between the two groups (p=0,65). Significant improvement of LVEF was also observed (53% to 57%, p <0.001) without difference between the two groups (p=0.112). Exercise tolerance improved similarly in both groups, assessed by the time of exercise stress test: we registered a global increase of 65 ± 1.38s after CRP, with no difference between the two groups (p = 0.157). Conclusion: Shorter duration CRP showed similar results concerning risk factor control, echocardiographic LVEF and exercise tolerance improvement, suggesting that they can be an effective alternative when needed.
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There is emerging evidence that decreased muscle mass and cardiorespiratory fitness (CRF) are associated with increased risk of cancer-related mortality. This paper aimed to present recommendations to prescribe effective and safe exercise protocols to minimize losses, maintain or even improve muscle mass, strength, and CRF of the cancer patients who are undergoing or beyond treatment during the COVID-19 era. Overall, we recommend performing exercises with bodyweight, elastic bands, or suspension bands to voluntary interruption (i.e., interrupt the exercise set voluntarily, according to their perception of fatigue, before concentric muscular failure) to maintain or increase muscle strength and mass and CRF during COVID-19 physical distancing. Additionally, rest intervals between sets and exercises (i.e., long or short) should favor maintaining exercise intensities between 50 and 80% of maxHR and/or RPE of 12. In an exercise program with these characteristics, the progression of the stimulus must be carried out by increasing exercise complexity, number of sets, and weekly frequency. With feasible exercises attainable anywhere, modulating only the work-to-rest ratio and using voluntary interruption, it is possible to prescribe exercise for a wide range of patients with cancer as well as training goals. Exercise must be encouraged; however, exercise professionals must be aware of the patient's health condition even at a physical distance to provide a safe and efficient exercise program. Exercise professionals should adjust the exercise prescription throughout home confinement whenever necessary, keeping in mind that minimal exercise stimuli are beneficial to patients in poor physical condition.
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BACKGROUND: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. METHODS: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28â days after enrolment. RESULTS: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48-68)â years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8-12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference -3.7%, 95% CI -18.8-11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. CONCLUSIONS: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone.